The Doctor oncall told me not to call him

Nurses Safety

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I want to know if anyone can help me handle this situation. I work in a small 3 bed ICU where I am the ONLY nurse. I recently had two critically ill patients. One had been on the floor (I had worked there one night and had her) and been transfered to the ICU with CP and ekg changes prior to my arrival that night. The cardiologist said the changes were not new, nor indicative of an MI.Her orginal DX was Vomiting and diarrhea. Upon arrival to the unit, I noted the patien's LOC was decreased and told it was because she had been given ativan for confusion and aggitation. I noted her adbomen was large, distended and hard, she was tachycardic and her BP was much lower than her baseline (noramally hypertensive.) I called the Md and reported these findings. Her H&H was WNL, but she was pale, grey and cool. I requested an NGT, but was told to "continue to give dulcolax as she had an ilieus and he wanted to get her bowels moving." The patient continued to deterioate and I called him to inform him there was no UOP over the past hour. He ordered lasix. I ended calling him at least 6 times as it was fairly obvious I had a GI bleed on my hands and I needed orders to take care of this patient. I kept the shift supervisor informed, but they were short on the floor and he had patients and told me I would just have to keep calling the Doctor. IV access was lost 4 people attempted to restart to no avail, Lab was unable to get blood from anywhere, including fingersticks, and I needed a central line and could not get anyone to come in and place one. And her left hand turned purple and pulseless over the course of the shift, a fact I reported everytime I called. The next night, I was told by the shift supervisor that this doctor was oncall again and had said I was not to call him that night for any reason as I had kept him up all night and he was sleep deprived. He said I was to write orders for anything I pleased and he would sign them in the morning! I got in trouble the next day because the patient's BP dropped into the 40's and I called HIM at 2300! I can't believe this. The is no protocol in place that would have allowed me to write an order for Dopamine and this patient was a full code.

It never ceases to amaze me how being a good nurse is often in direct opposition to being a "good employee." [/b]

Truer words were never spoken! If I had a nickle for every time my focus on patient care was labled by somebody else as "not being a team player" I would be one wealthy woman.

Silly me, I used to think that patient care and advocating for the patients was EVERYONE's first priority, and anyone who followed this code would be supported by the rest of the "team" and valued as a good nurse.

I also used to believe in unicorns, fairies, and wizards.

When I worked in CCU the ER sent us a female pt in her thirties who was having chest pain. The ER doctor felt that it was all emotional and relayed this to the cardiologist on call who never even bothered to see the pt. Well, this woman was obviously one sick cookie and having severe chest pain. Our calls to the cardiologist were of no avail, he just acted annoyed and told us not to call him anymore. Finally the woman went into v-fib and we had to shock her. Had to bother the poor doc against his orders. You bet he got his butt in to see her then. And yes, the pt. had a big, wopping MI.

What happened to the patient?? I am a new graduate, I've been working since August 2002 and this story is quite scary to me. I work on a cardiac unit and we have standing coronary orders for Lidocaine, Atropine, Fluid, etc. What kind of hospital is this that they don't have standing orders on an ICU?? If I were you I would probably find myself a new job. And in regards to the MD, if he doesn't want to be called when he is oncall, then he probably shouldn't be a doctor. Good Luck and I hope the outcome was much better than the story itself. God Bless!!!

Dear CatRN - I am arriving late in this conversation. I am appalled at the doc's actions. However, I am pleased that "the fates intervened" and you are no longer in that situation. I would echo the majority of what has been said already. You will recall from nursing school, "If you didn't write it, you didn't do it." It's called CYA-WBH (with both hands)!!

Take care and God Bless!!

P.S.: I live to call a doc in the middle of the night. That's why he/she gets paid the big bucks

See ya

Giggly, thank goodness we did have standing orders for Lidocaine, etc which didn't keep this poor woman from going into v-fib. We didn't have any standing orders for pain meds though. The doc had made up his mind without seeing the pt. that it wasn't cardiac. This was a few years ago when women with chest pain often weren't taken seriously. Fortunately she did recover. I hope that doc learned to listen to nurses when they expressed an opinion that a pt was very ill.

I had a dr. take the telephone out of a patients room one time

because she kept calling asking for the pain pills that he managed

to get her very used to. Got in great trouble the next day after

I plugged the phone back in. I say call them when you need too, no matter who you are...

Specializes in Women's health & post-partum.

What always exasperated me was the MD who ordered all kinds of tests & drugs, but neglected to order diet, activity, & analgesia--especially when I was the night nurse. Of course I called hiim. Every time. At about 1 am.

Specializes in Med-Surg Nursing.

Dear catRN,

Glad you got out of that hospital, their loss, your gain. I think you'll be much happier working at thi larger facility. Good luck!

Kelly

Specializes in cardiac, diabetes, OB/GYN.

Does not matter that he told you not to call. You ALWAYS call when you feel an issue needs to be raised. It is uncomfortable sometimes, but if you call in that situation and he gives you a hard time, tell him you know he can appreciate that both of you have patient interests and health at stake and he should know that while you understand his reluctance to be bothered at night, you do intend to keep him aprised of situations that require his invlovement. You can, as I have done, always counter with the reply that you can document that he asked not to be disturbed. Pretty sure that wouldn't look good in a court of law....(Ok, I know you wouldn't actually document that unless it became an issue, but it might bring him to Earth pretty quickly). Another thing I have done in similar situations is have another nurse or personell listen in and when he acts up, keep a record of it and who you utilized as a witness to the conversation. At night we often contact the docs through the operator because they document the exact times in a log, that they were contacted...

Never easy...

always call the doctor Its his or hers job they are responsiple for there pts and docoment to cover you butt if any legal action comes about

Specializes in Cardiac/Vascular & Healing Touch.

Document, Document, document, & also call the admin on call! See how the doc likes that!

I agree with Dr. Kate and sunnygirl. Call, call, call, and call again. As a matter of fact, after the 3rd or 4th call the MD should have come out and physically seen the patient. This issue should be taken up with the medical staff and administration. However, when you make waves like this and zero in on a particular doctor, just be prepared for the backlash. Especially if you are in a small, rural area where the doctors still have supreme power. You could lose your job. But that is another issue with me, why are you working in ICU alone? Why is your hospital asking/expecting you to work in ICU alone? That shows questionable judgment on the part of the leadership of your hospital. Probably due to financial pressure (either squeezing out more profit or trying to stay afloat), either way, you are being put in a position that is unsafe for you and your patient. I would seek other employment.

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