The Doctor oncall told me not to call him

  1. 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.
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    About catrn10

    Joined: Jan '03; Posts: 111; Likes: 2
    RN,Critical Care


  3. by   cindyln
    I would have been on the phone to him whenever I needed too whether he wanted me to or not.He's the doctor and he was on call. I sure hope your supervisor backed you up.
  4. by   renerian
    Gosh I worked on a BMT unit in the 80s/90s and even then we had standing dopamine orders to titrate for systolic b/p at minimum of 90.

  5. by   renerian
    Forgot we also had standing orders to do ankle IVs for sickle cell clients if other access was a problem. Standing orders for central lines as well. All this and you had two other clients.

  6. by   catrn10
    Well this little jewel of a hospital doesn't have any standing protocols, and as far as a line in a leg goes, you have to get a doctor's order for it, I did, she only had one usable leg as the other was covered in ulcers, and the "good" leg had no veins. There is only one doctor in the hospital at night, the ER Doctor, and He wasn't Checked off to do central lines.
  7. by   canoehead
    Call him, no matter what he says, and if your supervisor, or hospital doesn't back you up quit.

    If he won't respond to your concerns call the chief of service, and tell him what is happening. And make sure you write "don't call me" as an order in the chart, so he knows he is not getting away scot free.
    Originally posted by canoehead
    And make sure you write "don't call me" as an order in the chart, so he knows he is not getting away scot free.
  9. by   RN always
    wow! I can't believe this guy. My question is how was his attitude when you called him 7 times the first night. Was he mean to you? I agree with the above. Keep calling him..........then call him again. Then again just to make him mad!
  10. by   fab4fan
    This just sounds like a complete "Charlie Foxtrot" from start to finish. I feel for you.

    This "doctor" is not doing on call free; he's more than compensated for a sleepless night. Write whatever you want..."I'll co-sign it in the morning"???? Yeah, we all know what would have happened there. Our ICU doesn't have standing orders for dopamine/central just covers code meds and stuff like Tylenol and MOM.

    You did the best you could. Your supervisor should have gone up the chain of command, getting the medical director if necessary. I don't care how busy it was...that's part of being a supervisor. And I definitely would have documented the "don't call me order" and filled out an incident report.

    And why were you alone with 2 patients? What if one was coding and the other was unstable and needed a lot of care? I know this is a separate issue, but I work in a very small community hospital, and ICU is NEVER alone, even if it's just one pt.

    Sigh...sounds like you did the best you could. I had a pt many years ago who actually died under similar conditions, so I know to some extent where you are coming from. And I am not trying to deflect all the blame on the supervisor...the doc should have done his job, but it really is incumbent on the supervisor to follow the chain of command in these types of situations.
    Last edit by fab4fan on Jan 7, '03
  11. by   Dr. Kate
    Call and call again. If you get nowhere be sure the supervisor knows and start up the chain of command: unit MD director, chief of service, chief of staff. If you get that far with no satisfactory response, thte supervisor is obligated to call the administrator on call, that person needs to step in and make things happen. Let your manager know what happened and everything you did, with times. Send copies to the head of the medical staff office.
    Be sure every call with time and patient condition is documented, document every MD response, and every administrative response.

    And what kind of foolishness is it that the ER doc isn't "checked off" to do central lines.

    If all else fails get the family involved. Get them in because the patient is so ill, make sure they know the doc is blowing you off, make sure he knows the family is there. They're the ones who can sue his b--- for negligence.

    Oh, and look for another job. No one needs that kind of grief and lack of administrative support. 40 is not a normal SBP, it is an emergency and the one with the MD after their name is the one who has to write the orders.
  12. by   OC_An Khe
    Call and call everytime you feel that it is needed. When the MD gives you a hard time you coould always mention that the MD is abandoning the patient and that you will report that fact to the appropriate legal authorities.
  13. by   sunnygirl272
    what the hell are you doing working in a hosp where there is only one nurse in a unit???? how can you start a code? dial with your toes while bagging and doing compressions???
    oh..yeah, and what everyone else said...
  14. by   ShandyLynnRN
    If a doc is "on call" then he should expect to be called...if he was too sleep deprived to take the call, then it is HIS responsibility to find another doc to take the calls for him....otherwise, call him, and that is the purpose of him being on call...what a lame excuse for a doctor!!! And ditto to all the above posts!