Ooops, I told off a doctor

[catladynurse]

So I was visiting my patient in the hospital who is just gaining back bowel sounds and has alot of bowel issues ... well now, she has MRSA and the doc comes in and says, "Well the vaco is covering her but I want to put her on bactrim ds". So without even thinking, I'm like - Is that a good idea with her belly and the havoc bactrim reaks on everyones bellys.

Wooops. LOL. But whats funnier is tho doc says bactrim doesn't cause stomach issues but I've changed my mind and gonna put her on such and such. Good thing I had a mask on cause I was laughing at her backpeddling.

Isn't it my job to protect my patient from possible harm?

[pookyp, LPN]

If that was telling off.....I wanna see you mad.....

Lol!!

[K+MgSO4, BSN]

yeah................no. Tell off a doc involves me talking to the head of gastroenterology to stop talking about the patient outside her room. about another's hospital's theory that she has Munchhausen's. He is from South Africa and has a loud booming voice. She is a RN..................

I told him to take the discussion behind the nurses station. FIRMLY.

Or yesterday when an intern ordered a physiotherapy review on a pt that was completely mobile. I pointed out that his patient was wandering around the ward with NO issues and that her "back pain" was because she didn't want to play basketball and was cured if you told her it was cancelled. (dementia pt)

[wilsonbl5150]

"Isn't it my job to protect my patient from possible harm? "

EXACTLY!!!! You did a good job!!

[KRSLPN, LPN]

I feel that you acted in a complete UNPROFESSIONAL manner. You are lucky the doctor that you "told off" did not report your behavior. Since you were just visiting your patient and not working at the time makes you look and sound like a fool. You had no business speaking to and worse yet, laughing at a doctor in front of the patient. To put it into elementary terms for you, it was not cool, not cool at all.

[Anna Flaxis, BSN, RN]

That really *is* funny, since vancomycin, which she was already on, has GI side effects similar to those of Bactrim.

What antibiotic do YOU think the patient should be on, that she can take PO, that MRSA is susceptible to, and that has no GI side effects?

[Anna Flaxis, BSN, RN]

Isn't it my job to protect my patient from possible harm?

I don't see that you did that. The doctor's plan of care was appropriate.

[BrandonLPN, LPN]

How were you protecting the pt from harm? Like the doctor doesn't know the side effects of Bactrim? As a nurse, you should know that fighting an infection trumps possible GI distress. And Im sure the doctor deciding against that course of therapy really was unrelated to your "helpful" advice. Count yourself lucky SOMEONE in that room was a professional....

[mazy]

I'm going to agree with the others who feel that you didn't handle this right. If you were visiting the patient, and not actually providing care, then the question I would have is what did you know about the specifics of that patient's medical history that would put you in a position to give the dr. advice about what abx to use.

You did not tell off the dr., you were dismissive of him, and disrespectful, and in front of the patient.

Additionally, as a nurse who is actually on the job (and hopefully out and about in the world), your job is to try to work collaboratively with the drs. and other members of the team.

To exchange ideas in a respectful way with the goal of providing good patient care, and without bringing a lot of ego into the picture.

If you had a suggestion to make about tx, I would hope it would be made in the spirit of respectful collaboration, rather than with this idea that you are "telling the dr. off," as if that is something to be proud of.

Also, lot of abx cause gastric distress, not just bactrim.

[catladynurse]

i was concerned about my patients gi status since she has low motility and they were aspirating fecal matter out of her stomach, i just felt that bactrim would be way too harsh, also, i have been with this patient for a year and a half, so i know her alot better than the hospitalist,

isnt this about whats best for the patient not peoples feelings,. and no i did not laugh till i had left the hoispital.

[mazy]

Wooops. LOL. But whats funnier is tho doc says bactrim doesn't cause stomach issues but I've changed my mind and gonna put her on such and such. Good thing I had a mask on cause I was laughing at her backpeddling.

That's not what you said originally. Are you backpeddling now?

[Anna Flaxis, BSN, RN]

Even patients with low GI motility can become septic from inadequately treated infections. Again, what antibiotic that is effective against MRSA would you have suggested?