Over riding a resident?

[beeble]

I was wondering what your opinions are on this.

I worked nights. A pt had mild chestpain a few days after surgery (sternal incision).They had d/c'd pain meds d/t AMS. Inthe a.m. (0600) he c/o of this pain,'soreness'. The brand new resident was there. She then ordered a stat portable CXR, stat trops, and stat EKG.

Guess who would have to do the labs and EKG? The normal staff for these things would arrive at 0700.

I tried to talk to her that he stated this was the same pain he has been having and that it was normal soreness. She stated that"I followed him yesterday and he didnt c/o this'. I stated maybe you were focused on his AMS yesterday. She insisted they be done. 0600 is a crunch time. I didnt feel these things were truly 'stat'.

I paged her and she didnt call back. I then paged her senior who modified her orders to 'routine', meaning they would be done this a.m. when regular staff were here (not STAT).

Then she called back, I told her I had talked to her denior, and he modofied them. She then said I should have talked to her first and "How would I like it if she went to MY supervisor?.....

I didnt go to the senior with a complaint but a legitimate patient care issue.

What do you think?

[blondy2061h, MSN, RN]

Theirs not to make reply

Theirs not to reason why

Theirs but to do or die

Are you a nurse? Because I'm really fearful if this is your attitude toward patient treatment. If you're a student, I do hope that your professors will imprint upon you the necessity of knowing the reasoning behind every order you get.

[delilas]

I disagree with some of the sentiments of "you don't question the doctor/resident."

BULL. I've questioned the doctor multiple times in my career, and in several cases, I know my questioning orders I wasn't comfortable with not only saved lives, but made me a better nurse.

But I do not question the patient's definition of his pain, and I don't mess around with chest pain. Even if I am sure it is incisional soreness, even if it was 6:30 am, and even if I despise the resident for dumping it on me right before my replacement gets in, I'm going to do it, because the consequences of NOT doing it can hurt:

1) My patient

2) My reputation

3) My replacement

And I have no desire to hurt any of them. My job, especially in this economy, relies on good working relationships, good reputation. Regardless, the patient comes first.

[evolvingrn, BSN, RN]

I agree the test should have been done but it sounds like she wasn't 'dumping' it on the incoming nurse there would have been an ekg tech that would have been coming in. but again that only takes a minute to do.

[Flying ICU RN]

I didnt feel these things were truly 'stat'.

How to lose you license.

Here we have a case where a licensed physician is applying a medical "standard of care" as r/t symptoms of a specific medical diagnosis and history. She had made a medical decision, and had implemented a treatment plan of action. Your opinion as to the junior resident's qualifications ref this decision and the time of day are both irrelevant.

Here's where it goes really bad for you,...

At 07:10 (you have been gone 5 minutes) the patient has a lethal arrhythmia, codes and dies. The resident on call can justifiably claim that the delay in the implementation of her STAT orders, may have denied her critical information that would have allowed her to intervene in time to save the patients life. Family sues, the board of nursing will most certainly revoke your license.

The really ironic part is that if you had in fact been "Johnny on the Spot" with the STAT orders, he was going to code and die anyway, but you would have been absolved of any wrong doing.

I am continuosly amazed at how much effort people will go through to avoid a bit of work. How long and how much effort did it take you to get the senior to change those orders to routine? (Rhetorical question).

[AgentBeast, BSN, RN]

Are you a nurse? Because I'm really fearful if this is your attitude toward patient treatment. If you're a student, I do hope that your professors will imprint upon you the necessity of knowing the reasoning behind every order you get.

The point I was trying to make is that the role of the nurse is to advocate for the PATIENT not to advocate for THEMSELVES. Perhaps the Tennyson phrase was not the best way to do that, even though those that "didn't give reply, didn't reason why" wound up dead in the end . . .

[Music in My Heart]

I disagree with some of the sentiments of "you don't question the doctor/resident."

BULL. I've questioned the doctor multiple times in my career, and in several cases, I know my questioning orders I wasn't comfortable with not only saved lives, but made me a better nurse.

That is not what anybody is talking about... what everybody is criticizing is the OP's decision to circumvent the doc's STAT order and downgrade it to routine. That wasn't about helping the patient or even trying to prevent needless tests - it was only about the convenience of the OP.

[highlandlass1592, BSN, RN]

As to staying back on a shift, I can't count the number of times I haven't left on time - there is always some drama or something I maybe 4got to do, and no, many times I haven't been paid for overtime. I was told once 'nurses just have to stay back when patient issues arise, it's part of the job'.

Hold it, back the truck up...I stay over due to patient care issues, I EXPECT to be paid. I don't work for free and I don't know any profesisonal who does. Anyone who tried to sell you that line of garbage should be given a serious talking to. I'm not gonna leave a pt coding cause it's time to leave..but I expect and DESERVE to be paid. End of story.

[traumaRUs, MSN, APRN]

I think the OP gets it now as they haven't been back.

I do agree with the majority - if a nurse calls me with concerns - I assume they want them to be addressed. If I give orders and then find out that the nurse had gone over my head I would be upset and I would confront them.

As a mid-level, I have absolutely no problems with nurses/pts, etc., questioning my orders. However, I expect the courtesy of them questioning me prior to going over my head.

[blondy2061h, MSN, RN]

Hold it, back the truck up...I stay over due to patient care issues, I EXPECT to be paid. I don't work for free and I don't know any profesisonal who does. Anyone who tried to sell you that line of garbage should be given a serious talking to. I'm not gonna leave a pt coding cause it's time to leave..but I expect and DESERVE to be paid. End of story.

We were told for liability reasons if we're at work, we need to be "on the clock" and if we have to stay late, we're expected to get overtime for it. If we're not being paid for being there, we have no reason to be taking care of the patient, and become just a liability risk. We're expected to stay if things get hairy at the end of our shift until things settled, but we're expected to take overtime for this time.

[carolmaccas66, BSN, RN]

Hold it, back the truck up...I stay over due to patient care issues, I EXPECT to be paid. I don't work for free and I don't know any profesisonal who does. Anyone who tried to sell you that line of garbage should be given a serious talking to. I'm not gonna leave a pt coding cause it's time to leave..but I expect and DESERVE to be paid. End of story.

Good luck trying to get the money out of some of the agencies here! And also if you do stay back, I was told you are always covered for liability as a nurse which all hospitals carry, (well here in Aus anyway) because management realise that patient safety and finishing duties come first. And no I certainly wouldn't leave a patient coding either but many nurses I've spoken to have not been paid here for overtime - it seems to be expected you just stay back if you need to. I don't mind staying back 15-20 minutes but if it went into hours or more, I would demand to be paid as well.

[JulieCVICURN, BSN, RN]

First off, I would never ever do any overtime in any form and not get paid for it. It's illegal, and it's taking advantage of people. My employer will not allow any employee to work without being on the clock, period.

Second, yes, we do question the orders of residents. Our facility just became a teaching hospital recently and as part of our education on how to deal with the residents we were told to remember that many of us have more experience in our specialty than they do and if we see an order that seems wrong, we are to ask them about it. If they insist (which honestly, usually they don't. They defer to us. They know that we know cardiac ICU better than they do.) and we still have a problem with the orders, we are to call the attending physician.

On a side note, it's wonderful to have residents around. They haven't gotten arrogant yet and they're so collaborative, always asking what we think and taking our advice. It's fantastic. It's worth the price of having to really go over their orders and think about whether they make sense or not.

Mind you, I am in no way saying that I'm better educated than the docs. I'm just more experienced than those cute little newbies.

[carolmaccas66, BSN, RN]

First off, I would never ever do any overtime in any form and not get paid for it. It's illegal, and it's taking advantage of people. My employer will not allow any employee to work without being on the clock, period.

Second, yes, we do question the orders of residents. Our facility just became a teaching hospital recently and as part of our education on how to deal with the residents we were told to remember that many of us have more experience in our specialty than they do and if we see an order that seems wrong, we are to ask them about it. If they insist (which honestly, usually they don't. They defer to us. They know that we know cardiac ICU better than they do.) and we still have a problem with the orders, we are to call the attending physician.

On a side note, it's wonderful to have residents around. They haven't gotten arrogant yet and they're so collaborative, always asking what we think and taking our advice. It's fantastic. It's worth the price of having to really go over their orders and think about whether they make sense or not.

Mind you, I am in no way saying that I'm better educated than the docs. I'm just more experienced than those cute little newbies.

This is fantastic you have such good collaboration at your facility. I wish I worked with people like that. It almost gives me hope that nurse are really seen as professionals in their own right!