No, I haven't been scolded, counseled, or even looked at cross-eyed, but after the day I've had, it would not surprise me. Tell me, y'all, if this was you, what would you have done differently?
Case 1) Grandma brings in kiddo, around age 5, multiple c/o: cough, runny nose, sore throat, thinks she has a UTI, vomiting, etc. Typical viral picture. Drainage is clear, vomiting not excessive, 2-3 times over the last few days. Kiddo looked a tad puny, but was responsive and giggling when I examined her. All tests negative. Explained to GM about viral syndromes, symptomatic tx, etc. Did not want to jump straight to an antibiotic, as no real s/s to warrant such. Told GM that I typicall do not do Phenergan for a kiddo that young (and skinny as a rail), and that Emetrol was what we had had success with with this bug. She agreed to the treatment, and left.
Fast forward a few hours, GM is steaming mad, wanting to knwo why all I did was send a med that she already had at home to the pharmacy that she had to drive 30 miles to get. I was stunned. Explained again about viral syndrome, the treatment she agreed to, etc. She was having none of it, said that WHEN she brought the girl back, she'd make sure I didn't see her. Fine and dandy by me. Thank God I always do a note on my charts.
Case 2) Woman seen for an URI 3 days ago, represents and requests cough meds with narcotic, specifically. Was told by the other provider that saw her 3 days ago that she would not be prescribed this, as she was on a narcotic regimen already. I told her that I would not deviate form the treatment already prescribed (no cough heard the whole time she was here, chest clear, already on an antibiotic, etc.) She became irate and tried to say that she was no longer on her narcotic regimen, but as we had no way of knowing this for certain, I declined. She called the lot of us "worthless" and stomped out.
This is an urgent care setting. Both of these patients have PMDs, and no, they had not contacted them prior to coming in. The GM even said she brought the kiddo because the mom did not think she needed to be taken to the doc. Just wondering if I should throw in the towel. Yes, I'm thin-skinned today.
Specializes in med-surg, psych, ER, school nurse-CRNP.
Trauma, I'm dual-certified. I'm operating under my Family NP degree/licensure at this clinic. I did my Master's in ACNP, and went back for my Post-Master's in FNP. Told you I was an overachiever!
Specializes in med-surg, psych, ER, school nurse-CRNP.
I'm not an NP but I used to do phone triage for a pediatric clinic. The standard answer for phone requests for ABX or narcs was that the MD or NP would need to examine the child, we dont just call in meds at parents' request. My documentation of the phone call, in the patient chart, would include in quotation marks every 4 letter word and insult to my parentage that the caller responded with.
The next time they brought kiddo in the doctor would open the chart and say "oh, I see you called our nurse a %$#&(( and threatened her with XYZ" One of the physicians would just give a stern look but the others would inform the parent that they had 15 days to find another provider, and a certified letter would folow.
If they grovelled, cried, begged and apologized to me sometimes they would be re admitted to the clinic.
Seeing their own words in quotes in the chart embarrased them into acting right. And no, I did not delete my charted phone call after they apologized. It was there for eternity.
I document exactly the same way...my charts read like 'War and Peace' sometimes. But as I already explained in my 'Documentation Is Your Friend' thread, it has saved my (rather substantial at the moment) hiney more than once.
gosh you must be. from your postings here you were an agency RN in 2007 and now just a four short years you're now dual certified. gee it took me 2 yrs for an MSN then another three years for MY dual certifications.
Nope, NP. As was said, lol, not a newbie to the career, just to this clinic. And I know it's gonna happen. I'm just a worrier by nature.
I could have posted on the NP forum, I guess, but knowing most of my buds and a LOT of parents read the General forum, I wanted advice from them as to whether they would have reacted this way if I had prescribed the same treatment for their kiddos.
AngelfireRN, MSN, RN, APRN
2 Articles; 1,291 Posts
Trauma, I'm dual-certified. I'm operating under my Family NP degree/licensure at this clinic. I did my Master's in ACNP, and went back for my Post-Master's in FNP. Told you I was an overachiever!