Question regarding communicating with MD's

[hollyberry678]

A patient was supposed to have surgery today, but it was cancelled yesterday d/t a newly found condition. She requested some food at 5:30 am, and the night nurse got it for her. Shortly afterwards, the MD was around and said she was scheduled for some alternative procedures (biopsy, ect) and was supposed to be NPO.

When I came on at 7:00, I was told she might have something scheduled, to call the OR and see. I saw the MD in the hall, along with his attending, and asked him about this. He said she was supposed to be NPO, and that he "told the day nurse yesterday". I said I was the day nurse yesterday. He said he told someone. I said maybe that is why written orders are important (innocently). He stammered, ect. Later, when his attending wasnt around, he yelled at me for how he told someone, blah blah bla, I cant even remember, I just stood there, finally held up my hands to him like, dont get on my case. He apologized and said soory to vent on you.

He later came up to me and again apologized.

However, also, he has stopped someone in the hallway one time previous, and again, later in this day, to ask a random nurse in the hall to change the gtt rate on this pt's TPN (without first going through the writing the order, talking to the assigned nurse procedure). I learn of this by the nurse he stopped coming to me to tell me they changed this pts rate, they were stopped, ect. He would later write the order for this change.

Am I missing something here? 1. Did I offend this Dr by (kind of) standing up to his trying to say he 'told the day nurse' and correcting that or by saying 'maybe that's why written orders are important'? (I am new and fel maybe I said a no-no), also is it ook for DR's to stop any nurse in the hall and make changes like that? I feel I dont know what is going on with MY patient then, or is that ok? He alos later tried to say he told the PATIENT she was NPO....

thanks for answering

[User123456]

All i can think is that this doc is gonna pin a BIG mistake on the nurse that takes a hallway order and its not in the chart and it kills or hurts someone.

[elizabells, BSN, RN]

Yep. He sounds like just the kind of jerk who would do that. My unit has basically instituted a no verbal orders except in emergencies policy. We're a teaching hospital with computer charting (and about eleventy billion computers on the unit) so there's always SOMEONE who can write an order and a computer for them to do it on.

And no, it is not acceptable for him to stop whatever nurse he pleases to give an order on your patient. What if you're not available, the order is contraindicated, and the nurse doesn't know the pt well enough to know this? What if the person he stops isn't even a nurse and they don't ever come find you? Too many areas where danger could occur.

[cardiacRN2006, ADN, RN]

1. Did I offend this Dr by (kind of) standing up to his trying to say he 'told the day nurse' and correcting that or by saying 'maybe that's why written orders are important'?

No. Not only were you right but why would you care if you offended him?

[hollyberry678]

Thanks for your replies. CardiacRN, why did he "vent" on me?

[cardiacRN2006, ADN, RN]

Because he can!

Drs will vent to whoever listens...

[TiredMD]

Am I missing something here? 1. Did I offend this Dr by (kind of) standing up to his trying to say he 'told the day nurse' and correcting that or by saying 'maybe that's why written orders are important'?

It is unlikely there is anything personal going on here. He's just stressed, and is going about things completely wrong. In fact, if you've only interacted with him a couple times, it is likely he doesn't even know who you are. I work with dozens of nurses every day, and with the exception of a handful of the surgical ward nurses, I rarely know who I'm talking to.

I'm baffled as to why he wouldn't want to write out orders. Verbal orders are likely to be ignored or misunderstood, and I have basically stopped giving them except in code situations because they get messed up so often. Not only is this resident of questionable intelligence, but he is actually creating more work for himself by taking this tack.

[Dolce, RN]

Everyone needs to vent once in a while. I allow them to vent for a short period of time before I cut them off and express to them what I need them to do. Keep it short and professional.

[ebear, BSN, RN]

This resident is really taking on a lot of liability here, Holly. Also, if something "backfires" on these verbal orders, he can deny he ever gave them. Your word against his. This practice should not be a habit. Only in emergency situations should a verbal order be given. Other than that situation alone, all orders should be written and I suggest you tell him so. You did the right thing. His tail is likely to end up in a crack one day.

ebear

[Agnus]

In most hospitals these days it is not acceptable to take verbal orders when the doctors is present. He must personally write the order. This is considered best practice. The only time you should be taking a verbal is on the phone.

It is not an order until it is written. So if he gives a verbal and says he will write it later that is not an order. Hand him the chart tell him you will carry it out when he writes it.

If that is not acceptable go thought channels and lodge a concern about this Resident's unsafe practice.

NO it is not ok to tell someone and order. He should be communicating with that patient's nurse. Why do you think he backed down in front of the attending? He knew he was wrong. That is why he waited until the attending was not around to jump on your case about this. He knew he could not do this infront of the attending as it was wrong of him.

Hold your ground with this jerk. Protect your patients because he is not.