related to another post I made on reporting a MD

[angelbear]

I made a post previously on an MD that is kept on staff at the facility were I work who doesnt like to be called and gives wacky orders just for spite. Ok here is the deal I was working the floor the last few days and one of my pts was very ill. All she had was a prn aeresol and nothing else I could give her and she was obviously in resp distress. O2 sats were in the low 80's. Not even a prn o2 order. Our procedure manual states that we need a MD order to initiate o2(which I think is stupid) Anyway there was nothing I could do for her other than elevate the HOB position her for comfort give the prn aeresol. Then I called our on call NM to report the problem. She told me to go ahead and initiate the O2 so I let her know what the manual read and she told me to go ahead and she would get the order in the a.m. I had left her a message the day before stating my concern and my feeling that she needed more than what we could give. I asked her if she had gotten that message and she said yes she had and the pt would see the MD at the schedueled time. She did not want me to call the MD because of how he usually responds. I was very upset. Turns out the MD did see her the next day and admitted her to ICU for double pnemonia He was very upset that this had gone on for days and he had not been notified. I swear I am so frustrated. I am also glad that I documented the crap out of the whole thing both nights. Why the heck have nurses working the floor if you are not going to listen to them and why have MD's on staff you are afraid to call? I swear I feel damned if you do and damned if you dont. What does one do in a situation like this?

[EastCoast]

I am not sure where you work but why does the Nurse Manager have the ability to give a physician's order for oxygen?

Clearly this seems to be an example of a patient recieving poor care b/c the MD has put himself in a position of being untouchable.

So nursing bears more responsiblity.

[EastCoast]

I forgot to add in that didn't the patient have other symptoms over a period of time that would have alerted others that the patient was ill?

O2 sats in the low 80's are not just a benign 'throw them in some oxygen' type of symptom.

[Rustyhammer]

I've always considered initiating o2 as a nursing measure.

Sats in the low 80's certainly justifies it.

Calling the MD even at noc only the right thing to do but is good protection. CYA at all times. Call him/her and document what is said as well as the reason you called.

-R

[ceecel.dee, MSN, RN]

Patients don't get daily doctor visits? I don't think the physician has one thing to be upset about, if he doesn't even assess his own hospitalized patients! And, nurses don't chart to cover their butts, but to communicate with the multidisciplinary team at large, so all have a clear view of the patients status and what has been done for them by the nurse's perspective. That is why nurses read PT, ST, physician's progress notes too.

I have serious concerns about an institution that will not allow a RN to even apply O2 to someone struggling with their breathing!

Do you have an institutional ethics committee? Perhaps you can request to have this patient's chart reviewed by the QA committee?

Stick by your principles here...you are doing the right thing!

All the nurses (license), not to mention patient's (well being), in your facility are wide open to harm! Either the nurses must be able to call for every little thing, or they need to expand your nurse's autonomy and allow them to actually think on their own! (We are dealing with a very similar situation at our place, and it's really hard to get anyone to confront a physician.)

[BarbPick]

At Baptist Hospital in Miami Florida, the physicians are scared to death of the Nurses.

What I would have done. Forget your nurse manager, call the house supervisor, stat.

Got to the copy maching, make copies of the ABG's, o2 sat, the doctor's stupid orders, and present them to the chief of staff. CC to risk management, this is a CYA tactic.

Back to the Nursing house supervisor, they are responsible for the house 24/ 7. Tell her Dr jerk is ignoring his pateint and you feel an impending code coming on. O2 is a nursing measure, I do not care what the antique manual says.

(in Court) Tell me Ms Nurse, you stood there and allowed your patient to turn blue because you had a patient from a jerk who is a complete Bully?

[PMHNP10]

Wow...all I can say is NEVER, EVER avoid calling the MD because you are afraid of how he might respond. If you call and he leaves no orders and just makes it a point to cuss, you simply say so what can I do for this patient? If he still gives no orders, you document exactly what happened. That way when the pt sues the hospital you are 100% free and clear because you notified the MD. BTW...make sure you have another nurse on line if you know the MD is going to behave in such a way. I hate to say this, but if the pt (or family) files a suit, you will be held accountable for not calling the MD. And believe me, if push comes to shove, you will be left hanging out to dry--not the hospital. If you think I might be overstating this point perhaps you should take a look at the thread 14 KY nurses fired and 9 disciplined. Never a good idea to not call the MD. If he/she doesn't like being woke up, get another career.

[Noney]

Hey Angelbear,

If I'm remembering right you work in longterm care. The bottom line is yes you should have called the doc. Remeber no one can hurt you through a phone!

We have all dealt with this kind of jerk, if you had called him he may have blown it anyway, but he'll never admit that. I feel your NM left you hanging out to dry, if she doesn't have the backbone to deal with rude doc's she shouldn't be in management.

Cheer up tomorrow is another day:D

Noney

[mother/babyRN, RN]

AngelBear...So sorry for what you went through..Oxygen is considered a med so has to be ordered, in the unlikely someone administers it to someone with an impaired hypoxic drive.....I also thought it was stupid not to be able to legally initiate it ( although in delivery we do with an order later there and in the nursery if needed.), until a friend of mine was found negligent in court for doing exactly that....

[cannoli]

mother/babyRN, without breaching confidentiality please share what type of situation your friend experienced, it sounds like it would be a good learning experience for the rest of us.

[mattsmom81]

Chalk this one up to experience as you are feeling the guilt as a result of 'doing what the supervisor told you' and your patient suffered.

Bully docs are everywhere (and the nurses who allow themselves to be coerced). We simply cannot allow them to harm our patients!

I know it is frustrating if the hospital culture allows this type of thing. If you cannot get management support on dealing with docs, either ignore them and CALL ANYWAY...CYA...or look for a more supportive environment to practice in.

Bottom line: we are there for our patients not the docs.

Don't beat yourself up, but definitely learn from this. :kiss

[angelbear]

Noney you remember correctly this is LTC. You are all right I should have called the MD regardless of the fact that my NM told me not too. I did however document that she said to monitor til morning and not call MD. These NM's are notorious for giving us there orders ie give PRN aeresol Q 4 hours until seen by MD, Do VS Q 2hrs that type of stuff. For the most part just makes us feel like brainless puppets. Also just to clarify I am an LPN there is not an RN on noc shift just an on call NM. Thanks for all the responses.