reporting a negligent doc

Yes, it is our duty to monitor and resort ANY (and I do mean ANY) changes, including ones that escalate to the physician; if the physician if unwilling to intervene, the next step is documentation, rapid response, nursing supervisor and an incident report; then looking into nurse manager, as well as the chair of the department so they can handle the issue.

Nurses are advocates; one must be able to handle such conflicts with calm, effective knowledge and rationale-the pt assessment, even when there may be someone, meaning a doctor, who is not willing to listen; there are too many avenues that are available for a nurse NOT to take.

At least in this case, it states that the nurses did not monitor the situation; or their documentation didn't show that they at least tried to intervene; if that happened, it would've been on the doctor, not the hospital.

Another reason to have malpractice insurance as well.

In this case, the nurses were negligent in not monitoring CMS distal to the cast. At least that's what it looked like reading the link

The nurses failed to follow hospital procedures to monitor his toes for changes in color, temperature, and movement, to check circulation every 10 to 20 minutes, and to report any changes to medical staff.

If you (generic you) notice that his toes are swelling, changing color, and losing sensation--a worsening CMS assessment--and you don't get any action from the MD on call, yes absolutely you need to act. Simply notifying and documenting won't save anyone's leg. You can escalate up the call chain--up to the chief of orthopedics if the hospitalist won't come. Or like you said, a RR call would be appropriate. It's an urgent change in pt condition after all.

In the olden days before we had RR teams in nonacademic hospitals (yes, Virginia, such things did happen), we reported to the charge nurse and MD. If the MD didn't respond in an appropriate way (and that was our call), then the charge or supervisor put in a call to the chief of service, and if he (it was almost always a he) didn't respond appropriately, the supervisor or DON put in a call to the chief of staff. I can count on the fingers of one hand the number of times it ever got that far and have enough left over for the Scout salute. While an individual attending physician might be a jerk who doesn't trust nurses, the chiefs of service have usually been around long enough to know better when they hear from a supervisor or DON.

This entire decision tree still applies, and yes, if nursing drops the ball by not going up the medical chain and the patient suffers for it, nursing can be held accountable.

And of course, document, document, document. "Dr. X notified of x,y,z... States no changes in medical plan of care at this time. MAChargenurse RN, charge nurse, notified." "Dr. X notified of a,b,c in addition to x,y,z. Does not wish any changes in plan of care. ANSupervisor, RN notified. Call to Dr. Chiefofservice re ..."