Dr makes me feel so incompetent?

Never let anyone make you feel stupid for using good nursing judgement.

I'm confused. You gave the PRN clonidine for withdrawl symtoms? What were those symptoms? Did the clonipine resolve them?

Anytime we give PRN drugs you have to chart why you gave it and then later to chart if it was effective. You didn't have an order to give clonidine for B/P. You took that upon yourself to administer a drug that wasn't ordered because there were no other orders and are now unprepared to explain to the Dr. why you went rogue.

As far as checking the B/P, that was very wise as the clonipine was not a routine B/P med and you would have no history of how it affects that patient.

Unless the HTN is due to withdrawals. In that case giving it is completely appropriate.

If it was a PRN dose, I would of rechecked his bp again. But would of given it about 4 hours or so before I did.

If the BP was still high, and not within the normal range I would talk to a senior rn first, espically since the meds primary reason for the med wasn't their BP.

unless it was super high and not usual for the pt then I would talk to dr.

His BP was lowered and you havent mention the pt having any other symptoms associated with the bp, so In the future I would talk to senior nurses and make sure you have given it enough time before rechecking the Bp.

Also I would of informed the dr once the Bp had dropped, saying you had no concerns and didn't need them, so they didn't have to waste their time calling. I know that might come off wrong, but drs are busy and get a lot pages so when they call and there's actually no issues you can see why they get annoyed. Especially if it keeps on happening from other staff as well.

I work Cards step-down and anytime we give any meds that have the potential to impact BP's... we check and then recheck an hr later. Of course it varies... like how long someone has been on a med, their baseline BPs and what their BPs are known to do after admin. But given that we give so many meds which impact the heart we obvious are compulsive with checking pressures. Clonidine and Narcs can drop pressures so yes you were doing what's prudent!

That MD was a dork. Anytime I deal with a rude MD I just retort with... well if his/her pressures suddenly drop then you'll thank me for actually paying attention to them... or something along that line. Don't let rude MDs discourage you. The 2x times I've been floated to a MedSurg floor I stick my peeps on the tele and check BPs par my normal flow and both times it served me well... I discovered new Afib with RVR in an elderly pt and in another their BP tanked after a small dose of a beta blocker.

Just sayin'

As a new nurse, I eventually learned that some doctors try to intimidate nurses so that they don't get bothered with calls. If you have a concern, call. Maybe run it by another more seasoned nurse first if you are unsure, but, at the end of the day, it's your license and your call.

And learn to quickly and confidently do SBAR. If it's something simple like an elevated BP, you can quickly state patient Bob Smith in room 27 is actively withdrawing from alcohol. He has a history of hypertension, with SBP generally running in the 160s. At 1725, his BP was 165/95, HR 75. He received (dose) of Clonidine at that time for anxiety. At 1830, patients BP was 185/95, HR 75. His anxiety level appears to be controlled at this time. He denies pain. He has no PRN orders for his hypertension. Would you like to order something for it?

Then the grumpy doctor can simply say no and hang up on you. Document and carry on. Sometimes, it's best to give them yes/no questions.

My favorite nursing professor used to say we're here to save patients from their doctors. She said it jokingly, but sometimes it's the truth. Always trust your intuition over any doctor, document the crap out of everything (especially when you are clashing with them), and always follow your hospital's procedures (my procedures were always to check BP an hour later).

I was giving a patient 0.1 mg of clonidine. I checked his bp prior and it was 154/101 rechecked it after clonidine it was 178/112. I called the MD. She didn't call back until later, he had no other s&s of stroke of anything abnormal. So about time she called it was 135/89.

Her : why are you checking his bp?

Me: He has an order for clonidine

Her:So why are you checking it? does it have parameters?

This exactly what makes me hate nursing. I'm so tired of feeling so incompetent.

I thought I was being an advocate for my patient.

But guess not.

The next time a doc asks you that question, ask him/her (respectfully) "Why wouldn't you recheck it?" A good and prudent nurse will recheck, especially if the order is new.

You felt incompetent because you allowed the doc to make you feel that way.

But that's no reason to "hate nursing." Rather, it's a challenge for you to be able to explain your actions to educate the doctor.

You did just fine, Honey. (Grandma here)

They're human like the rest of us and I am sure that once in a while, one of them slaps their forehead and has an "Oh yea!!" kind of moment....

My favorite nursing professor used to say we're here to save patients from their doctors. She said it jokingly, but sometimes it's the truth.

Such ridiculous yapping from those influencing future nurses is possibly one of the more stupid things about nursing. Absolutely ridiculous.

I bet she has that "Nurses Call the Shots!" T-shirt, too.

I just feel so stupid as a new nurse. You think you're doing the right thing and then get belittle. I'm working in an drug addiction place and its just so tough. Because the other nurses don't seem to care. They tell me not to call on call but when I'm stuck I need to speak to someone. I know he has HTN but still in school we were always taught to check their bp. Plus I just started and she communicates with my boss so I'd hate for her to tell him something to the fact that I'm incompetent and the oncall phone charges $150. Sorry just had to vent

No one can make you feel incompetent (or anything else) without your permission. I think Eleonor Roosevelt said that. If someone chooses to belittle you rather than to respond professionally, that's on them, not you.

Of course you feel stupid as a new nurse. You ARE stupid, in the sense that you don't know everything you need to know to function safely, independently and competently. Feeling stupid is what keeps you from making a major mistake that could seriously harm or kill a patient. As a crusty old bat, we LIKE new nurses who feel stupid. We hate and fear new nurses who think they know everything. Seriously. A new nurse who feels stupid is open to learning; a new nurse who thinks she knows everything is impossible to teach.

Checking blood pressure before giving an anti-hypertensive is a safety thing. If there aren't parameters for holding the med, there certainly *should* be. Next time, ASK her for parameters.

Just for future reference, how long after you gave the clonidine did you recheck the blood pressure? What is the onset of action for clonidine? When would you expect peak action?

Was it a scheduled dose or a PRN dose?

I understand checking the BP prior to a scheduled dose, but we don't commonly recheck the BP a certain time after the dose. What usually happens on my unit is: I check the BP @2100, I give the pt their scheduled dose of BP medicine. Then I recheck their VS @2330 because their Q4HR VS are due. The only time I would recheck their BP earlier than that is if it was unusually high.

If it's a PRN dose, what are the parameters? Our providers typically write out parameters such as, "give PRN dose of clonidine 0.1mg for systolic >170 or diastolic >100. Hold for diastolic

I'm not trying to make excuses for this provider. I'm sure they were quite snippy with you, and many times, providers do this for no reason at all. But they also receive a lot of phone calls when they're on-call, and I find it helpful to think about this before I pick up the phone and call them. When in doubt, I run it by my CN and pick her brain. A simple, "would you do this?" can save you and the doctor a lot of time.

I totally agree with everything said in this post. I have also checked the graphic sheet to see if this patient is known to run high BP's or is this is new. And at times, I have started my phone conversation with the doctor, after confirming who he is, and say "this is a CMA (cover-my-ass) call". It's not that I wanted to call but I have my license to protect also. I have never had a doc get mad at me for this opening.

You did nothing wrong. One said she doesn't usually check for scheduled meds, but I have been taught to check BP and HR for any anti-hypertensive given. In general, you should check the policy on this if it is not clear to you, and follow policy. Period. The fact that the patient was actually quite hypertensive at the time and did not respond favorably, I still feel you did the right thing.

It would be impossible for me to count all the times a doctor (or co-worker for that matter) UNJUSTLY questioned me or gave me INCORRECT information over the years. As long as you err on the side of safety, you aren't actually making an error...Withholding or delaying needed treatment in an emergency, would be the only "error on the side of safety" possibility I can think of.