SL Nitroglycerin, O/C MD Blues

highlandlass1592, BSN, RN · Apr 5, 2011

This is really a tough situation to be in. A lot would go into my assessment into whether calling the doctor or not. Is this new for the pt? What were they admitted to the hospital for? Is there a possibility this pt was having an MI? See where I'm going with this?

Honestly, if we get to the nuts and bolts of the situation, your patient had a prn order for Nitro so some type of episode like this might have been expected. BUT, and this is a big one...you had a change in your patient condition. And, contrary to this bonehead's tirade, no matter where I've worked changes in patient condition are supposed to be reported to the MD. Was your patient stable? Sounds like it. Would I have called? Probably not, especially if the patient was diagnosed with stable angina (which is purely supposition on my part, I have no indication of patient dx based upon your post). But I'm going to be honest here.......Whether or not I would have called doesn't matter....you did what YOU thought was best and that's all that mattered. You made a judgement call and based upon the fact the pt hadn't needed nitro before, I can't fault you for your decision.

Now, on to the bonehead: To someone who wants to yell and scream and try to commit a tirade on me: Nope, not gonna put up with it. It's hard to maintain your composure in a situation like this. You could have said something like, "Dr. Idiot: this pt had a change in status and based upon the fact she hasn't required any nitro during her hospitilization I was concerned she may have been having a cardiac problem. If you choose to do nothing further, fine. But I will not tolerate being talked to in that manner. I will document your statements in the chart. I will not allow you to berate me for being a thorough and professional nurse" I would then write up an incident report, notify the appropriate channels regarding someone creating a hostile work enviroment and notify my nursing manager/supervisor. This kind of garbage IS NOT to be tolerated. I would still encourage you to take this up the chain of command, he's the covering MD for a reason, if he doesn't like being bothered, he shouldn't take call.

That all being said, I've been in this situation. I've had doctors who didn't like getting calls in the night to tell me I wasn't allowed to call them again. I have also told them I would call them if the situation warranted and if they continued to threaten me, we'd be in the chief of staff's office to discuss it. It's all about the patients, not the ego of the MD. Don't take this nonsense.

kanzi monkey · Apr 5, 2011

I would definitely send an FYI page. But even if the rest of the world would disagree (which I don't think they would), that is still not an excuse for the doc to treat you like that. I would have hung up on him (said something like "gotta go, good bye!"), then reported him. I'd definitely have let his attending know in the morning. That's inappropriate and unprofessional in so many ways--and for crying out loud, it's not even his own patient. I don't think the attending would be pleased at ALL to know that the staff covering his patient's is abusive to nurses.

That's bull.

You did nothing wrong.

evolvingrn, BSN, RN · Apr 5, 2011

If someone has ordered nitro then i would not call because it would not be a new 'baseline' from them. Our orders actually specify to call if 3 don't relieve the CP. Don't feel bad, i had a similar situation just the other night.. his behavior was unprofessional and inappropriate. You made a nursing judgment and I think its prudent to go with 'your gut'. on situations like this.

Isabelle49 · Apr 5, 2011

Personally, you did the right thing. Write the doc up about treating you the way he did. He had no right to do that. What would have happened if you gave the 1 nitro and 45 minutes later the patient coded???? Too bad for the sleepy doc, he should have gone into dermatology if he didn't want to be awakened. You are a patient advocate, and don't forget that, not for anyone or anything! Thanks for being so good at what you do.

Isabelle49 · Apr 5, 2011

Here's what happened to me one evening, before 8 pm. Working in home health, seeing a patient for the first time, needs foley catheter change and total admit assessment. Patient is severely debilitated and mentally not there. While changing foley, patient noted to have very large green discharge from lady partsl area and had a putrid smell. I changed foley, completed admit spoke to daughter about suspected infection and called MD. Called MD 2 more times, Called MD 2 more times. He finally called me back and said I shouldn't call him for something like that - I told him that I had to call him, as it is a requirement of my license that I notify him of a problem. Guess what? The patient died the next day! True story.

Pat_Pat RN · Apr 5, 2011

Did the admitting orders have anything written about "notify doctor if pt. C/O chest pain". This is actually an order on our "C/P R/O MI" orders from our ER. So I do it.

"Hi! Dr. XYZ, yeah Pat, Mrs. QRP is having pain, I called for an EKG, it looks normal, nitro relieved pain. You want me to....ok...mm-hmm....ok, bye."

ETA: totally missed this was in the LTHC section. I'm totally not up on what the norm is there.

NurseKatie08, MSN · Apr 5, 2011

I believe the OP is speaking of the long term setting.

That being said, OP: You absolutely did the right thing. In my facility, if we have to utilize prn Nitro we notify the MD/NP on call just for the fact that we used it. Always notify for a change in condition. That covering was a jerk.

ANNIENURSEANGEL · Apr 5, 2011

you did the right thing. We all know, if you did not call, he would be wondering why he was not notified.

CoffeeRTC, BSN, RN · Apr 5, 2011

Looks like you now need parameters for this med. Most often we see it as give X3 then notify md. I probably wouldn't have called if the first was effective, but I wouldn't fault anyone for calling. This was the on call doc? What does the reg doc say/ want?

Calling the doctor won't kill a patient, not knowing what to do and doing nothing will. You did okay!

msn10 · Apr 5, 2011

That doc sounds like he would have yelled at you in the morning if you didn't call him. Sounds like he just wants to yell.

To answer you question:

If the patient has a cardiac history and/or is on a cardiac floor then I wouldn't call. That type of symptom is to be expected. I would make a note of it so the doc can see it in the morning. However, almost any other floor or if this was a new diagnosis for the patient, then I would call. Better yet, ask your nursing supervisor what the protocol/practice is for the floor you work on. How do your fellow nurses handle him?

He told me he was not speaking to me anymore because he could not consider me a professional.

Also, don't worry about that statement. With his ego, he won't remember the conversation.

Esme12, ASN, BSN, RN · Apr 5, 2011

You can't get sued for malpractice for calling the MD and his failure to act if the patient codes.........you can however get sued if you don't call and the patient codes and the MD says....WHY DIDN'T YOU CALL ME?????

I would call if there was not an order as when to call or not call. Most standing orders will state Nitro sl q 5 min x 3 for chest pain if no relief do stat EKG and call MD. Some will state call MD if patient has chest pain give nitro blah balh blah.

Besides......if I had a dime for everytime a MD asked me if I knew what time it was or yelled at me for botherig them in the middle of the night.......I'd make Warren Buffet look like a pauper..... :lol2: :lol2: :lol2:

I just consider the source and go home to bed with a clear conscience! :smokin: