Struggling with ER doc-advice?

GHGoonette, BSN, RN · Apr 4, 2011

I would call a green area meeting with my nursing colleagues and compare notes. If everyone has the same complaint, see the NSM. This doctor is highly unprofessional and is not someone I would like either to work with, or treating either myself or my family.

**canoehead, BSN, RN** · Apr 4, 2011

Make incident reports for your manager, and let her handle it.

FutureNurse_8708 · Apr 4, 2011

I don't think you would be "tattling" at all. He is really unprofessional and he might not be taking care of the patients the correct way. I wouldn't want to work with someone like that. And I do like what Canoehead said, make incident reports and let the manager handle it.

Altra, BSN, RN · Apr 4, 2011

Agree with the suggestion of incident reports for the clinical situations -- make sure you have facts at hand -- but be prepared for the possibility of ... absolutely nothing changing.

It's the clinical situations that may get addressed. If you can document, for example, the vital signs and clinical presentation of the patient who turned out to have a pneumo and it is evident that that patient was clinically unstable and in distress, AND can document that the MD was made aware of the patient's presentation/vital signs details at X time but the patient was not seen until Y time ... then you may force the department head and/or hospital administration to take some action.

Document voluminously when working with this joker.

JKL33 · Apr 4, 2011

Very frustrating and possibly dangerous. Proceed in a level-headed way.

1) Don't allow his behavior to compromise your professional actions. Be straight-forward and professional/neutral when communicating. When he calls you out of triaging the "drug seeker" for example, say, "I am not allowed to tell the patient that, but if you would like to do your MSE now, then you would also be able to discuss what you think is reasonable treatment". No huffing/puffing/eye-rolling. BTW, I'm not saying you did that, but that's how it often goes because these characters are frustrating! Sometimes they even feed off others' frustration with them, and that just bogs the whole situation down even more with NO one working effectively. Totally avoid that whole thing by keeping your cool and doing what you know is right at all times. If, during your shift, you feel your ability to do the right thing is threatened because of him, notify your charge nurse or supervisor.

2) Don't take any more verbal orders from him unless it is an emergent situation where someone is recording and his order will be repeated back w/ witnesses. If he tries to give you any other verbal orders >> "I want to make sure I avoid any more misunderstandings so I am going to ask you to put that in the computer and I'll get it done right away."

3) Discuss FACTS related to potential safety issues with your supervisor/manager ASAP. I know he sounds like a jerk, but still a word of caution: Sometimes we see things that upset us but don't know/understand the doctor's rationale for what s/he is doing. Using the 'cherry-picking' as an example - with single coverage, sometimes there is a method to the madness of clearing a few easy patients before taking on a stable but time-consuming case (You do know that Press Gaineys are only sent to patients well enough to be discharged from the ER, right? - - and the PTB Powers-that-Be have decided Press Gainey scores are VERY important). This guy might not care about all that but I'm just saying in all circumstances that make you uncomfortable, FIRST make sure you understand why he is doing what he is doing, and then you will be better prepared to report any patient safety or inappropriate care issues by relaying facts.

Good luck!

Esme12, ASN, BSN, RN · Apr 4, 2011

I am having some issues with one of our doctors in the ER and I'm not quite sure how to handle it and was wondering if you all could give me some feedback.
This doctor is not someone I trust AT ALL. He is a notorious gossip (we work in a small hospital), I have already witnessed him bad mouth nurses to other nurses behind their backs and back pedal when called out on it, and he is just overall someone I get a bad vibe from. I say this only because my first instinct when I have an issue with someone is to go talk to them and see where our communication issues are coming from and how we can fix them, but I am concerned that me going to talk to him will only get me gossiped about and maybe even complained to my manager about.
I have had SEVERAL clinical problems with him the last few shifts I have worked-from him giving a verbal order then putting it in the computer differently and arguing that he would never state the verbal order (even though it was heard by another nurse), stating 2 meds that are clearly different are the same thing, he picks through the charts when we get backed up to see the "easiest" patients first (there is only 1 doc on, so that can become really problematic when he does this), inappropriately pulling the nurses out of pt rooms......the list goes on and on.
For example yesterday he pulled me out of the middle of a triage to tell me that the pt I was triaging is a notorious drug seeker and is here all the time and to tell her that it would be at least a 3 hour wait and that she wouldn't get any narcotics anyway. (Of course I didn't tell her that-that's NOT part of my job.) The worst part was that he felt the need to do this while we had a pt sitting with a pneumothorax that had been in the ER for over an hour and had not been seen yet (because of the cherry-picking the patients).
I am considering going to my manager about this, but I'm not sure what that will accomplish. Like I said, I usually just approach people about problems that I am having with them but I just am afraid that it will backfire on me-he is just a very weasel like person. He is the only doctor that I have had any issues with, and at least 2 other nurses have told me they have the same problems but I still feel like going to my manager is almost like "tattling." Am I wrong? How would you handle this situation? TIA for any feedback!

I would go to your manager and tell her of your concerns......ask her what you should do about this uhmmm doctor:rolleyes:. Unfortunately, there will always those who work in your department that are less than desirable. What does your charge nurse say about this MD.....how do the other nurses feel. How do the other MD's feel about your cherry picker? Sometimes letting the following doc know that your support them is helpful in making the4 on comming doc hold this guy responsible and call him on the carpet. If your manager is a good manager she would want to know when her nurses are being terrorized by one of the MD's so she can put in back in his place or at least tell you how to handle this uhmmm doctor:rolleyes:.

I am concerned about the verbal order incident. I have worked in thre ED for a long time in a couple of states and several ED's and they all have had a NO VERBAL ORDER policy.......except in "emergent" situations due to occurances just like this one....and worse. I have actually seen nurses fired becuse of verbal orders whether or not there is a no verbal order policy.

I know that there are behaviors that occur within the ED that are "usual and customary" and not necessarily within policy and procedure like verbal orders.......I would avoid this with his uhmmmm:rolleyes: Doctor at all costs. I would hand him the chart to him and be sure to tell him that you are happy to follow any of his orders.........AFTER he has written them properly on the chart so that thre can be NO miscommunication like that one time.......smile sweetly and hand him the chart for him to write them:smokin:....... because if the patient isn't coding...he can write them.....if he is in a code......most things can wait a few min so he can write them.

If you do get a verbal order and you are allowed to take them be sure you write them on you ED order sheet like any other verbal or telephone order........V.O.R.B (verbal order read back) Dr. Schmuck/A.Nurse RN 04/04/11 @ 1628.

A lengthy but good legal presentation from a legal consultant RN and JD. I've used her stuff many times to give you an inside quick look up for the dangers and liabilities of the ED......:)

http://www.gha.org/telnet/2582.pdf....

2007edrn · Apr 9, 2011

Becareful. I have had just this sort of thing happen to me lately and now I have been asked to "find another position" in the hospital.

I always question any orders that don't make any sense to me...always in a respectful way. Most of the MD' s in my ED don't take offense to it because I always look up the drug and make sure that I can answer my own question first. However, I guess I have made a couple of MD's upset and they have gotten the director of the ED (also a MD in our ED) to take their side after I took a verbal order from him. During an out burst by a teenager on suicide watch after his father was allowed to visit him in the room and the patient got outraged, violent & pulled his IV out, the staff went into the room to get the father out and control the patient. The MD went in the room and verbally ordered soft wrist restraints and Haldol 2.5 mg. I went and pulled the Haldol and came back to the room repeated his verbal order Haldol 2.5 mg IM and he hesitated and said, "No make it 1.25 mg." So I pulled it and gave it IM. Later the MD put the order in the computer as DROPERIDOL 1.25 IM. I questioned the order because I had given Haldol 1.25mg IM. The MD became very aggrivated and changed the order to Haldol. Later he went to my management and complained about my preformance and they started picking apart my charting. Nobody is perfect but the management started picking apart my charts and then called me in to tell me I am not a good fit in the ED and need to find another position because several MD's question my nursing abilities in the ED....however, I am welcome to stay until I find another position.

BTW, I had two other nurses that stated to management for me that the MD did call for Haldol. Why in the world would he want to order Droperidol????

I just worked a 36 hour week after being asked to find another position and it has been the WORST 36 hour shift of my life knowing that they really don't want me there.

I guess my point is .....MD's carry a lot more power than nurses do....even when they are wrong.

**canoehead, BSN, RN** · Apr 14, 2011

2007EDRN

Once you had other RN's backing you up on what the doc said they should have been picking apart his charting, not yours. Unless there's more to the story I would consider that harassment.