This MD culture

[darren_callcareer18]

I just want to vent out a little because I had to call a doctor at 7PM because my patient was complaining of alot of things. First chest pain that radiates to her back .They did trops, X-RAY and ECG they were all negative. However, at the beginning of my shift she was complaining of numbness and tingling on her face all morning and reported to the MD since potassium was low. He ordered for a replacement to that. However all vitals were normal.

Few minutes after that I was called by my supervisor and was told not to call the doctor and to call her first. I don't know, but I feel like that my call to the MD was not valid.

I just want cover myself because what if this patient complaint was really something? Then they would asked me why I did not do something after finding out the patient report.

Just kinda discouraging to start my 12 hour shift.

[LovingLife123]

I would be upset too. I don’t get these small hospitals where physicians think the hospital should run just fine without them. They get paid the big dollars. Call is part of it. It’s that simple.

Let them complain. I would also remind the charge nurse that it’s required to call them. You cannot decide whether a symptom is anything or not. Technically it’s out of your scope of practice. You cannot determine what symptom is insignificant.

[Wuzzie]

Keep calling and document everything he says including if he says anything about not calling him. Also notify the supervisor that you called him and document that. If she doubles down on the call her first thing let her know that you’ll be documenting that in the chart as well. You can do this in a way that is professional by saying something like “ shall I document this in the nursing notes or in the orders?” while wearing an innocent smile. She will protest but stand your ground. Trust me, if you do what she says and something happens to a patient she will throw you under the bus so fast your head will spin.

[Sour Lemon]

Is your supervisor on site? If so, I would run things by her before calling in non-urgent situations. Where I work, our charge nurse makes most calls to the MD(s).
For an urgent situation, or a situation where I can't 100% agree with the charge nurse, I just go ahead and call. Your calls sound like good ones, to me.

[JKL33]

Out of curiosity, what kind of information are you providing when you call?

[darren_callcareer18]

1 minute ago, JKL33 said:

Out of curiosity, what kind of information are you providing when you call?

I called the MD to let him know that the patient was having a left facial tingles and numbness. This patient has history of aneurysm. She was supposed to be discharged yesterday but since she was complaining of radiating chest pain she remained admitted.

So, I provided the patient complain and review the history of the patient (since the MD just took the shift from a different MD). I also mentioned about the low potassium level which he ordered for replacement to that.

I also mentioned if he wanted to consider changing the PO antibiotic since the patient was sweating hard, had a throbbing headache, and was itching on her legs. But he did not want to change it.

I wonder what other nurses would do in this situation? You see, this kind of doctor make the nurses hesitant on calling them that usually resulted to patient injury or dead. I have read and it is on the news everywhere about stories of nurses not calling the MD after patient report because of the MD being difficult and grumpy. (Read a nurse license suspended after failing to report a slight drop in heart rate of a neonate)

[Davey Do]

8 hours ago, Wuzzie said:

do this in a way that is professional by saying something like “ shall I document this in the nursing notes or in the orders?” while wearing an innocent smile.

Follow Wuzzie's advice, darren, and make sure you don't get your smiles mixed up!

8 hours ago, Wuzzie said:

she will throw you under the bus so fast your head will spin.

Wuzzie knows about head spinning:

[darren_callcareer18]

11 minutes ago, Davey Do said:

Follow Wuzzie's advice, darren, and make sure you don't get your smiles mixed up!

Wuzzie knows about head spinning:

haha A for the effort LOL

[Jory, MSN, APRN, CNM]

I would tell your supervisor in the most polite and professional way possible that you can't do that.

The nursing supervisor isn't a provider and if something should happen to that patient and the supervisor felt a call to the MD wasn't warranted, you can't stand in front of the BON and use that as a defense.

This is why physicians get paid what they do....the level of responsibility, the schedule, when you are working, you are working. If you don't like being woke up or disturbed, find another profession.

I get unnecessary calls too...but it is part of the job.

[mtmkjr, BSN]

Playing the devil's advocate here,..

perhaps there's more to the story. In my unit, on day shift the nurses call the provider but after hours the charge nurse does it. This is mainly for consolidation. Any one nurse might not know what is going on with other patients - by having the charge nurse handle it, he or she can make one call.

I don't think you are risking anything by having the supervisor make the call. Expect the supervisor to keep you updated as to what the MD wants to do. Give it an appropriate amount of time, and if you don't hear back, call the supervisor and ask what the MD said. If the supervisor actually did not contact the MD for any reason that you disagree with, then you would go ahead and make the call on your own.

And document everything of course.

[darren_callcareer18]

2 hours ago, Jory said:

I would tell your supervisor in the most polite and professional way possible that you can't do that.

The nursing supervisor isn't a provider and if something should happen to that patient and the supervisor felt a call to the MD wasn't warranted, you can't stand in front of the BON and use that as a defense.

This is why physicians get paid what they do....the level of responsibility, the schedule, when you are working, you are working. If you don't like being woke up or disturbed, find another profession.

I get unnecessary calls too...but it is part of the job.

That's what I thought too. The patient was complaining of numbness of her right face, and early this morning a chest pain that radiates to her back. I would take her complain as valid because this is a new onset.

I just could not believe that the doctor called my supervisor after the call that to let her know first about my assessment before calling him. I felt discouraged.

Everything is documented that I did my best to collaborate the issue, and if by chance patient complain, my hands are clean.

[darren_callcareer18]

11 minutes ago, mtmkjr said:

Playing the devil's advocate here,..

perhaps there's more to the story. In my unit, on day shift the nurses call the provider but after hours the charge nurse does it. This is mainly for consolidation. Any one nurse might not know what is going on with other patients - by having the charge nurse handle it, he or she can make one call.

I don't think you are risking anything by having the supervisor make the call. Expect the supervisor to keep you updated as to what the MD wants to do. Give it an appropriate amount of time, and if you don't hear back, call the supervisor and ask what the MD said. If the supervisor actually did not contact the MD for any reason that you disagree with, then you would go ahead and make the call on your own.

And document everything of course.

I was just wondering if a patient has a chest pain and informed my supervisor, how should I chart it tho? "Patient complain of chest pain radiating to her back. Contacted supervisor awaiting for response."