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This MD culture

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darren_callcareer18 works as a Nurse.

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Davey Do has 35 years experience and works as a Behavioral Health RN.

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6 minutes ago, darren_callcareer18 said:

I just could not believe that the doctor called my supervisor

You never know why Docs will do some of the things they do.

One time that really stymied me was when I worked in surgery. I was scrubbed in with a podiatrist doing a bunionectomy and everything  went well. Afterwards, the assistant supervisor approached me and said, "Dr. C doesn't want you to scrub in on any more of his surgeries". I asked why and she said he gave no reason.

I had friendly chats with the Doc about running shoes and this and that in the past and I thought we had a very pleasant relationship.

That was over 30 years ago and I was much more sensitive and had a need to be liked, so I was kind of hurt.

I have since learned and accepted that we all have our foibles, idiosyncrasies, and shortcomings and I don't have to like it, I only have to accept it.

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darren_callcareer18 works as a Nurse.

29 Likes; 2,904 Visitors; 67 Posts

4 minutes ago, Davey Do said:

I have since learned and accepted that we all have our foibles, idiosyncrasies, and shortcomings and I don't have to like it, I only have to accept it.

I will mantra this. 

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39 minutes ago, darren_callcareer18 said:

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."

 

 

Just like that but make sure you put the name of the person you contacted. I would tend to write it as “ Patient A complains of chest pain 8/10, radiating through to back. Denies nausea, diaphoresis or SOB. (Then write your interventions) N. Nurse RN notified at —— per policy. Awaiting call back.”

But then I’m not an overall trusting person and I’ve been thrown under the bus enough times to never let my guard down. 

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darren -

I've never been asked to report concerns and changes in condition to anyone other than the provider team responsible for the patient. So I wouldn't be comfortable with that. Others are, I am not, and I have my reasons. As a charge nurse I also would not accept responsibility for this; I just think the whole middle-man/woman routine is asking for trouble (from all perspectives).

That said, having a peer resource or another nurse whose expertise you trust with whom to talk things through before making some of these calls is something different than a rule about who is allowed to call, and is a good thing. Review the complaint or concern, the patient's history, the relevant details of the admission, your assessment of the patient, a picture of the overall situation, etc. Get your concise report ready and make your call. Have the EMR open/handy to quickly reference other information as needed.

This ^ is the compromise I would make. But I wouldn't agree to seek permission for calling. Subtle difference, but definitely different. And I definitely wouldn't agree to relinquish a duty that can't truly be relinquished.

If  there were a situation where an RN tended to make a lot of inappropriate calls, then that RN would deserve coaching and mentoring - - for his/her patients' sake, and his/her own sake (professional growth).

👍🏽

PS - don't get hung up on this "RNs are reluctant to call because...." That is never an excuse. We don't control others, and they are responsible for their actions/interactions. But we have a duty that doesn't change based on someone being sickly sweet, neutral-toned, or a little gruff. If there is an outlier provider who routinely has issues with communication that can be dealt with.

 

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darren_callcareer18 works as a Nurse.

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18 minutes ago, JKL33 said:

darren -

I've never been asked to report concerns and changes in condition to anyone other than the provider team responsible for the patient. So I wouldn't be comfortable with that. Others are, I am not, and I have my reasons. As a charge nurse I also would not accept responsibility for this; I just think the whole middle-man/woman routine is asking for trouble (from all perspectives).

That said, having a peer resource or another nurse whose expertise you trust with whom to talk things through before making some of these calls is something different than a rule about who is allowed to call, and is a good thing. Review the complaint or concern, the patient's history, the relevant details of the admission, your assessment of the patient, a picture of the overall situation, etc. Get your concise report ready and make your call. Have the EMR open/handy to quickly reference other information as needed.

This ^ is the compromise I would make. But I wouldn't agree to seek permission for calling. Subtle difference, but definitely different. And I definitely wouldn't agree to relinquish a duty that can't truly be relinquished.

If  there were a situation where an RN tended to make a lot of inappropriate calls, then that RN would deserve coaching and mentoring - - for his/her patients' sake, and his/her own sake (professional growth).

👍🏽

PS - don't get hung up on this "RNs are reluctant to call because...." That is never an excuse. We don't control others, and they are responsible for their actions/interactions. But we have a duty that doesn't change based on someone being sickly sweet, neutral-toned, or a little gruff. If there is an outlier provider who routinely has issues with communication that can be dealt with.

 

Thank you! I totally agree to you! very well said.

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darren_callcareer18 works as a Nurse.

29 Likes; 2,904 Visitors; 67 Posts

1 hour ago, Wuzzie said:

 

Just like that but make sure you put the name of the person you contacted. I would tend to write it as “ Patient A complains of chest pain 8/10, radiating through to back. Denies nausea, diaphoresis or SOB. (Then write your interventions) N. Nurse RN notified at —— per policy. Awaiting call back.”

But then I’m not an overall trusting person and I’ve been thrown under the bus enough times to never let my guard down. 

I agree never let our guard down,.

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KatieMI has 6 years experience as a BSN, MSN and works as a Internal Medicine.

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Well, here is a view from the other side. 

For this particular case, too much is unknown. Was it "real" chest pain, or the patient was one of those folks who would complain on growing pain in their wings in hopes to delay discharge to maybe get yet another chance for a shoot of "something for my pain"? Was it real tingling, or he was just sleeping on that side? Did it disappear in, like, 15 to 30 min? Ets., we just do not know. 

Also, was it correct call to the correct physician? Or it was one of those random calls to whoever listed in "treatment team" to "report it" and fulfill yet another task? Was it just report, or one of those "can I just get SOME orders because, well, I feel like I need SOME orders?"

Was the doc known for laissez-faire approach to things? Was he/she known difficult one? 

As a matter of fact, I would name the ability of making decisions of calling or not to be one of better tests of a nurse's critical thinking abilities. The fail-free tactic of "if any doubt whatsoever, just call" too easy becomes a kind of free, albeit tasky, ride for nurses - and plain abuse for providers. No one, including patients, wins at the end of it. NO ONE. 

For calling physicians who are known to be harsh/yelling/just difficult to deal with/difficult to understand/etc. I think it is perfectly OK to ask another nurse to call IF that another nurse fully knows the clinical situation, not only what patient complained on an hour ago. 

I also think that every "symptom call" like above MUST be precided by full nursing assessment, including fresh set of vitals (taken personally by RN) and clear description of what and where is going on. "Just letting know" about some vague complain won't help me to make a clinical decision. Worse, especially if paired with clear demand of "something to be done" (so that the nurse could happily place orders and feel like he/she "did something, advocated for the patient and made the difference"), it can lead to clinical decisions which will be clearly wrong. We all do not want that to happen, do we? 

The many times discussed here case about nurse RV who injected Vec instead of Vers very likely started from a similar call to "just update" and then demand "something for severe anxiety" (however severe it was in the first place). I wonder if the author of that call will ever come to light, as well as the doc who placed the order. 

While it is not nursing scope of practice to make a diagnosis, nurses are clinicians. Not "helpers and reporters", but clinicians. Nobody can take out a nurse's responsibility to access, think and analyse. If a nurse "just updates and lets know" every provider about everything and anything, then, well, let me tell the truth - this is not "just letting know", "just advocating for the patient" and so forth. It is blatant lack of professional qualifications to do the job the nurse is at. It is that deep-ingrained antiintellectualism of nursing culture. And one day it will lead to yet another tragedy.

And I do not even mention that the time that nurse spends calling and "just updating" everybody all around could be better used for being with patients and doing things which indeed would make a difference one day, such as education, encouragement and family engagement in plan of care. 

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Persephone Paige has 15 years experience as a ADN and works as a Med-Surg.

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Recently had a doctor think I should've taken something a patient said more seriously, he had me stay in the room with him as we discovered together that it was orthostatic hypotension. But, I took note and have been hammering him with this same patient's every complaint since. You don't get to have it both ways. 

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Document everything as has been mentioned .A while back staffed a similar situation-I was agency and refused to go back.

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Oh I know how the op feels. I can tell you, I've had the pleasure of watching a few md's eat crow after they chewed me out for calling them about a change in a patients condition. one was the medical director at a nursing home I was working and needed to clarify a med of a newly admitted patient. he told me and another nurse we were incompetent blah blah blah... after his little rant I still needed the med clarified. 

I understand we have charge nurses/supervisors etc.. but it is YOUR license you have to protect so use your nursing judgement not someone else. Can't use "my supervior told me not to call bc it wasn't necessary" defense with the BON or in a lawsuit.

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ruby_jane has 10 years experience as a BSN, RN.

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On 3/3/2019 at 7:01 AM, darren_callcareer18 said:

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."

 

Oh dear lort.... Protect your license!!! That's nuts. Just nuts. This is a pt with a florid history and if the doc doesn't want your eyes and ears the doc is nuts.

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Ddestiny has 6 years experience as a BSN, RN and works as a ICU RN.

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I think you're getting some great advice, so I just want to add one small point.

It's rare that I have heard a doctor say "don't call me" and rarer that it's been something stated negatively (i.e. I have no problem with a provider reassuring the newer nurse that, no, you don't need to call me at 0500 every morning when the labs result with the critically low WBC count, for the patient whose admitting diagnosis is febrile neutropenia). When these 2 things do happen, I take it as an order...and write it as a verbal/telephone order.

If I think that my not calling him/her about X might cause a problem, then I make sure that they understand that I'm taking this as an order that will be documented as such.

"So your order is not to call you about X. Are there any parameters you'd like me to include with that?"

That tends to get someone's attention. And if not then I keep going with "well, I anticipate ___ might happen, would you like me to call you then?".

Obviously this is not for every little issue, but if you feel like there might be a potentially dangerous issue developing then I see it as an important part of advocating for your patient.

Worst case scenario? If your patient is deteriorating, then one benefit of calling a Rapid Response is that it gets the attention of multiple other people that may (or may not) agree with you. It's sad, but when I worked the floor I did see nurses that had to go "over their doctor's head" with a rapid response to get taken seriously (and their patient taken care of).

Well, so much for keeping this short.... 😃

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