This MD culture

Nurses General Nursing

Published

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.

We'll have to agree to disagree.

9 hours ago, gonzo1 said:

A few years later he was put in prison for all kinds of bad things.

YIKES!!!! Good thing he's not able to practice anymore.

1 Votes
Specializes in ICU/ER/Med-Surg/Case Management/Manageme.

It does sound to me, based on your assessments, a physician call was indeed warranted. I agree with others that the nurse caring for the patient is the one to make the call. She/he will have answers the supervisor or charge nurse won't necessarily know.

That said, even as an experienced nurse in the ICU, I always consulted with another nurse prior to making a call in the middle of the night or even on a weekend. (Unless, of course, it was an obvious emergency situation). Sometimes just running things by someone else can help and if nothing else, that other person might even give suggestions on what to report to physician.

Now for the fun thing...?...years back I recall one of the meanest, ugliest, nasty docs I have encountered in my 36+ years of nursing. Other nurses would quake in their shoes if they had to call him. Day or night. You would report something - major or not - and he would just hang up on you. No comment. Zip. Nothing. I used to "volunteer" to call him. Each time he hung up, I'd call him back..."sorry, doctor XXX, we got disconnected before I could take your order". And I'd do it over and over until I got a response. With the Wuzzie grin. ?

6 Votes
Specializes in Critical care, Trauma.
On 3/6/2019 at 1:38 PM, FDM87 said:

I did that and got written up for “questioning orders” ?

That's terrible. As part of the healthcare team, we are supposed to also "check and balance" each other. That requires asking questions (and being willing to accept someone questioning you). Egos just get in the way.

Specializes in NICU/Mother-Baby/Peds/Mgmt.
On 3/3/2019 at 8:01 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."

Lol. And would you really take any orders from the supervisor? If they say something incorrectly and you do it it's going to be your butt, unless of course they're willing to write the telephone order which I doubt.

On 3/6/2019 at 7:10 PM, DallasRN said:

It does sound to me, based on your assessments, a physician call was indeed warranted. I agree with others that the nurse caring for the patient is the one to make the call. She/he will have answers the supervisor or charge nurse won't necessarily know.

That said, even as an experienced nurse in the ICU, I always consulted with another nurse prior to making a call in the middle of the night or even on a weekend. (Unless, of course, it was an obvious emergency situation). Sometimes just running things by someone else can help and if nothing else, that other person might even give suggestions on what to report to physician.

Now for the fun thing...?...years back I recall one of the meanest, ugliest, nasty docs I have encountered in my 36+ years of nursing. Other nurses would quake in their shoes if they had to call him. Day or night. You would report something - major or not - and he would just hang up on you. No comment. Zip. Nothing. I used to "volunteer" to call him. Each time he hung up, I'd call him back..."sorry, doctor XXX, we got disconnected before I could take your order". And I'd do it over and over until I got a response. With the Wuzzie grin. ?

I wish to be like you! ? I wish to work with you so I can learn your persistence. haha

Specializes in Prior Auth, SNF, HH, Peds Off., School Health, LTC.
6 hours ago, Elaine M said:

Lol. And would you really take any orders from the supervisor? If they say something incorrectly and you do it it's going to be your butt, unless of course they're willing to write the telephone order which I doubt.

Yeah, anything the doctor told the supervisor would need to be charted by the supervisor, whether it be new or additional orders, or even if all the doc says is “noted”, or whatever....

The point is, that if you call the Sup’ with info, and then the sup’ calls the doc, and then afterwards calls you back with doc’s response, you can’t chart info that is at that point third-hand. You aren’t allowed to chart what somebody else said the orders were.... So if “Sally Supervisor” wants to talk to the doc, then she is also then responsible for documenting that call and the response of the doc. And you need to be unmovable on that point: You will NOT take third-hand orders— Period. Hard stop. The end.

It’s like the game of telephone that kids play— by the time some info gets passed along verbally through multiple people, there’s a higher probability that it will be inaccurate with each telling.

You should only be taking responsibility for orders (or lack of them) that you personally receive from a provider/doc. Because if you chart something that was told to you through your supervisor as though it was info that came to you from a provider directly, then that is how it will look to the BON, hospital admins &/or lawyers, a judge, or a jury if something bad happens... and you can protest all you want, it won’t matter....

Remember: if it’s not charted, it didn’t happen— AND — the way something is charted is the way it happened.

Don’t get me wrong though— I think the “tag-team” call system that the doctor wants is ridiculous, and the fact that your supervisor seems OK with it is almost as asinine as the doctor suggesting it in the first place.

I would strongly consider taking this up the chain of command to the DoN, and even risk management if the idea is still gaining traction after talking to your DoN. Present it as a patient safety issue, because the doc is intentionally throwing up roadblocks to appropriate patient care by trying to prevent you from giving them the necessary and relevant information they need to assure that the patient’s needs are met.

Of course, that means that you are doing your part to prioritize what information gets passed to the doc and how and when you report that info:

  • what info can be passed on via the chart?(learn where in the chart you can record info that you want the doc to have... where will he see what you’ve written?)
  • what info can you pass along when the doc is there on rounds.?
  • What info needs to be passed along immediately no matter what time it is?

I’ll never understand why some docs don’t get that we’re on the same team— and we have the same goals: Provide safe and appropriate patient care until they are well enough to be discharged. :yes:

1 Votes
Specializes in ICU, LTACH, Internal Medicine.
6 minutes ago, Duranie said:

I’ll never understand why some docs don’t get that we’re on the same team— and we have the same goals: Provide safe and appropriate patient care until they are well enough to be discharged. :yes:

When we're on the road, we also have the same goal: to get safely where we need to be. Sadly, some people choose unsafe ways to do that, get in trouble and put others in trouble too.

Same way here: we all work on provide safe and appropriate patient care, but some of us choose to do things which unnecessary complicate the situation. And that can happen with everyone involved. The nurse who chooses to call at 3 AM to "just let know" that patient had loose BM after mag citrate is just as guilty as the doctor who yells at her. Probably even more so, because a provider carries much heavier responsibility about more patients and for him/her being overtired and upset is much more potential danger of making a wrong decision. But BOTH nurse and doc are placing absolutely unnecessary obstacles in the way of getting to the common goal - get patient out of there in better health.

Specializes in Prior Auth, SNF, HH, Peds Off., School Health, LTC.
30 minutes ago, KatieMI said:

When we're on the road, we also have the same goal: to get safely where we need to be. Sadly, some people choose unsafe ways to do that, get in trouble and put others in trouble too.

Same way here: we all work on provide safe and appropriate patient care, but some of us choose to do things which unnecessary complicate the situation. And that can happen with everyone involved. The nurse who chooses to call at 3 AM to "just let know" that patient had loose BM after mag citrate is just as guilty as the doctor who yells at her. Probably even more so, because a provider carries much heavier responsibility about more patients and for him/her being overtired and upset is much more potential danger of making a wrong decision. But BOTH nurse and doc are placing absolutely unnecessary obstacles in the way of getting to the common goal - get patient out of there in better health.

All true. Which is why I made the points about prioritizing communications with a provider... when, where and what info gets communicated.

I think nursing schools should require a professional communication course as part of the curriculum. Maybe some do... maybe some offer it as an elective, but don’t require it.... I know my school had an “effective communication”- type course, but it was a general or business-oriented course... and though it would probably have had some benefit... I think nursing schools need a course that is specific to teach effective communication among healthcare providers.

Especially since many of the coming generation of nurses are accustomed to writing in text-speak in 140 characters or less. And so many of the young adults that are in the pool of potential nursing students, sadly, have very little experience speaking on the phone at all.

1 Votes
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