unsafe conditions

[girlgizmo]

i hope someone can help with some advice. i have almost 4 years nursing experiece with close to 3 of those years working on a surgical specialty floor at a major teaching hospital. this past summer i decided to begin travel nursing, my firstassignment is at a small community hospital. at this small hospital i have waited up to 2 hours for MDs to call back after being paged ( more than once). the other day i paged the covering MD about a BP of 165/111 the patient was symptomatic with nausea and being light headed. ( new onset of BP, no hx of htn, pt. admitted for renal stone) after 20 min. md called back, gave no orders stated he would be in to see pt. soon. had to page MD again 3 hours later for phenergan after pt. vomited. MD finally arrived to see pt. 5 hours after initial page. then discharged pt. without addressing bp issue. i tried to address this and finally 2 more hours passed the md agreed to give a one time med order before dc'ing pt.

this was just one example of many from this md in one weekend. he came in today for rounds, wrote notes and ordered labs on patients when he never entered their room. am i too spoiled by working with interns/residents who come see pts daily and address all care issues before discharging or am i right to be deeply concerned about the standard of care at this new hospital? i wrote the incident up but other staff nurse said the MD has been written up alot of other times. do i go to jacho, the state board of medicine? thanks for letting me vent:angryfire

[Manyse]

I can totally relate to your situation. One problem I have had in my practicum area is doctors' lack of communication about who is on call. I called a doctor the other day, and he got so mad that I called him and told me another doctor was on call. When I called the doctor he had told me was on call, that doctor said the first doctor was on call. The doctor's directory also confirmed that the first doctor was on call. After this little run around. I called the first doctor again and he more calm about the situation and gave me orders for the patient. I thought to my self what if this was an emergency? This is just one of the issues I have faced with calling doctors. I your case, as far as reporting doctors, I would follow the organizational chart until your voice is heard.

[VickyRN, MSN, DNP, RN]

Moved to General Nursing Forum.

[leslie :-D]

what am i missing?

pt had an isolated event of high bp?

what was his bp when you took it later?

did it come down?

i'm not convinced antihypertensives are indicated, based on 1 bp.

perhaps the stone got lodged somewhere?

as for not addressing phenergan immediately, i'm not seeing where this is negligence.

please, by all means, enlighten me.

leslie

[RN1989]

Document, document, document.

Pt's bp is such and such. Doctor Soandso paged.

No return call from Dr. Repaged doctor.

No return call from Dr. Repaged doctor.

And so on. The name of the game is CYA.