Was I out of line ?

one_speed · Jul 12, 2007

It sounds to me as if you did step over the line... big time... maybe even bladed your co-worker.

Granted now you may have learned something and can apply your triage assessment skills to come up with the right intervention on your own. IMO it was unfair to stick it on someone elses back when you went looking for advice.

How can you write it as an order when they haven't even assessed the person. Just because a person has neck pain post MVC doesn't mean they have a fracture, and at the same time there are plenty of stable c-spine fractures walking about in the same circumstances (waiting to be sent home with a collar for rehab.

If you were concerned, you shoukld have placed a c - collar on the patient and lay them on the stretcher to be assessed further.

one_speed · Jul 12, 2007

By the way, I think that if you bladed me like that in the same situation I'd be hesitant to offer advice in the future as well ( i.e not talk to you in a similiar context).

This is different from if the MD had assumed care for the patient, assessed and decided to do further diagnostics to clear c-spine.

my $0.02, sorry if this isn't what you wanted to hear.

Ian

Praise,RN · Jul 12, 2007

After triaging a pt. from a minor mvc 12 hrs pta with c/o neck pain, I informed the physician of the pt's complaints and questioned the appropriatness of a c-collar. The physician stated, "If she walked in, she doesn't have a break. It is not necessary" I charted exactly what he said. I KNOW I should have just placed the c-collar and let him worry about clearing the c-spine; but I didn't. The doctor saw my entry on the nurses note and stated " Dont put stuff like that on the chart" I stated " I just charted what you said, I just wanted to document that I informed you of the pt's complaints and you did not feel it necessary to place a collar." The physician then stated "If you do it again, I just wont talk to you" ARE YOU KIDDING ME? ARE WE 12 YRS OLD, HE IS NOT GOING TO TALK TO ME!! Please respond and tell me if you think I was in the wrong. (about what I charted, I know now to just put on the c-collar)

I would have charted patient assessed (actual), MD notified of patients concerns verbally. No additional MD orders given. Keep your charting simple and to the point and avoid blamming, as this could cause problems legally and professionally

Hope this helps,

Praise, RN

bill4745, RN · Jul 12, 2007

I agree. Place the collar. The doc had not even seen the pt.

JessicRN · Jul 12, 2007

I agree with everyone else the doctors comment although fecicious should not have been taken forbadden and should not have been documented as such. Yes it should have been documented that no orders were given but Placing a collar and boarding a pt from triage does not need a doctors order it is a nurses judgement. The doctor can then remove the collar and board himself and that you also document. " Pt c/o of severe neck pain sp mva boarded and collared. MD notified board and collar removed by MD no new orders " there no one is bladed just the facts were given and you have piece of mind that you did all you could for the pt ( by the way I triaged a pt who walked in with a broken neck so the MD is wrong, yes there is a small chance but I take no chances in triage)

Hate to say it but I think you do owe him an apolegy. How would you like it if someone quoted you word for word when you were having a bad day. Yes legally you might be ok for saying it but I do not think he meant it that way. You could have responded "you know doc I agree that there is a slim chance but but of the severity of the accident I would feel so much better if we boarded and collared him" I am sure the doctors answer would be go ahead.

one_speed · Jul 12, 2007

+1 to the above, I'd apologise as well and make good with your team mate. I think that he would respect you more for it.

As we all know, the collar might be a good idea. IMO no need to back board though (we've been through this discussion before). Backboards are only useful for transporting the patient from the scene, lay them on a stretcher if you are concerned.

cheers,

Ian

tvccrn, ASN, RN · Jul 12, 2007

I'm sorry, I have to disagree with everyone who has replied here. Unfortunately, we have gotten to the point where we need to CYA. The doctors feel they can do whatever they please to whomever they choose. They won't stand up for you in the event of an adverse outcome. I have seen it time and time again, if it comes down to it, it's them against you and they won't hesitate to lie. Quoting the doctor verbatim (not forbadden) is a way to make sure that you are covered should this be called into question. As long as you charted it factually (IE: Pt reporting neck pain, recently involved in MVC, MD informed of neck pain and questioned about need for C-collar. MD responded, "If she walked in, she doesn't have a break. It is not necessary", and didn't resort to making your opinion on his response known in the charting, I think you did fine.

Yes, I would have went ahead and placed the collar before talking with the doctor and let him remove it if he wanted to do so, then charted that as well. Placing the collar on a trauma patient, with or without the complaint of neck pain or patient's ability to move around, is simple nursing action and should be done.

AnnieOaklyRN, BSN, RN, EMT-P · Jul 12, 2007

hi,

No you were not out of line, you documented to cover your butt in case something were to happen and the doctor needs to accept that.

There was a case in my area several years ago where a younger woman walked into the ER after what was suposidly a minor accident with neck pain and they too probably didn't think to start protecting that c-spine. When this young woman lifted her arms before getting into a johny it would be the last time she lifted her arms because she did indeed have a cervicle fracture.

However just puting a c-collar on DOES NOT protect the c-spine as patients still have lateral movement in their necks which is why out in the field we use head block in addition to a c-collar. In other words just throwing a c-collar on someone and letting them ambulate doesnt do any good, if your really concerned about the neck you need to get them in a bed and keep there head/neck inline manually or with headblocks.

Also I find that a lot of people hear "neck pain" from trauma and just automatically throw a collar on and board them without doing any assessment as to where the pain is etc. An actual assessment versus assumption can give you a good indicator as to what the risk is that they actually have a fx.

Just my 2 cents

Swtooth EMT-P, RN

Altra, BSN, RN · Jul 12, 2007

I would not have quoted the MD. Your nurses notes are documentation of patient care, not conversations between co-workers. "MD made aware of patient's complaints, no orders received" would have sufficed in covering your butt without making it appear that there was some kind of pissing match between you & the MD, calling into question the care provided by both of you.

Is it your practice where you work that the triage RN does not place a c-collar without an MD order? As I see it, if your assessment led you to believe that the pt. should have a collar, then you need to place the collar.

ETA: I agree that an apology to the MD is in order. MDs have a license to protect too.

RunnerRN, BSN, RN · Jul 12, 2007

I too think that you were out of line. If you thought the pt needed to be collared, then you should have done it. A simple "MD aware, no new orders received" would have been sufficient.

I also agree that an apology is in order the next time you see this doc. You were pretty much covering your orifice by exposing his.

ETA: His response wasn't exactly the most mature. Sounds like a jerk.

fultzymom · Jul 12, 2007

I would have documented something like, "PCP notified of complaints. No new orders received at this time." That would have covered you in the situation but not pointed the fingers directly at him.