BrnEyedGirl, BSN, MSN, RN, APRN 1,236 Posts Specializes in Cardiac, ER. Has 18 years experience. Jul 16, 2007 Wow,...I'm new to ER,.just transfered in Jan,...spent 8 yrs on a cardiac unit befor that,...if I quoted everything verbatem that Dr's, pharmacists, radiologists, social workers, other nurses, EMT's, etc,.said to me we would have all been fired a long time ago!!!! I'm now in a Trauma center ER,.at triage we don't really have a chance to even talk to a Dr and as a previous poster mentioned,.if I think it warrents a conversation with a Dr. then I have protocols to follow,.I'd have put on the collar and not even tried to get a Dr to dx a pt he hasn't even seen,.. if I need an immediate oppinion from a Dr I probably need to call my charge nurse and tell him/her I need a room for a pt now!Hope you can work this out with the Dr,...perhaps we should all remember this next time we open OUR mouths!
Knoodsen 95 Posts Specializes in ER, ICU. Jul 16, 2007 gee dub,If you felt so strongly that the patient required c-spine precautions, then why did you ask anyone about it? I would be hesitant to offer advice as well, if I thought there was a chance it would be quoted in a chart. That physician was exhibiting wisdom, not a lack of maturity. "Don't put stuff like that on the chart" is good advice.everyone else,I am impressed by the many reasoned and sober thoughts regarding this topic. Unfortunately, we cannot escape legal exposure. The nature of emergency nursing is such that we often have some other things to do besides document the things we do. I don't know about you, but my charting reflects only a tiny fraction of what I do during my shift. Of course, we have to do the best we can to protect ourselves. Learn to identify the patients that are sick. (This can be tricky. Work on it.) Document a good assesment. Record all interventions; monitors, O2, tubes, lines, and meds. If they stabilize, then document how well they are doing every couple of hours. This justifies you ignoring them while caring for another sick one you found. If the patient is not sick, then document how well they are doing. This justifies your having left them in the waiting room for several hours. To a documentation guru or an attorney, this is mighty thin charting. I think it is realistic. It's a lot to ask for when lives are at stake and more than I see a lot of nurses do. Use brief, factual statements. Stay focused on proving they are unsick. (This can be fun.) e.g., Pt. shouts, "Hey. Short of breath over here". (Quotes are great.), Boyfriend reports pt. "going into shock". 2+ radial pulse, skin PWD., parents report pt. "just vomited". child eating Cheetos.
teeituptom, BSN, RN 4,283 Posts Specializes in ER, ICU, L&D, OR. Jul 16, 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)If I had been the doctor, I would have run you out of the hospitalIf I had been your charge nurse I wuld have run you out of the hospitalIf I had been a fellow RN I would have run you out of the hospital
DiannaK 40 Posts Specializes in cardiology. Has 14 years experience. Jul 17, 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.If I'd seen the same pt in Triage, I would have placed a C collar. All it took was one time getting screamed at about NOT putting a collar on a pt ....If there's a question about whether I should place a collar of not, I will call back and ask the MD. When I place a C collar .. I will always "spine precautions" in the comments. This lets the MD know the pt is collared, and (hopefully), they will be seen quickly and potentially cleared. As far as your documentation, you did nothing wrong, either. You documented facts, not opinions. Good luck
jjjoy, LPN 2,801 Posts Jul 17, 2007 If I had been the doctor, I would have run you out of the hospitalIf I had been your charge nurse I wuld have run you out of the hospitalIf I had been a fellow RN I would have run you out of the hospitalHow about first rationally discussing the issue and how it could have been handled better?
brissie 89 Posts Specializes in CICU. Jul 19, 2007 Haven't we all said things we regret? Wouldn't we have been mortified if they had been written down in a legal document? As mentioned above a simple "EMD notified, no new orders" would have sufficed. Even if this were to make it's way to court then you would have been covered by this statement since by informing the MD of the patients status and him not giving any orders he has assumed care of this patient. I have to agree that you left him out to dry. We should be a team.
jjjoy, LPN 2,801 Posts Jul 19, 2007 I have to agree that you left him out to dry. We should be a team.Left him out to dry? It may come across that way, but do you truly think that was her intention? The way I see it is that OP suspected a collar was needed but wasn't sure. If there's a specific facility policy on that, then she should follow that. Of course, when it's busy, the nurse may not have feel they have time to pull out the policy manual and look up the specific guidance they need, so they ask someone else. She asked the MD and he said it wasn't needed. The OP didn't feel comfortable contradicting the MD and yet didn't feel totally comfortable with what he told her. What to do? A better choice would have been to just collar anyway. There was the risk of being told she had wasted time and had been overly cautious with that (and may even have been scolded for doing it when the MD had said no) but in the interest of safety, that would be the best choice. Instead, the OP decided to go with what the MD said and made sure to note that he had okay'd it. She could have documented it differently such that it wouldn't've come across as "hanging him out to dry" but I doubt it was her intention to come across that way. The doc certainly wasn't much of a team player either in this case.
Yvette Acute ER RN 9 Posts Specializes in ER Nursing. Has 10 years experience. Jul 19, 2007 I think the greater issue is having inexperienced nurses in triage....Triage is critically important, lets not forget about recent cases of patients dying in the waiting room. As a practice, all head/neck trauma get a collar....period. They are quite simple to remove later, and although they provide minimal protection, it is protection nonetheless. I have worked in facilities that allow agency or floater nurses to perform triage, and I firmly believe it takes some time as an ER nurse to be able to determine if a patient is "sick" at first glance. In addition, it is unprofessional to blade a colleague with charting. An apology is in order, keeping in mind that this physician sounds like an idiot.Just my two cents, for what it is worth....:typing
tvccrn, ASN, RN 1 Article; 762 Posts Specializes in Critical Care. Has 20 years experience. Jul 19, 2007 After reading all the replies and being able to see the point in the majority of them.....I still disagree.If a doctor will say something like that, they will do anything to make it seem like they did no wrong if this were to go to court. You can bet you patootie that he wouldn't back that nurse and may even stoop to saying that he kne wnothing about the pain.I would have charted it verbatim as well. We are told to chart that way about the patients, why not the doctor?
jjjoy, LPN 2,801 Posts Jul 19, 2007 In addition, it is unprofessional to blade a colleague with charting. to "blade" a colleague - that means stab them with a knife, right? While I'm not saying the OPs action was the best choice, given her level of experience and intention, I would not compare it to a violent act. If the nurse had an axe to grind with the MD and was continually writing notes verbatim whenever she heard him say something dumb off the cuff, that would be another story. In this case, it sounds like the doc DID give poor advice and later, only focused on the defensive charting and not on his own advice to not collar the patient. A number of people keep saying that the nurse should've known to collar the patient, but here the MD didn't seem to be so sure of that protocol either.
48RVRN 51 Posts Specializes in ER, ER, ER. Has 15 years experience. Jul 19, 2007 I don't think that your intention was to cause this situation but it happened. You and the doctor may want to sit and talk about what happened and try to fix your relationship. Next time chart things like "Physician informed, no orders received" or just "ERP informed" that covers your butt without any hassle.
Nursey Face 68 Posts Jul 19, 2007 If I had been the doctor, I would have run you out of the hospitalIf I had been your charge nurse I wuld have run you out of the hospitalIf I had been a fellow RN I would have run you out of the hospitalThis comment is counterproductive and doesn't help her at all. If it were me and you responded to my post with this, I would have just been angry and it wouldn't have helped me. If we want to educate our new grads on appropriate protocols, let's be little more gracious, understanding and HELPFUL. I found this post and the posts about "blading" frustrating and I don't know the person who posted from a hole in the wall.Let's not eat our young! Help a girl out!
