Was I out of line ?

Kidrn911 · Jul 19, 2007

This 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!

I don't think anyone was trying to eat the young here, but common sense shouldn't be left at the ER doors by staff, as it is often done by the patients. IMHO

48RVRN · Jul 19, 2007

Help a girl out!

Now that comment I can agree with! The poster asked for criticism not slapping. Look, next time just chart that you informed the ER physician. Don't chart his frustration. And do sit down and talk to him/her! Try to build a better relationship

Anyone who hasn't made a screw-up please raise their hand.....Mine's 'WAY down!!!

passionate · Jul 20, 2007

I don't think your thinking was out of line. I may have wanted to chart the exact Dr. response as well but I have found that I can chart to the intent and not tick anyone off and be true to the pt. I wouldn't apologize per se' I would talk with that physician however and make sure that you are good to work together in the future. Express to him why you did what you did and then listen to what he says. In the future you can expect that he listen to you. Good luck, nursing is a slippery slope.

AndiERRN · Jul 23, 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.

kiss... keep it simple stupid... writing too much can get you in a heap of trouble... i wouldn't have put the collar on her either but i would have let the doc know i didn't. i would also apologize to the doc not because i'm worried about his licence but because it will make my life easier in the long run...:trout:

andi errn

code50 · Jul 23, 2007

you did exactly what you should have done. what did we learn in nursing school? document,document,document! you have to cover yourself.....let the imature doc have his temper tantrum, but you have a license to protect. did the doc literally have "xray vision"? you did the right thing! relax!:balloons:

smilin_RN · Jul 24, 2007

I guess everyone has a different opinion, i have dealt with doctors who think its not a productive day if they dont' make some nurse feel like poop on their shoe. He should be held responisible for his actions, and his lip. yeah maybe the collar should have been placed regardless but he deserved the spotlight on that kind of attitude. I am sure he was probably late for a golf game or something. he wasn't having a bad day, he was having an ego trip.

teeituptom, BSN, RN · Jul 24, 2007

I guess everyone has a different opinion, i have dealt with doctors who think its not a productive day if they dont' make some nurse feel like poop on their shoe. He should be held responisible for his actions, and his lip. yeah maybe the collar should have been placed regardless but he deserved the spotlight on that kind of attitude. I am sure he was probably late for a golf game or something. he wasn't having a bad day, he was having an ego trip.

Leave Golf out of it

longjourneydream · Jul 24, 2007

I feel it is always better to overdo than under-do, as long as it does not hurt the patient. As far as documentation, never put another persons job on the line,esp. documenting in a permenent record.

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.

RunnerRN, BSN, RN · Jul 25, 2007

I guess the thing that really struck me about this thread is that it was one person covering himself at the expense of someone else, when it wasn't necessary. There are several docs I work with who I don't trust, but I still wouldn't have charted that exactly. I think something like "Dr Smith aware of pt c/o and hx. Per Dr Smith, no c-collar to be placed. No orders received." would have also worked.

The ER is very dependent on teamwork. I'm sure we don't know the whole story of this doc's history, but I try to not do anything that will disrupt the teamwork in my dept unless it is worth it. This didn't seem worth it to me. (And I have told docs no, or talked to another ERMD to clarify an order.....one doc wanted me to give Labetalol to a younger pt who had a documented high BP, but was quickly coming back down to baseline. I took a manual which was 130/90s, and refused to give the med. I talked to another doc who agreed with me. When I told the first doc I wouldn't give the med, he started to yell and told me that I needed to follow his orders. I told him that he could give the med if he wanted, but I would not be giving it. I didn't, however, chart that the doc said "The pt needs this medicine. You will follow my orders." in the chart. There was nothing in the chart about this exchange.)

If it WAS worth it to you, then you would have just placed the c-collar after the doc said no. Not tried to cover yourself with his words, because in court that still wouldn't fly.

dream'n, BSN, RN · Jul 27, 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)

Wait, I'm reading this a little differently. It seems to me that the nurse was the FIRST one that questioned whether is was necessary to follow protocal and place a c-collar. To which the Dr. (responding to her nursing judgment) agreed it wasn't needed in this situation. Then, just in case, she added that little note to protect herself. Maybe I'm reading it wrong....if I'm not, she owes him an even bigger apology.

rjflyn, ASN, RN · Jul 28, 2007

Nice lively discussion.

Anyway, I am not going to comment on the OP's original post but on the c-collar it's self.

If you believe someone is injured and you feel the warrant a c-collar then you need to be fully immobilizing them. This means placing them supine on a long-board, with straps, head block and the works. To do anything less actually may be making one more liable. You wouldn't put half a foley catheter in or start half an IV.

Rj

swartzrn · Jul 29, 2007

When I triage someone such as an MVA who walked in and I have a question about what I should or should not do, I always try to err on the side of caution--it's better to have the collar in place and not need it than to have needed it and not have placed it. If the doc wants the collar off, then that doc can be the one to remove the collar. When I have been in triage and placed a collar on a pt only to have the physician come along and remove it once the pt gets to the back, I will go back and document, "c-collar removed at this time per Dr. __." As a matter of fact, anytime I have a patiet collared and the collar is removed, I will document that the collar was removed by the physician or whomever..or if the physician tells me to, I will write "c-collar removed per Md instruction" or something similar. We've had incidents where the patient removed his own c-collar and that got documented as well.

In the case of the question you asked the doc and his response, I probably would've just written, as other have said, "MD informed of pt, no orders received" and been done with it. That way you have documented that 1. you did tell the physician and 2. the physician did not give any orders. I probably would not have written that comment.

ER nursing, especially, is a team effort and getting along with each other is important. You don't have to like your co-workers personally but you do need to have a decent working relationship with them. This doctor sounds immature to me with his comment back to you but you now have a bit of a rift between you that needs to be made right somehow if you are to continue having a good working relationship with him.

Just my opinion.