What to Do When the Doctor Throws the Nurse Under the Bus by Lying

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I received a pt with an order to transfuse if hemoglobin drops below 8. When the blood was drawn for the pt, the hemoglobin was 7.3 so I was preparing to start a blood transfusion when I noted there was no consent for a blood transfusion in the patient's chart. As it was dinner-time already, I called the hospitalist and asked him to do the patient's consent. He refused. I called the doctor who wrote the order for the blood transfusion and she was also unable to do the consent as she was home. The doctor who wrote the order stated to call the attending. I proceeded to call the attending multiple times until my shift was over. I called the nursing supervisor and she stated to have the oncoming nurse continue to page the attending. Of course I wrote a nursing note objectively stating that I paged the attending multiple times and endorsed for the night nurse to continue to page. When I came back to work the next day, the night nurse stated that she was able to reach the attending at midnight and he stated he would come in during my shift to do the consent. I was thrilled. The consent was signed and I didn't think anything of it. Upon getting ready to leave later on, I noted by chance that the doctor had written a response to my nurse's note from the previous night where I stated I could not reach him. He wrote that he told all the nurses including me how to reach him on his cell phone. He also wrote that he had spoken with me and told me he would come in the following day to do the consent and that my nurse's note was unacceptable and incorrect. I was very upset. He did not tell me or my fellow nurses or the nursing supervisor how to reach him. In addition, he lied in stating he spoke to me the day I needed the consent. I was very upset. I feel that his note makes me look incompetent. Has something like this happened to anyone else? Should I have done something when I noted his lies in his note? Could I get in trouble for this? The situation has greatly upset me and any advice anyone has would be most appreciated.

caliotter3

38,332 Posts

This calls for an incident report. I do not know what else to do. Perhaps someone else can provide more appropriate info.

enuf_already

789 Posts

Two words. Incident report. You had orders and couldn't follow them because of an unusual occurrence that prevented the patient from receiving the prescribed care.

Many hospitals also have a committee that you can report to that will investigate the incident and make suggestions to the physician in a non-punitive way so this won't happen again. It will put the physician on the radar in case similar circumstances (not being able to get in touch with him) happen repeatedly.

icuRNmaggie, BSN, RN

Specializes in MICU, SICU, CICU. Has 24 years experience. 1,970 Posts

This was a delay in treatment which requires an incident report. ( Write the shyster up.)

Tenebrae, BSN, RN

Specializes in Mental Health, Gerontology, Palliative. Has 10 years experience. 1 Article; 1,706 Posts

You can only document what you have done. Document, document, document.

Have just had a similar experience with a doctors interesting documentation.

Patient A, was on a fentanyl patch 50mcg. Doctor increased the dose to 75mcg, however did not stop the 50mcg patch. So looking at the documentation it appeared that patient A was on 125mcg fentanyl patch.

As a result the nurse applied the 75mcg patch without removing the 50mcg patch. While the nurse followed the doctors documentation they were at fault for not questioning the dose. It is not standard for such a large increase all at once.

Anyhow, I faxed the med chart so that the doctor could cancel the med order. Only problem was that the doctor canceled it from date A which was the day of the increase, not date B which was when the doctor actually made the change.

This small change in documentation had the potential to make a mistake due to confusing charting seem as an outright med error due to negligence. I documented it from our perspective and sent it through to the clinical manager to ensure they have all the information

Ruby Vee, BSN

Specializes in CCU, SICU, CVSICU, Precepting & Teaching. Has 40 years experience. 67 Articles; 14,000 Posts

Document -- PSN or incident report or whatever. Also talk to your manager about this. If he's well known for doing this sort of nonsense, you'd like to do that.

I once took a verbal order from a physician who later denied having given the order. (This was a LONG time ago, when verbal orders were common.) Another physician had witnessed the interaction, so I had back-up. My manager popped out of her office with a Polaroid camera, for those who remember what that is, and snapped his picture. She then put it up on the bulletion board in the break room on a huge, bright red poster board with letters one foot high saying "Do NOT Take Verbal Orders From This Yahoo!" Within hours, he was in her office begging to be told what he could do to get his picture taken down! No one EVER had problems with him again. (Except the one time the cardiac surgeon punched him, but that's a whole 'nother story.)

Esme12, ASN, BSN, RN

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 42 years experience. 4 Articles; 20,908 Posts

Document -- PSN or incident report or whatever. Also talk to your manager about this. If he's well known for doing this sort of nonsense, you'd like to do that.

I once took a verbal order from a physician who later denied having given the order. (This was a LONG time ago, when verbal orders were common.) Another physician had witnessed the interaction, so I had back-up. My manager popped out of her office with a Polaroid camera, for those who remember what that is, and snapped his picture. She then put it up on the bulletion board in the break room on a huge, bright red poster board with letters one foot high saying "Do NOT Take Verbal Orders From This Yahoo!" Within hours, he was in her office begging to be told what he could do to get his picture taken down! No one EVER had problems with him again. (Except the one time the cardiac surgeon punched him, but that's a whole 'nother story.)

Did you work in my unit? LOL

We had physicians that we had a "policy" that you never spoke with him without a witness.

OP where did he write this ridiculous stuff? What an ass.

I agree incident report and go to risk management or call the corporate compliance line (whatever they call it at your facility) speak to your nurse manager.

((HUGS)) we have all had run in's with MD's like this....:sarcastic:

Here.I.Stand, BSN, RN

Specializes in SICU, trauma, neuro. Has 16 years experience. 5,047 Posts

My manager popped out of her office with a Polaroid camera, for those who remember what that is, and snapped his picture. She then put it up on the bulletion board in the break room on a huge, bright red poster board with letters one foot high saying "Do NOT Take Verbal Orders From This Yahoo!" Within hours, he was in her office begging to be told what he could do to get his picture taken down!

That. Is. Awesome!!!! :D

HikingEDRN, BSN, RN

Specializes in Emergency Department; Neonatal ICU. Has 5 years experience. 195 Posts

Document -- PSN or incident report or whatever. Also talk to your manager about this. If he's well known for doing this sort of nonsense, you'd like to do that.

I once took a verbal order from a physician who later denied having given the order. (This was a LONG time ago, when verbal orders were common.) Another physician had witnessed the interaction, so I had back-up. My manager popped out of her office with a Polaroid camera, for those who remember what that is, and snapped his picture. She then put it up on the bulletion board in the break room on a huge, bright red poster board with letters one foot high saying "Do NOT Take Verbal Orders From This Yahoo!" Within hours, he was in her office begging to be told what he could do to get his picture taken down! No one EVER had problems with him again. (Except the one time the cardiac surgeon punched him, but that's a whole 'nother story.)

Love this. And another time, perhaps in another thread so as not to derail this one, I would love to know the "punched by the cardiac surgeon" story ;)

OP, so sorry this happened to you. Document it and file an incident report. Why did the hospitalist refuse? Was it a surgery order or something?

canigraduate

3 Articles; 2,107 Posts

I am sorry this happened to you. I would file an incident report for delay of care and also talk with the doc in question to find out what his rationalization was. I would have your NM or another official with you when you talk to the doc to keep it professional. Go ahead and make sure to get the paper trail in place on this guy in case this going to be a trend. "Nip it in the bud."

xoemmylouox, ASN, RN

Has 13 years experience. 3,150 Posts

That MD is trying to cover himself at your expense. I agree that writing up an incident report is valid. His documentation is inappropriate and opens the facility open for a lawsuit if anything should happen and a lawyer saw it. Also now you know that when you deal with this individual try to make sure you have a witness and document, document, document. CYA.

LakeEmerald

Specializes in Emergency/ICU. Has 4 years experience. 235 Posts

In my hospital, the consent for transfusion form may be signed by the patient with the nurse as witness. This may occur only after the MD has informed the patient of the risks and benefits of having the transfusion, but the MD doesn't sign the form itself. We do not do this for surgeries or other procedures. Are we doing this wrong?