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

[blackdiamond407]

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.

[icuRNmaggie, BSN, RN]

In the future, with this physician, I would call both the pager and the cell phone every fifteen minutes and document accordingly.

The "I said call my pager" - " I said call my cell" is a common excuse for people who dodge their on call responsibilities.

Then they berate the staff because they weren't notified and write a slanderous note about the nurse. I don't let them play those games.

I have written " Dr Smith Chief of Surgery notified of need to intubate rather than to continue to wait for a response."

That particular person answers his pager now in 2 minutes or less.

[SharionRN]

Luckily,I have not experienced anything of that sort. But, I would have addressed the physician's lies by informing my clinical nurse manger and making him/her aware of this event. Bring in all parties involved(nursing supervisor, on-coming nurse, hospitalist, ordering physician, and any of the "fellow nurses" that this physician claimed he had "give directions to on how to get in contact with him," etc.). I think this is the type of issue that needs to be fully investigated, because if this physician thinks its ok to lie over something such as consenting a patient, then what else will he/she do to cover their tracks. Sorry this happened to you, and hopefully the truth will come out.

[icuRNmaggie, BSN, RN]

The call my pager/call my cell (and it changes with each person they talk to) is a ruse and an alibi used by mds who are arrogant jerks from a certain large city on the East Coast, who plan not to answer either one. Seriously.

If you hear that phrase repeat it to another nurse and get the number, write a big sign that says DR SHYSTER CALL MY CELL and the number and tape it near the phone. And call both numbers....

[hecallsmeDuchess]

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?

Not to derail the original thread, but we do this at my hospital too. We and the patient sign after the doc's gone over the need for transfusion including risks and benefits, and then we can place consent in paper chart for the doc to sign later. Personally, once I know or think someone might get transfused, I prepare a consent so the doc can sign it when he comes to see the pt so that he won't hurry off the unit, I feel more comfortable that way.

OP, sorry the doc did that to you, that was sneaky on his part and uncalled for. I'm glad others suggested incident report, I would have never thought of it and I'm sure it'll come in handy for me on those days I wonder who I could report a doc to...

[imintrouble, BSN, RN]

Well at least it's obvious the MDs sometimes read the nurse notes.

[toomuchbaloney]

Generate an incident report.

Notify your malpractice insurer.

If this patient suffers any adverse event which results in a legal review of the chart the doc has set it up to explode, I reckon risk management might want to know if the patient is still in the facility.

[delphine22]

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?

This is what we do, but only after the doc has met with the pt and discusses the risks/benefits/alternatives of transfusion. Otherwise it is not informed consent. I assume with the OP that no doc had talked to the pt about transfusion before ordering it (which is where the problem actually lies). If you know the pt might need transfusion, just talk to them about it when you write that order, docs!

[agcaruso]

He really looks unprofessional documenting that nonsense in a patients chart. Hopefully he'll be reprimanded by the higher ups for that as well.

The other problem with this situation is that you have to make so many calls only to get blown off twice and to have the issue resolved the next day. We spend way too much time in nursing tracking down someone who will do what is right for the patient.

[toomuchbaloney]

He really looks unprofessional documenting that nonsense in a patients chart. Hopefully he'll be reprimanded by the higher ups for that as well.

The other problem with this situation is that you have to make so many calls only to get blown off twice and to have the issue resolved the next day. We spend way too much time in nursing tracking down someone who will do what is right for the patient.

This is a good point. The unit management should get involved to make this a workable system for the nurses delivering the care for the patients. That is why they make the big bucks.

[nurseprnRN, BSN, RN]

Generate an incident report.

Notify your malpractice insurer.

If this patient suffers any adverse event which results in a legal review of the chart the doc has set it up to explode, I reckon risk management might want to know if the patient is still in the facility.

Even if the patient is NOT still in the facility. The RM will put a note in a file and three years later when the summons comes and everyone has forgotten and Dr Liar has moved to Siberia, it will still be there. Trust me, s/he wants to know now. She may even speak to Dr. Liar before he packs his long-johns.

[KelRN215, BSN, RN]

Well at least it's obvious the MDs sometimes read the nurse notes.

That was the most surprising thing about this story, honestly. I've never known and MD to read a nurse's note. Makes me think he knew he had to cover himself so went looking for trouble.

If the hospital's standards are that on-call MDs carry pagers, the whole "I gave her my cell phone number" excuse really doesn't fly. He still needs to respond to his pager.

What kind of hospital are you in/what service is this patient on? You must work in a small hospital if there wasn't a Resident in a call room over night who could be woken for this.

[strawberryluv, BSN, RN]

Damn, doctors playin' games these days...

Thanks for this anecdote. This is a scenario I will take with me when I graduate.