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.

[DeeAngel]

File an incident report over the note and another because of the delay in care. Save a copy or screenshot of every. single. thing. you. do. Start of your paper trail and please, please do not procrastinate on this. The doc may have thrown you under the bus but that doesn't mean you have to stay there!

[Lev, MSN, RN, NP]

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.)

Sounds like an awesome nurse manager. A rarity today.

[lakepapa]

Incident/patient safety report immediately. Statements from witnesses if you can get them. I document the who, what, and when on each and every page BTW. I've run across a few of these "nobody paged me/first I've heard of it" providers before. Luckily, they're the exception where I work. Also, make sure you get the word out on Dr. X to the other nurses on your unit. (Loved the Polaroid story!)

[PrincessO, MSN, RN, NP]

To OP,

I believe the doc decided to retaliate because you stated you paged him several times and he did not return any of your calls. Charting is supposed to be nondefensive and objective. I usually state the time the MD was paged, the name, and awaiting a return call. I do this each time I call so that there is a time line. I also state the name of the supervisor that was notified as well as night nurse notified to f/u. We should not throw anyone under the bus in our charting, but we need to chart in a way to protect us. For him to respond by defending himself in the note is very unprofessional. I would write an incident report and notify your supervisor as well. If he was the MD on-call then he has to answer the number listed in the on-call sheet. Telling the nurses to page him on his cell phone is not acceptable unless it is on the on-call sheet.

[JustMe]

Looks like the MD never learned that the chart is a LEGAL document! Nurses need to document EVERYTHING but always objectively. That guy's going to end up in court one day and you don't want to go along for the ride!

[jalyc RN]

As a supervisor I once left a message to an unresponding attending that if I did not hear from him within 15 minutes I was calling the chief medical officer. I did just that and our CMO reamed the attending a new one the next day, so we never had that problem again. He also informed every doctor with privileges there of what would happen if he EVER got another call like that one. No incident report needed and patient was taken care of timely. lol

[R. Obias Jr., R.N.]

right thing to do is to make complete and proper documentation at all times,immediately report to a supervisor, don't wait till morning or try and pass on to next shift. another thing is that I am assuming if you are the attending nurse or not when the patient was admitted or that you were present when the doctor gave the order and failed to have consent form signed. if this was a patient in critical condition , expect the doctor to lie to have himself cleared of any negligence cases.

[nowim clean]

On my unit any RN could/would have the patient sign the consent for blood and start the transfusion. This is done all the time.

[sofla98]

I AGREE!!! I would've filled out and sent an incident report before I left for the day...If I cannot reach a doctor after calling and calling and even trying to contact other physicians? Incident report it is!

[sofla98]

On my unit any RN could/would have the patient sign the consent for blood and start the transfusion. This is done all the time.

Not all hospitals are the same about consents...In my hospital, EVERY consent is signed by the doctor and family with the nurse or someone else witnessing. But, I work in peds.

[Ruby Vee, BSN]

On my unit any RN could/would have the patient sign the consent for blood and start the transfusion. This is done all the time.

The point is that their particular facility has the policy that the MD obtains consent and the MD did not, in fact, obtain consent in that instance. What is done "all the time" on your unit may or may not be the correct policy for the OP's unit, and it may or may not even be per policy on YOUR unit.

[RosesrReder, BSN, MSN, RN]

Most places I have worked have a blood product consent signed along with the consent to treat at ADMISSION. Therefore you don't struggle if transfusion need arises. I have verbal orders because unless there is a witness, the doctor is always right. I am so glad I got out of the hospital setting. Now I deal with one physician and its via a recorded line.