What exactly do physicians do again?

[wanderlustgirl]

So I'm not trying to step on any toes here, but I am just a little shocked at two experiences I've recently had and I want to know if this is normal or just two bad cases...

First, I worked at a small critical access hospital and we had to call a rapid response on a patient. All of the nurses rushed in and worked their magic while I watched over the floor since I was the only PCT and all of the nurses were busy. 20 minutes after the rapid was over, the physician came calmly and slowly walking down the hall and asked our nurses about the rapid. She was two months pregnant and took frequent hour long naps throughout the day and really just didn't seem at all concerned about the rapid response (if being 20 minutes late didn't say enough, IMO).

Now I've transferred to another hospital in the same network but it's a bigger hospital with all of your expected units. So last night I was watching our telemetry monitor and a patients heart rate dropped to 40, 30, 17... I alerted my nurse and we ran in. The woman was gray, not breathing, and by that time had no pulse. We called a code blue and I started compressions while the nurse got her oxygen. In a matter of minutes the code team was there and took over and once again I found myself monitoring the floor because the nurses were in the room working on this patient. About 10 minutes after the code started, the physician came walking up like he had no care in the world, stopped outside of the room and looked in for a whole maybe 8 seconds, and then left! He didn't ask a single question, walk in the room, hell, he probably didn't even know the patients name!

I've just found myself really outraged both times that the physicians did NOTHING. Is this how it normally goes? To me it just seems like doctors prescribe the meds and the nurses do, well, everything.

[blackvans1234]

Well during a code a physician or PA/ NP has to be there to order emergency medications that the RN's would give.

Maybe in the second case that was just a different doctor just waltzing by and curious as to the commotion.

You said the ''code team'' was there in a matter of minutes, and technically a physician is part of every ''code team''

As far as im aware, nurses can't push meds during a code without an MD order (verbal)

[Rose_Queen, BSN, MSN, RN]

As far as im aware, nurses can't push meds during a code without an MD order (verbal)

This is why many (if not all) hospitals have ACLS protocols. Nurses may give drugs without a direct verbal order from a physician, because not all hospitals have 24/7 in-house physicians other than ER. The protocols cover meds given. Otherwise, some hospitals would never have a successful outcome with a code because they'd be waiting for the physician to arrive and then you could also run into the issue of "failure to rescue".

[MunoRN, RN]

The importance of pushing meds during a code in a timely manner is why we have ACLS protocols. If your facility recognizes ACLS protocols as standing protocols then that's your MD order, no MD should have to be in the room.

Our MD's typically don't show up to Rapid Responses, which to be honest with me is fine, they typically go smoother with the MD's doing their thing over the phone rather than in the room.

[Sun0408, ASN, RN]

RR and code teams are in place so the primary MD does not need to be there. If the MD is needed, we communicate primarily via telephone. If the pt needs to be seen, it is often later after the event.

Are you sure the MD that walked past the code was the pts primary??

[anon456, BSN, RN]

Wow, that sounds like very bad situations! Usually when we call a rapid response we have more MD's and other staff that can fit into the room, there within 30 seconds.

[Horseshoe, BSN, RN]

If you work at a teaching hospital, you will have more MDs showing up to the codes than you want.

And agree with above, no MD orders needed during a code if you are following ACLS protocol, which you should be doing if you are responding to a code.

[RNperdiem, RN]

Where I work, the doctors are always there quickly when I need them. Of course, I work in a large ICU where the doctors stay busy all day just like the nurses.

[Horseshoe, BSN, RN]

While there are slacker doctors (just as there are slacker nurses), most doctors I've known work very hard, put in a whole lot of hours, and are often not compensated properly. They also usually have incredible debt incurred in Med school. It's not a life I would want.

[xoemmylouox, ASN, RN]

As mentioned before MDs do not have to be present for a code, just the orders. I have found if there is more than one MD present egos get in the way of patient care.. Sometimes it's best when they no show.

[DookieMeisterRN]

Like previous others have said, there are ACLS protocols to allow drugs to be administered. I've worked in many hospitals from a small community critical access to large university and have never seen mandatory physician attendance to a rapid response.

I would hesitate to judge other professionals also unless you've walked in their shoes. Instead of bashing a doctor without knowing the whole story that PCT could have asked a nurse or even found a way to bring it up to the MD them-self if one were diplomatic and creative.

We are a team and it doesn't help anyone to degrade our fellow teammates.

[dirtyhippiegirl, BSN, RN]

If you work at a teaching hospital, you will have more MDs showing up to the codes than you want.

Hence why you start them doing compression rounds.