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.

[squatmunkie_RN]

Wow...The ER doc never comes during rapid response in my hospital, but always makes it to a Code Blue quickly. I remember once when we had a code blue (v-fib) there was a cardiologist on the floor doing rounds, he came and placed a femoral central line for the patient (who was not even his). Which was very nice of him, as the pt had only a 22g at the time and no other veins to poke

That's happened more than once too, on our floor. This doesn't have to do with all physicians.

[RT_Skyler]

Docs are not even on the RR team here. One ER doc or a PA-C will respond to an actual code.

[PMFB-RN, RN]

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

*** Actually not the case at all. Any ACLS qualified staff can adminster ACLS meds in a code without a physician order in the vast majority of hospitals. Staff are covered by the hospital's ACLS protocols and policies.

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

*** Actually not the case. In my job as full time rapid response RN I am designated by hospital policy as alternate code team leader. I run the codes until / if a physician arrives at the scene. In some cases they never do for a variety of reasons. Many, many ICU and ER nurses run codes, even if officialy there is a physician assinged to the code team. Lot's of times I have had residents hand to running of a code over to me, like for instance when a second code is called while we are still working on the first. I am also authorized (by written policy as we RRT RNs are the code administrators for our hospital and all of us are ACLS instructors) to take over the running of a code from the physician if I believe they are not effectivly running the code. In practice I almost never do that as the residents are usually very open to my suggestions, but just last month I took over the running of the code from a resident who got excited and wasn't able to make himself understood in english (had to have him removed from the room, haven't seen him since and am wondering what happened to him).

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

*** Actually not the case. Such a requirement would defeate the whole rational behind the ACLS protocol and ACLS training for nurses and other staff. The timely administration of ACLS medications is the goal. Every, or nearly every hospital will have a protocol and policy that coveres ACLS trained staff for medication administration during a code

[PMFB-RN, RN]

Docs are not even on the RR team here.

*** Same in my hospital.

[dirtyhippiegirl, BSN, RN]

Y'all definitely do more sleeping than nurses. If that's what you mean.

Aw. Maybe it's because I work at a large teaching hospital but I definitely do NOT envy our residents. (Or for that matter, our acute care NPs and PAs that also take call.) At least my job has designated hours where I'm either doing my job or not.

[Caffeine_IV]

The doctors do not come to RR unless by chance they are on the floor. I did think an MD had to be at the code to pronounce the patient if unsuccessful.

[wanderlustgirl]

Thanks for the replies. I was just curious because I know that these were the physicians assigned to these patients that showed up and left with just a glance, and I'm sure every hospital is different but it just seemed very odd to me.

[NutmeggeRN, BSN]

Y'all definitely do more sleeping than nurses. If that's what you

mean.

Bwahahaha!!!!

Gonna be long year for medstudent2016 first time on the floor, when the experienced nurses bail you out........

Take what you are hearing in this forum to heart. It iwll serve you well.

We are a team....and there is no I in TEAM!

[SNB1014, RN]

ive seen frequently that the md stays long enough to intubate, check lung sounds and vanish. they are usually the on call code dr form the ER.

i called a post of cabg pt's CV surgeon on the phone to let him know the code wasn't looking so hot, if you will. he drove from his office (i assume, dropped what he was doing??) and walked into the room for the code. he said to keep it going until he got there. once he was there, he ran the code for another 15 or so mins. the surgeon did not want this guy to die, lemme tell you, but eventually called it.

but truth be told, internists, hospitalists especially, may make more money than the RNs, but the hours and patient load they have is way way worse than nurses. they may have their own set of patients, but are covering for their partner and have to answer those questions and direct that care. when you factor in stress, patient load and hours, some doctors dont make enough, IMO.

others are glorified med students.

[SNB1014, RN]

i was told that if a patient is in resp distress (read, no arrest) we are to call a code blue to get an MD in there asap to intubate.

[uRNmyway, ASN, RN]

Guess it must depend on where you are and scope of practice for the nurses and all. The hospital I used to work, if a code was called, the code team came. That team consisted of ICU nurses, the ER doc (this was NOC, and our ER docs were AMAZE-BALLS!) and resident-on-call. We didn't have a protocol for medication administration for codes, so the MD actually had to give verbal order for everything. The nurses did anticipate and often have things ready, but had to have orders to push.

As far as what doctors do, I guess it again depends on where you are, and who the doctors are. I've seen some pretty hands off doctors, just like I've had some come in extra early when we had to call for orders in the middle of the night because their patients were not doing so well. They could have just as easily had us page on-call resident, but chose to come in.

[monkeybug]

I wonder how much bailing will actually happen, though? I bailed out the residents I liked. If they were jerks, I'd sit back and watch them drown with a sense of extreme satisfaction. I do see a lot of 3 am Tylenol and urine output update phone calls in his/her future, though. We had an attending who would bring the interns around and introduce us, and he'd usually tell them to be kind to the nurses because we'd either save them or make their life a living hell, whichever they deserved.