Why do the weekend on call docs not listen to us

DemonWings · Oct 31, 2011

Its really sweet that you cared enough to be mad for this baby nurse, we baby nurses appreciate your concern more then you know:) I had patients today with on call docs and they seem to want to put everything off until Monday, its a shame

xtxrn, ASN, RN · Oct 31, 2011

There are medical directors in any facility. If your supervisor can't get through to the dix on call, then ask for the medical director to be paged.... BTDT. It works. You may p-o the on call docs, but so be it. If they don't get it that you're trying to 1) help the patient 2) CYA, and 3) cover THEIR butts, then they're too stupid to worry about. :eek:

If there are consulting docs, I've called them before, also, and said that "I tried paging the admitting doc 3 x in the last hour without a return call, and the guy is still having intermittent seizures, do you have any ideas?" (was usually someone like a urologist or pulmonologist, but hey, in a pinch, any old MD will do They gave me some "tide ya over" orders, and miraculously I'd get a call from the admitting jackhole.

COVER YOUR BUTT. Document, and if you can print a copy, get it, and have the other nurse witness it w/time and date; black out any names of patients. The date and medical record # will still be there. Document notifying the charge and supervisory nurses. Don't ever let a charge/supervisor tell you not to chart their names in a chart. That's bs. They won't be paying your rent when you get sued and fired.

Last resort: refuse to take the assignment for that patient (BTDT, over pain management issues and what amounted to torture of a patient). You have that right- if it goes beyond the care you feel you can safely provide (can't just toss one because they're annoying :)). Take two of someone else's (if you're not on the phone all day calling phantom docs, it won't matter that you've got one more to deal with :)).

Good teamwork :up:

Bgp0231 · Oct 31, 2011

When do they listen to us period? An complex most of them have well in my state anyway...:-)

Ok I normally don't vent but this weekend was awful for one patient. First of all I cared for this patient earlier in the week and he was doing fairly well post surgery was having some renal issues. So I come back Friday and am assigned the group below this patients group and this patient was quite a bit worse, he was having difficulty keeping his O2 sats up and was placed on 50% venti mask and would still desat. The poor nurse that had him was just a baby nurse and was trying very hard. She sought the advise of the other more experienced nurses when needed. None of this patients doctors were on this weekend and none of the doctors on call would listen when she would call them about the patient. She called when the patient spiked a temp of 101. She called a creatine of 12.7. She called when patient had to be placed on a high concentration mask to keep sat at 90%. In all the on call docs were called no less than 4 times each about this patient. None of them did anything until patient could no longer maintain his Sats on the high con mask and the rapid response had to be called and the patient was I intubated and was in full renal failure. The worse part is not only were these on call docs all called but each one saw the patient with their own eyes. Are they blind how could they not see how bad he was. It did not have to be this way for this patient. Whats worse is one of the docs came in today wanting to know info (I&O labs ect) on the patient I guess trying to cya. Sorry just needed to vent a little

turnforthenurse, MSN, NP · Oct 31, 2011

Its really sweet that you cared enough to be mad for this baby nurse, we baby nurses appreciate your concern more then you know:) I had patients today with on call docs and they seem to want to put everything off until Monday, its a shame

Yes thank you :)

And either that, or "leave it for dayshift"...can't say I tried.

Just remember to DOCUMENT, DOCUMENT, DOCUMENT. Cover your butt. I once had a patient who was hypertensive (DBP >100) but the HR was hovering around 57. Patient was due to have Lopressor 25mg. I called the doc and told them that I had this patient the other night and the patient tends to brady down into the mid 40's. I was concerned about giving 25mg of Lopressor because I was afraid they would brady down too much. I gave something else for the BP earlier (I think scheduled Norvac? Can't remember). Anyway, the doc told me to give the Lopressor and also to give some Vasotec IVP. The doc thought the 25mg of Lopressor wouldn't hurt the patient. I asked some more experienced nurses in my unit - they said they would give it because the problem was the high BP, and one experienced nurse said she wouldn't give it. I went ahead and gave it, but I documented everything the doctor told me to cover my butt in case something happened. Thankfully nothing did, the patient was fine.

maelstrom143 · Oct 31, 2011

I know just what you mean

We had a similar issue to this a few years ago where the doctor would not listen when I tried to tell him (over numerous calls and in person) the patient was destabilizing, told me it was the guy's baseline. Guy ended up coding. Doctor ended up walking patient to ICU and apologizing. I would have preferred no apology and him taking care of the problem before it became an emergency.

Luckily, wife was at bedside the whole time and witnessed my calls to the doctor and my notification to the charge and others. The patient and wife were very sweet and grateful for all we did for them. I was just mad...did not have to get that bad:mad:, jmho.

ChristineN, BSN, RN · Oct 31, 2011

Yes thank you :)
And either that, or "leave it for dayshift"...can't say I tried.
Just remember to DOCUMENT, DOCUMENT, DOCUMENT. Cover your butt. I once had a patient who was hypertensive (DBP >100) but the HR was hovering around 57. Patient was due to have Lopressor 25mg. I called the doc and told them that I had this patient the other night and the patient tends to brady down into the mid 40's. I was concerned about giving 25mg of Lopressor because I was afraid they would brady down too much. I gave something else for the BP earlier (I think scheduled Norvac? Can't remember). Anyway, the doc told me to give the Lopressor and also to give some Vasotec IVP. The doc thought the 25mg of Lopressor wouldn't hurt the patient. I asked some more experienced nurses in my unit - they said they would give it because the problem was the high BP, and one experienced nurse said she wouldn't give it. I went ahead and gave it, but I documented everything the doctor told me to cover my butt in case something happened. Thankfully nothing did, the patient was fine.

I generally don't give Lopressor for heart rate less than 60 (per policy at my hospital). If your pt was that hypertensive they could have just done Hydralizine, affects BP without lowering HR.

beckster_01, BSN, RN · Oct 31, 2011

xtx covered most of what I was going to say, but I will say it again. Get their names, document EACH change in condition, the name of the doc that you called, and what the doc did about the situation (find a sugar-coated way of saying "nothing"). I always make sure my charge is involved in situations like this, but I am a toddler nurse :)

It also helps me to have a couple suggestions in place for interventions. For example, "I am really worried about this patient, are you sure you don't want to ____? If not, can you explain why? We have asked for a MICU consult for medicine patients, they are usually happy to come down and assess the patient BEFORE they crash, and will give you parameters for when to give them a call.

This may not work in your situation, but we also frequently call our ICU across the hall, they have NP's/PA's 24/7 so it is easy to have them come over and look at our cardiac patients. I feel more comfortable working with someone who has taken care of my cardiac surgery patients for 5 years than a weekend night float who covers them 3 times a week.

beckster_01, BSN, RN · Oct 31, 2011

the patient was destabilizing, told me it was the guy's baseline. Guy ended up coding.

I love that line :) "That is their baseline." I'm sorry but who spent 12 hours with this patient yesterday, vs. 12 minutes? I had a sweet little lady with Parkinson's who's mental status was fluctuating. The night shift had sternal rubbed her so hard she bruised from it! She didn't even flicker an eyelid. What did the covering NP say? "That is her baseline, she has Parkinson's!" Riiight. That day my charge nurse and I spent an hour convincing the PA to do something, turns out she had a UTI. Some abx and fluids and she came right back to us :)

BCRNA · Oct 31, 2011

Do a QI incident form. Physicians will start doing there job when they start getting questioned by their peers about not providing patient care when they are on call. Sounds likes he needs to be put on the "hot seat" to justify why he ignored the patient and did not intervene until the patient went into resp. distress and had to be intubated. Some physicians will only correct their bad behavior when a "peer" intervenes. Many physicians think they answer to no one, so you have to get the medical director to intervene. It will step on some toes, but a QI is the only thing to correct some people.

sarahjuly · Oct 31, 2011

I am a baby nurse. I had a very similar weekend. I voiced concerns to everyone about my Pt on Friday. I came in to start my shift on Saturday and found out my Pt. was in pretty bad shape. Thank goodness for a very supporitve and helpful shift supervisor. It was a very long night, and I was pretty mad that my concerns had been ignored the night before! By the end of my shift my Pt. was in our hospitals ICU.

turnforthenurse, MSN, NP · Oct 31, 2011

I generally don't give Lopressor for heart rate less than 60 (per policy at my hospital). If your pt was that hypertensive they could have just done Hydralizine, affects BP without lowering HR.

I don't either, and I initially held it because of the HR (scheduled 2100 med), but then saw the BP was shooting up...so I called the doc to see what they wanted me to do.