Would you have called the doc? (LONG)

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I would like some honest input from my peers. I live in an area that has only two major hospitals. I switched from the bigger of the two to the smaller hospital due to schedule changes - my former hospital did not offer evening shift, only 12's and I could no longer work night shift for various reasons. For the most part, I like my new job very much. The pace is a little slower most nights (a looooot slower) and I just love what I do, so i'm adjusting. It is hard at times because they do a lot of things differantly but I'm getting used to it. Oftentimes my new co-workers talk about my old place of employment in a very negative manner - basically that "they" are a bunch of idiots....I don't recall any of my old co-workers ever mentioning my current place of employment as we were usually to busy running our tails off....Last night I was working with one other nurse who is fairly new (6 months of experience). There are always two nurses per 3-11 and 11-7 shift. She is really quite good and a pleasure to work with. I got a call from the ER and they told me that we had a patient of Dr. _____'s coming in (this doc works at both hospitals so I know him.) They gave me the following info: Pt is 24 weeks, states her water broke, is having contractions, states she has the urge to push, is in a lot of pain. I tell my coworker to set up a room, to get IV supplies ready, I call the nursery to give them a heads' up. I page the Doc so I can give him a heads up as ER told me she would be arriving any minute and coming straight to me. There was a lot of confusion as to who was on call with the group that I called - there are three groups, the one that I called happens to be the only one that also worked at my old hospital, so the all know me, and I've never had a problem with them. Anyway, during the phone calls to get to the correct on-call doc, the patient is brought up via stretcher accompanied by the paramedics. She is screaming, crying, scared to death. I follow them into the room, help transfer her to the bed. Take off her pants, tell Marcy to establish IV access and to draw labs. Put oxygen via face mask on her, try to calm her down (she's crying and telling us that she's hurting and feels pressure). I note no bleeding -ask her if she thinks her water broke, she says she felt something come out earlier. She then says she fell. I palpate her abdomen and it feels moderately firm. Is she bleeding internally? I look at vital signs...fine for now. She looks about 24 weeks, but we have no prenatal records on her. Whole other story... Within minutes, we have labs drawn, an IV going, we've position her in left lat trend, oxygen per face mask, and thankfully get fetal heart tones that sound great. We establish a history. During all this I got word that the MD was on his way. As he walked into the room and recognized the patient. He privately told me that she has done this "act" before and hoped that was the case this time. He performs a pelvic exam with speculum, orders IV pain meds, performs ultrasound. Everything looks fine. He tells me, good job..at least my new nurse coworker will know what to do in case something happens for real. We'll watch her overnight. He was very pleasant and acted relieved that the patient was ok and left after about 10-15 minutes. Signed the orders and left. The new shift comes in and I give report. They tell me that I better be lucky that this patient didn't belong to the other group (the group that I don't have a lot of experience with) because they would have chewed my a--. They tried to make me feel like a complete idiot for calling the doc before the patient was in-house and I should have done a complete assessment on her before calling him. They say this isn't like my other hospital and we have a lot of "princesses" here. They say, "well, you know that group (the one I called) better then we do (the group i called rarely delivers at our hospital and prefers my old one. This new hospital is private by the way, the old one is not. Should I have not called the doc? Normally, I would always completely assess the patient, but she came up via ambulance and with what the ER was telling me I figured the doc would have to come in anyway....Did I over react? As I left, my new co-worker was very angry. She told me that she was proud of the way we handled the situation. I had tears in my eyes in the parking lot because they were so critical of my actions...what would you have done?

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Specializes in ER.

You did just fine. You knew that doc would want to be called, and you did it. I agree that ANY doc would be obligated to come in eventually, and giving him a heads up allows him to wake up or whatever. The worst thing that could have happened- the doc could have gotten annoyed at being called, and you could apologize for not knowing their preferences and they SHOULD understand. You needed to err on the side of caution and you did.

Why would any coworker be annoyed with those choices? Ridiculous. I can see them giving you an FYI about the doc's preferences, but even so, if you choose to call, it is your right.

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I would have done exactly the same thing.

What if the situation had been as reported, and you had not called the doctor, and this pt. precip'd the 24-weeker right into the bed? Then they probably would have yelled at you for not calling the dr, wouldn't they?

sounds like you have not only princesses but witches too to deal with!

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Specializes in Nursing Instructor & Asthma Educator.

You did the right thing. If at the end of the day, youhave done your very best, no one can fault you.

Let them be quiet.:o

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Specializes in Maternal - Child Health.

You absolutely did the right thing! You did not have the luxury of waiting to "eyeball" the patient before calling the doctor in this circumstance. If she had truly been ruptured and ready to deliver, how would your co-workers have explained their delay in notifying the doctor? In this era of lawsuit-happy patients, that would have been an invitation to the courtroom!

As hard as it can be sometimes not to give in to peer or doctor pressure, you must always use your best judgement as to when to notify a physician. If the physician chooses not to come in, then the liability is all his/hers.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

"would I have called the doctor"?

You bet your bottom dollar I would. Yell at me? Try it.

What else WOULD any prudent nurse do in this situation? Remember that question, as you know, it's what you might hear in a court of law had you NOT called the doctor and this would have been a more serious and dire case!

You absolutely did the right thing. Don't go doubting yourself. I do worry about the culture of your workplace regarding "the other practice" ----it does not bode well.

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Yes, I would have called the doc. Better to be safe than sorry with the scenario you described. I am blown away by the behavior of your peers. They sound horrible.

Melissa

I would like some honest input from my peers. I live in an area that has only two major hospitals. I switched from the bigger of the two to the smaller hospital due to schedule changes - my former hospital did not offer evening shift, only 12's and I could no longer work night shift for various reasons. For the most part, I like my new job very much. The pace is a little slower most nights (a looooot slower) and I just love what I do, so i'm adjusting. It is hard at times because they do a lot of things differantly but I'm getting used to it. Oftentimes my new co-workers talk about my old place of employment in a very negative manner - basically that "they" are a bunch of idiots....I don't recall any of my old co-workers ever mentioning my current place of employment as we were usually to busy running our tails off....Last night I was working with one other nurse who is fairly new (6 months of experience). There are always two nurses per 3-11 and 11-7 shift. She is really quite good and a pleasure to work with. I got a call from the ER and they told me that we had a patient of Dr. _____'s coming in (this doc works at both hospitals so I know him.) They gave me the following info: Pt is 24 weeks, states her water broke, is having contractions, states she has the urge to push, is in a lot of pain. I tell my coworker to set up a room, to get IV supplies ready, I call the nursery to give them a heads' up. I page the Doc so I can give him a heads up as ER told me she would be arriving any minute and coming straight to me. There was a lot of confusion as to who was on call with the group that I called - there are three groups, the one that I called happens to be the only one that also worked at my old hospital, so the all know me, and I've never had a problem with them. Anyway, during the phone calls to get to the correct on-call doc, the patient is brought up via stretcher accompanied by the paramedics. She is screaming, crying, scared to death. I follow them into the room, help transfer her to the bed. Take off her pants, tell Marcy to establish IV access and to draw labs. Put oxygen via face mask on her, try to calm her down (she's crying and telling us that she's hurting and feels pressure). I note no bleeding -ask her if she thinks her water broke, she says she felt something come out earlier. She then says she fell. I palpate her abdomen and it feels moderately firm. Is she bleeding internally? I look at vital signs...fine for now. She looks about 24 weeks, but we have no prenatal records on her. Whole other story... Within minutes, we have labs drawn, an IV going, we've position her in left lat trend, oxygen per face mask, and thankfully get fetal heart tones that sound great. We establish a history. During all this I got word that the MD was on his way. As he walked into the room and recognized the patient. He privately told me that she has done this "act" before and hoped that was the case this time. He performs a pelvic exam with speculum, orders IV pain meds, performs ultrasound. Everything looks fine. He tells me, good job..at least my new nurse coworker will know what to do in case something happens for real. We'll watch her overnight. He was very pleasant and acted relieved that the patient was ok and left after about 10-15 minutes. Signed the orders and left. The new shift comes in and I give report. They tell me that I better be lucky that this patient didn't belong to the other group (the group that I don't have a lot of experience with) because they would have chewed my a--. They tried to make me feel like a complete idiot for calling the doc before the patient was in-house and I should have done a complete assessment on her before calling him. They say this isn't like my other hospital and we have a lot of "princesses" here. They say, "well, you know that group (the one I called) better then we do (the group i called rarely delivers at our hospital and prefers my old one. This new hospital is private by the way, the old one is not. Should I have not called the doc? Normally, I would always completely assess the patient, but she came up via ambulance and with what the ER was telling me I figured the doc would have to come in anyway....Did I over react? As I left, my new co-worker was very angry. She told me that she was proud of the way we handled the situation. I had tears in my eyes in the parking lot because they were so critical of my actions...what would you have done?
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I appreciate the responses. My number one priority is the patient. I don't understand why there is such a fear of notifying the doctor! It's his JOB!!! I don't expect anyone to hold my hand. Besides, who really knows if this is what this other group would prefer - this is what the two nurses I gave report were telling me. I thought about it last night on the way home and really don't think I would have changed a thing...expect maybe had some terb in my pocket in case it got to that point and it was ordered......I'm thankful that there are others who agree with me...I'm a patient advocate - My choice to become a nurse was alway to help my patients...not to make sure a doctor doesn't get mad...

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Know what you're going through. I did some agency nursing on the side. I worked ICU and ICU step-down. I have never seen more nurses afraid to call an intensivist than that bunch. They would confer with each other and second-guess themselves. Sounds like your co-workers. The main crux of the problem? The group of intensivists were asses. Verbally abusive and demeaning. I will always call a doc. Their choice of profession. I do always have a thorough assessments with vitals done and pertinent info in front of me before calling. You did the right thing. Don't let your co-workers have you second-guessing a job well done.

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Add me to the list of nurses who think you did exactly the right thing.

Good job!

steph

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You were absolutely correct in calling the doc. You are the patient's advocate - their voice. The nurse response makes me think of a current thread "why are nurses so catty?" Maybe you should reference that thread for ideas to the temperment of your fellow staff.

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Specializes in Perinatal, Education.
You were absolutely correct in calling the doc. You are the patient's advocate - their voice. The nurse response makes me think of a current thread "why are nurses so catty?" Maybe you should reference that thread for ideas to the temperment of your fellow staff.
Although I agree it was a good call to call the doc, I also know that I often get erroneous report on the phone from our ER. What they tell me on the phone can often be totally different when it shows up in front of me. But, if they were just in a snit because "that's not how we do it here" then you need to lead by example. Just keep being a patient advocate and hoepfully it will catch on !
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