Wrote a doctor up!!!

[ShayRN]

Last week I felt I was verbally abused by a doc. I am probably too nice to some of them at times, so maybe they think it means I am a push over. We had an 89 year old NH patient come to the floor from ER with an IV in her foot. The bag was empty, so ofcourse the site was no good. I told the nurse to just pull it, the last thing we need is a thrombus because we were trying to unclot a site in the foot. She also was dehydrated with an INR>6 and a b/p 88/40's or so. So according to hospital protocol, she tried twice and couldn't get it. Then I (the floor "expert") tried twice and blew the vein. So we called IV team and it was after 10:30, so they weren't taking any more calls. I called the doc and said, what should we do? Any ideas? He started SCREAMING at me. "This is the second time we have had issues on THIS unit. What do you want me to do you say? I say, she needs the site, go put one in, NOW!" I said to him, very FIRMLY, "Doctor, there is no need for you to yell at me this way, I am telling you we cannot get the site in and am asking you what other options you want to consider. So, you can stop it right NOW!" He kept yelling, "I said get a site in her. This is ridiculous, it is just basic medical practice." So I repeated, "there are NO VEINS TO START AN IV, what other options do we have, I can't get a line, what part of that are you not understanding?" He just kept yelling and saying, "just go put a line in her NOW." Like, I didn't want to, right? So, finally, I said, listen, I am going to call a house supervisor because this is getting us NOWHERE. I did call and she happen to know a nurse on the intensive unit who worked as a float on the IV team. She was gracious enough to come up and start a line, (on the inside of her wrist.) That line blew the next day:sniff: So, anyway, I wrote up my conversation with the doctor and sent it to the administration. Someone up there must be pretty upset, because they actually called me on the unit tonight to find out what happened. When I told them, he said, Oh, that was completely inappropriate. I am going to forward this to his chief of staff and I can assure you it will be dealt with....Nothing may ever come of it, but it makes me feel good knowing I stood my ground for myself and MY PATIENT!!!!

[gr8rnpjt, RN]

Was the doc an attending in house when you called them or was he at home. Just wondered, because the day i see one of our docs insert a peripheral line is the day it will snow someplace it shouldnt.

Normally if we cant get a site, we go through the chain,,supervisor tries,picc or central sub-clavian put in the next day,

I was wondering the same thing... I have been out of the loop for a while (clinical setting) but I used to work steady nights and calling a doc had to get an ok from the house supervisor back in my day.

And were you looking for an order for a picc line, and do they do that at night.

I am just thinking maybe he was frustrated because it was not clear what you wanted him to do.

None of that really matters, because in the end, he was very rude and needed to be written up, so you go girl.

I one time had a doctor call up at 7:30 am and he yelled into the phone, "Let me speak to the (non PG13 phonetic) nurse that called me last night in the middle of the night." I was so glad it wasn't me that called him, but I sure felt bad for her. She took the phone and turned beet red. She would not talk about what he said, but I felt really badly for her. She did not write this dr up, but I understand how hurtful it can be when you are only trying to be and advocate for your patient, and the dr gets mad at you for doing your job.

[Daytonite, BSN, RN]

When I worked in acute hospital supervision we wrote doctors up on occassion for their behavior. Most staff nurses probably don't realize that it does happen. These administrative complaints go to the hospital administration and to the medical staff offices. Each medical service has one doctor who has assumed the "chief" position and must deal with these complaints. These "chiefs" understand medical staff policy as well as the hospital employee policies and will often get after the doctors who act like fools as you experienced. Docs are much more closed lipped about it, so don't expect to hear that this doctor got his ears clipped. This was a really minor thing for this doc to get so worked up and angry about. Talk about prioritizing--what was he thinking? I expect that this doctor who gave you so much trouble is going to get a good talking to by his chief. He may even be told to appologize to you. Like any employee, the complaint will be placed in his file. If there were other complaints filed against him in his file it will become an issue when his renewal of hospital privileges comes up. More and more the people in charge of medical staffs have realized that doctors who are abusive to facility staff have got to be stopped. It is more costly for a hospital to orient and train a new nurse employee than grant privileges to a new physician. I'm sure you'll get a lot of posts from people who will love hearing that a doctor got written up! Enjoy the comments!

I wouldn't have put up with his ranting at me on the phone the way this jerk did. I would have just hung up on him and called the supervisor. I might also have asked him if there was another doctor he could recommend we call to perhaps consult about placing a central line. He probably would have really went ballistic on that idea!

With regard to the IV, having been an IV therapist for many years as well. . .Did you try putting warm packs on this lady's arms for 15 or 30 minutes to help bring up veins? When all else fails there is hypodermoclysis, an old procedure where IV fluids are infused into the subcutaneous tissues of the anterior thighs. It is a last ditch measure, but with a doctor's order a nurse can perform it.

[DutchgirlRN, ASN, RN]

Way to go!! I wrote a doctor up last year. He was the "BIG" cardiologist and many thought holy smokes sister you're history. My nurse manager backed me up as did the supervisor. The doctor then wrote me up and administration backed me up and told him he was wrong. He didn't speak to me for a whole year. Just this past week when I worked he actualy spoke to me (socially). I was told by one of the other docs that administration told him he should apoligize. Like the jerk you dealt with I doubt you'll ever get an apology but you did the absolute right thing and YOU GO GIRL !!!:yelclap:

[TweetiePieRN]

Good for you in advocating for yourself and your patient!! I have only been an RN for over a year and had to write a doctor up TWICE due to the same issue...pain control! I work in oncology and most of our pts need some type of pain control. This particular doc is not an oncologist, but labels everyone "DRUGSEEKERS" regardless of if its true or not. I don't care if someone IS a drugseeker. Pain is what the patient says it is.

Rumor has it (I don't like rumors) that this doc has had a drug ridden past, so maybe this is why he is super-conservative about pain control. Regardless, I don't think its acceptable to allow your patient to be in so much pain, when there are lots of options out there.

Again , great job and you should be proud!!! :)

[BabyRN2Be]

Great job!

Wooooooot! That was the thing to do and I'm glad you did it!!!

[Shannon RN 2be]

It's great that you stood up for yourself. Good Job!

Hugs :icon_hug:

Shannon

[Tenesma]

why would you take a foot IV out --- flush it and use it. Instead you subjected this poor patient to a bunch of sticks for no good reason....

And exlain to me how flushing an IV is going to cause a clinically significant thrombus (unless she has a wide open PFO with right to left shunt) in a patient whose INR is 6.... gimme a break

[rn/writer, RN]

why would you take a foot IV out --- flush it and use it. Instead you subjected this poor patient to a bunch of sticks for no good reason....

And exlain to me how flushing an IV is going to cause a clinically significant thrombus (unless she has a wide open PFO with right to left shunt) in a patient whose INR is 6.... gimme a break

You raise some valid questions, but I have to tell you, I cringe at your tone. I don't know enough about this subject to evaluate the merits of your information (though what you say sounds convincing), but I DO know that few people respond well to someone sounding judgmental and critical.

The OP tried to help her patient. If she inadvertantly caused her more aggravation, she will probably feel bad enough about that without your "gimme a break" comment.

Superior knowledge is not a substitute for kindness.

[UM Review RN, ASN, RN]

why would you take a foot IV out --- flush it and use it. Instead you subjected this poor patient to a bunch of sticks for no good reason....

And exlain to me how flushing an IV is going to cause a clinically significant thrombus (unless she has a wide open PFO with right to left shunt) in a patient whose INR is 6.... gimme a break

It's quite possible that details were sketchily given in order to protect the patient's privacy. This is the Internet, after all.

I wasn't there so I assume that Shay is giving us the gist of the matter. Howver, I had a patient who came up from the ER in much the same condition as this patient. The bag was dry, the IV was trashed, it was sad.

(We finally got a #22 in a blind stick to an AC spot that I swear wasn't there an hour before. They even had a hard time getting a PICC line in the next day in Radiology.)

Some people's veins are just that fragile, that an IV will work fine for awhile, then blow. Or a great vein will show up seemingly out of nowhere, making us all look stupid.

It happens.

Also, with an INR that high, it's obvious that the patient already had issues with clots. Who knows, maybe the ER gave her some Vit K and then sent her up with fluids nearly gone but the Vit K just kicking in and no subsequent lab draw ordered, who knows?

My point is, playing armchair quarterback on this particular part of the scenario wasn't what the thread was about.

It was about the physician's inappropriate and unprofessional remarks.

And while I'm at it, I'd also like to respond to this comment:

I one time had a doctor call up at 7:30 am and he yelled into the phone, "Let me speak to the (non PG13 phonetic) nurse that called me last night in the middle of the night." I was so glad it wasn't me that called him, but I sure felt bad for her. She took the phone and turned beet red. She would not talk about what he said, but I felt really badly for her. She did not write this dr up, but I understand how hurtful it can be when you are only trying to be and advocate for your patient, and the dr gets mad at you for doing your job.

I learned something valuable from what you said. In reading over this comment, I realized that I would've probably done the same exact thing--hand the phone over.

But now, I want to advocate for other nurses on the receiving end of such unprofessional, disrespectful behavior. I hope that I have the guts to stand up to that doc and remind him that no nurse I work with can be described in such vulgar terms, and refuse to pass on the call until he calms down. I'm thinking that maybe that doc could've used about 10 minutes on hold?

[Daytonite, BSN, RN]

why would you take a foot iv out --- flush it and use it. instead you subjected this poor patient to a bunch of sticks for no good reason....and exlain to me how flushing an iv is going to cause a clinically significant thrombus (unless she has a wide open pfo with right to left shunt) in a patient whose inr is 6.... gimme a break

i can answer your question for you. you never flush a clogged iv--never. especially, in the foot. you run the risk of pushing a clot, no matter how small into the vein. every thrombus of any vein should be considered clinically significant! show me a nursing textbook that tells you it's ok to flush a clogged iv because any resulting thrombus will be clinically insignificant--you can't because it's wrong! thrombus also leads to phlebitis--something you definitely want to avoid in a lower extremity, especially of a debilitated elderly person. having worked on iv teams for 6 years i can tell you that when an iv has been flushed to clear it of clots, it seldom lasts longer than another 24 hours and often has to be changed within 8 hours. putting pressure on a flush solution to clear a clot results in microscopic damage to the vein that you can't see. phlebitis or a blow resulting in infiltration very often results. the only acceptable way to clear a clotted iv is to aspirate the clot--it's very tricky and sometimes difficult and a good deal of the time it is not successful. when a patient like this elderly one is severely dehydrated and may have had a long history of ivs it is not unlikely for a situation like the poster writes about to happen.

it really irks me that nurses are the first to say they are advocates of kind, loving care for patients, yet they will abuse the hell out of an existing iv because they don't want to have to re-start it. veins are part of a person and need care and protection also, not roger ramjet coming at them with flush after flush trying to save an iv that is already finished.

[DutchgirlRN, ASN, RN]

why would you take a foot IV out --- flush it and use it. Instead you subjected this poor patient to a bunch of sticks for no good reason....

And exlain to me how flushing an IV is going to cause a clinically significant thrombus (unless she has a wide open PFO with right to left shunt) in a patient whose INR is 6.... gimme a break

Gees, relax a little. We let nurses vent we don't beat them up further!

[kadokin, ASN, RN]

Was the doc an attending in house when you called them or was he at home. Just wondered, because the day i see one of our docs insert a peripheral line is the day it will snow someplace it shouldnt.

Normally if we cant get a site, we go through the chain,,supervisor tries,picc or central sub-clavian put in the next day,

I was wondering the same thing... I have been out of the loop for a while (clinical setting) but I used to work steady nights and calling a doc had to get an ok from the house supervisor back in my day.

And were you looking for an order for a picc line, and do they do that at night.

I am just thinking maybe he was frustrated because it was not clear what you wanted him to do.

None of that really matters, because in the end, he was very rude and needed to be written up, so you go girl.

I one time had a doctor call up at 7:30 am and he yelled into the phone, "Let me speak to the (non PG13 phonetic) nurse that called me last night in the middle of the night." I was so glad it wasn't me that called him, but I sure felt bad for her. She took the phone and turned beet red. She would not talk about what he said, but I felt really badly for her. She did not write this dr up, but I understand how hurtful it can be when you are only trying to be and advocate for your patient, and the dr gets mad at you for doing your job.

I had a funny thought when I read this. Would it be appropriate to tell the physician in question that none of the nurses are currently (non PG13 phoetic), but if he could leave his #, you'd call him back as soon as you found a nurse engaged in said behavior. Just a thought!