On-call medicine jerk

One of my previous posts indicated I had a run in with a doctor so here's the post that explains it...

It was on a weekend and so the reg doctors mainly were covered by other non regular doctors. We also had an admit from another hospital with whom the covering doctor accepted. Unfortunately he's not used to the policies and procedures of accepting other pt's from other hospitals and as such, this pt was due to arrive during the evening shift.

Now, these doctors get off at 1800hrs and after that we're expected to call the on-call medicine for orders. And this particular doctor swung by our unit before heading out. As such, I asked him about this particular pt and whether he was going to write orders before he left. He stated that since he didn't get a chance to assess the pt with his own eyes and hands, that he didn't feel comfortable writing orders... ok, fair enough. And off he went to spend the evening with his family.

The pt arrived after 1800 of course with a PICC line and a few other things going on. When the pt arrived I called the on-call medicine doctor for orders. I explained the situation and was told that he would NOT write orders for this pt and that I had to contact the covering doctor that accepted the pt. In response, I told the doctor that it was HIS responsibility NOT the covering doctor as it was after 1800hrs. Well that of course did not go over well. He got REALLY snotty with me, full of attitude and told me that I had to page the covering doctor and have him RETURN to the unit to write orders!!! I told him that I would not do that as it was HIS responsibility to write the admission orders, so this doctor said that HE would page the covering doctor and speak with him. OK, that's YOUR porogative (exactly what I told him) and 2 min later the covering doctor called me to say that he was going to come back to the unit to write the orders.

I could NOT believe that he would come back!!! IMO it just goes to show you the type of person and doctor that he is! Seriously wish that he was a more frequent doctor on our unit. And I don't believe that this doctor is used to writing admission orders as he asked for guidance and of course I offered. Tho several hours later, when I was putting together the admission package and making sure that everything was put into place, I realized that diet orders were forgotten.

As such, I had to again call the on-call doc - to get an order for an IV fluid as it was better to leave this head injury pt NPO unit speech pathologist could do a swallowing assessment on this pt. But when I asked for it, I was told that I had to AGAIN page the covering doc since "he didn't finish his admission orders". Of course I said that I wouldn't do it, and that I was only asking for a simple IV order, D5W or 2/3 & 1/3 just until morning when the covering doc would be back. He of course wasn't talking respectfully to me and when you disrespect me, don't expect me to be the kindest back. In the end he again said that he would speak to the covering doc again. My response, "that's your choice", "I'll be here".

Again the covering doc called and told me "if you need ANYTHING else for this pt, regardless of what time, just have me paged. Don't call the on-call doc for anything regarding this pt, I'll do it." and gave me orders for my IV and said that he would come in the AM to see if anything else needs to be done.

I followed up this event by emailing a couple of people above me and was told that the covering doc should have written orders before the pt arrived based on information in the admission packet we get from the other hospital.

NOW, I don't know of ANY doctors/nurse practitioners/dieticians/heck even nurses, who would write ADMISSION orders without setting eyes or hands on a pt. I understand on-call docs do this sort of thing all the time without setting eyes or hands on pt's, tho they are only writing orders for the interim til the regular doc can do something about the issue (as in a PRN analgesic order for a pt in pain), not writing admission orders. And they ask questions about why the order is req and any applicable information. And normally the on-call doc will swing by the unit when they're not busy so that they can write in the pt's chart and do the whole eyes/hands on assessment, and talk with the pt normally.

When I spoke with the chief doctor in charge of the other doctors (he's a reg doc on our unit), I was informed that I was correct in my thinking that it's the on-call responsibility to write the orders should the pt come to us after 1800hrs. I also sent an email and the response I got from my charge nurse was that no, the covering doc should have written orders. Such conflicting info!!! Was told that the doc was wrong with how he spoke to me but that's about it. The covering doc emailed me later and indicated that the jerk on-call doc apologized to him but did I get an apology for the way he spoke to me?! NOT A CHANCE!!! UGH!

Discharge papers received

So by the power received by the doctor in my hospital, I have been told to go home... tomorrow that is. Dizziness in crazy intensity is occuring - new symptom for me... but Dr doesn't really care.

I'm being put on prednisone to hopefully help alleviate or cure the symptoms I'm experiencing. The Dr consulted the neurologist on what to do for me - I think I've stumped them with what's going on with me. Hell, I'm stumped so why shouldn't they be?!

I'm not exactly looking forward to going home - I don't quite feel ready for it. My body feels "off" and still not back to normal and therefore I don't feel ready to leave here. Especially to take care of little tyke.

I had my first shower in like 5 days, I know ewwww gross right.... well I assure you, if I could stand upright for longer than a bathroom pee break, I would be having one!!! Almost fell over today when I was heading back to my room I was sooooo dizzy. But hey, that doesn't seem to matter to anyone until I actually FALL. Ridiculous really. Felt good to have a shower, at least I look like a proper human being now, and I don't stink at least (not that I did before, thank goodness for the invention of anti perspirant and toothpaste!).

The ONLY thing I'm looking forward to is that I can see my family - my hubby and my baby girl. Even though my little tyke is a handful (being almost 3 will do that!), I miss her dearly and love her to bits and pieces. Hubby seems to have actually missed my absence. Tho I suppose when the caregiver of the little one leaves, that makes more responsibility for him right?! So I don't really blame him for missing me :P Even tho I say that, I know that he misses me because he loves me - as I love him. He's my rock... just wish he would have spent more time with me while I've been in hospital - I've been really lonely considering he's spent VERY little time being with me. A couple of dinners here and there is about all. It hurts my feelings but what can I do? And I know that one might say that he has the responsibility of taking care of little tyke... well considering we live with his family, that's not necessarily a requirement since he can ask them to watch her while he comes to me. He has brought her with him a couple of times - I know that little tyke certainly misses me. When she's seen me, I still had the IV and so she was quite apprehensive about touching me cause I had a "boo boo".... VERY sweet and VERY innocent.

I also miss my own bed - tho I do like the electric aspect to the hospital bed - quite convenient at times!!! Certainly makes one more lazy when getting out of bed!

Long story short - I leave tomorrow AM, I'll know more about follow up then. I know that the Dr is giving me at least til Tuesday to recuperate and should I need more time then I have to see my family Dr. I guess that will have to do, it's not like they're giving me another choice in the matter!

What nurses talk about....

At the end of my shift last night, a bunch of us nurses gathered to talk about a couple of things.... we talked about one of the new hire nurses (got hired at the same time as I) experiences and how it differs from the veteran nurses experiences - more like what one would do vs. what another would do.

The situation was this.... if you did a bladder scan on a patient because they were complaining about fullness and pain - found that there was a substantial amount that was being retained, would you do a straight in and out THEN call the Dr for the order OR would you call the Dr, report the finding and request an in & out, also, what would you do if a Dr refused it....

Veteran nurse said that she would NOT have waited for a Dr's order, would have done the in & out and called the Dr for the order - neglecting that policy indicates otherwise... and even said that she didn't care if she got fired for it because it was in pt's best interest.

Newbie nurses (I included) - have called Dr's for such FIRST - but this is seen as us not having a back bone.

So what would YOU do?

When I have called Dr's for in & out's, I have already done a bladder scan and feel that information is a girl's best friend. I think it's like arming yourself for when questions get asked. Now, if I had a pt who required an in & out but a physician was refusing to give one (did happen to that newbie btw), I think I would go to the unit leader/charge nurse to speak about it, since having the leader on your side is like arming yourself - it's peer review and support. I know that the nurses on my unit support one another, and their patients - and ultimately would do what's best for the patient. Even if that means going against a Dr.

The newbie kept paging that Dr. for several HOURS, probably not realizing that the other option available to him was to do the in & out without the order and that one could be obtained later from the MRP (most responsible physician).

We also talked about our past patients and where they are... one of the nurses generally checks out various units within the hospital, as some of our patients end up on rehab units, we like to know if they're still there or not...

Last night this nurse revealed that one of our patients.... the one I told this blogging world about - the woman with the MASSIVE CVA (AKA stroke). Turns out that she aspirated at home - from the family trying to feed her! And she was back in ICU, intubated and STILL not a DNR (Do not resuscitate)... it amazes me, truely astonishes me that a family would WANT to watch someone suffer. If that was MY family member, I would NOT want my family member to be a full code if they are going to have crappy quality of life. If they can barely move, can barely communicate, and are entirely dependent on others for EVERYTHING, and that the family isn't all that interested in learning to take care of this family member.

It's crappy when people keep a loved one around for THEIR need, not caring about how it is for their family member. I guess this is something that I will learn to live with, because there is NOTHING I can do about it.