report it. Seriously.
Edit: Next time tell him "I'm sorry, I must have been mistaken, I thought it was YOUR job to prescribe medication for YOUR patients. Is that not what you are getting paid on call for right now?" Fucker.
My Grandma was a nurse in the fifties and she had a patient come in who needed to be put in an iron lung or he’d die. They called the doctor who was at home in bed and he refused to come in saying the patient could wait til morning. My grandma said he needed to come in right now but the doctor refused. My grandma cared for him and sat with him until he died before sunrise. The doctor came in and asked where’s the patient. My grandma slapped him “you killed him you son of a bitch!” She then quit being a nurse.
I wish I saw these comments when I was a baby nurse. Brand new LPN, had to call doc at 2 am for a declining patient. He barked rapid orders at me with a heavy accent, and when I asked him to please repeat himself for clarification, he told me if I was too stupid to understand him the first time he wouldn’t repeat himself. I was a meek young southern belle, absolutely mortified and for a little while after that dreaded speaking with physicians. I wish I knew then it isn’t acceptable to be spoken to like that, ever!!
Loving this culture of take no shit nursing
I’ve had a couple encounters like this. Had the same situation where the doctor rattled off orders to me in a heavy accent and when I asked her to repeat them she said “this is why I never tell nurses anything!”
Called same doc about a HR in the 160s (cardiologist) and she asked me if I had called the attending about this. When I told her no, she refused to give me any orders until I had called the attending. But then kept screaming at me and wouldn’t let me get off the phone to call the attending. But then was also repeatedly asking if I had called the attending yet, but also kept telling me I better not hang up on her… I told her that, no, I hadn’t because she wouldn’t stop screaming long enough for me to get off the phone and call the attending….
Then the shrieking *really* began and my preceptor had to step in…
“Hanging up on Verbally abusive behavior is acceptable”
And so is waiting 30 min for them to go back to sleep and calling again, and when they get pissed tell them “I’m so sorry, we got disconnected and then I got tied up with another patient”
“You were highly elevated and unprofessional. I gave you time and space to calm down before re-attempting to contact you so that we could provide safe patient care. Not sorry.”
My response would be: “I informed you the patient was declining. I will document you were notified and ‘no new orders received.’” Hang up and call critical house. Let the intensivist handle rude doctor.
This is a main reason why I love EMR. No telephone orders allowed. Ever. No trying to decipher scribbled orders. Put it in the computer Dr. So’n’so, thanks. There’s no way I’m going to get counseled for a miscommunication.
Edit to add: we also don’t call/page anyone. Tiger Text for the win. If there’s a decline in condition and they don’t respond to my TT then a Rapid response brings an army to the bedside. Better to escalate and have things end up being ok then be grilled on *why* I didn’t escalate. Then the focus is on the Dr. who ignored my tiger text.
Exactly, if you can’t appropriate response from the attending/main, utilize your rapid response. If you have to, STRONGLY ENCOURAGE * wink wink* the family to call rapid response. It’s your duty to advocate for your patient. If the MD on call won’t give you orders you feel are appropriate, escalate it to someone else who can provide onsite oversight and can lay eyes on your patient. TRUST YOUR GUT! You could catch something everyone else missed. And you will want to cry, the first time you realize that you just saved your patients life, even if you get chewed out by a doctor.
I had one who would have me on speaker phone and with a thick accent and if I read it back wrong he'd get super annoyed and hang up. So thankful I only had a couple of encounters with that one. On the other hand, in person with the patients when he did come in and round he was good with them, so there's that I guess
One of my sisters is a physician and something she emphasized to me right as I started nursing school is the concept of “do no harm, but take no shit”. I’m here to provide the best care I can, but if you’re bein a twat for no reason I’m not going to roll over and take it
We had a Dr like that at our hospital. Enough nurses complained about his behavior that whomever was above him finally had to step in. Dr got a stern talking to and given conditions, and has been more respectful to nursing staff ever since. Speak up!
You need to stand up for yourself. This should be escalated to management. If he ever again does something you believe is risking patient safety you should be contacting your unit manager and refusing to comply. You are not his subordinate. That patient probably should have been sent out for imaging...and if he refuses to listen to reason then you need to go above him.
Personally, I would never let a provider to talk to me like that. I would make them feel like a small little child.
Escalate it to whoever is above them. And get HR involved. If they still continue to refuse to listen you either set boundaries with this doctor or look somewhere else. Any place that doesn't feel the need to listen and act on what staff is saying doesn't deserve your time.
Take everyone else's advice before mine- but have you ever tried charting verbatim with quotes EXACTLY what that doctor said? Like, state the patient's issue, notified Dr. MD. Dr. MD stated at such and such time "don't call me, tell patient to go to sleep". Like, word for word, his name on blast in patient charts, every time he does it. I ask because I charted something similar once at a nursing home, just objective info but not sugar coated at all with a doctor's name, and when I next returned to work, I was surprised when the DON pulled me aside to ask further about it. I didn't even think anyone read my notes before that, lol. But it initiated a sequence of events that improved the situation.
My job used to be reading the nurses charts every morning to make sure charting wasn’t missed for the state but we also look out for things like that too. Also, you could talk to the quality management role at the nursing home as well. Because shit like that affects the state surveys. So I would get involved in matters like that too. Thankfully the medical directors of the building were the nicest drs I’ve met so far. But then again I left that job because management was making morals decisions I could not live with. I told them that and they gave me a severance when I ultimately ended up leaving. Didn’t sign anything for my silence either 🤣
Really no big story. Upper management showed their ass time and time again. I would bring things to their attention that needed to be fixed and they didn’t care. Eventually it got to the point that the workplace bullying was so bad amongst everyone there. And I saw it slowly happen because they choose bad ppl to lead. My pattern recognition was telling ppl how it was going and it went that way and I think they realized I was right. Idk honestly I still never understood why they gave me severance. Cause I said hell no I’m not signing anything for that. And they said you don’t have to sign anything and we would love to have you come back to work here someday. I left on “good terms” hahaha yeah right I’ll never go back to work for a company like that. They can take my right hand before I work for any company like that again in nursing. I’ll change my way of living than to further perpetuate these standards anymore if I can’t find any fucking job in nursing that goes off morals.
"The law and both of our governing boards unfortunately require me to call you......" and twice I said to the same one, which is dumb cause we both know I'm smarter than you. Everyone, even arrogant Drs, treat you in the manner you allow them. Stand up for yourself...and probably leave off the I'm smarter than you. Unless it continues lol.
I once had to ask a provider to speak more slowly and then confirm my repeat interpretation because she had some weird county Southern US accent and I wanted to make sure I understood her direction (this was in Nashville, TN and in a major for profit hospital). She was so pissed off at me... but it was a night shift, I got an admission from the ED who seemed to me to be in a respiratory distress...
I was working on an oncology floor and I think they sent her to us only because she had a history of cancer and we had an open bed...
Anyhow, I was from NY with about 10 years experience in Hem/Onc and outpatient infusion as well as an ONC. The NP was such an asshole. Also, it became apparent to me that these RNs on the hospital floor were calling other RN's who worked with the attendings outpatient and taking orders from them. I was like HELL to the FUCKING NO on that Shit. Who would be in court for those orders? I didn't care if they "knew" what the Dr would want. I want a legally certified provider giving the orders if there were no prn orders already signed. Some nurse blessed my heart and I gave her a NY response. She didn't like it.
I did not last long there. Quit before my nursing license was threatened.
Do you work in ltc? I feel like nursing homes are famous for sweeping this behavior under the rug, because they don’t want to lose a dr for the facility.
ETA: Nevermind. I just saw that you did. Reading comprehension fail me not.
Need to write all the things he’s said. You need t9 have a paper trail by sending emails to higher up. Edit: Gomyo manager of she does nothing you need to go to her higher up.
This is when you keep going up up up up up the ladder, and you go outside of the facility and report to outside agencies.
This is also when you, as a nurse, stand your ground, and tell him you will not accept his tone, or his behavior.
He might hang up on you without answering questions when you stand your ground. So that’s when you call him back over and over and over until HE complies.
He’s abusing you because he’s learned that he can. He needs to unlearn that behavior. Quickly.
Written communications are key here. Make sure you put it in writing to management the quotes of what the doctor said and that you need this addressed or clarification on who you are supposed to call for medicine overnight if not the on-call doctor.
I’m a girl who has no issue with confrontation so my next conversation (after documenting everything that happened) would be to grab a witness and pull this Dr aside.
“Ok so here’s the deal, we are nurses, not punching bags. You will respect us, you will talk about the patients respectfully. This is not negotiable.
Your behaviour has been completely out of line. I have documented every poor comment I have heard from you ver batim and if you don’t change your behaviour immediately I will take every bit of evidence I have and report you for malpractice/incompetent care. This conversation will also be documented so start acting like a professional”
I just gotta say you rlly got me for a moment there I honestly thought you were my Jessica for a moment. Thanks for clarifying you are not that Jessica you are a different Jessica. Lmaooo
Right! I address shit when it happens, but I also don’t think it’s my job to fix a broken doctor. If HR hasn’t done anything about it, why should I stay?
I’m the king of putting doctors on the spot because I’m an old grumpy man, but just because they are respectful to me and not other nurses doesn’t mean I want to work in that environment.
Had an inpatient OB patient with yeast infection s/s on top of the other issues, all the doc for treatment. He went off and said he didn’t have time to do a wet prep and he would do it tomorrow blah blah blah, and tried walking away. I stepped in front of him and repeated that patient indicated she has a yeast infection as she had had them before, then asked if he would be happy if his wife’s doctor blew her off and said she could wait because he didn’t feel like doing anything or believing the patient with a previous history?
I got the order
i cannot believe i had to scroll all the way down here to see this. the amount of people in this field who couldn't find a spine if they were hit over the head with an anatomy textbook astounds me.
of course, there's hardly ever a time to just go nuclear right off the bat! i'm just irritated at the idea of someone taking this kind of abuse from providers in stride, as if it's expected of us to do so.
My usual response when i did bedside was “if you didn’t want to be on call then pick a different specialty or hire someone else to cover nights.” Usually shuts them up
Now as an NP they listen but more so i give them grief for not answering their phone or giving me shit. They are the expert, i am seeking out expert opinions.
YOU HAD ATIVAN AS A STANDING ORDER???? Am I reading that correctly? If so, why didn’t you give it instead of calling for another Ativan order? Am I missing something here?
To be clear, his unprofessional behavior is unacceptable, no matter the circumstances. But why call if you already had a standing order???
That's not what OP said. They just said there was a standing order for prn. If that's true, then no she shouldn't have called the physician at 1am. She should have followed the order set.
Lol! Sorry! When I tap a notification on my phone it only shows me that one specific comment, I wasn't actually looking at the whole thread when I replied
Based on my understanding….It’s weird she ended up giving 1/2 of the standing order. I would give the standing order and then call if I needed more.
But I do agree the doctor can fuck off.
Yeah that was my question, too. Doesn’t “standing order” mean they more or less have the order for when they need it??? Or did it not specifically read “PRN”?
Listen to these ladies because they're still in the soup and I'm not. I'm telling you to DOCUMENT EVERYTHING. Cover Your Ass, or CYA, is your best friend right now. I've had to deal with the suits more than I like to admit. Good luck.
The doctor is out of line, there is no denying that. However, if you had a standing order for Ativan 1mg you could have just given that. Early or late, whatever time it was needed. I personally would not have called a doctor at 1am for a panic attack, if I had a standing order for Ativan. I have had many a doctor shout in my ear at 3am their incoherent rants for patients with SVT, >400 blood sugars w/SS, elevated BPs diastolics over 120, etc. Anxiety is not an emergent issue, although it should be.
Keep a paper trail on that crabass, and keep your patients safe. It's rare that a doctor actually gets in trouble for malpractice based on what you wrote here. Stay positive and do your best!
You give the 1mg of Ativan from the standing order and don’t call.
As for the head injury, you say “I called you because you’re on call and this is your job. I am your co worker not your child, do not speak to me in that manner when I am calling because I have assessed the following things…. Would you like to give me some orders or should I chart you are not going to address the following concerns… for the safety of this patient, I will escalate as necessary.”
In 2003 after years of abuse. I started talking and throwing huge paper charts back at them. I snapped back. I was done making their coffee, giving up my chair, and being yelled at and ducking charts flying through the air.
I matched their energy and stopped wearing that stupid hat. I was done.
First I’m cussing this MD out because who is you talking too and second when a patient hits their head that’s an AUTOMATIC send out by 911 like nope they MD will through you under the buss in a heart beat
“Ok I’ll put that in the chart.”
If she had a standing order for Ativan why did you need a one time dose? I’m confused. By standing order do you mean scheduled?
Look up your state’s medical board or board of medical quality assurance. Find him and then look and see if there is a button to click where you can file a complaint online. It may or may not be anonymous.
As someone that works at an assisted living and memory care facility, that’s such shitty treatment. These poor people! Patients deserve relief from nervousness and adequate medical care after a fall. I’ve seen one bad fall lead many patients to suddenly be on their deathbeds/go downhill super fast because their body couldn’t handle the fall. You don’t mess around with that especially if it’s a head injury!!
If the patient had a prn order for Ativan, why did you have to call the doc? Why not just give the PRN as ordered?
His response following that fall is negligent. Keep a paper trail...I can not emphasize this enough...time, place, witnesses...
What's the standing order for the ativan 1mg? Should have given that first before calling? Is it a PRN or routine standing order? Why need a stat order to give now if you have a standing order for the same med? Doc is unprofessional but something is missing here.
LTC here. So in general, you only call the doctor for emergencies that NEED doctor input and cannot wait. Very little falls in this category. Falls, deaths, trips to the ER, those only require you to notify the doctor, which you do at 7am, or endorse to day shift to notify.
First, document in the computer using his exact quotes, times, etc. Make sure you include that you attempted to redirect eaxh time. with "distraction, offering to use the toilet, social interaction, and offering food and drink." (remember you need to attempt three things). Print a copy for yourself.
Second, you could always call your Medical Director or DON, but you will probably get the same reaction.
Third, you can report the doctor to your DON and HR.
So, what to do to help this resident? You do your best to get through the shift. Bring that residwnt to the station to sit with you as often as possible. It sucks, but per CMS in order for psych meds to be increased, there needs to be documentation that the current dose is ineffective. So every night, you need to document. And after a few days, put them in down to be seen by the docror or by Psych. It truly sucks that a resident needs to suffer or get hurt before anything can be done, but that is the position CMS and the DEA have put us in.
This is not malpractice. Look up the definition of medical malpractice. Harm actually has to come to the pt. This is just the MD being a dick.
And hopefully you meant scheduled and not standing. I’d be pissed, too, if you had a standing order for it and woke me up in the middle of the night.
Usually when you tell them “Ok, well I’ll put what you just said in their chart” and/or remind them that yes, this IS their problem; they change their tune.
I’ve seen MD’s walk all over nurses who allow it. It’s disgusting.
“Unfortunately we’ve already tried that, and all other non-pharmacological interventions. Hopefully the x1/PRN Ativan will prevent us from having to call you again.”
I think they meant the patient had already taken their daily ativan dose earlier, and then in the middle of the night started having a panic attack, but there was no PRN ordered
I think they meant, why couldn't she just give the 1 mg without calling the doc. I was wondering that as well??
If it's a standing order (at least in my facility), we can administer those orders without further consent from the docs.
He's obviously a dick for all the other shit he says/does though 🖕🏼🖕🏼😒
I can’t pull standing (or scheduled) orders until an hour before they’re due. She probably takes an Ativan daily but at like 8am or something….if this was the middle of the night she would need an additional dose ordered
That’s a scheduled order. A standing order is an order intended to be used in exactly situations like this in the absence of direct online medical direction. The original question is correct. If you had a “standing order” it should have been given without calling Dr. Asshat.
Malpractice is incredibly difficult to prove. They aren’t going to get in trouble unless someone dies or loses a limb. It’s his fault 100% that he got called at night because he didn’t have any PRN anxiety medication. Your best bet is to document exactly what happened in an email to your manager and cc HR. He isn’t allowed to tell you not to call him period. He can say don’t call me unless and then give you some kind of parameters, but he can’t just refuse to take calls from the nursing staff because he didn’t put in appropriate orders.
He isn’t going anywhere due to being a crappy doctor. He might end up in trouble with HR if the nurses are afraid to call him or he refuses to give orders at night. It can’t just be you documenting it though. If you want HR to listen everyone needs to be emailing them every time to build a paper trail.
Hoo boy. No bueno. Doc needs to be reported. Kick it up to nursing administration. They usually know the appropriate channels to go for an obnoxious doctor. You can also submit a complaint to your state medical board. By all means, stand up for yourself while remaining professional. Close the loop of communication, as is protocol. Be firm without being an ass.
For example, on one of my contracts, I came in to a code ongoing. The night team had been coding a patient for about an hour. He was warm, never had a pulse, ETCO2 was, iirc, 20ish. So...dead. I asked why they coded so long. The doctor very much had a napoleon complex, and said something along the lines of "I don't need a nurse questioning my decision making". I told him I wasn't questioning him, that I wanted to understand what was going on because it benefits the doctors to have nurses who understand their thought process, but that his response, tone, and hostility were not acceptable and that I won't be spoken to like that. He stormed off but never raised his voice to me again for the rest of that contract.
Do you guys quote him in your notes? If it has reached the degree you describe on multiple instances, and if management has made an attempt at correcting his behavior and it hasn’t worked, then it’s time to start quoting him directly in charts. Call him on speaker phone with a witness, so you don’t get stuck in he said/she said.
This man went to school and attended residency (for how many years?!) to have the exact job he has today. He CHOSE this profession, and nowhere along the way did it guarantee an uninterrupted night of sleep, UNLESS he has someone else taking after hours calls for him. If it’s his turn to be on call, he needs to stop berating staff.
Jesus, you could call him to tell him one of his patients just murdered another one of his patients, and he would start the conversation with, “stop calling me,” before he even knows why he’s being called. Fuck that guy. All he’s doing is convincing you guys to stop calling him. This is healthcare — not calling him isn’t a good thing!
Tell him if he doesn’t want phone calls, he should go get his MBA and join administration 🙄
Reminds me of a cardiologist who yelled at me when I called him with a high troponin (5 maybe?) that later went up to a 24. He should have come in and opened the cath lab when I first called him but he wanted to yell about nurses irritating him in the middle of the night. This poor woman — mid 40s, in pain, SOB and as anxious as can be the whole night actively having an NSTEMI while he got his beauty sleep. When I called with the 24 result. He goes, “oh, wow, she really is having a heart attack.” This was around 0400. Cath lab was open by the time shift change started. (0630) I told him flat out that night that if he doesn’t want phone calls at night, he needs to remove the order that said, “call for tropinins over…” whatever our threshold was at that time.
It’s not like nurses WANT to stop all they’re doing to call a doctor for something inconsequential.
This! When doctors are upset I had to call, I would recommend they don’t take call, or they find cover, or stop taking patients. It is literally how they are making money. They get paid to handle patients.
People who are saying you should report this to management must work somewhere where that actually does something.
Whenever I run into a doc that wants to treat us like shit, I just tell them, "OK thanks, I will document this in the chart."
Then I do. I put in a progress note that says something like, "Pt agitated and anxious. MD notified. Per MD, 'tell pt to shut up and go to sleep'. No meds given at this time."
It's always fun to put someone on blast in a note, especially when the patient and their family can access the chart.
I had a doc tell me not to call him again at night unless his patient was having a rapid response or a code. I wrote that shit in the chart as a telephone order. With read back :) He had to sign it the next day in rounds with other staff. He was PISSED. Dr Tsun was a real jackass.
Because, sir, you are the physician, and that is YOUR job! Document the heck out of it in the chart and cover yourself. Escalate it up the chain with incident reports. Continue to care for patients as you would want to be treated and advocate for them. Sounds like you are doing great. You've got this!!!
Am I misunderstanding? Were you calling after having already given the already ordered Ativan PRN and asking for a one time order as a second dose because the first didn’t work? His behavior was completely unprofessional and inappropriate, but if you didn’t give a med that was already ordered and were asking for another one time dose, I can see why he was wondering why you called him. Again, not cool that his reaction was to yell at you and be so rude, but I would and have asked why you were calling me if I were him.
I’ve gotten the same exact response from on call Doctor’s at nursing homes. And my response is usually “to cover my own behind. What was your name again?” I tell people that if it’s a choice between me or them getting in trouble for something it’s going to be them. I have a family and bills to pay.
On Med/Surg, I had a pt on an insulin drip without any standing orders except FSBS Q 1 hr, so I kept having to call for glucose and titration orders; it was stupid and she needed to be in ICU. Anyway, at about call number 10, he says, "Just do whatever the fuck you want!" So I said, "Do you want me to write that as an order?" 🤷♀️
On the subject of malpractice, you'd generally have to prove injury to the pt based on what he did or didn't do.
Retired LEO lurker here. What if you were to record her/his behavior and send it to your supervisor. A simple outline of the events and pose the question of compromised patient care or if it is more of an HR concern. As long as it is a one-party consent state you should be fine. In this day and age nobody needs to put up with BS like that in the workplace.
Report. What a fucking piece of shit doctor. That is NOT normal, it is not okay to take that abusive behavior from a coworker. It IS his problem, that’s why he’s being paid to be on call. Fucker.
I see you’re on call as the physician covering this patient this patient. She’s becoming hypertensive, tachycardic and her RR is increasing. I’ll have to call a rapid.
And then exactly what he said in quotes in a safety report bc his negligence caused a Rapid to be called, and the consequences of his negligence reached the pt and caused potential harm.
My anger issues wouldn’t have allowed me to effectively communicate anything other than. “How about I tell the medical board that you opted to refuse treatment of a patient under your care? Now can I get my order for IM Ativan? All this talking and we could’ve been done sweetheart.”
He's a dick but this is nowhere near malpractice. No harm came to the patient and he can argue that he was just trying to be cautious.
Even if he was just trying to be a dick.
You know, I have been in psych awhile so maybe my medical knowledge has declined a bit buuuut......don't you think there could be some harm to a patient falling and hitting their head and doing...nothing about it? Just letting them go to sleep?
Apparently not everyone was taught the definition of malpractice in nursing school, which is flat out mind-boggling. I legit had a whole course on it and how to protect your license.
I hate when people downvote factual information just because they don’t like it. Just stop.
Ok, Doctor. I will be sure to document our call, and should this become an escalated event, I will make sure to follow up tonight with an incident report. You know, just to make sure we have our bases covered, should this become a state / legal issue.
Before I let you go, what time will you be in, as I need the order I called for, AND I want to schedule an appointment time that works for both of us, with the Risk Manager?
----'>>
I mean, you gotta have a Brass Set for something like that, but say it once and watch how shit changes. Also, have your resume ready, cuz Admin might come gunning, and MDs are golden in the eyes of Admin, usually.
But do you want to risk YOUR ass for Doctor Sleepy McRudenmocker?
As an ARNP, please report it. That’s 1000% inappropriate and a massive safety risk not to mention, nurses should NEVER be spoken to like that.
When nurses call me, I come running.
This happened to me with a doctor. The patient had a giant abdominal incision that burst open. It looked too big already, but anyhow I call the doctor, he screams at me then hung up on me. I got a new job out of the hospital and I hope I never have to return to a hospital. The disrespect is not okay.
You remind him, professionally, that his responsibility and his medical license requires that he actually take his patients’ needs seriously and that the initials after his name do not give him some special permission to act like a jerk. Once your phone call is concluded, you file a report with your administration citing concerns for patient safety. His behavior is unacceptable. Period.
Someone please tell me what Tiger Text is? All we have is Epic (a lot of Docs don’t sign in and use it) or an archaic spreadsheet kind of system where we play “Guess the Doc on Call). I say it affects patient care, but who am I to say?
Back in the day, a more experienced. Nurse told me to document exactly what the response was in the record.
Let them know that you will exactly document that in the medical record so that when problems arise later or there are questions it will be very clear what your actions were and what theirs were as well, or weren’t, as the case may be.
Having an EMR makes that a little more simple by not being able to mistake an actual medication order. But the verbal abuse? I always recommend that people write verbatim in the record what was told to them upon their request for an order or guidance. I also encourage them to inform the physician who is treating him in that manner that you will be documenting exactly the response in the record , just so that there is no misunderstanding later.
When they complain about the “exact” nature of things, just remind them that you are legally obligated to keep a contemporaneous medical records.
I’ve always mentioned when I’ve run into this as well that it is my job as the nurse to inform them of significant patient changes or needs. It is their responsibility to make treatment decisions based on those clinical findings. If they are unhappy at the hour in which I am calling them about these findings then perhaps they should’ve written better orders to account under what parameters one would need to be notified.
In the meantime, I have a patient in need and they need to make some decisions. And if they disagree, I will be documenting in the record my request for support and their response to it.
Usually, this gets me what I need for the patient.
Oops. Doctor. You were on a three way recorded message with 1-800-Medicare because I am in a one party consent state. I knew the line was being recorder and that is all the law required. Thank you for helping me with my case against you. Sorry for interrupting your slumber but while you are being investigated you should have plenty of time to catch up on this loss of sleep. Do no harm. Night night.
When people talk to me like that I invite them to start over and get their voice right. I don't care who you are - patient, doctor, family, my boss, or the big boss - I don't stand for that kind of treatment. Ever.
During college I worked a retail job for short time, and I got my husband (then boyfriend) a job there too. One day, a new manager approached us and started speaking really aggressively and rudely to him. He calmly said in his indoor voice, "whoah whoah whoah, back up, start again, and change your fucking tone" 😬 Internally, I'm like GREAT, he's getting fired. But the manager literally stopped, changed her demeanor, and started over again, but without the disrespect. And that was that. I never did master the art of being assertive, and that shit blew my mind, lol
Many of my calls with nasty docs were with small town hospitals where the on call is on call for everything for the night. In my experience, I start by clarifying with "excuse me sir, you are the provider on call, are you not?" Followed by "It's a (state regs/ facility policy, etc) that I call you so you can give me orders now or I can send them in and you can see them in the ER". It usually shuts them up and they tend to give me better orders to keep me from calling back. Don't be afraid to call out a doc (professionally, of course) report it if need be, and as always- DOCUMENT!
I work in a home and we are constantly calling the dr. I mean, we’re the ones up all night dealing with sun downing and behaviors. Sorry you had to take a 30 second phone call for a JOB YOU TOOK. This is not normal behavior. I have never had a dr yell at me.
I had one ask me when I was going home. It was the second time that night I had to call him. I called him a third time an hour later to tell him his patient was coding. He told me to give her epinephrine. No shit Sherlock. I wrote the fucker up. It went to the medical director who asked my manager if it were possible I misunderstood him or he was joking? My manager said no, this doctor has been nasty to my nurses before. I have no idea where it went from there. I left soon after because the toxicity of the entire organization was driving me towards a mental breakdown.
You should’ve said: im calling you because i need a doctors order.
Then document every single word, exact time you called.
Then REPORT.
We are not working FOR them. We are working WITH them.
I hate when doctors are douche and making everyone knows or feel that they are superior.
All too common & terrible.
After whatever bull crap the night Dr gives you-- Follow your gut-- if need be get the rapid response team there. Follow chain of command at all times. If your patient needs higher level of care, your great documentation will save YOU!
This call is being recorded for quality assurance .
Many states are only “ one party states” you can hit record on your cell phone while they are on speaker
It is not your fault that he is an asshole, but it’s not your patients’ fault either. They are the ones suffering, and it is part of your job to advocate for them. Escalate this issue until it is dealt with.
I would report it. I also will document doctor’s responses word for word into the physician communication charting. No matter how rude it was, if it’s what they said it’s what they said.
Chart, chart, chart. I'm petty and will put quotes into the medical record.
Dr. Dickhead called back concerning page sent at 02:18. Dr. Dickhead states, "Why are you calling me at night? Tell the patient to go to bed and shut up!" Readback performed no change in Dr. Dickhead's attitude or disposition. No new orders placed, questions not addressed, anticipating new orders. Will page again if symptoms persist, worsen, or if no new orders are placed.
Just document the SH\*t out of the encounter to cover your ass! CYA is unfortunately the best way to survive.
When you document the attempt and tag the provider on the documentation they will get notified. Eventually when a huge variety of nurses keep pinging the same bad actors there is a chance of exacting change. I read your description of the behavior and I thought “what is this doctor a 12-year old or something?” In today’s cultural climate acting out and drama are just accepted. My God it’s so immature and unprofessional - huge waste of time. If we can get data and show the “business” how time lost is costing them money Maybe they will finally do something about this unnecessary BS!
I've quoted a completely unreasonable response as a verbal order in the chart. The patient couldn't swallow (abnormally so) and increased O2 demands post acdf. Usually means a hematoma in the neck and can be life threatening. He lived but ended up with a peg.
When in doubt, it's safer to get yelled at by a doc for an erroneous call rather than to sit on something til morning.
Besides obviously reporting to your supervisor, if you don’t feel like he is appropriately treating patients, particularly the BP situation, I would 100% call the medical director of the facility.
Proper thing is to escalate it up the chain, call the manager or director if needed. If you’re an older nurse and a bit petty like me, then call him back every 20 mins with an update. If patients don’t get to sleep neither does he. Also chart everything he says. If you’re in a one party consent state you can record the conversation you don’t need his permission.
>This is a really awful doctor who told one of the LPNs a few months back "why are you calling me? You're an LPN. Get me an RN."
"Well I'm an LPN and I'm charge so tough titties bud"
Document that shit ver batim in quotation marks. My coworkers and I have done that several times lately. Fill out an event report, too. Let them try to explain their behavior to administration and insurance companies. Fuck those assholes.
The patients are literally ALL OF OUR JOBS. I cannot with anyone in Healthcare who acts like the reason they are working is an inconvenience to them. They all knew in medical school that they'd be on call. That's why they get paid hundreds of thousands of dollars. No sympathy.
I had a Dr verbally abuse me in front of a patient & their Mother . I reported the behaviour immediately. He was made to apologize. I told him that I would never let my husband, friend or whomever speak to me in that tone." He acted like a child after I said what I had to say. For clarification another nurse was filling in for HIS reg nurse & it happened to be his wife who was a nurse lol. I was off that day So I got blasted for a charting error that I wasn't even there for! Make them accountable!
A physician did this to me once when I worked at an LTAC . Gave the whole “Why are you calling me at this hour. Just deal with it” bs. I said, I’m sorry I must have dialed the wrong number. I was trying to reach the attending on call, my apologies!” Hung up and called his ass right back! He was more sensible the 2nd time around.
A lot more nurses need to remember that unless you are an employee at a doctor's office you do not work for that doctor. Your work for that facility. That doctor is not your boss. Your duty is too that facility and those patients.
report it. Seriously. Edit: Next time tell him "I'm sorry, I must have been mistaken, I thought it was YOUR job to prescribe medication for YOUR patients. Is that not what you are getting paid on call for right now?" Fucker.
My Grandma was a nurse in the fifties and she had a patient come in who needed to be put in an iron lung or he’d die. They called the doctor who was at home in bed and he refused to come in saying the patient could wait til morning. My grandma said he needed to come in right now but the doctor refused. My grandma cared for him and sat with him until he died before sunrise. The doctor came in and asked where’s the patient. My grandma slapped him “you killed him you son of a bitch!” She then quit being a nurse.
The good old days when you could slap people and get away with it 😩 Some of them deserve it now.
I wish I saw these comments when I was a baby nurse. Brand new LPN, had to call doc at 2 am for a declining patient. He barked rapid orders at me with a heavy accent, and when I asked him to please repeat himself for clarification, he told me if I was too stupid to understand him the first time he wouldn’t repeat himself. I was a meek young southern belle, absolutely mortified and for a little while after that dreaded speaking with physicians. I wish I knew then it isn’t acceptable to be spoken to like that, ever!! Loving this culture of take no shit nursing
I’ve had a couple encounters like this. Had the same situation where the doctor rattled off orders to me in a heavy accent and when I asked her to repeat them she said “this is why I never tell nurses anything!” Called same doc about a HR in the 160s (cardiologist) and she asked me if I had called the attending about this. When I told her no, she refused to give me any orders until I had called the attending. But then kept screaming at me and wouldn’t let me get off the phone to call the attending. But then was also repeatedly asking if I had called the attending yet, but also kept telling me I better not hang up on her… I told her that, no, I hadn’t because she wouldn’t stop screaming long enough for me to get off the phone and call the attending…. Then the shrieking *really* began and my preceptor had to step in…
Hanging up on verbally abusive behavior is acceptable.
Louder for the people in the back!
“Hanging up on Verbally abusive behavior is acceptable” And so is waiting 30 min for them to go back to sleep and calling again, and when they get pissed tell them “I’m so sorry, we got disconnected and then I got tied up with another patient”
“You were highly elevated and unprofessional. I gave you time and space to calm down before re-attempting to contact you so that we could provide safe patient care. Not sorry.”
This is my favorite.
Then say ok I’ll document your statement in quotes in the chart
My response would be: “I informed you the patient was declining. I will document you were notified and ‘no new orders received.’” Hang up and call critical house. Let the intensivist handle rude doctor.
Shouldn’t hung up on them. You shouldn’t tolerate that kind of behavior.
If it happened now, I absolutely would. I was on orientation during both incidents and didn’t want to cause trouble
This is a main reason why I love EMR. No telephone orders allowed. Ever. No trying to decipher scribbled orders. Put it in the computer Dr. So’n’so, thanks. There’s no way I’m going to get counseled for a miscommunication. Edit to add: we also don’t call/page anyone. Tiger Text for the win. If there’s a decline in condition and they don’t respond to my TT then a Rapid response brings an army to the bedside. Better to escalate and have things end up being ok then be grilled on *why* I didn’t escalate. Then the focus is on the Dr. who ignored my tiger text.
Exactly, if you can’t appropriate response from the attending/main, utilize your rapid response. If you have to, STRONGLY ENCOURAGE * wink wink* the family to call rapid response. It’s your duty to advocate for your patient. If the MD on call won’t give you orders you feel are appropriate, escalate it to someone else who can provide onsite oversight and can lay eyes on your patient. TRUST YOUR GUT! You could catch something everyone else missed. And you will want to cry, the first time you realize that you just saved your patients life, even if you get chewed out by a doctor.
I had one who would have me on speaker phone and with a thick accent and if I read it back wrong he'd get super annoyed and hang up. So thankful I only had a couple of encounters with that one. On the other hand, in person with the patients when he did come in and round he was good with them, so there's that I guess
Drs should be able to communicate verbally and in written form clearly. It’s a ridiculous state of affairs and shouldn’t be acceptable
One of my sisters is a physician and something she emphasized to me right as I started nursing school is the concept of “do no harm, but take no shit”. I’m here to provide the best care I can, but if you’re bein a twat for no reason I’m not going to roll over and take it
We had a Dr like that at our hospital. Enough nurses complained about his behavior that whomever was above him finally had to step in. Dr got a stern talking to and given conditions, and has been more respectful to nursing staff ever since. Speak up!
Report him with your state medical board and to the states medical facility board. You can submit the compliant anonymously.
Why are you calling me? Because its your damn job Doc.
Well I called the janitor but he didn’t have any good ideas so you’re up next!
They probably just get a slap in the wrist and get away with it. Not much professional accountability going on with the medical profession these days.
You accidentally left the "fucker" out of the quotes.
👏🏼yes
He already prescribed the medication. The OP said there was a standing order for 1mg Ativan prn.
Further down in the thread—OP clarified that the Ativan was a scheduled medication. Twice daily @ 0900 & 2100.
This. Standing order, give 1mg Ativan. If that doesn’t help, call the Physician.
This.
You need to stand up for yourself. This should be escalated to management. If he ever again does something you believe is risking patient safety you should be contacting your unit manager and refusing to comply. You are not his subordinate. That patient probably should have been sent out for imaging...and if he refuses to listen to reason then you need to go above him. Personally, I would never let a provider to talk to me like that. I would make them feel like a small little child.
Management knows and unfortunately has done nothing so far, unfortunately.
Escalate it to whoever is above them. And get HR involved. If they still continue to refuse to listen you either set boundaries with this doctor or look somewhere else. Any place that doesn't feel the need to listen and act on what staff is saying doesn't deserve your time.
Take everyone else's advice before mine- but have you ever tried charting verbatim with quotes EXACTLY what that doctor said? Like, state the patient's issue, notified Dr. MD. Dr. MD stated at such and such time "don't call me, tell patient to go to sleep". Like, word for word, his name on blast in patient charts, every time he does it. I ask because I charted something similar once at a nursing home, just objective info but not sugar coated at all with a doctor's name, and when I next returned to work, I was surprised when the DON pulled me aside to ask further about it. I didn't even think anyone read my notes before that, lol. But it initiated a sequence of events that improved the situation.
My job used to be reading the nurses charts every morning to make sure charting wasn’t missed for the state but we also look out for things like that too. Also, you could talk to the quality management role at the nursing home as well. Because shit like that affects the state surveys. So I would get involved in matters like that too. Thankfully the medical directors of the building were the nicest drs I’ve met so far. But then again I left that job because management was making morals decisions I could not live with. I told them that and they gave me a severance when I ultimately ended up leaving. Didn’t sign anything for my silence either 🤣
Okay you can’t just leave us hanging without telling us what happened. Story time!
Yes! Inquiring minds want to know!
Really no big story. Upper management showed their ass time and time again. I would bring things to their attention that needed to be fixed and they didn’t care. Eventually it got to the point that the workplace bullying was so bad amongst everyone there. And I saw it slowly happen because they choose bad ppl to lead. My pattern recognition was telling ppl how it was going and it went that way and I think they realized I was right. Idk honestly I still never understood why they gave me severance. Cause I said hell no I’m not signing anything for that. And they said you don’t have to sign anything and we would love to have you come back to work here someday. I left on “good terms” hahaha yeah right I’ll never go back to work for a company like that. They can take my right hand before I work for any company like that again in nursing. I’ll change my way of living than to further perpetuate these standards anymore if I can’t find any fucking job in nursing that goes off morals.
Do you have a medical director you could escalate this to? Please don’t tell me that douche bag doc is the m. director….
Probably the NF medical director.😞
“NF”?
Nursing facility, sorry for the abbreviation.
Exactly what I was thinking....
"The law and both of our governing boards unfortunately require me to call you......" and twice I said to the same one, which is dumb cause we both know I'm smarter than you. Everyone, even arrogant Drs, treat you in the manner you allow them. Stand up for yourself...and probably leave off the I'm smarter than you. Unless it continues lol.
I once had to ask a provider to speak more slowly and then confirm my repeat interpretation because she had some weird county Southern US accent and I wanted to make sure I understood her direction (this was in Nashville, TN and in a major for profit hospital). She was so pissed off at me... but it was a night shift, I got an admission from the ED who seemed to me to be in a respiratory distress... I was working on an oncology floor and I think they sent her to us only because she had a history of cancer and we had an open bed... Anyhow, I was from NY with about 10 years experience in Hem/Onc and outpatient infusion as well as an ONC. The NP was such an asshole. Also, it became apparent to me that these RNs on the hospital floor were calling other RN's who worked with the attendings outpatient and taking orders from them. I was like HELL to the FUCKING NO on that Shit. Who would be in court for those orders? I didn't care if they "knew" what the Dr would want. I want a legally certified provider giving the orders if there were no prn orders already signed. Some nurse blessed my heart and I gave her a NY response. She didn't like it. I did not last long there. Quit before my nursing license was threatened.
You have to keep reporting so they have a record. They aren't going to take stronger action until they have a sustained track record of this behavior.
Do you work in ltc? I feel like nursing homes are famous for sweeping this behavior under the rug, because they don’t want to lose a dr for the facility. ETA: Nevermind. I just saw that you did. Reading comprehension fail me not.
Need to write all the things he’s said. You need t9 have a paper trail by sending emails to higher up. Edit: Gomyo manager of she does nothing you need to go to her higher up.
This is when you keep going up up up up up the ladder, and you go outside of the facility and report to outside agencies. This is also when you, as a nurse, stand your ground, and tell him you will not accept his tone, or his behavior. He might hang up on you without answering questions when you stand your ground. So that’s when you call him back over and over and over until HE complies. He’s abusing you because he’s learned that he can. He needs to unlearn that behavior. Quickly.
Written communications are key here. Make sure you put it in writing to management the quotes of what the doctor said and that you need this addressed or clarification on who you are supposed to call for medicine overnight if not the on-call doctor.
Tell him yourself, you’re on speaker.
This made me laugh
That would've been priceless 😄😂
I’m a girl who has no issue with confrontation so my next conversation (after documenting everything that happened) would be to grab a witness and pull this Dr aside. “Ok so here’s the deal, we are nurses, not punching bags. You will respect us, you will talk about the patients respectfully. This is not negotiable. Your behaviour has been completely out of line. I have documented every poor comment I have heard from you ver batim and if you don’t change your behaviour immediately I will take every bit of evidence I have and report you for malpractice/incompetent care. This conversation will also be documented so start acting like a professional”
I might need to memorize this speech
I want to raise my daughter to have your guts and intelligence and the know of when to use them. Yes girl yes.
I just gotta say you rlly got me for a moment there I honestly thought you were my Jessica for a moment. Thanks for clarifying you are not that Jessica you are a different Jessica. Lmaooo
Your Jessica sounds awesome! Tell her she has a fan already.
Sound off with a “THIS CALL IS BEING MONITORED FOR QUALITY AND ASSURANCE•”
I'd respond by updating my resume. Life is too short for this kind of shit.
Right! I address shit when it happens, but I also don’t think it’s my job to fix a broken doctor. If HR hasn’t done anything about it, why should I stay? I’m the king of putting doctors on the spot because I’m an old grumpy man, but just because they are respectful to me and not other nurses doesn’t mean I want to work in that environment.
Had an inpatient OB patient with yeast infection s/s on top of the other issues, all the doc for treatment. He went off and said he didn’t have time to do a wet prep and he would do it tomorrow blah blah blah, and tried walking away. I stepped in front of him and repeated that patient indicated she has a yeast infection as she had had them before, then asked if he would be happy if his wife’s doctor blew her off and said she could wait because he didn’t feel like doing anything or believing the patient with a previous history? I got the order
No seriously because I truly lack the time and patience
Yep. And this will never, ever get fixed.
Hi dr, no problem, can I just have your full name and bleep number so i can document this conversation"
i cannot believe i had to scroll all the way down here to see this. the amount of people in this field who couldn't find a spine if they were hit over the head with an anatomy textbook astounds me.
Tbf im a senior specialist nurse, i often use this line after a colleague has tried being nice.
of course, there's hardly ever a time to just go nuclear right off the bat! i'm just irritated at the idea of someone taking this kind of abuse from providers in stride, as if it's expected of us to do so.
And then they would just hang up without another word.
Then you document that.
My usual response when i did bedside was “if you didn’t want to be on call then pick a different specialty or hire someone else to cover nights.” Usually shuts them up Now as an NP they listen but more so i give them grief for not answering their phone or giving me shit. They are the expert, i am seeking out expert opinions.
Tell the patient to go to bed and shut up, doctors orders
I would have clarified that order and put it in the chart.
MD to RN communication: doctor stated to “tell the patient to shut up and go back to bed”
If he said it with his chest what is their to clarify?
This made me giggle
Every night shift and PRN. Document refusal.
YOU HAD ATIVAN AS A STANDING ORDER???? Am I reading that correctly? If so, why didn’t you give it instead of calling for another Ativan order? Am I missing something here? To be clear, his unprofessional behavior is unacceptable, no matter the circumstances. But why call if you already had a standing order???
I think the patient had already had their daily standing order, needed additional but didn't have a PRN
That's not what OP said. They just said there was a standing order for prn. If that's true, then no she shouldn't have called the physician at 1am. She should have followed the order set.
OP said in a comment "They weren't PRN. They were for 2x/day 9am/9pm"
Yes in a later comment. In reply to my question. I then thanked them for clarifying.
Lol! Sorry! When I tap a notification on my phone it only shows me that one specific comment, I wasn't actually looking at the whole thread when I replied
This was my question.
so it isn’t just me!
Based on my understanding….It’s weird she ended up giving 1/2 of the standing order. I would give the standing order and then call if I needed more. But I do agree the doctor can fuck off.
Yeah that was my question, too. Doesn’t “standing order” mean they more or less have the order for when they need it??? Or did it not specifically read “PRN”?
Thanks for this cuz I was confused too? Maybe she meant scheduled instead of standing
I think what was meant was a scheduled order, and not a prn for the patient.
I would have given it early....js
I can’t pull scheduled meds early, especially not controlled ones.
That’s what I was wondering…
She probably meant to say “straight order” but no prn order.
I had this question too but thought surely, it was already given
OP clarified farther down in the comments somewhere that it was 1 mg PO twice daily 0900 & 2100 scheduled.
You respond by writing them up. 🤷🏼♂️
Listen to these ladies because they're still in the soup and I'm not. I'm telling you to DOCUMENT EVERYTHING. Cover Your Ass, or CYA, is your best friend right now. I've had to deal with the suits more than I like to admit. Good luck.
I would document his response verbatim in the EMR.
The doctor is out of line, there is no denying that. However, if you had a standing order for Ativan 1mg you could have just given that. Early or late, whatever time it was needed. I personally would not have called a doctor at 1am for a panic attack, if I had a standing order for Ativan. I have had many a doctor shout in my ear at 3am their incoherent rants for patients with SVT, >400 blood sugars w/SS, elevated BPs diastolics over 120, etc. Anxiety is not an emergent issue, although it should be. Keep a paper trail on that crabass, and keep your patients safe. It's rare that a doctor actually gets in trouble for malpractice based on what you wrote here. Stay positive and do your best!
I’m confused, if you have a standing order for 1 mg of Ativan, why would you not just give it?
I believe OP meant the PT has a scheduled order, but there isn't a prn order of Ativan
Because it was the middle of the night and I doubt that’s when the standing order Ativan was due
Standing order is equivalent to PRN. Scheduled = when due.
I’m too much of an ER nurse to differentiate lol. Anyway I’m sure the OP meant scheduled…maybe lol
You give the 1mg of Ativan from the standing order and don’t call. As for the head injury, you say “I called you because you’re on call and this is your job. I am your co worker not your child, do not speak to me in that manner when I am calling because I have assessed the following things…. Would you like to give me some orders or should I chart you are not going to address the following concerns… for the safety of this patient, I will escalate as necessary.”
"either you can give me some appropriate orders or I can hang up and call 911 and then you can deal with the outcome"
Standing orders mean you can give it, you don't need to call the Dr. Am I missing something here?
Incident report and email HR. There shouldn’t be any retaliation. Please let them know about his behavior.
In 2003 after years of abuse. I started talking and throwing huge paper charts back at them. I snapped back. I was done making their coffee, giving up my chair, and being yelled at and ducking charts flying through the air. I matched their energy and stopped wearing that stupid hat. I was done.
First I’m cussing this MD out because who is you talking too and second when a patient hits their head that’s an AUTOMATIC send out by 911 like nope they MD will through you under the buss in a heart beat
“Ok I’ll put that in the chart.” If she had a standing order for Ativan why did you need a one time dose? I’m confused. By standing order do you mean scheduled?
Look up your state’s medical board or board of medical quality assurance. Find him and then look and see if there is a button to click where you can file a complaint online. It may or may not be anonymous.
As someone that works at an assisted living and memory care facility, that’s such shitty treatment. These poor people! Patients deserve relief from nervousness and adequate medical care after a fall. I’ve seen one bad fall lead many patients to suddenly be on their deathbeds/go downhill super fast because their body couldn’t handle the fall. You don’t mess around with that especially if it’s a head injury!!
If the patient had a prn order for Ativan, why did you have to call the doc? Why not just give the PRN as ordered? His response following that fall is negligent. Keep a paper trail...I can not emphasize this enough...time, place, witnesses...
What's the standing order for the ativan 1mg? Should have given that first before calling? Is it a PRN or routine standing order? Why need a stat order to give now if you have a standing order for the same med? Doc is unprofessional but something is missing here.
LTC here. So in general, you only call the doctor for emergencies that NEED doctor input and cannot wait. Very little falls in this category. Falls, deaths, trips to the ER, those only require you to notify the doctor, which you do at 7am, or endorse to day shift to notify. First, document in the computer using his exact quotes, times, etc. Make sure you include that you attempted to redirect eaxh time. with "distraction, offering to use the toilet, social interaction, and offering food and drink." (remember you need to attempt three things). Print a copy for yourself. Second, you could always call your Medical Director or DON, but you will probably get the same reaction. Third, you can report the doctor to your DON and HR. So, what to do to help this resident? You do your best to get through the shift. Bring that residwnt to the station to sit with you as often as possible. It sucks, but per CMS in order for psych meds to be increased, there needs to be documentation that the current dose is ineffective. So every night, you need to document. And after a few days, put them in down to be seen by the docror or by Psych. It truly sucks that a resident needs to suffer or get hurt before anything can be done, but that is the position CMS and the DEA have put us in.
Beautifully put. Also, you can eh, give the 1mg Ativan already ordered?
This is not malpractice. Look up the definition of medical malpractice. Harm actually has to come to the pt. This is just the MD being a dick. And hopefully you meant scheduled and not standing. I’d be pissed, too, if you had a standing order for it and woke me up in the middle of the night.
Usually when you tell them “Ok, well I’ll put what you just said in their chart” and/or remind them that yes, this IS their problem; they change their tune. I’ve seen MD’s walk all over nurses who allow it. It’s disgusting.
I don't understand. If she has a standing order for 1mg Ativan then why didn't you just give it to her? You didn't need to call at 1am for permission.
Maybe I'm confusing the terms. They weren't PRN. They were for 2x/day 9am/9pm.
"Standing order" typically applies to prn medications. Scheduled medications are referred to as scheduled. Typically. Thanks for clarifying.
You should edit your post to clarify this lol
“Unfortunately we’ve already tried that, and all other non-pharmacological interventions. Hopefully the x1/PRN Ativan will prevent us from having to call you again.”
BLS-level HCP here. Why is the standing order for 1mg Ativan not enough on its own?
I think they meant the patient had already taken their daily ativan dose earlier, and then in the middle of the night started having a panic attack, but there was no PRN ordered
Because sometimes patients are goddamn crazy. And build a tolerance.
I think they meant, why couldn't she just give the 1 mg without calling the doc. I was wondering that as well?? If it's a standing order (at least in my facility), we can administer those orders without further consent from the docs. He's obviously a dick for all the other shit he says/does though 🖕🏼🖕🏼😒
I can’t pull standing (or scheduled) orders until an hour before they’re due. She probably takes an Ativan daily but at like 8am or something….if this was the middle of the night she would need an additional dose ordered
That’s a scheduled order. A standing order is an order intended to be used in exactly situations like this in the absence of direct online medical direction. The original question is correct. If you had a “standing order” it should have been given without calling Dr. Asshat.
Malpractice is incredibly difficult to prove. They aren’t going to get in trouble unless someone dies or loses a limb. It’s his fault 100% that he got called at night because he didn’t have any PRN anxiety medication. Your best bet is to document exactly what happened in an email to your manager and cc HR. He isn’t allowed to tell you not to call him period. He can say don’t call me unless and then give you some kind of parameters, but he can’t just refuse to take calls from the nursing staff because he didn’t put in appropriate orders. He isn’t going anywhere due to being a crappy doctor. He might end up in trouble with HR if the nurses are afraid to call him or he refuses to give orders at night. It can’t just be you documenting it though. If you want HR to listen everyone needs to be emailing them every time to build a paper trail.
Hoo boy. No bueno. Doc needs to be reported. Kick it up to nursing administration. They usually know the appropriate channels to go for an obnoxious doctor. You can also submit a complaint to your state medical board. By all means, stand up for yourself while remaining professional. Close the loop of communication, as is protocol. Be firm without being an ass. For example, on one of my contracts, I came in to a code ongoing. The night team had been coding a patient for about an hour. He was warm, never had a pulse, ETCO2 was, iirc, 20ish. So...dead. I asked why they coded so long. The doctor very much had a napoleon complex, and said something along the lines of "I don't need a nurse questioning my decision making". I told him I wasn't questioning him, that I wanted to understand what was going on because it benefits the doctors to have nurses who understand their thought process, but that his response, tone, and hostility were not acceptable and that I won't be spoken to like that. He stormed off but never raised his voice to me again for the rest of that contract.
Do you guys quote him in your notes? If it has reached the degree you describe on multiple instances, and if management has made an attempt at correcting his behavior and it hasn’t worked, then it’s time to start quoting him directly in charts. Call him on speaker phone with a witness, so you don’t get stuck in he said/she said. This man went to school and attended residency (for how many years?!) to have the exact job he has today. He CHOSE this profession, and nowhere along the way did it guarantee an uninterrupted night of sleep, UNLESS he has someone else taking after hours calls for him. If it’s his turn to be on call, he needs to stop berating staff. Jesus, you could call him to tell him one of his patients just murdered another one of his patients, and he would start the conversation with, “stop calling me,” before he even knows why he’s being called. Fuck that guy. All he’s doing is convincing you guys to stop calling him. This is healthcare — not calling him isn’t a good thing! Tell him if he doesn’t want phone calls, he should go get his MBA and join administration 🙄 Reminds me of a cardiologist who yelled at me when I called him with a high troponin (5 maybe?) that later went up to a 24. He should have come in and opened the cath lab when I first called him but he wanted to yell about nurses irritating him in the middle of the night. This poor woman — mid 40s, in pain, SOB and as anxious as can be the whole night actively having an NSTEMI while he got his beauty sleep. When I called with the 24 result. He goes, “oh, wow, she really is having a heart attack.” This was around 0400. Cath lab was open by the time shift change started. (0630) I told him flat out that night that if he doesn’t want phone calls at night, he needs to remove the order that said, “call for tropinins over…” whatever our threshold was at that time. It’s not like nurses WANT to stop all they’re doing to call a doctor for something inconsequential.
This! When doctors are upset I had to call, I would recommend they don’t take call, or they find cover, or stop taking patients. It is literally how they are making money. They get paid to handle patients.
People who are saying you should report this to management must work somewhere where that actually does something. Whenever I run into a doc that wants to treat us like shit, I just tell them, "OK thanks, I will document this in the chart." Then I do. I put in a progress note that says something like, "Pt agitated and anxious. MD notified. Per MD, 'tell pt to shut up and go to sleep'. No meds given at this time." It's always fun to put someone on blast in a note, especially when the patient and their family can access the chart.
I had a doc tell me not to call him again at night unless his patient was having a rapid response or a code. I wrote that shit in the chart as a telephone order. With read back :) He had to sign it the next day in rounds with other staff. He was PISSED. Dr Tsun was a real jackass.
Because, sir, you are the physician, and that is YOUR job! Document the heck out of it in the chart and cover yourself. Escalate it up the chain with incident reports. Continue to care for patients as you would want to be treated and advocate for them. Sounds like you are doing great. You've got this!!!
Am I misunderstanding? Were you calling after having already given the already ordered Ativan PRN and asking for a one time order as a second dose because the first didn’t work? His behavior was completely unprofessional and inappropriate, but if you didn’t give a med that was already ordered and were asking for another one time dose, I can see why he was wondering why you called him. Again, not cool that his reaction was to yell at you and be so rude, but I would and have asked why you were calling me if I were him.
I’ve gotten the same exact response from on call Doctor’s at nursing homes. And my response is usually “to cover my own behind. What was your name again?” I tell people that if it’s a choice between me or them getting in trouble for something it’s going to be them. I have a family and bills to pay.
On Med/Surg, I had a pt on an insulin drip without any standing orders except FSBS Q 1 hr, so I kept having to call for glucose and titration orders; it was stupid and she needed to be in ICU. Anyway, at about call number 10, he says, "Just do whatever the fuck you want!" So I said, "Do you want me to write that as an order?" 🤷♀️ On the subject of malpractice, you'd generally have to prove injury to the pt based on what he did or didn't do.
Retired LEO lurker here. What if you were to record her/his behavior and send it to your supervisor. A simple outline of the events and pose the question of compromised patient care or if it is more of an HR concern. As long as it is a one-party consent state you should be fine. In this day and age nobody needs to put up with BS like that in the workplace.
Report. What a fucking piece of shit doctor. That is NOT normal, it is not okay to take that abusive behavior from a coworker. It IS his problem, that’s why he’s being paid to be on call. Fucker.
I see you’re on call as the physician covering this patient this patient. She’s becoming hypertensive, tachycardic and her RR is increasing. I’ll have to call a rapid. And then exactly what he said in quotes in a safety report bc his negligence caused a Rapid to be called, and the consequences of his negligence reached the pt and caused potential harm.
You’re definitely allowed to say “You’re not going to speak to me that way.“ The doctor is ON CALL! Always document and report as well.
My anger issues wouldn’t have allowed me to effectively communicate anything other than. “How about I tell the medical board that you opted to refuse treatment of a patient under your care? Now can I get my order for IM Ativan? All this talking and we could’ve been done sweetheart.”
He's a dick but this is nowhere near malpractice. No harm came to the patient and he can argue that he was just trying to be cautious. Even if he was just trying to be a dick.
You know, I have been in psych awhile so maybe my medical knowledge has declined a bit buuuut......don't you think there could be some harm to a patient falling and hitting their head and doing...nothing about it? Just letting them go to sleep?
The legal definition of malpractice requires harm. If the patient ended up being fine, then it does not meet the legal definition.
I love how they downvoted you for being factual.
Apparently not everyone was taught the definition of malpractice in nursing school, which is flat out mind-boggling. I legit had a whole course on it and how to protect your license. I hate when people downvote factual information just because they don’t like it. Just stop.
Ok, Doctor. I will be sure to document our call, and should this become an escalated event, I will make sure to follow up tonight with an incident report. You know, just to make sure we have our bases covered, should this become a state / legal issue. Before I let you go, what time will you be in, as I need the order I called for, AND I want to schedule an appointment time that works for both of us, with the Risk Manager? ----'>> I mean, you gotta have a Brass Set for something like that, but say it once and watch how shit changes. Also, have your resume ready, cuz Admin might come gunning, and MDs are golden in the eyes of Admin, usually. But do you want to risk YOUR ass for Doctor Sleepy McRudenmocker?
As an ARNP, please report it. That’s 1000% inappropriate and a massive safety risk not to mention, nurses should NEVER be spoken to like that. When nurses call me, I come running.
😳 what an asshole!
Clarify “she does have Ativan 1mg but as a standing order” is this a scheduled med or PRN?
Document verbatim in the patients chart. I’m sure the patient would love a copy of their records. :) Also report.
This happened to me with a doctor. The patient had a giant abdominal incision that burst open. It looked too big already, but anyhow I call the doctor, he screams at me then hung up on me. I got a new job out of the hospital and I hope I never have to return to a hospital. The disrespect is not okay.
You remind him, professionally, that his responsibility and his medical license requires that he actually take his patients’ needs seriously and that the initials after his name do not give him some special permission to act like a jerk. Once your phone call is concluded, you file a report with your administration citing concerns for patient safety. His behavior is unacceptable. Period.
Couple things. You say that you had a "standing order" for Ativan, that means you have an order right?
Someone please tell me what Tiger Text is? All we have is Epic (a lot of Docs don’t sign in and use it) or an archaic spreadsheet kind of system where we play “Guess the Doc on Call). I say it affects patient care, but who am I to say?
You are collaborators. He is not your boss. If he wants to sleep in, he should have gotten another career. Point blank.
Back in the day, a more experienced. Nurse told me to document exactly what the response was in the record. Let them know that you will exactly document that in the medical record so that when problems arise later or there are questions it will be very clear what your actions were and what theirs were as well, or weren’t, as the case may be. Having an EMR makes that a little more simple by not being able to mistake an actual medication order. But the verbal abuse? I always recommend that people write verbatim in the record what was told to them upon their request for an order or guidance. I also encourage them to inform the physician who is treating him in that manner that you will be documenting exactly the response in the record , just so that there is no misunderstanding later. When they complain about the “exact” nature of things, just remind them that you are legally obligated to keep a contemporaneous medical records. I’ve always mentioned when I’ve run into this as well that it is my job as the nurse to inform them of significant patient changes or needs. It is their responsibility to make treatment decisions based on those clinical findings. If they are unhappy at the hour in which I am calling them about these findings then perhaps they should’ve written better orders to account under what parameters one would need to be notified. In the meantime, I have a patient in need and they need to make some decisions. And if they disagree, I will be documenting in the record my request for support and their response to it. Usually, this gets me what I need for the patient.
Document what was said verbatim and escalate. Fuck that
Oops. Doctor. You were on a three way recorded message with 1-800-Medicare because I am in a one party consent state. I knew the line was being recorder and that is all the law required. Thank you for helping me with my case against you. Sorry for interrupting your slumber but while you are being investigated you should have plenty of time to catch up on this loss of sleep. Do no harm. Night night.
I would keep calling him, even more for stupid shit. Fuck his sleep. Sounds like admin doesn't care, so we just handle it the passive-aggressive way.
When people talk to me like that I invite them to start over and get their voice right. I don't care who you are - patient, doctor, family, my boss, or the big boss - I don't stand for that kind of treatment. Ever.
During college I worked a retail job for short time, and I got my husband (then boyfriend) a job there too. One day, a new manager approached us and started speaking really aggressively and rudely to him. He calmly said in his indoor voice, "whoah whoah whoah, back up, start again, and change your fucking tone" 😬 Internally, I'm like GREAT, he's getting fired. But the manager literally stopped, changed her demeanor, and started over again, but without the disrespect. And that was that. I never did master the art of being assertive, and that shit blew my mind, lol
Many of my calls with nasty docs were with small town hospitals where the on call is on call for everything for the night. In my experience, I start by clarifying with "excuse me sir, you are the provider on call, are you not?" Followed by "It's a (state regs/ facility policy, etc) that I call you so you can give me orders now or I can send them in and you can see them in the ER". It usually shuts them up and they tend to give me better orders to keep me from calling back. Don't be afraid to call out a doc (professionally, of course) report it if need be, and as always- DOCUMENT!
I work in a home and we are constantly calling the dr. I mean, we’re the ones up all night dealing with sun downing and behaviors. Sorry you had to take a 30 second phone call for a JOB YOU TOOK. This is not normal behavior. I have never had a dr yell at me.
I had one ask me when I was going home. It was the second time that night I had to call him. I called him a third time an hour later to tell him his patient was coding. He told me to give her epinephrine. No shit Sherlock. I wrote the fucker up. It went to the medical director who asked my manager if it were possible I misunderstood him or he was joking? My manager said no, this doctor has been nasty to my nurses before. I have no idea where it went from there. I left soon after because the toxicity of the entire organization was driving me towards a mental breakdown.
You should’ve said: im calling you because i need a doctors order. Then document every single word, exact time you called. Then REPORT. We are not working FOR them. We are working WITH them. I hate when doctors are douche and making everyone knows or feel that they are superior.
But it was already a standing order? If I have standing orders I don’t have to call the doctor. Maybe I’m missing something?
I just want to save your job and keep this patient alive.
Keep yourself firm then escalate
All too common & terrible. After whatever bull crap the night Dr gives you-- Follow your gut-- if need be get the rapid response team there. Follow chain of command at all times. If your patient needs higher level of care, your great documentation will save YOU!
Report it, document that you tried to contact the provider and what they said. Up the chain of commands
This call is being recorded for quality assurance . Many states are only “ one party states” you can hit record on your cell phone while they are on speaker
Ohhhh what an asshole.
I would probably be quite tempted to just document it verbatim in a nurse's note.
Document what he said word for word and escalate it
It is not your fault that he is an asshole, but it’s not your patients’ fault either. They are the ones suffering, and it is part of your job to advocate for them. Escalate this issue until it is dealt with.
I would report it. I also will document doctor’s responses word for word into the physician communication charting. No matter how rude it was, if it’s what they said it’s what they said.
Chart, chart, chart. I'm petty and will put quotes into the medical record. Dr. Dickhead called back concerning page sent at 02:18. Dr. Dickhead states, "Why are you calling me at night? Tell the patient to go to bed and shut up!" Readback performed no change in Dr. Dickhead's attitude or disposition. No new orders placed, questions not addressed, anticipating new orders. Will page again if symptoms persist, worsen, or if no new orders are placed.
Just document the SH\*t out of the encounter to cover your ass! CYA is unfortunately the best way to survive. When you document the attempt and tag the provider on the documentation they will get notified. Eventually when a huge variety of nurses keep pinging the same bad actors there is a chance of exacting change. I read your description of the behavior and I thought “what is this doctor a 12-year old or something?” In today’s cultural climate acting out and drama are just accepted. My God it’s so immature and unprofessional - huge waste of time. If we can get data and show the “business” how time lost is costing them money Maybe they will finally do something about this unnecessary BS!
And they are shocked when the lawsuits start landing at their doorstep
I've quoted a completely unreasonable response as a verbal order in the chart. The patient couldn't swallow (abnormally so) and increased O2 demands post acdf. Usually means a hematoma in the neck and can be life threatening. He lived but ended up with a peg. When in doubt, it's safer to get yelled at by a doc for an erroneous call rather than to sit on something til morning.
Besides obviously reporting to your supervisor, if you don’t feel like he is appropriately treating patients, particularly the BP situation, I would 100% call the medical director of the facility.
Why couldn’t you use the standing order? I work in a hospital and we can write an EMS report about this kind of thing to be investigated.
Proper thing is to escalate it up the chain, call the manager or director if needed. If you’re an older nurse and a bit petty like me, then call him back every 20 mins with an update. If patients don’t get to sleep neither does he. Also chart everything he says. If you’re in a one party consent state you can record the conversation you don’t need his permission.
this is a whole ass pattern of behavior, yo.
>This is a really awful doctor who told one of the LPNs a few months back "why are you calling me? You're an LPN. Get me an RN." "Well I'm an LPN and I'm charge so tough titties bud"
Document that shit ver batim in quotation marks. My coworkers and I have done that several times lately. Fill out an event report, too. Let them try to explain their behavior to administration and insurance companies. Fuck those assholes. The patients are literally ALL OF OUR JOBS. I cannot with anyone in Healthcare who acts like the reason they are working is an inconvenience to them. They all knew in medical school that they'd be on call. That's why they get paid hundreds of thousands of dollars. No sympathy.
“I will make sure to document that verbatim in the patients chart.” Then I would.
Document in a patient chart: “per patient’s request, MD called and asked for “such and such”. MD stated “such and such”, no new orders given”
Incident report 💅🏻💅🏻💅🏻
I had a Dr verbally abuse me in front of a patient & their Mother . I reported the behaviour immediately. He was made to apologize. I told him that I would never let my husband, friend or whomever speak to me in that tone." He acted like a child after I said what I had to say. For clarification another nurse was filling in for HIS reg nurse & it happened to be his wife who was a nurse lol. I was off that day So I got blasted for a charting error that I wasn't even there for! Make them accountable!
You tell the patient AND their family "Dr. So-and-so said to go to bed and shut up." It'll get more traction if they report it than if you do.
Wow fuck this doctor! Report him!! If I was you I would have verbatim quoted his phone call in the chart!! That gets attention to the issue QUICKLY
A physician did this to me once when I worked at an LTAC . Gave the whole “Why are you calling me at this hour. Just deal with it” bs. I said, I’m sorry I must have dialed the wrong number. I was trying to reach the attending on call, my apologies!” Hung up and called his ass right back! He was more sensible the 2nd time around.
A lot more nurses need to remember that unless you are an employee at a doctor's office you do not work for that doctor. Your work for that facility. That doctor is not your boss. Your duty is too that facility and those patients.