Doctor’s orders…

When working in the ED, nurses expect to care for many different types of illness, disease processes, populations, ages, and more. We can also expect to work in many different styles of departments, with doctors and nurses of varying knowledge, experience, and personalities.

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Overtime, I have learnt that in every department you will expect to find a handful of similar personalities, especially with the doctors. Initially, you will recognize the “laid back doctor”. This doctor will be comfortable with nurses ordering test, initiating fluids, and generally trusting and being “OK” with most of what the nurse feels needs to be done. You will experience the “uptight doctor”, who feels nothing happens unless cleared with them first. You might experience the “old timer” who feels that everything needs to be a doctor’s order, including the saline lock. You will experience the “younger doctor” who will actually do many tasks on their own like actually take a temp! There are “teaching doctors”, and those who don’t want to teach, the “personable one”, and even some that are down right cranky. I have worked with some amazing doctors and some that I wouldn’t trust to care for my family. Over the years, I have seen an increase in female ED doctor’s, and I will say, the female doctors are usually amazing; however, some carry the stigma of needing to prove themselves and this can develop into them having a few sharp edges.

I did experience this phenomenon in one of the ED’s I worked.

Cool Wind

It was late in the afternoon and I was carrying for a young diabetic patient, of approximately 10 or 11 years old. I had only been caring for this patient for a short time and I was anticipating new doctor’s orders. When I finally received the chart & orders, I noted that insulin and a few other medications were ordered. With pediatrics we are extremely cautious, and this case warranted the same level of caution as usual. I found a co-worker to come with me into the medication room to double check the orders and co-sign the medications. Although describing the facts up to this point may seem simple, the process was in fact more time consuming. The chart took quite some time to be processed, finding a co-worker was not simple, and drawing up the medications with a double check always takes a bit of time. Once I was ready, I took the medications to the patient only to find out his mother was not in the room. The patient did state, “I think she already gave me my insulin”. Wait, what? Twice more I had to return to the room before the mother had in fact returned and verified the medication had been given. The mother stated, the doctor had approved and encouraged them to give their own insulin. I nearly lost my mind! 1. It was a good thing I waited to verify with the mother and didn’t just give the insulin and 2. Why did the doctor write the order knowing the mother was going to administer the medication? The risk that this child may have been double dosed on insulin because of a doctor’s order is terrible! I approached the doctor to verify the order/directions to the mother and explained my concerns. My concerns were not received well, my time for prepping this medication was disrespected, and the potential error was dismissed with the comment “well, you caught it before you gave it, didn’t you?”. It was the sharply stated “what do you want from me now, an apology?” that left me so angry with this female Doc that I felt compelled to inform her on how she should document her orders to reflect permission to the parent or at the very least communicate this with the nurse. Knowing the parent may give the medication, would have changed my approach and saved me tons of time by checking with the parent first among other things. The story ends well with the patient avoiding admission, but this wasn’t the first or last time I would experience “sharp edges” with a particular gender of ED doctors…

Do you have a similar story? I’d love to read about it in the comments below!

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IMG_1560Trudi

(Disclaimer: As always, I have left out any identifying details to protect the confidentiality of the patient, this story may not have taken place in the state or facility talked about in this blog post.)

 

 

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