If you cant read my writing I dont know what to tell you.

Ok so I have noticed an influx of nurses who have a hard time dealing with doctors...I recently (actually yesterday) had a phone confrontation with a doctor.Ok so I called him to clarify new orders and from the start he displayed an attitude.I said to him that the reason I'm calling him because I noticed that he added new blood pressure medication for my patient (she was never on blood pressure medication before this is new to her) and also he wrote in to stop her iron pill but he didnt specify if it was a temporary hold or the permanent one.Mind you this lady has a iron deficiency anemia and she ended up couple of days in the hospital with severe abdominal pain (due to her hernia) also during her hospital stay she turned bradycardiac,so her admission diagnosis was severe bradycardia.The lady has been taking iron pills for ever.However,before ending up in the hospital few days ago she recently had a blood transfusion for the excacerbation of her anemia.I dont know the whole story (if she has been compliant with her iron pills-personally I dont thinks so cause the first time I was there her meds were locked up upstairs of her hourse,mind you she is not my client (I was filling for another nurse) Now after this recent hospitalization for the abdominal pain and brady the doc decides to write an order to stop iron.I asked him why he is stopping the iron and he got upset and said because of her constipation (ok but you also wrote a prescription for Colace).I mustered up the courage and ask :but are you sure cause she has iron deficiency anemia) He said we a rude tone "Yes,I'm sure" I was like ok...whatever.Then I questioned him about his order for the ACE inhibitor,I told him that I checked her home chart and her blood pressure has been running normal and he said yes because she is on the ACE inhibitor and I said no she is not cause she didnt fill in her new prescription yet (she got out of the hospital couple days ago) Then he tells me well she better get the meds now!Then I tell him can you vertify how many pills she is suppose to take for each med-I swear I could not read some of his hand-writing especially the numbers (it didnt even looked like 1 more like half) Anyway,he gets really rude with me and says "If you cant read my writing,I dont know what to tell you,all I get is compliment for my writings,no ones ever complain.I proceed to explain him that I'm new in reading orders,that I'm a new nurse.My words kinda break the ice and he speaks more politely after hearing that I'm new.Still though I question his sanity and orders

Ps.O I also forgot to mention she is CHF (altough doesnt display typical symptoms).She is 87. Last edit by Blackheartednurse on Jul 7, '10
My cousin doctor usually receives calls for prescription order clarifications. I hear her talk to nurses when we're together and she is always polite, no matter how simple the inquiry was. Even if it were to ask about adding a fever medication. It was right of you to ask. But I would document it in the chart that I called the doctor to confirm the order and that he said the order stands

Sounds like Doctor Personality has a personal issue, which you do not have to buy into. You are advocating for your patient, and doing your job, within your scope of practice. He knows damned well what your scope of practice is, and that you were well within your means to question. I agree with Doza, document your clarification call. Any nurse worth a grain of salt would have done what you did. Kudos to you!

There is an art to calling physicians. First off, remember that s/he is the doctor. S/he went to med school. S/he diagnosed the patient and prescribed medication which is within his scope of practice, not yours. Yes, in HH you are his eyes and ears and you are part of the team to provide safe care to the patient, but it is helpful ESPECIALLY as a new nurse to remember the differences in your respective scopes of practice. Secondly, the doctor is busy. I promise. So know what you need to say and be concise, especially since the doctors do not know you. We give all of our new grads SBAR forms so that they can actually fill them out before calling the doctor. When you call, it might help if you start out by saying, "Hi, I'm xxxx and I'm a new nurse. I have a few questions about your patient xxxx. Do you have a minute?" You should also have the most recent labs in front of you when you call. The patient has a history of anemia, what was it the last time it was checked?Finally, please review your drug references before calling the doctor. ACE inhibitors should not cause or exacerbate bradycardia.

If the patient has CHF, then the ACE inhibitor was likely prescribed to comply with CORE measures, as it is a requirement for a CHF patient to be on an ACE or an ARB (as long as there are no contraindications such as CRI, hypotension, true allergy, etc) with a diagnosis/history of CHF and an EF of <= 40%, whether or not they are currently symptomatic. As for d/cing the iron pills, I have no idea. It is a shame that the MD was so rude to you over the phone, instead of taking a minute to explain his reasoning to you. Unfortunatly, we do have to deal with this sometimes. Do not let this deter you from calling in the future to clarify orders, though. Remember, it is YOUR license on the line!(I will add that I had a patient a few weeks ago in the hospital setting that had a chronic anemia that was being treated as iron def., but when the HEM/Onc did further testing, realized that it was NOT iron def anemia, and promptly stopped her Multi Vits and Iron pills, saying that her IRON reserves were very high, and the Iron supp was harming her rather than helping. I added this to tell you that there could have been a good reason, even if the MD wouldn't explain it to you. )

Ok this is what I think has happend.I definitely think that the lady was experiencing constipation due to her iron.I really believe that she run out of her benefiber (she was taking it for her constipation) and no one bothered to refill it for her.I think she was straining and that is what caused the bradycardia..and therefore she ended up in the hospital..When I came in yesterday to see her her pulse was still low radial 60,apical 64.I would understand if the doctor would want to hold the Iron temporarily but what is the purpose of adding a new med (colace) to her medication regimen and then d/c Iron forever,doesnt make sense to me seriously.As far as Lisinopril,ok I understand if his reason for presribing ACE inhibitor would be for CHF,but no he said "Hypertension" that she did not have.Ok possibly she might have been hypertensive during her hospital stay (due to severe pain) but like I mentioned before according her home chart she runs a normal blood pressure without out any blood pressure meds.I would love to follow up on this patient,unfortunately she is not my patient.I love nursing,its like a puzzle you have to put all the pieces together

During my first year I work with a well known "difficult" Dr. in my facility. I had many "questions" whyhe prescribed a certain Antibiotic via IV instead of PO. When I asked him why; he said " Honey, before you askeda question you need to educate yourself". It hurt my feelings but the lousy comment made me a better nurse.

Quote from BlackheartednurseOk this is what I think has happend.I definitely think that the lady was experiencing constipation due to her iron.I really believe that she run out of her benefiber (she was taking it for her constipation) and no one bothered to refill it for her.I think she was straining and that is what caused the bradycardia

Quote from kloneI assume you didn't take her vitals while she was on the toilet. Generally, a vagal response only affects HR momentarily. If you took her vitals an hour later, she wouldn't still be vagaling.

If I can't read an order, period, I call the doctor or get the shift coordinator to do it (if I'm new somewhere). If I can't read a drug, I don't give it no matter what. I clarify and question everything. I have seen nurses nearly get into very hot water from not questioning order/s, or not assuming an order said one thing, when it said another. It wastes time questioning stuff but it is a necessary part of the job.

Well I looked up the caused of bradycardia. Too much iron in the body can cause bradycardia.