Everyone who knows me has heard me preach about why us Nurses need to stand up and advocate for our patient's, here a great example. I have a pt 9weeks preg, severe hyperemesis placed on TPN at home. Picc placed at hospital  rt antecubital vein, TPN is delivered. I change the pressure dsg site clear all okay so far, I check for blood return there is none, manipulation etc ( I am a PICC Nurse) so all my tricks and still no blood, then I learn from the husband that the tip was NOT verified because she is preg they did not want to do x ray, the pt has been complaining of pain in her chest area and rt arm pit area since placement, the hosp infused an intire bag in and this pain has been since that infusion. She has been bent over throwing up in toilet several times a day, my concern is the tip may have migrated with all the emesis and force of vomiting,I have seen this happen, I call the doc it was late last night, on call doc is a jerk, telling me "its okay where is the tip going to go" he yells, did you want me to give you a list of places? I responded to him, well just infuse the TPN it is too late tonight to do anything, I said will all of her complaints and not having it verified I am not going to make the call that it is in the correct place, I said I will document clearly my objections and then document that YOU are insisting the TPN be infused, that way when we go to court, the ball is in YOUR court! And you can explain why you did something against better judgement, He then said " well don't do that, just have her go to have it x rayed but I am sure it is in the right place" I responded well are you willing to loose your practice over it? He said well NO I said neither am I, she went to have it x rayed and the tip was deep in the subclavian vein twisted and caused a tear and it was enbeded in the tear. GOOD THING I did NOT infuse, they had to pull the line and use a different vein altogether, the radiologist called me and told me had we forced continuous fluids she could have had a big problem. I made sure the jerk doc on call new this, he appolojized to me. Never let a doc intimidate you into doing something your gut tells you is wrong, I always follow my gutt. We need to be able to stand up and advocate for our patient no matter how big a jerk the doc is.

 thank you

Good for you.  Your patient was lucky to have you as her nurse!

I think that the confidence comes with age. I use to be more meek and mild, but not now. I worked hard for my title and if I know I am in the right, then I am going to let whoever, MD know if he's in the wrong!

 I agree with the thought that standing up gets easier with lots of experience, but truthfully I have always stood up for my patient's from the first day I walked onto the labor and delivery floor to work, my goal in telling this story is to encourage ALL nurses new and old with experience to STAND UP for your patient to ANY doctor that you feel is wrong, medicine is NOT a science it is more an art an art of mistakes and doctors make a ton of them. WE as nurses are the last line of defense for our patient's who are helpless. I encourage ALL of you nurses to hold your head up and with confidence stand your ground, you will always find bullies, but times ARE changing doctors are no longer being allowed to treat nurses badly, if you go to the mat obviously be sure you are right, if you are take it the distance you will gain MORE respect from other doctors if you stand up rather than hiding in the background. Yes confidence comes with experience, but common sense in many cases moves you forward. We must stand up, we just have too.  Thanks for reading sorry so long here.

 LOL that is great, I have been told the same thing before and you know what I did it again anyways! That was a great story and just shows us nurses have great gutts, listen to it always it is usually  correct and I would rather err on the side of pissing off a doc than loosing a patient. Kudos to you.

keep on using your instincts. i know first hand what its like to deal with doctors that don't listen to the nurses. they forget they don't spend the time we do with our patients. also we may not have a doctors license or tittle yet many of us are a world of experience and information. many don't treat us like  the professional colleages we are. now when something happens to a patient because of their stupidity and arrogance they are quick to put the blame on the nurse. i like you am very outspoken my job and first priority is to give my patients the best care i know how even if it means going toe to toe with a doctor. oh well. i could write a book on all the times i had to challenge a doctor and get my voice heard for the sake of my patients entrusted to me. we nurses need to continue to be our patients advocate and also fight for the respect as colleages and professionals we are. there are more good nurses than bad ones stand up.               elizabeth_bourdony@yahoo.com

Wow!!!  Good for you!   I am glad you stood up to the Doctor for the patients (and fetus) safety.

I had a similar situation once with a very obese bed ridden woman who threw a PE.  I kept calling the Doc and finally when he answered his page he told me to start O2 at 2lpm and she'd be ok!!

Meanwhile I was on another phone speaking with a Radiologist who agreed with me of the symptoms the patient had and he performed a CXR and Scan.............guess what??  + PE...........Doc came on the floor swearing at me because the patient went to Radiology without consent..........I had him speak to the Radiologist and then he gave me a vebal or for the CXr ETC.

I still remember her name and starting a heparin drip on her.................she ended up dying 2 days later..............so sad

This is why I left the hospital!!!

 I feel the same way!!  I say this to other nurses all the time.  I sincerely don't give a ...... if it puts the doc in a bad mood or he/she persist to yell or scream at me if I am uncomfortable doing something.  We as nurses are just as responsible for our patients.  I had many situations where I have "disagreed" with the doc's decisions/orders... etc.  It is so true.. you have got to go with your gut.  It will tell you everything.  I have even one time called a doctor with purely "vital signs are perfect, presentation on this patient seems to be perfect, physical/ mental / emotional assessments is not outwardly revealing anything... but I am almost ill with a horrible gut feeling that something is not right"  After he scoffed and laughed and asked me if I was serious.... I said I am begging you to order some basic lab work, cbc, cmp... I am serious and something is really etching at me.  He finally agreed... The lab work came back with a glucose of 609, no diabetic history, no family history of diabetes, no presentation of symptoms..yet... needless to say shortly after lab work was received, so were new orders and pt starting to present symptoms...  YOU HAVE GOT TO GO WITH YOUR GUT    Awesome post.. sorry I blabbed for so long!   lol

dmazment says ...

You're going to have to learn sap and the first rule here is cover your ass.  Many drs will try to get away with anything and then turn around and say they didn't say something. Always remember, your patient's safety and well being come first and if it's 9am or 2am and something is wrong they need to be made to stand up to the plate and do what's right for the patient.

I agree with you there... CYOA is a motto we follow in our facility. The doctors there are quick to say they never said this or that.  We advocate for our patients.. and when some nurse's are like it's 3am i am not calling the doc. I say.. hand me the phone.  the patient is to important to let a doc intimidate you.. that is why they are there.. for the patient.. you would think that it wouldn't bother them so much to be updated on a patients status or notified when something is wrong.

 Great story!  We are 1st patient advocates, then comes everything else.  We cannot allow ourselves to be intimidated into making bad decisions.  I would venture a guess that this MD will take a nurse's observations more seriously.  If he does not,  he has a serious case of rectal-cranial inversion.  

The absolute bottom line is this.  We as nurses are the patient advocates.  We are the first  and last in line to protect our patients.  kayak says it well, to often being a good nurse does not make one a good employee.  It's too bad, hospital administrators don't understand this, nor do many,not all, physicians.

We do what we do to protect our patients, give them the best care we can and hope we don't get our butts in the proverbial wringer in the process.

 I've been in nursing almost 15 years , I was a nursing  student then but  can still remember like it was yesturday. This arrogant  doc said to the nurse I was buddied up with.

"Everytime I work with you .........It's  like reinventing the wheel" . All she said was sorry doctor.  I was horrified.

Document Document Document that way there is always proof of what and how it happend

dmazment says ...

sap says ...

WOW! Kudos to you. I don't know if I could stand up to the Dr. I'd be afraid I'd be fired...............even though I have a big mouth and speak my mind all the time as well as stand up for myself. This seems different to me. Besides, I'm still a "student". I can only imagine what's to come. A doctor isn't God...............................he doesn't know everything.

You're going to have to learn sap and the first rule here is cover your ass.  Many drs will try to get away with anything and then turn around and say they didn't say something. Always remember, your patient's safety and well being come first and if it's 9am or 2am and something is wrong they need to be made to stand up to the plate and do what's right for the patient.

 Very true