Help! The nurse sold me down the river!!

[pedstar09]

Hi everyone,

I am currently doing a Hem/Onc rotation in peds. I have enjoyed it so far!
Yesterday we received a 16 yo F patient who we got s/p port placement for her chronic transfusion requirements. We were going to observe her overnight and discharge the next day. I was asked to evaluate her by the residents. I obliged gladly.

As the port was entering in her right atrium, it was very close to her breasts. I obviously wanted to take a look there to see if anything was abnormal there. I pulled a nurse with me so that I can look in that general area (also cover my bottom so that she doesn't accuse me of any bad behavior in future...)

But that is exactly what happened. She complained to the nurse that I was inappropriate to her. The nurse wrote in her comments that "the patient was still woozy from her surgery". Nevertheless, the patient was AO x3. she also said in her comments that I was pressing very hard around her area of port. I swear to God, I did not even touch the patient in that area. Just took a looksy for any discharge/bleeding/etc.

So, these comments ended up in my evaluation. I still got a pass for the rotation, but I think these untrue comments harmed me tremendously.

1. Am I at fault? I want to improve, so please let me know if I was wrong in any way.

2. The nurse was essentially a b***ch. I am not going to argue with that person, but how can a comment from her end up in my evaluation, without even seeing my side?

3. The PD and the clerkship director don't want to hear my side of the story. I have talked with my school. The director said they will have my comments in response to this evaluation on my transcript...but, should there be a mechanism in check before putting these biased/wrong/unsupported comments on my evaluation?

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[Gambler 101]

That sucks. I can't think of a way to fix the current problem.

When I do an exam, I always "shout out" what I'm doing. In this case, " I'm going to do a post-op look at the incision. I'm not going to touch anything. I'm just looking for any excess bleeding or redness." This always helps me avoid confusion and involves the patient in the exam. Also, I wait 4 hours for post-op check.


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[Psai]

I'm not sure what a nurse's comments is doing in your evaluation. You should bring it up to your school's administration, especially since it can affect your residency chances

 

[pedstar09]

That sucks. I can't think of a way to fix the current problem.

When I do an exam, I always "shout out" what I'm doing. In this case, " I'm going to do a post-op look at the incision. I'm not going to touch anything. I'm just looking for any excess bleeding or redness." This always helps me avoid confusion and involves the patient in the exam. Also, I wait 4 hours for post-op check.


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That's a good idea. I will definitely do that from the next time. I was not told to wait 4 hr after surgery to check, so thank you for teaching me that!

I'm not sure what a nurse's comments is doing in your evaluation. You should bring it up to your school's administration, especially since it can affect your residency chances

I am not sure either. This was an away rotation at a prestigious place with a little bit more "air" around their name. My school is a "no-name school" (their words, not mine) from a different geographic location. I get it that they want to feed their superiority complex in that issue. The rotation is over now. The PD and the clerkship directors have stopped answering my phones/replying to my emails to clarify on this issue. My school on the other hand has been very supportive of me and I am going to bring this up to my administration. Considering that I am almost done with 4th year now, nothing might happen about this in future lol

 

[DRsmartypants]

Just to summize and make sure I understand
-You did not physically touch patient
-You clearly said what you were doing to the nurse(checking the site)
-Patient complained, and nurse wrote "patient woozy"

Firstly, I don't see how what a Nurse said should go into your transcript, I would bring it up with your school adminstration. Anyone who is less then a midlevel has no right to even try to judge what you may or may not be doing wrong.

Secondly, I don't see how the Nurse could flat out lie saying you touched a patient, I would try to remember who else was in the area and try to talk to them. However Nurses tend to band together and they will "attack" you so be careful how you go about this.

I don't really see a way out of this outside of going right to administration, tell them your side.
-Typically in my experience, if there are three people in a room, majority rules, if the Nurse lied and agreed with the patient(who essentially upholds the "law" in the room), then you are kind of screwed. I would potentially try and talk to a resident or attending and see if they can help you at all.

 

[evilbooyaa]

A comment from a nurse shouldn't make it into your evals, agree with that. A nurse writing "patient was woozy" isn't the same thing as "patient was woozy and being groped by disgusting medical student in the room".

If your school is being supportive, then they should be able to remove it, but if the PD and clerkship director aren't being useful, your chances of getting into a residency in that hospital system (especially in that spceialty) are now close to 0. Don't have a great way to reconcile that besides screw those guys.

*EDIT* - Just saw that she documented you were pressing very hard in the area. All you can do is reiterate that you DID NOT touch the patient over and over when asked, ride out the rest of the rotation (which is hopefully short) and get the heck out of dodge and never look back at that hospital. I can't think of a good way of retaliating that won't be a bigger headache for you down the line.

 

[PaxRoma]

to the OP, there is nothing to do at this point. At your MSPE, you can request the comment be omitted, worth a try. In the future, it is best to let the pt know ahead what you are about to do, explain that it will be uncomfortable, and gauge their approval/disapproval before you proceed.

 

[URHere]

If you're at the end of your MS4 year, then I can't really imagine this impacting you too strongly. You've almost certainly already applied for residency - you aren't asking for a letter of recommendation, you transcript has already been submitted, and no one is going to bat an eye over a "pass" from a Spring MS4 approaching graduation.

If you applied to the program where you did the away rotation, they may have ranked you poorly after this incident. Otherwise, it's just an unfortunate situation that you should be able to leave in your past without too much of a headache.

 

[Doctor4Life1769]

Screw it.
If you can get it off your MSPE, great. However, it doesn't matter at this point.
To hell with that program, too.

 

[J ROD]

Well, since you are at the end of 4th yr, and submitted your ROL Wednesday. What happened on Thursday will have little effect on you now. Just know you will not be going to that place you were just at.

I would just let it go and move on. Crap happens in life. Just be glad it is not worse.

 

[pedstar09]

Thank you all for your inputs. Yes, I realize that it is time for me to put this unnecessary stress behind me. This place would have been my #1 if this had not happened..oh well, there must be a bigger plan behind this nonsense.

On a related note, shouldn't these evaluations done completely by attendings and inputs from nurses, etc should not be a part of it?

I did talk to my school. This is not going to be on MSPE and there will be a followup..so lets see. Honestly, the place where I (hopefully) match can just glance over this and not give me a hard time about this crap..
Anyways, thanks once again for this!

 

[DRsmartypants]

I've personally never heard of a nurse's comments making it into an evaluation unless there was gross misconduct/malpractice, but even then it is still up to the discretion of the attending.

 

[jonb12997]

I just want to clarify, you're a 4th year student who is graduating in a few months? If so, I guess I'd unfortunately assume you probably won't match at that hospital, but other than that, since you got a pass it shouldn't be a big deal at all at this point...


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