taking orders from young doctor.

[timerick]

Originally posted by fab4fan
That is why I ran all the orders that particular PA wrote past the attending. I value my license too much to risk it for anyone, doc, PA, NP...

Sounds like you may have been motivated toward prejudice against this particular PA rather than by safety. Were "all" this PA's order unsafe? Why did you have to run "all" of them by the attending? Didn't the attending get tired of your constant questions over triviata?

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[fab4fan]

No, the attending didn't care, to be honest.

I guess you could call it prejudice; I am biased against taking off orders that are dangerous.

Without getting too specific, on one occasion this guy ordered a med combination that could have been lethal. Giving the meds he ordered was absolutely contraindicated..no ifs and or buts.

He blew off a toxic med level I reported; the attending adjusted the med.

Ordered an antibiotic for a pt., and, you guessed it, pt was allergic to that antibiotic (yes, the allergy was documented)

So, if that makes me prejudiced, so be it. Interesting that this guy no longer works at that facility, and he was "dropped" from the family practice group he worked for.

Perhaps he wasn't cut out for being a PA. I don't think it helped that his 4y degree was in accounting, and he'd had no previous experience working in any type of health care setting.

 

[timerick]

I have no problem with not following an order when it's questionable. The best thing I think is to take it to the person who gave the order and ask for clarification... perhaps he/she isn't aware of a piece of pertinent information.

But to take every order someone gives and go over their head and pass it by the person over them, even when the order is absolutely sensible, doesn't make sense. Sounds vindictive and catty.

 

[PACtoDOC]

I could be reading this wrong but it seems the nurse here in question either was dealing with a real idiot PA, or was being a bit vindictive. But in my experience, nurses don't just generally get vindictive for no reason. Nurses generally help out docs and PA's when they make incorrect orders, because they know it happens. My guess is that this PA was condescending and arrogant which probably led to being alienated by the nuring staff. I have never EVER had an order questioned by an RN on the floor even though I have inadvertently screwed them up from time to time. Now I have been called for "clarification" which is the nurses polite way of saying "are you sure you want to do something like this!!!?". I just cannot imagine if a PA is conscientious and courteous to the nursing staff that they would get treated like this. But don't think this can only happen to PA's, because even a doc can get alienated by the nurses if they are a jerk. It just gets transmitted in a different fashion, such as a 2AM call or page to tell the Dr. "Mrs. X is having a bit of constipation, would you like me to give her fiber or laxative??". Nurses do a lot of really crappy work that no one else wants to do, and they are very educated people (who often don't get to use the full extent of their knowledge). So treat them the way you want to be treated and you can generally be the stupidest provider on the floor and they will still cover your ass. I am guesing this PA just could not figure out how to relate to people and co-workers.

 

[fab4fan]

PACtoDOC: You pretty much hit the nail on the head.

I don't question orders just for the heck of it or to give someone a bad time. That would be unprofessional on my part.

But if someone writes a bad order and I don't catch the mistake, it's my neck on the block, too. I could lose my license for that. The job is stressful enough without having to constantly be concerned over a dangerous practitioner and wondering whether the latest order he wrote was safe/appropriate.

But you are right, PACtoDOC...most nurses (myself included) will bend over backward to help providers that treat them decently. Most rational docs/providers are thankful when you catch something questionable.

Sounds like you've got a good rapport with the staff you work with.

 

[fab4fan]

timerick: I forgot to add that initially, I did take questionable orders to the PA. That's when I got the speech about how he was "superior" to me, and my job was to follow his orders. So I did try to talk to him before doing something so drastic as taking all of his orders to the attending; unfortunately, this particular PA was not receptive to being questioned/giving clarification.

I know not all PA's are like this guy, so what I'm saying is NOT a global indictment of the profession. I appreciate when others, like PACtoDOC take time to reach out and make suggestions as to what the cause of the problem may be.

 

[baggywrinkle]

Originally posted by PACtoDOC
I could be reading this wrong but it seems the nurse here in question either was dealing with a real idiot PA, or was being a bit vindictive. But in my experience, nurses don't just generally get vindictive for no reason. Nurses generally help out docs and PA's when they make incorrect orders, because they know it happens. My guess is that this PA was condescending and arrogant which probably led to being alienated by the nuring staff. I have never EVER had an order questioned by an RN on the floor even though I have inadvertently screwed them up from time to time. Now I have been called for "clarification" which is the nurses polite way of saying "are you sure you want to do something like this!!!?". I just cannot imagine if a PA is conscientious and courteous to the nursing staff that they would get treated like this. But don't think this can only happen to PA's, because even a doc can get alienated by the nurses if they are a jerk. It just gets transmitted in a different fashion, such as a 2AM call or page to tell the Dr. "Mrs. X is having a bit of constipation, would you like me to give her fiber or laxative??". Nurses do a lot of really crappy work that no one else wants to do, and they are very educated people (who often don't get to use the full extent of their knowledge). So treat them the way you want to be treated and you can generally be the stupidest provider on the floor and they will still cover your ass. I am guesing this PA just could not figure out how to relate to people and co-workers.

One way to find out who is really in charge is to piss off a nurse. They outnumber everyone else in the building and you can't get crossways with just one, it will always be the entire unit or the entire hospital. When they come asking for clarification take the hint or expect to have them go over your head or leave it with you to do by yourself. Believe me, while you are in the process of hanging yourself a good nurse will be documenting her little heart out in triplicate with the nursing supervisor as witness.

I have been the focus of such attention and seen it directed at hard headed physicians. Pity the poor recipient when they start tag team calling a questionable order right on up the chain of command. By the third or fourth phone call the recipient will begin to wear down! Another tactic I grew to know and love was when a nurse would call and rip me a new one then hang up. Invariably my return call or inquiry at the desk would be met by another cool disinterested nurse, the one I was seeking to strangle being nowhere to be found. God bless them, the nurses will not be denied.

Be good to your nurses. They will remember your kindness with cake when you leave