Every nurse knows one...a doctor who doesn't always think in the patients best interest. Suppose a pt is being admitted with sudden severe AMS. I ask for the diagnosis. Fatigue. What? fatigue
, I don't want to deal with the neurologist on this weekend, it will have to wait until Tuesday.
My mouth is sealed. I understand HIPPA, I understand the doctor can decide the diagnosis but in the meantime where is this fair to the patient? Does the patient not have rights as well?
What is a nurse to do? Absolutely nothing is the decision I have come to I absolutely won't violate HIPPA. If I report the doc then my job is in jeopardy not the doc's because that's how things generally work.
May 26, '07
Actually, DG, this doesn't have much to do with HIPAA. It has to do with following the standard of care.
This doc realizes that the patient has AMS and THAT should be the admitting dx. Then the possibilities for WHY the patient has AMS should be explored and ruled out. Those tests would include: CT head, labs (electrolyte imbalances), EKG, CXR, 2DE. Not only a full neuro workup but also a full cardiac workup should be done, since an MI can also cause fatigue. So can anemia or electrolyte imbalance.
The point being that this patient might not last the weekend if they are that ill and left untreated.
And you just have to ride the doc's butt until he orders things along those lines. If he doesn't, it'll be your license on the line, so go up the chain to your supervisor and document carefully.
It sure wouldn't hurt for you to do fingersticks to check blood glucose as well as initiate frequent vitals and neuro checks. An NIHSS eval and swallow screen wouldn't hurt either.
But nowadays, no doc can simply admit a patient and then let them lie there all weekend without ordering the most obvious tests and consults, and as a nurse, you'd be expected to know that. So bring it to your supervisor and keep calling this doc with requests to nudge him in the right direction.
Last edit by UM Review RN on May 26, '07
May 26, '07
It's not a hypothetical situation. This happened, just can't give out too many details. Sorry.
Last edit by DutchgirlRN on May 26, '07