Advice on situation over hip/femur
This week I had an interact with a nurse practitioner at work that I need advice on. I still plan on talking to our radiologist but he won’t be on site until next week to ask him what I should do if this happens again.
Earlier this week we had a patient come into the ER for a fall and hip/femur pain. The nurse practitioner ordered a pelvis, hip and femur x-ray. Everyone in the department agreed that only the pelvis and femur would be needed since the femur included the hip views. I go into the ER with a student and tell the nurse practitioner I would be doing the pelvis and femur since the hip was included. She popped off “when ortho wants the hip you will be coming back to do it”. The student and I do the imaging and I go back to the department and post out the pelvis and femur but keep the hip on the list (don’t cx because of her statement). Fast forward 2 hrs pt was transferred we weren’t called back to do any hip imaging and the report is back. I cancel the order due to it causing confusion with transcription.
On Friday, my boss (nurse practitioner’s friend) who was been off all week has a conversation with me that I have no rights to cancel orders (understand that) and that although it’s the same images that I should had just taken the same image twice because the ortho doc was upset that we didn’t do a hip x-ray they would just do it at there facility. Again, we weren’t asked to come back and take a dedicated hip at the time. Despite it possibly doing harm to the patient by exposing them 2 unnecessary times. She also make the comment that her friend would get over it but what I did possibly upset her back up and he wasn’t someone to get over it quickly.
Today I worked with the nurse practitioner again and the first thing she said to me was “I told you orthopedic would want it.” And ortho asked “do you not know the difference between a femur x-ray and a hip x-ray.” I replied, “if they still wanted it after the images we took I would have came back and did them.” Letting her know if it was something needed/want after the initial pictures if they didn’t get what they needed on the femur I had no problems coming back. She said “it wasn’t my fault their entire femur hurt.”
(It’s worth noting I had a different doctors few days earlier that wanted a hip and femur and I only did the femur and there were no complaints)
At the time I did what I did to advocate for my patient by reducing dose (someone later pointed out that they also would have been charged more for if both the hip and femur were charged for). I want advice on my next steps or what I should do in the future if the same situation happens. Should I have just done the hip as she requested?
As stated before I’m going to speak to our radiologist in person next week about the situation and see what he says. (Not sure if my boss will actually accept his take since she has also said in the past that what our doctors say supersedes the radiologist since they are the ones on site). I don’t feel like I was entirely in the wrong, but maybe I was since I didn’t do the exam exactly how it was ordered since the views were included in a different order.