Freaking Take My Order Already

[AF_PedsBoy]

So as a sub-intern it's annoying enough that you have to run around and write all the orders and then find the resident so they can be cosigned. Then I flag the chart and put it in the rack. Two to three HOURS later the chart is still sitting there, orders not taken, and when I mention to the secretary, "Oh and there are some orders for this kid," she just gives me a bored look and says, "Put it in the rack," where it's been for two freaking hours. It was bad enough that at 11:00 AM my kidney rejection kid was written for his third dose of solumedrol at 2:00 PM, and at 1:30 PM when I walked up to his nurse and asked, "So you know about my kid's next solumedrol dose?" She says, "No." And I look over and my chart is still sitting there, flagged, right where I put it when the secretary said, "Orders. Put it in the rack." The same thing happened when I had a swab that needed to be sent to virology - the order hadn't been entered for two hours, and the swab was sitting around for 20 minutes before I walked over and said, "I'm going to walk this sample down to virology myself. If you can enter the order in the computer that'd be great." When I walk back up to the floor she walks over and says, "What's your name," she then takes hold of my chin, says, "My name is Gloria. Your order was entered and I don't want you ever using that tone of voice again." I just give her a polite smile and walk off, thinking, "I'm starting to think Kinetic was right about secretaries.

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[scootad.]

Ah the joys of being a medical student (the lowest scum on earth)

 

[CityIvy]

hehe, i can't wait to be a subI in a few months...

pedsboy, i'm hoping to get some advice from 4th years....where is a good place to do medicine subI if you want to go into medicine?

 

[AF_PedsBoy]

Ha ha, I feel like a reject med student, but I really don't know any more about planning than you third years at this point in the year - my planning was pretty specific since I was looking into air force residencies and all my away rotations were eaten up by active duty tours.

 

[MD'05]

" When I walk back up to the floor she walks over and says, "What's your name," she then takes hold of my chin, says, "My name is Gloria. Your order was entered and I don't want you ever using that tone of voice again." I just give her a polite smile and walk off, thinking, "I'm starting to think Kinetic was right about secretaries.

She actually touched your chin?! That is battery. I would report that as soon as you receive your rotation grade.

 

[Echinoidea]

She actually grabbed you?! Grade or no grade, I would have lost it right there. Is there some conspiracy among certain nurses and secretaries to degrade medical students? This is'nt the first time I've heard of this happening.

 

[ericdamiansean]

YOu need help suing her?

That's manhandling

 

[tupac_don]

So as a sub-intern it's annoying enough that you have to run around and write all the orders and then find the resident so they can be cosigned. Then I flag the chart and put it in the rack. Two to three HOURS later the chart is still sitting there, orders not taken, and when I mention to the secretary, "Oh and there are some orders for this kid," she just gives me a bored look and says, "Put it in the rack," where it's been for two freaking hours. It was bad enough that at 11:00 AM my kidney rejection kid was written for his third dose of solumedrol at 2:00 PM, and at 1:30 PM when I walked up to his nurse and asked, "So you know about my kid's next solumedrol dose?" She says, "No." And I look over and my chart is still sitting there, flagged, right where I put it when the secretary said, "Orders. Put it in the rack." The same thing happened when I had a swab that needed to be sent to virology - the order hadn't been entered for two hours, and the swab was sitting around for 20 minutes before I walked over and said, "I'm going to walk this sample down to virology myself. If you can enter the order in the computer that'd be great." When I walk back up to the floor she walks over and says, "What's your name," she then takes hold of my chin, says, "My name is Gloria. Your order was entered and I don't want you ever using that tone of voice again." I just give her a polite smile and walk off, thinking, "I'm starting to think Kinetic was right about secretaries.

That is pretty common, floor clerks are pretty lazy and they'd rather be yapping then working on the orders. But in any case best way to make sure your pt gets the order is to: 1) alert the nurse to someting imp not the clerk and 2) pull the duplicate copy from the chart and send it to pharmacy, b/c you will never get the medication until pharmacy sends it to you. Don't even
bother with the clerk. And non imp meds like benadryl, colace, compazine prn wont' be that urgent. Now if you have a stat antibiotic or pt is seizing, then you need the meds iimmediately. good luck.

 

[bts4202]

I sugest that you go do a formal write up of the clerk for grabbing you. That is completely unacceptable and you will then have the power in the situation.

 

[toofache32]

So as a sub-intern it's annoying enough that you have to run around and write all the orders and then find the resident so they can be cosigned. Then I flag the chart and put it in the rack. Two to three HOURS later the chart is still sitting there, orders not taken, and when I mention to the secretary, "Oh and there are some orders for this kid," she just gives me a bored look and says, "Put it in the rack," where it's been for two freaking hours. It was bad enough that at 11:00 AM my kidney rejection kid was written for his third dose of solumedrol at 2:00 PM, and at 1:30 PM when I walked up to his nurse and asked, "So you know about my kid's next solumedrol dose?" She says, "No." And I look over and my chart is still sitting there, flagged, right where I put it when the secretary said, "Orders. Put it in the rack." The same thing happened when I had a swab that needed to be sent to virology - the order hadn't been entered for two hours, and the swab was sitting around for 20 minutes before I walked over and said, "I'm going to walk this sample down to virology myself. If you can enter the order in the computer that'd be great." When I walk back up to the floor she walks over and says, "What's your name," she then takes hold of my chin, says, "My name is Gloria. Your order was entered and I don't want you ever using that tone of voice again." I just give her a polite smile and walk off, thinking, "I'm starting to think Kinetic was right about secretaries.

I have an interesting perspective on this. I'm an oral & maxillofacial surgery resident, which is a dental specialty. Some of us also do the 3rd and 4th year of med school for a medical degree, which happens in the middle of our residency.

My point is this: I was doing a rotation as a medical student and experienced the same thing. Next time I needed to interact with the nurses, I flipped my badge around from "med student" to "resident" and everything changed. Then it was "yes, doctor" and "no, doctor".

Amazing.

 

[doc05]

stop acting like a medical student and start acting like a surgical resident. I don't know a single surgical resident who would put up with that crap. you're not "asking" for things to get done -- they are ORDERS.

 

[Dr.Evil1]

I can totally identify....my medical sub-I is driving me crazy dealing with floor nurses and clerks. I can't believe she actually touched you and had that whole I'm your mommy type of response. I would have probably lost it right there.

I am hating the 3 am calls on stupid lab values. Cross covering I get a call about an panic value CK-MB of 4.6, the nurse wakes me up to tell me this and I get all excited. I ask well what's the index...oh that's 0.7 meaning it is all just from this guys resolving rhabdomyolsis. I know its not her fault but it is just really annoying.

 

[mfleur]

Can't we all just get along?

 

[ItsGavinC]

I have an interesting perspective on this. I'm an oral & maxillofacial surgery resident, which is a dental specialty. Some of us also do the 3rd and 4th year of med school for a medical degree, which happens in the middle of our residency.

My point is this: I was doing a rotation as a medical student and experienced the same thing. Next time I needed to interact with the nurses, I flipped my badge around from "med student" to "resident" and everything changed. Then it was "yes, doctor" and "no, doctor".

Amazing.

Frickin' awesome. My oral surgery class sucks today, but that story was excellent.

 

[PACtoDOC]

Payback comes the day you match where you did that sub-I. That bi*ch would have 3 years of my attitude from the day my white coat grew 18 inches!!! My experience has shown me that even as a med student, if you have that 3 mile stare and stick your chest out, they don't screw with you much. Just the other day I was sitting at the nurses station pulling some labs off the computer on my patient, and some nurse walked up and said "Did I say you could sit in my chair ?". I replied with a smile, "Did I ask if I could sit in your chair?". That was the last I heard from her.

 

[mfleur]

Payback comes the day you match where you did that sub-I. That bi*ch would have 3 years of my attitude from the day my white coat grew 18 inches!!! My experience has shown me that even as a med student, if you have that 3 mile stare and stick your chest out, they don't screw with you much. Just the other day I was sitting at the nurses station pulling some labs off the computer on my patient, and some nurse walked up and said "Did I say you could sit in my chair ?". I replied with a smile, "Did I ask if I could sit in your chair?". That was the last I heard from her.

You know that pissing off the nurses will only screw you in the end. Might I just suggest a little diplomacy. There will always be bitter nurses and a**hole doctors and even egotistical, jacka** med students, but you would be amazed what happens when we all treat oneanother with a little respect.

 

[Cristagali]

Next time that nurse gives you a saline flush during one of your procedures...will you wonder if its really epi or KCL??? Don't screw with the nurses..they'll get you in the end!!

 

[MD'05]

Next time that nurse gives you a saline flush during one of your procedures...will you wonder if its really epi or KCL??? Don't screw with the nurses..they'll get you in the end!!

If a nurse ever pulled bullsh*t like that, he/she would be up on criminal charges.

 

[fourthyear]

Yeah, it's annoying that some people are lazy at their jobs - some secretaries, some nurses, and at some hospitals it's a culture that perpetuates itself, where nothing gets done fast and there's not much you can do about it.

But it is NOT true that you somehow get some new respect when you become a doctor. I'm a 2nd year surgery resident and learned long ago, as a med student, that the best way to deal with these people is be nice and cooperative and eventually, beleive it or not, you can get on their good side and they will step up and help you out when you ask.

Sure, it sucks to have to put up with mediocrity, but if you want things to get done, being an ass and barking orders at people won't get you too far most of the time. Gloria probably badmouthed you to the whole floor - warning everyone about your attitude, so that even the nice cooperative hard-working nurses will probably get to your orders last (and the nicer resdients orders first) b/c they think you're a jerk.

All you had to do was explain to the nurse and the secretary that the virus swab was an important result you were waiting on to make further treatment decisions, then politely offer to take it downstairs for them b/c it was so importatnt to you and you could see they were very busy (even if they weren't busy, say it sincerely b/c if they're taking a break they must feel they've had a hard day and deserve a break at this point) - do this nicely and I promise you you'll get the nurse falling all over him/herself to hurry up and get it done so you don't have to run it down yourself. The chair thing too - it's silly but I've been approached with that too - and I offer to give up the chair...they usually take it the first time, but once they see that I'm a reasonable person who respects their workspace (remember they are permanantly stuck in this place, whereas students and residents are passers-through moving on to other rotations next month), they usually end up insisting I keep the chair the next time. Believe me, this works. It's all about being a person who respects others (even if they're lazier than us) rather than being a person who thinks "I am doctor, do as I say".

 

[Cristagali]

I was of course just kiddinig about the KCL flush, but I have seen nurses cause great disruption to a particular residents life, so much so, that his boss told him to repeat his intern year or find another hospital. he was a neurosurg resident, who never responded to his beeper, always treated the nurses like crap, (and other services docs too), so the nurse kept documenting his shortcoming to the point his boss just couldn't ignore it anymore. This was a nurse driven issue and he got it in the end. SO beware and be nice..then go to the gym and work out!!

 

[EctopicFetus]

Im post call on my Ob rotation. I can add to this with a little rant of my own. So last night the resident asked me to do and H&P on this lady in the OB triage. So I head to the computer and get all the pertinent BS to put on her H&P. When I am about to start talking to the patient they decide to move her to her room in L&D. I walk in the room and I ask the patient if she speaks english and she says no. I ask my resident if I should call the interpreter and she says that there isnt one on staff at 330 am. (now keep in mind that 1/2 of the nurses there speak spanish). The resident says ask the nurse or LPN or whatever to translate. I walk into the room and i tell the nurse the situation and she politely agrees. We almost finish when one of the other nurses calls her out to chat about something unrelated to patient care. I move on to the physical exam and she still isnt back. I do my best to finish up.

After I finish I start reading my OB book and the nurse who pulled out my translator starts talking really loud about how they dont pay her to translate and she raises her voice when saying she wouldnt do it. Then someone asks me "hey medical student" are you done with the patient? I reply politely that I am. Then she walks past me and says, "They should make them wear their names in big letters on their foreheads." I wanted to give her a piece of my mind but I realize they are just venting their frustration. Sadly, it is their poor treatment to medical students that leads to attendings treating them poorly for their whole careers. I will say I havent had many bad experiences with nurses as I get along well and am friendly with most of them. However this Bitch from last night needs an attitude adjustment I just wont be the one to give it to her yet!

Also As someone said above the difference in treatment of a Student vs Resident is amazing!

And dont even get me started on unit secretaries!

 

[dkwyler94]

As can every other medical student out there, I can totally relate. I think what it comes down to, is they are tired of feeling inferior to doctors, or had some doctor chew them out, or have some chip on their shoulder. They don't feel they can take it out on the actual doctors, so they take it out on us as medical students. It is funny. I worked as a Nurses Aide for 5 years prior to medical school and had a very good relationship with nurses and unit secretaries. Since becoming a medical student and getting so much attitude from them, my respect has totally declined. They feel doctors don't respect them, but in my experience they bring it on themselves.

I have had nurses/unit secretaries refuse to do things, even after my resident has signed it or asked me to write a VO in the chart for them. If it is important (a stat order), I just go to the charge nurse and write a formal write up. I have done a few. I won't do it if it just an insult to me (although battery should absolutely be reported), if it is detrimental to the patient, if is unacceptable and needs to be officially dealt with.

One recent experience I had was when I was rounding and the nurse came over and took the chart I was writing my progress note in. I guess she didn't think I needed to be writing a progress note. She wanted to update her note. It is unfortunate, but a lot of nurses are pretty petty.

 

[powermd]

After I finish I start reading my OB book and the nurse who pulled out my translator starts talking really loud about how they dont pay her to translate and she raises her voice when saying she wouldnt do it. Then someone asks me "hey medical student" are you done with the patient? I reply politely that I am. Then she walks past me and says, "They should make them wear their names in big letters on their foreheads."

Being a med student working in a new hospital environment can be a very dehumanizing experience. One thing you should understand is that med students are uniformly treated this way because the majority are shy and socially awkward in the work environment, and the nurses/secretaries don't appreciate that this is an artifact of being a fish out of water. The ony thing you can do is try to be as courteous and social as possible so they will begin to see you as an individual. You will no longer be "medical student", but "Dave" that great guy who is so much more pleasant to work with than the heard of other med student passer-bys. Anytime you have a chance to talk non-work chatter with the staff- do it, and enjoy yourself. You are a visitor there, but this is where they live. They will treat you well if you seem to care about what they care about.

This phenomenon extends into internship until you are well known to the nursing and secretarial staff. When cross-covering I have received annoying pages for stupid things only to arrive on the floor and hear a nurse say to the others, "oh, Dr. <me>" is on tonight, I'm so sorry we bothered you." It didn't work that way until I built a good name for myself around the hospital. They tell me who the other interns are that they love.. and hate. Believe me, you want to be on their good side. It's just not worth it to be a dick to anyone.

 

[EUA]

battery?!? you've got to be kidding me. cocky med students who treat nurses like their own personal slaves deserve every ounce of abuse they get in return. i'm a 4th year who did such ancillary care before med school so i've been on both sides of the fence. when you are rotating somewhere you are their guest and you should treat people accordingly.. dont' eat their food or take their chairs or be snotty. it is a priviledge to be there. we are the low men on the totem pole at this stage of our careers and that's just the way it is. do your time man! and take the stick out of your ass. you're lucky that nurse didn't do worse than just grab your chin, which you sorely deserved, you prima donna. ugh! it is med students like this that give all of us a bad reputation.

 

[PACtoDOC]

battery?!? you've got to be kidding me. cocky med students who treat nurses like their own personal slaves deserve every ounce of abuse they get in return. i'm a 4th year who did such ancillary care before med school so i've been on both sides of the fence. when you are rotating somewhere you are their guest and you should treat people accordingly.. dont' eat their food or take their chairs or be snotty. it is a priviledge to be there. we are the low men on the totem pole at this stage of our careers and that's just the way it is. do your time man! and take the stick out of your ass. you're lucky that nurse didn't do worse than just grab your chin, which you sorely deserved, you prima donna. ugh! it is med students like this that give all of us a bad reputation.

I think you have been saving up and injecting the leftover Fentanyl or something. I think it is a lot more rare to find a cocky med student and way more common to find a bitchy, high TtoT titer, trailer park living, Virginia-Slim smelling unit clerk who thinks their feces smell like imported Equadoran morning glories!!! Just because you disimpacted a few people in your old glory days does not mean that every "ancillary" staff member has the right to abuse med students. I too served my time in the "ancillary corps" and I would have never treated a courteous medical student any differently than I would treat an attending. Of course there are dingus students who deserve such treatment but don't lump everyone in that category who owns a short white coat, because that was not what THIS conversation was about.

 

[juddson]

Payback comes the day you match where you did that sub-I. That bi*ch would have 3 years of my attitude from the day my white coat grew 18 inches!!! My experience has shown me that even as a med student, if you have that 3 mile stare and stick your chest out, they don't screw with you much. Just the other day I was sitting at the nurses station pulling some labs off the computer on my patient, and some nurse walked up and said "Did I say you could sit in my chair ?". I replied with a smile, "Did I ask if I could sit in your chair?". That was the last I heard from her.

Oh my. You are making me so hot!!!

Judd

 

[AF_PedsBoy]

Man what a bastard I am for walking a sample down three floors to the lab after the order (that had already been cosigned might I add) had been sitting in the rack, flagged, for two hours. And I cannot believe I got antsy after my patient, who was in active renal failure post transplant, had his order for high dose steroids sitting in the rack for two or three hours. My orders were all timed and dated so I guess I really could have sat around just to see how long it would have taken before the orders got entered but for some reason I was concerned about my patients' well being. And where in the world are you working where it's isn't considered unprofessional to lay hands on a co-worker...? And before you jump all over me saying the staff is busy with the patients, I'm talking SECRETARY - I happen to have had a very good relationship with all the nurses during my sub-i.

 

[EctopicFetus]

Let me say I also have had a great relationship with all nurses except those biznitched in OB, let me also say it could be coincidental that I am hating my rotation.

All this being said the biggest B on the Ob floor loves me. We joke and have a good time. Some of the nurses are just pissed on where they are.

All that being said no matter how busy you are it shouldnt take you 7 hours to remove a Foley from a 16 yr old girl. Sorry I dont know where you work but while most nurses are extremely hard working I often see the same group of nurses shooting the breeze and not helping patients. Funny enough the stupid woman who left this Foley in my 16 yr old patient was just jabbing along until i politely asked her to help my patient.

Anyhow the bottom line is most nurses are real good but there are a few who are lazy and worthless and can be becuase there is a shortage of them and we are in dire need of them. A lot of this depends on where you work. Me and PowerMD are from the same school we both rotated through a certain awful hospital in Chicago, some of the nurses there are nasty and lazy. Ive got 2 weeks until I will be done with my 3rd yr rotations at this place. Thank god.....

 

[doc05]

Man what a bastard I am for walking a sample down three floors to the lab after the order (that had already been cosigned might I add) had been sitting in the rack, flagged, for two hours. And I cannot believe I got antsy after my patient, who was in active renal failure post transplant, had his order for high dose steroids sitting in the rack for two or three hours. My orders were all timed and dated so I guess I really could have sat around just to see how long it would have taken before the orders got entered but for some reason I was concerned about my patients' well being. And where in the world are you working where it's isn't considered unprofessional to lay hands on a co-worker...? And before you jump all over me saying the staff is busy with the patients, I'm talking SECRETARY - I happen to have had a very good relationship with all the nurses during my sub-i.

what you need to do in this situation is tell the unit clerk that the order is urgent and needs to be entered right away. otherwise, just assume that it will take several hours for things to get done.

the solution is to move to computerized order systems, which most modern hospitals have these days. I suspect you're rotating at a small-medium sized community hospital?

 

[Febrifuge]

The nice thing about electronic systems is that even a low-life tech like myself can be looking over all the patients in the department, and see that there's a number in the 'LAB' or 'XRAY' or whatever column, meaning something was ordered n minutes ago, but hasn't yet been marked as complete.

And that transparency means that anyone can know generally where we're at in terms of any patient's plan, or at least know what's next. If that number is a high one, even a low-life tech like myself can harmlessly comment, "dude, this guy's been waiting for an hour to go to x-ray, how about I just take him?" or "so, what's up with the labs on the guy in cube 6?"

You know how docs lose track of time, or just have other stuff come up, so they can't swoop in and do everything at once, and the whole plan goes to crap? Well, the same thing happens to support staff. It's easier to share the load if more than two people know about something that needs to be done.

 

[Apollyon]

a low-life tech like myself

a low-life tech like myself

You're a low-life! Ha ha!