Justifying orders to nurse vent

[gstrub]

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So I just had to vent this because I am so mad right now.

I am on call. In the SICU. We get paged a lot at this hospital for small things, which I suppose I have to get used to, but one thing that I was getting annoyed at came to a head this evening.

Page: "Are we continuing to do q6hr hct checks on pt X?"
(Pt X is a man with pancreatitis s/p debridement who has been tachy and who this nurse reported earlier in the day to have bloody stools).

Me: Call back, very politely, "Hello, this is Dr. G about pt X, and yes we are continuing those checks." I now believe this conversation is over right? Not so fast...

Nurse: after long pause waiting for explanation, and with real attitude, "um, why?"

Me: "We are checking it to make sure it doesn't go down."

Nurse: "Well, that's not good enough. I need a better explanation."

Me: "I'm sorry, but we want to continue those checks, just like the order says."

Nurse: "What's your name? I am going to page your fellow and write this up."

After this she goes on about paging my fellow and writing me up. The best part was that she paged me later and I called back, and she thought I was the fellow (even though she paged the same number, and I answered the same way), and she started telling the story as if I had simply told her off. It was classic! She also mentioned that Drs. can't just expect orders to get done because they write them...I bit my tongue nearly off.

I am happy to explain medical rationale, always. I don't have to though. Especially not to someone who treats me like I need to justify every single lab order with them. Also (I didn't say this but wanted to), anyone who needs an explanation about why we are checking hct in a patient who is tachy at baseline, has bloody stools (which she reported), and just had their pancreas debrieded...well...

/vent

 

[Janedoedoctor]

I am happy to explain medical rationale, always. I don't have to though. Especially not to someone who treats me like I need to justify every single lab order with them. Also (I didn't say this but wanted to), anyone who needs an explanation about why we are checking hct in a patient who is tachy at baseline, has bloody stools (which she reported), and just had their pancreas debrieded...well...

/vent

As you work under a fellow, I'm going to assume you're an intern or junior resident. I'm noy saying the nurse didn't act bitchy, but I don't agree with your reasoning either. You're both at fault here.

An experienced ICU nurse is more than just a puppet whose only function is to carry out your orders. Nurses are an integral part of the critical care team and they have a right to know and understand what meds and tests their patients are getting and why. So yes, you did owe her a better explanation than 'because I said so'.
In a training hospital, the veteran ICU nurses are vastly more experienced than most doctors and they will save you (and the patient) multiple times over the course of your training.

This said, the nurses' motive for this particular call was probably that she wanted to get out of doing the blood draws. You were within your rights to ask her to do them anyway, and the call to your fellow was serious overkill on her part. But your attitude towards the nurses is not very professional either.

 

[gstrub]

I'd agree with you wholeheartedly if the nurse had asked for rationale because she was concerned about what we were doing, or even if she just wanted to know. The issue I had was the question she asked was "are we going to keep doing this" and my answer was yes. That spurned an attitude that was counterproductive for the entire team, because it was obvious she didn't want to keep drawing labs. If you want a rationale, ask for it and I will explain it. And this wasn't some bizarre order either. If we have to call the nurses to explain every order we write we'd be doing that half of our day. And we round with the nursing team, and explain the plan for the day, so whatever, this nurse was just being a passive aggressive bitch and I felt like complaining about it.

 

[Winged Scapula]

As you work under a fellow, I'm going to assume you're an intern or junior resident...

Without knowing the OP's status here myself, you may be making an incorrect assumption.

The SICU often runs differently than a MICU and there may very well be senior surgery residents or even Chiefs on call even with a fellow on the team.

It is true that the intern often is first call, but IMHO (and those of others with extensive SICU experience) the resident on call in the SICU may be an intern (unlikely during the night these days with changes in work hours), PGY-2, 3, 4 or 5. We rotated through the SICU *every* single year in my residency and fellowship.

So while he may or may not been out of line in his response to the nurse, we shouldn't assume that he was a junior resident who had a lesser knowledge base than the ICU nurse, just because there was a fellow on the team. And sometimes residents just gotta vent.

 

[anynoise]

As you work under a fellow, I'm going to assume you're an intern or junior resident. I'm noy saying the nurse didn't act bitchy, but I don't agree with your reasoning either. You're both at fault here.

An experienced ICU nurse is more than just a puppet whose only function is to carry out your orders. Nurses are an integral part of the critical care team and they have a right to know and understand what meds and tests their patients are getting and why. So yes, you did owe her a better explanation than 'because I said so'.
In a training hospital, the veteran ICU nurses are vastly more experienced than most doctors and they will save you (and the patient) multiple times over the course of your training.

This said, the nurses' motive for this particular call was probably that she wanted to get out of doing the blood draws. You were within your rights to ask her to do them anyway, and the call to your fellow was serious overkill on her part. But your attitude towards the nurses is not very professional either.

I dont agree with you. A nurses function is simply that.. I dont care how experienced they are. The system breaks down if experienced nurses think they can think l ike doctors. They are experienced.. Yes.. at being NURSES. Once people like you equate being an ICU nurse with being a doctor.. there lies the problem. Is nursing experience helpful.> Of course.. Does she have a right to question a simple order like that.. NO. If he said give IV cyanide stat.. YES question that? but dont question a simple q 6 hr hemoglobin becuase you are lazy. We dont have time to go through details as to your rationale in writing an order with a nurse.. every single order. You know how painful that is? Especially when many orders are judgement calls .. and if he/she is wrong.. fine.. and extra hg check here and there is not gonna harm the patient.. And its not the nurses right to be wrong it is the interns right. its his training and experience.

 

[Janedoedoctor]

I dont agree with you. A nurses function is simply that.. I dont care how experienced they are. The system breaks down if experienced nurses think they can think l ike doctors. They are experienced.. Yes.. at being NURSES. Once people like you equate being an ICU nurse with being a doctor.. there lies the problem. Is nursing experience helpful.> Of course.. Does she have a right to question a simple order like that.. NO. If he said give IV cyanide stat.. YES question that? but dont question a simple q 6 hr hemoglobin becuase you are lazy. We dont have time to go through details as to your rationale in writing an order with a nurse.. every single order. You know how painful that is? Especially when many orders are judgement calls ..

I'm not sure what you mean by "people like me". Fellows? I'll just ignore it so the thread won't go off track.
If you had read my post properly, you would have understood that I didn't defend this particular action from this particular nurse. Her motive was plain laziness and she had the gall to pester the resident over it 👎

And I do not equate being any kind of nurse to being a doctor. I'm just saying that in an ICU, patients are being cared for by a TEAM and that things can and will go wrong if everyone on said team doesn't understand at least the basic principles of what is being done to the patient.

I stick to my opinion that junior doctors should stop and listen if senior nurses have concerns about the patients' management. Some nurses are plain lazy and try to make you cut corners. Most have the best interests of the patient in mind when they comment.

 

[colbgw02]

But your attitude towards the nurses is not very professional either.

The OP's attitude is just fine. He may have been thinking bad things about the nurse, but he never conveyed those thoughts (or at least he didn't include that in his anecdoate). Considering the nurse's actions, I'd say those thoughts are very reasonable, and the OP would have been justified even if he had put the nurse in her place. We're not talking about some rare drug administration or doing a procedure without proper supervision. The order was for a straightforward lab with a rationale that should have been self-evident to everyone, including the clerk at the front desk. At a private hospital without GME, there's a decent chance that nurse would have been reprimanded had she pulled that with an attending. Everyone realizes that nurses, especially experienced SICU nurses, are a crucial, but the OP never gave any indication that he believes otherwise. He's on SDN strictly to vent, and he admitted as much in the thread title.

 

[Shinken]

I stick to my opinion that junior doctors should stop and listen if senior nurses have concerns about the patients' management. Some nurses are plain lazy and try to make you cut corners. Most have the best interests of the patient in mind when they comment.

I agree with the above 100%.

Also, have you stopped to consider that rather than questioning medical reason the nurse was looking for a justification to appease a case manager? Many times my orders were 'questioned' by nurses but not because they doubted my medical management but simply because they needed to report a reason to justify my order for billing/Medicare/hospital stay justification.

Perhaps the SICU nurse wanted an answer along the lines of "we're checking H/H q6h because of possible active bleeding" so she could report the reason? I don't know, just guessing here.

 

[lowbudget]

"You're right. Let's check it q8 hours then. Call me if heart rate remains tachy after __ hours. Thanks."

(Go back to sleep.)

 

[CambieMD]

"You're right. Let's check it q8 hours then. Call me if heart rate remains tachy after __ hours. Thanks."

(Go back to sleep.)

There is no reason to start a war over this.

Cambie

 

[pseudoknot]

I agree with the OP's frustration. But it's also true that the path of least resistance usually involves trying a little harder to explain things when questioned.

 

[Killer T Cell]

I agree with the OP's frustration. But it's also true that the path of least resistance usually involves trying a little harder to explain things when questioned.

Omg I'm having flashbacks!! I was constantly questioned during my Sub-I, at least a couple of times a week. My senior wouldn't let me defer it to her and wanted me to become experienced in handling these Spanish Inquisitions. As much as I hated it then, I love her for not coddling me and teaching me how to deal with this.

Even though I am not a resident yet, I got a glimpse of it and I can totally understand OP's frustration. But I definitely second taking the path of least resistance.

 

[chocomorsel]

As you work under a fellow, I'm going to assume you're an intern or junior resident. I'm noy saying the nurse didn't act bitchy, but I don't agree with your reasoning either. You're both at fault here.

An experienced ICU nurse is more than just a puppet whose only function is to carry out your orders. Nurses are an integral part of the critical care team and they have a right to know and understand what meds and tests their patients are getting and why. So yes, you did owe her a better explanation than 'because I said so'.
In a training hospital, the veteran ICU nurses are vastly more experienced than most doctors and they will save you (and the patient) multiple times over the course of your training.

This said, the nurses' motive for this particular call was probably that she wanted to get out of doing the blood draws. You were within your rights to ask her to do them anyway, and the call to your fellow was serious overkill on her part. But your attitude towards the nurses is not very professional either.

I love it how the word "professional/unprofessional" gets thrown around in medicine. Please tell me where the OP was unprofessional. He/she told the nurse that he/she wanted to make sure that the H/H does not drop in a patient with bloody stools. That right there is reason enough and obviously the nurse is the one with the problem if she is daft enough to not know that H/H's should be followed on a bleeding patient. He/she did not say "because I said so". Doctor do not need to explain every single order to nurses unless it is truly something that could be detrimental to a patient's health or the nurse needs some teaching on something he/she doesn't understand. If the nurse has an attitude, then that's his/her problem. Bigger things to worry about.

 

[chocomorsel]

I agree with the above 100%.

Also, have you stopped to consider that rather than questioning medical reason the nurse was looking for a justification to appease a case manager? Many times my orders were 'questioned' by nurses but not because they doubted my medical management but simply because they needed to report a reason to justify my order for billing/Medicare/hospital stay justification.

Perhaps the SICU nurse wanted an answer along the lines of "we're checking H/H q6h because of possible active bleeding" so she could report the reason? I don't know, just guessing here.

You are right, except the same nurse is the one who reported to the resident about bloody stools. Can't she/he put 2+ 2 together? It would have been different if she'd received report from another RN and this had been not been passed along during change of shift. If she's as experienced as her crappy attitude shows, then she should know that when a patient's bleeding it's not unusual to check H/H more frequently. To the OP, the prior poster above who made a comment about a private hospital is right. Nurses in academia can be quite difficult to deal with sometimes because they know they can treat residents any kind of way.

 

[45408]

As you work under a fellow, I'm going to assume you're an intern or junior resident. I'm noy saying the nurse didn't act bitchy, but I don't agree with your reasoning either. You're both at fault here.

An experienced ICU nurse is more than just a puppet whose only function is to carry out your orders. Nurses are an integral part of the critical care team and they have a right to know and understand what meds and tests their patients are getting and why. So yes, you did owe her a better explanation than 'because I said so'.

He gave her the actual reason right up front (watching the trend). I don't think that calling to question random orders is appropriate either.

 

[Osteoimperfecta]

As you work under a fellow, I'm going to assume you're an intern or junior resident. I'm noy saying the nurse didn't act bitchy, but I don't agree with your reasoning either. You're both at fault here.

An experienced ICU nurse is more than just a puppet whose only function is to carry out your orders. Nurses are an integral part of the critical care team and they have a right to know and understand what meds and tests their patients are getting and why. So yes, you did owe her a better explanation than 'because I said so'.
In a training hospital, the veteran ICU nurses are vastly more experienced than most doctors and they will save you (and the patient) multiple times over the course of your training.

This said, the nurses' motive for this particular call was probably that she wanted to get out of doing the blood draws. You were within your rights to ask her to do them anyway, and the call to your fellow was serious overkill on her part. But your attitude towards the nurses is not very professional either.

Maybe you can give us an example of how you would word your response after this sequence in the conversation


Me: "We are checking it to make sure it doesn't go down."

Nurse: "Well, that's not good enough. I need a better explanation."

 

[Doctor Bagel]

Maybe you can give us an example of how you would word your response after this sequence in the conversation


Me: "We are checking it to make sure it doesn't go down."

Nurse: "Well, that's not good enough. I need a better explanation."

Not saying that the nurse wasn't being totally obnoxious here, but I'd probably have said a little more. Maybe something like, "well, based on the blood observed in his stool and his tachycardia, we're concerned that he might have a significant bleed. Consequently, we need to check the h/h regularly for signs of significant blood loss." Emphasize the clinical instability of this pt to explain why you're making the nurses do PITA blood tests every 6 hours.

Still, she sounds like a jerk.

 

[Osteoimperfecta]

Not saying that the nurse wasn't being totally obnoxious here, but I'd probably have said a little more. Maybe something like, "well, based on the blood observed in his stool and his tachycardia, we're concerned that he might have a significant bleed. Consequently, we need to check the h/h regularly for signs of significant blood loss." Emphasize the clinical instability of this pt to explain why you're making the nurses do PITA blood tests every 6 hours.

Still, she sounds like a jerk.

I agree, but there is still an outside chance that this nurse says this is not good enough. Hospital jerks are bred different. It is usually about power/respect and less often about the patient. The same nurse will do that lab q2 if written by Dr Crazythrowafit CT surgeon without questions. In a sense, hospitals are like grade-school, and the only unique people are the ones who are calm, mature, and willing to give answers like your post at the expense of looking weak/powerless. Truth be told, these people are very very few.

 

[gstrub]

Not saying that the nurse wasn't being totally obnoxious here, but I'd probably have said a little more. Maybe something like, "well, based on the blood observed in his stool and his tachycardia, we're concerned that he might have a significant bleed. Consequently, we need to check the h/h regularly for signs of significant blood loss." Emphasize the clinical instability of this pt to explain why you're making the nurses do PITA blood tests every 6 hours.

Still, she sounds like a jerk.

If she had said "I'm just curious, why are we following his HCT" I would have given the "this patient has pancreatitis and is tachy at baseline, and with bloody stools, the best indicator of bleeding will be serial HCTs." Hell I LIKE explaining this kind of thing. The problem was she paged me to ask me IF we were continuing to follow it, and when I said yes, she acted like she was waiting for a justification of the use of her time. And when she, in a rude and impatient tone, asked "um...WHY?" that's when she got the ******* answer of "we're watching to see if it goes down."

It seems that at this hospital this is par for the course for the juniors...constant pages to ask if we are continuing to do something, when the underlying question is "why." It's classic passive agressivism. I got paged to look at a pimple the same night...oh well.

 

[MSmentor018]

I've been on both sides of this coin. did you ask the nurse, "so what do you think or how would you like to keep a track on the H/H?". usually this type of deal is a simple power play, otherwise it's easier for the nurse to just draw the blood and move on. most of the time ICU RN's will think and try to do the best for the pt, even if it's the wrong decision. they get paid per hr, either sitting around doing nothing or drawing q6. is the pt a hard stick? no IV? Jehovah witness? hemophiliac? RN from a community center where they're given a lot more latitude? there's gotta be something more to this.....

as for case mgt (I did a few months) and such, nurses are never asked to change orders based on economic issues. although they will leave notes or call the doc to do so, esp from pharmacy. unless they do a stint in case mgt or admin they have no idea how much things cost. they may think they do b/c someone 10 yrs ago made up some number but realistically, not even close

 

[core0]

So I just had to vent this because I am so mad right now.

I am on call. In the SICU. We get paged a lot at this hospital for small things, which I suppose I have to get used to, but one thing that I was getting annoyed at came to a head this evening.

Page: "Are we continuing to do q6hr hct checks on pt X?"
(Pt X is a man with pancreatitis s/p debridement who has been tachy and who this nurse reported earlier in the day to have bloody stools).

Me: Call back, very politely, "Hello, this is Dr. G about pt X, and yes we are continuing those checks." I now believe this conversation is over right? Not so fast...

Nurse: after long pause waiting for explanation, and with real attitude, "um, why?"

Me: "We are checking it to make sure it doesn't go down."

Nurse: "Well, that's not good enough. I need a better explanation."

Me: "I'm sorry, but we want to continue those checks, just like the order says."

Nurse: "What's your name? I am going to page your fellow and write this up."

After this she goes on about paging my fellow and writing me up. The best part was that she paged me later and I called back, and she thought I was the fellow (even though she paged the same number, and I answered the same way), and she started telling the story as if I had simply told her off. It was classic! She also mentioned that Drs. can't just expect orders to get done because they write them...I bit my tongue nearly off.

I am happy to explain medical rationale, always. I don't have to though. Especially not to someone who treats me like I need to justify every single lab order with them. Also (I didn't say this but wanted to), anyone who needs an explanation about why we are checking hct in a patient who is tachy at baseline, has bloody stools (which she reported), and just had their pancreas debrieded...well...

/vent

I would have made two calls. One to the fellow. No one likes to be surprised by these calls. Then I would call the charge nurse. The conversation would go something like this:
Is there something wrong with Mr. X? I just got a call from nurse Y. She was asking about the blood draws (relate conversation here). You know I spend a lot of time down there and I've never had a problem like this. Do you know whats going on?

The answer is likely to be, I'm sorry Doctor I'll take care of it.

I propose a clinical trial of carrying out orders as written vs. the current standard of care.

 

[Substance]

I would have written her up for not only unprofessional behavior but also for dangerously inadequate fund of knowledge. I mean, if she really knew anything about health care she would have known why you were drawing the hcts.

 

[kitsunepixie]

I had to justify to a PACU nurse why I had to do a neurologic exam on a baby with a huge head bleed that underwent an emergent procedure today. She snidely said, "What are you doing? Do you really have to do that NOW!?" This same nurse has given me attitude when I've post-oped patients in the past, since checking them involves waking them up, which inevitably causes them to cry and distracts the nurse from her charting. I get that, but we HAVE to do it to make sure our patients aren't just lying there fixed and dilated or that their EVD has somehow come out, which always seems to happen in recovery anyway. The time before that she snapped at me, "She cries and she moves every thing. There. " It's so different from most of the other nurses in the PACU in the adult world who are usually HAPPY to see a doctor checking up on their patient, although those patients are usually alert enough right after their ETT is pulled in the OR to get a good exam AND conversation before they leave the OR.

This time, it was the last straw I had to tell my attending since this particular attending is very strict about wanting an exam done in the recovery room since the patients are usually too deep while they're awaiting transfer from the OR and sometimes the wait to go out of the PACU can be quite long if the hospital is full. She called the nurse and was pleasant with her but laid down the law that I was in the right. The nurse said, "Oh, I felt like apologizing when I saw her leave...all I can say is that I'm post-menopausal and it's the end of my shift." 🙄 My attending also said it was probably one of those things that just happen sometimes with female doctors and female nurses...👎

I told my mom, who's a Cardiac ICU nurse, about my interactions with that same nurse and she was in total disbelief that a nurse would refuse to let a doctor examine her patient and be a B**** about it, too.

 

[Acherona]

I can totally relate to the OPs sentiment. Happens all the time, especially with female residents and female nurses. I personally resent having to constantly explain basic medical concepts to lazy, low-intelligence, poorly-educated nurses only to be met with attitude. It's not my job on top of everything else I have to do.

 

[FibulaFx]

Can't believe people have been attacking the OP for this. I would've thought/said the same things. I figured this thread was going to turn into a bunch of other people sharing their anecdotes too. Guess not.

 

[Colbert]

Having just finished my MICU rotation, I can feel the OP on this one. It was essentially my first rotation as an intern (after an orientation) and my first night on call we had a patient with HONK. We had an order in for glucose levels every hour. The nurse paged me within 10 minutes of our attending leaving to tell me that they didn't need to be done that regularly and told me to change the order. I said I can't, we're actively treating her glucose levels and that's one of her biggest issues, so it's important we know what it is. She simply responded with, "Well, it's just not going to get done that often" and hung up. I was so flabbergasted that I deferred to the fellow and asked her to help me handle the situation. It was almost like we had to beg her to do her job.

The amount of times I had to ask nurses to get the blood draws that were ordered to be done 3 hours before or to update the flowsheets so I could tell what the BP or urine output was at was insane. And then, after I'd ask them to please update it, I'd get paged saying, "Oh hey, the urine output was 0 for the last 3 hours, please advise." Glad to be out of there.

 

[Mattchiavelli]

I would have asked who the nurse's charge was and on what specific grounds they were refusing the order for when I brought this to the attention of said charge nurse.

Sorry, I have had ICU nurses question orders and present their rationale leading to me changing orders when it makes sense. Normally it is on "well usually we give doeses from X-Y" or something like that. I have also worked with nurses to make orders less of a PitA like getting orders to synch up chronologically so they can collect more labs less frequently instead of checking 1 thing every 30 minutes. Every time I was able to get a rationale and we could work it out. The nurse the OP was working with was being childish. IMO if a nurse is going to question/refuse an order, the burden is on them to bring up SOME reason as to why they are being insubordinate and not just keep asking "why" like a 3 year old.

 

[zenman]

If she had said "I'm just curious, why are we following his HCT" I would have given the "this patient has pancreatitis and is tachy at baseline, and with bloody stools, the best indicator of bleeding will be serial HCTs." Hell I LIKE explaining this kind of thing. The problem was she paged me to ask me IF we were continuing to follow it, and when I said yes, she acted like she was waiting for a justification of the use of her time. And when she, in a rude and impatient tone, asked "um...WHY?" that's when she got the ******* answer of "we're watching to see if it goes down."

Problem here is you didn't hang up immediately after saying, "yes." You had at that point answered her question.😀

 

[zenman]

I would have written her up for not only unprofessional behavior but also for dangerously inadequate fund of knowledge. I mean, if she really knew anything about health care she would have known why you were drawing the hcts.

I like this!👍

 

[Janedoedoctor]

Having just finished my MICU rotation, I can feel the OP on this one. It was essentially my first rotation as an intern (after an orientation) and my first night on call we had a patient with HONK. We had an order in for glucose levels every hour. The nurse paged me within 10 minutes of our attending leaving to tell me that they didn't need to be done that regularly and told me to change the order. I said I can't, we're actively treating her glucose levels and that's one of her biggest issues, so it's important we know what it is. She simply responded with, "Well, it's just not going to get done that often" and hung up. I was so flabbergasted that I deferred to the fellow and asked her to help me handle the situation. It was almost like we had to beg her to do her job.

The amount of times I had to ask nurses to get the blood draws that were ordered to be done 3 hours before or to update the flowsheets so I could tell what the BP or urine output was at was insane. And then, after I'd ask them to please update it, I'd get paged saying, "Oh hey, the urine output was 0 for the last 3 hours, please advise." Glad to be out of there.

😱

Reading this, I start seeing your (and the OP's) point. I've never had nurses behave THIS bad. Sometimes they don't feel like drawing a gazillion labs and start complaining a little. But the kind of unprofessionalism and indifference towards the patient that you descibe here are (hopefully) rare.
Perhaps I'm being hopelessly naive, but wouldn't this be discussed with and solved by a nursing supervisor the next day?

 

[Socrates25]

Part of the problem is that attendings generally cave to nurses too often. Too many of them want to "play nice" and want to avoid conflict so they passively just let the residents deal with it so they dont have to get involved.

 

[Socrates25]

I would have asked who the nurse's charge was and on what specific grounds they were refusing the order for when I brought this to the attention of said charge nurse.

Sorry, I have had ICU nurses question orders and present their rationale leading to me changing orders when it makes sense. Normally it is on "well usually we give doeses from X-Y" or something like that. I have also worked with nurses to make orders less of a PitA like getting orders to synch up chronologically so they can collect more labs less frequently instead of checking 1 thing every 30 minutes. Every time I was able to get a rationale and we could work it out. The nurse the OP was working with was being childish. IMO if a nurse is going to question/refuse an order, the burden is on them to bring up SOME reason as to why they are being insubordinate and not just keep asking "why" like a 3 year old.

Yes, I would have flipped it over on her and said "I'm not changing the order until you give me a good reason."

Let her call the fellow and the attending if she wants.

 

[RadOncDoc21]

Part of the problem is that attendings generally cave to nurses too often. Too many of them want to "play nice" and want to avoid conflict so they passively just let the residents deal with it so they dont have to get involved.

Unfortunately this is true... I'm not saying it's fair or the right thing, but the only way to survive is to get the nurses on your side so that they will look after you on call. They have all the power (your pager#) and they know you have to answer it no matter what. I can remember the worse times were during shift changes where the new shift felt the need to update you on lab results you already knew (since you been there all day and night).

One trick I learned is to make mini-rounds and ask if there was anything that needed to be done before going back to the call room, make sure you ask them how their day was going, smile, then go to bed. Some battles are not worth fighting because in the end nobody wins.

-R

 

[WentForitandWon]

Since this is a vent thread. . . . . (story intentionally vague to avoid HIPPA violation)

Walked in to see a patient the other day. Very nice guy that I had very good rapport with. Something is different this morning though. He's very pissed off because he just found out that the IR drain that was painful and put in the day before had a closed stopcock (should have been open and draining a fluid collection). I apologize on behalf of everyone involved- I gave a cursory look at the drain the day before ~12 hours after it was put in and noted no output but left it up to the IR service to decide to flush or not the flush etc. (this is the standard practice at our hospital).

Anyway, after I leave the nurse ( a seasoned woman in her 60's) comes in and condescendingly tells me

"When we round it is very important that we examine all the drains a person has in their body"

My response: Yep, sure is. . . sure wish IR had managed their drain the right way.

What I didn't say: yeah, especially the 3 shifts of nurses who were taking care of this patient in the previous 24 hours, while I was on call cross-covering 3 services with a 50 patient census.

To be fair, I should have checked the stopcock on the tube. But, I was one of many people who missed the problem. I know that. But her attitude is ridiculous. I don't know where these nurses get the balls to say things like this.

Sometimes the best thing you can say is nothing. it just leads to paperwork, emails, and meetings about being a team player.

 

[Buzz Me]

Doing your own "mini rounds" in the evenings, often after the 7pm change of shift, is so key. Allows you to catch little errors and clarify things for the night crew.