Most ridiculous question from a nurse while on call

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Arrhythmia said:
Don't nurses need your OK to reinsert a new one? With Medicare not reimbursing cath related infections, a lot of MDs opt not to have a another catheter in. Or if a pt is confused and pulled it out, then there's another chance he/she will do so again and might cause injury. The nurse was just covering her behind. Thus, I dont find your story funny at all. Sorry.
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Covering her ***** and not knowing the reasons for why things are done. It amazes me that sometimes nurses can be doing something for decades and yet still not know WHY certain things are done (and yet at the same time, they want to be physicians 🙄) Here is a great example of a nurse coming onto this forum confusing an extubation scenario with foley removal. Often times, if a patient self extubates in the ICU, we may see how they do on their own prior to deciding to re-intubate or not. The same rule does not apply to foley's. If there was one in before, there is a reason why its in there. We don't put them in for convenience as much as some nurses would like us to and like TIRED said, Medicare doesn't dictate why either
 
as a new nurse in the ED I happened upon a sleeping patient at the beginning of my shift whose vital signs hadn't been rechecked all night. The patient was being held in the ED because the house was full, and the night doc and nurse had apparently felt the patient did not require freq reassessment.

anyway, the patient turned out to be septic and his bp was 60's/30's, febrile, tachycardic, and diminished LOC. I drew 2 sets of blood cultures while establishing 2 large bore lines, and gave the abx that had been ordered by the admitting doc several hours previously.

Several weeks later the patient and his wife wrote an emotionally charged letter to hospital administration praising me by name and the care i had given. "If it hadn't been for (my name) my husband would not be alive today". I thought it was sweet of them to write that letter but I got called to the carpet by the overnight doc who had seen the patient when he first came in. He ranted at me angrily for "making the night shift's care look bad" and making it seem like they "dropped the ball."

i was amused at the doctor's hysteria over this, and I said "Doctor, even if you guys had dropped the ball, do you think I would ever imply that much less say that to a patient or their family member?" there is no pleasing some ppl i guess.
 
PennySaved said:
as a new nurse in the ED I happened upon a sleeping patient at the beginning of my shift whose vital signs hadn't been rechecked all night. The patient was being held in the ED because the house was full, and the night doc and nurse had apparently felt the patient did not require freq reassessment.

anyway, the patient turned out to be septic and his bp was 60's/30's, febrile, tachycardic, and diminished LOC. I drew 2 sets of blood cultures while establishing 2 large bore lines, and gave the abx that had been ordered by the admitting doc several hours previously.

Several weeks later the patient and his wife wrote an emotionally charged letter to hospital administration praising me by name and the care i had given. "If it hadn't been for (my name) my husband would not be alive today". I thought it was sweet of them to write that letter but I got called to the carpet by the overnight doc who had seen the patient when he first came in. He ranted at me angrily for "making the night shift's care look bad" and making it seem like they "dropped the ball."

i was amused at the doctor's hysteria over this, and I said "Doctor, even if you guys had dropped the ball, do you think I would ever imply that much less say that to a patient or their family member?" there is no pleasing some ppl i guess.
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So what's your point?
 
PennySaved said:
as a new nurse in the ED I happened upon a sleeping patient at the beginning of my shift whose vital signs hadn't been rechecked all night. The patient was being held in the ED because the house was full, and the night doc and nurse had apparently felt the patient did not require freq reassessment.

anyway, the patient turned out to be septic and his bp was 60's/30's, febrile, tachycardic, and diminished LOC. I drew 2 sets of blood cultures while establishing 2 large bore lines, and gave the abx that had been ordered by the admitting doc several hours previously.

Several weeks later the patient and his wife wrote an emotionally charged letter to hospital administration praising me by name and the care i had given. "If it hadn't been for (my name) my husband would not be alive today". I thought it was sweet of them to write that letter but I got called to the carpet by the overnight doc who had seen the patient when he first came in. He ranted at me angrily for "making the night shift's care look bad" and making it seem like they "dropped the ball."

i was amused at the doctor's hysteria over this, and I said "Doctor, even if you guys had dropped the ball, do you think I would ever imply that much less say that to a patient or their family member?" there is no pleasing some ppl i guess.
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Looks like your fellow nurses are the ones who dropped the ball...no one is checking vitals or giving the IV abx that were ordered hours ago?
 
As a med student, had a DM patient come in with URTI that had kicked them into a hyperglycemic hyerposmotic state. Luckily, some quick insulin and fluids was able to keep them out of DKA. The patient was admitted overnight for obs. When I got in next morning and scanned the am labs, the patient was in DKA! I was like wtf!

So after paging the intern, I checked the chart. The patient had spent most of the night in the ER waiting for a room, where the BG was meticulously checked by the nurse and recorded. However, as the BG slowly increased past 200, 300, 400+ the nurse apparently never thought to give the ordered SSI. In fact, the patient never even got their scheduled insulin dose that evening.

Even worse, the patient had been on the floor for a couple hours on the DM protocol, and still had not had their BG checked or any insulin given!

It was at this point I stopped worrying about killing a patient as a med student. I figured the system would kill them way before I ever had a chance to.
 
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psychbender said:
WRAMC, by chance?
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Nope, sorry.

I just finished a surgery AI, and I was screening pages for the chief while she tried to catch up on some sleep.
Me: Hi, this is WLG returning a page for Dr. X.
Nurse: Hi, I have a question about a prescription for patient Y.
Me: Shoot.
Nurse: He's written for 1 tab of Drug Z, but all we have are 25mg tabs.
Me: Well, how much is in 1 tab?
Nurse: 25mg.
Me: (Not wanting to wake the chief) Go for it.

It's paraphrased; I was much nicer and less cavalier in person. Mostly because I felt bad. Either she was just being bitchy, or she was just following some ridiculous protocol (at an inopportune time). Either way, I'm sure she wasn't any happier about it than I was.
 
PennySaved said:
as a new nurse in the ED I happened upon a sleeping patient at the beginning of my shift whose vital signs hadn't been rechecked all night. The patient was being held in the ED because the house was full, and the night doc and nurse had apparently felt the patient did not require freq reassessment.

anyway, the patient turned out to be septic and his bp was 60's/30's, febrile, tachycardic, and diminished LOC. I drew 2 sets of blood cultures while establishing 2 large bore lines, and gave the abx that had been ordered by the admitting doc several hours previously.

Several weeks later the patient and his wife wrote an emotionally charged letter to hospital administration praising me by name and the care i had given. "If it hadn't been for (my name) my husband would not be alive today". I thought it was sweet of them to write that letter but I got called to the carpet by the overnight doc who had seen the patient when he first came in. He ranted at me angrily for "making the night shift's care look bad" and making it seem like they "dropped the ball."

i was amused at the doctor's hysteria over this, and I said "Doctor, even if you guys had dropped the ball, do you think I would ever imply that much less say that to a patient or their family member?" there is no pleasing some ppl i guess.
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It is the nursing staff's job to check vitals every x hours in the ED.

So let me get this straight...your own nursing colleagues didn't do their job, and almost killed a patient. Then finally you decided to follow the admitting doctor's orders and claim to have saved the patient's life. What exactly do you want credit for?
 
what a bizarre culture though. yes, aboslutely, the night shift RNs dropped the ball. The guy was being held indefinitely in the ED and while there, all patients regardless of their admission orders should be thought of as potentially critical. To chart "Pt condition stable" or "Vital signs stable" in the ED is something to be avoided, I think, because we don't hold patients long enough to establish a trend that defines what is stable.

This delay in care in this case was absolutely a nursing issue. (BTW, at no point would I credit myself with saving a life. The doctor's orders and the hospital protocols saved his life.) However, it struck me as weird that I was shamed by the ER doctor when I had actually implemented his orders and followed the protocols and delivered ICU level care in a Baker Act room in the ED on a no-lunch 12 hr Sunday shift. The patient's wife was unsatisfied with the care her husband received at the hands of night shift (in her mind that included the night shift ER doc and the ER nurse) and she excluded me from her complaint by name because she felt I delivered good care.

Cut to several weeks later, the ER doc yells at me in the middle of the nurse's station for "making it seem like you saved his life while the rest of us neglected him." He was pretty cruel about it, mocking the lady's positive comments about my actions in a falsetto tone, etc. Presumably he thought I must have made biasing remarks to the wife and cast myself as their savior. It jarred me that he'd yell at me and drew negative attention to me based on assumption. I would have preferred a gold star or a cookie.
 
Here is the winner:

Page at 0300:

Nurse: Hello, are you covering the 10th floor?
Me: Yes.
Nurse: Are you familiar with Mr. K?
Me: Yes.
Nurse: Well, he just had a really large bowel movement. The FOB was positive but he has an anal fissure.
Me: ...um...what's your question?
Nurse: I don't have one.
Me: I'm sure you find poop fascinating, but that's not an appropriate call. Goodbye.[I hang up]
 
WholeLottaGame7 said:
Nurse: He's written for 1 tab of Drug Z, but all we have are 25mg tabs.
Me: Well, how much is in 1 tab?
Nurse: 25mg.
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Hopefully, in the non-paraphrased version, you actually asked the nurse what the dose of the medication was, as your question "How much is in 1 tab" was actually told to you when she initially stated her case "He's written for 1 tab of Drug Z, but all we have are the 25 mg tabs." Your question was redundant and your reply didn't answer her question as to if a 25mg tab was an appropriate dose. If the drug was, oh, say diphenhydramine, there are 12.5mg, 25mg and 50mg tabs. If it was something like metoprolol (extended release), that comes in 25mg, 50mg 100mg and 200mg tabs. The point is, there was no dose given. It isn't about following some "ridiculous" protocol or her being bitchy, it is about the order being written incorrectly. Do you really want to give an 80 year old frail woman 25 mg diphenhydramine and completely snow her? Do you really think 25 mg metoprolol will cover the raging hypertensive guy who takes 200mg at home? I agree, there have been some unfortunate calls listed on here, but this one seems pretty appropriate to me.

I guess I'm more disappointed in your senior resident for giving you her pager (and I'm curious as to why a service chief is being paged about a medication issue instead of the intern), as she should know better, but your cavalier attitude of superiority should be checked, as this was an appropriate call and your big, bad, show-her-how-stupid-she-is question did nothing to advance the answer.
 
I just wonder what kind of details are left out from your story because you've mentioned a few instances of how the family thanked you or excluded you from the complaints - how exactly is it that the family thought you saved the patient's life? did you correct any misunderstandings the family had regarding this view? I can see why the attending might have assumed you took credit because based on what you've described, its likely that you either did so or didn't bother correcting the family when they assumed as such. Also, how did the family know how critical the situation was? did the patient go to the ICU (i would assume such an unstable patient in severe sepsis would require ICU admission) and if not, did the instability of the patient get played up by someone?
 
If she was the first person in hours who assessed the patient, recognized crisis, and acted then she DID save the patient. Families aren't always *****s. If the patient was ignored all night (and I'd love to say it doesn't happen, but sometimes it does), then she assesses him, finds a very unstable state, and takes action, the family can SEE that the patient was unstable. They don't need to be told. :laugh:
 
SocialistMD said:
Hopefully, in the non-paraphrased version, you actually asked the nurse what the dose of the medication was, as your question "How much is in 1 tab" was actually told to you when she initially stated her case "He's written for 1 tab of Drug Z, but all we have are the 25 mg tabs." Your question was redundant and your reply didn't answer her question as to if a 25mg tab was an appropriate dose. If the drug was, oh, say diphenhydramine, there are 12.5mg, 25mg and 50mg tabs. If it was something like metoprolol (extended release), that comes in 25mg, 50mg 100mg and 200mg tabs. The point is, there was no dose given. It isn't about following some "ridiculous" protocol or her being bitchy, it is about the order being written incorrectly. Do you really want to give an 80 year old frail woman 25 mg diphenhydramine and completely snow her? Do you really think 25 mg metoprolol will cover the raging hypertensive guy who takes 200mg at home? I agree, there have been some unfortunate calls listed on here, but this one seems pretty appropriate to me.

I guess I'm more disappointed in your senior resident for giving you her pager (and I'm curious as to why a service chief is being paged about a medication issue instead of the intern), as she should know better, but your cavalier attitude of superiority should be checked, as this was an appropriate call and your big, bad, show-her-how-stupid-she-is question did nothing to advance the answer.
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Perhaps I paraphrased poorly, but the point was that she had the right dose and seemed to pretty clearly understand that; she was basically telling me the paper order just needed tweaking. I agree, it's important to dot all your T's and cross all your I's; the reason I posted it was that it just seemed like an issue that could have waited until the morning to page the senior about. Or she could have paged the PA. No intern (I was AI).

And just FYI, I presented it cavalierly, but as I stated in my post, if anything I talked to her extra-empathetically because I didn't know the real motivation she chose to call at that hour. And judging from this thread, I will be in the bottom 5% of residents in the Rudeness to Nurses category. But since you seem pretty sure that you know me (and the chief resident) after one post, maybe you're the one with the attitude of superiority? Just a thought... (Translation: what's the point of the name-calling?)
 
EternalMD said:
I just wonder what kind of details are left out from your story because you've mentioned a few instances of how the family thanked you or excluded you from the complaints - how exactly is it that the family thought you saved the patient's life? did you correct any misunderstandings the family had regarding this view? I can see why the attending might have assumed you took credit because based on what you've described, its likely that you either did so or didn't bother correcting the family when they assumed as such. Also, how did the family know how critical the situation was? did the patient go to the ICU (i would assume such an unstable patient in severe sepsis would require ICU admission) and if not, did the instability of the patient get played up by someone?
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it was balls to the wallls, and when i assumed care, his condition was totally changed from the way it was understood by the admitting doc (who had not seen the patient but given telephone admission orders) The ER doc had dispo'd and gone home. There was no critical care consult at that time because in spite of a LLL infiltrate and a hx of MRSA, the ICU beds are only given to patients who are, like, hemodynamically unstable.

As far as the family is concerned-- complain they did!! I was sweating trying to get the intensivist on the phone, establish code-worthy IV access, apply for an ICU bed based on my assessment findings. Our unit clerk had called in sick that day. The patient was going down the F*ing tubes and he was a nice guy. In his 40's; it wasn't like he was some nursing home dementia patient with no quality of life. it was a scary moment for me, trying to convey by phone to the infectious disease doc, and to the intensivist, the cardiologist, and keeping my charting current throughout all of it.

The family watched everything go on. I did not pursue interaction with the wife because everything else had more priority. I was trying to prime the guy with fluids and hang the pressors and get him out of the ED. Drawing a whole new critical care panel, a grey on ice for the lactic acid level, calling RT to get ABGs, and all the while trying to be diplomatic with the wife.

She was afraid her husband was going to die. Not because I told her he was so sick. Any layperson could see he losing his reserve. I had him in Trandelenberg and I did give simple answers to the questions she asked whenever possible. What should i have done? sent her to the waiting room lest she think I was taking care of her husband?

Evidently you are implying that I am dishonest which is exactly what the ER doc did to me weeks later.

Every time the wife said "but they didn't check on him all night, i assumed he was fine! i need to transfer him to another hospital right now! " I would listen, validate her by saying that I could see she was frustrated, but telling her how great the intensivist is--And the intensivist that day was amazing. I never broke rank with my home team. I mentioned that night shift nursing staff had been stretched thin and I guaranteed her that her husband would be receive ICU level care in the ED while the ICU made a spot for him. I never once reinforced her belief that this could have been treated earlier if the admitting doc had rounded on him, or if the night nurses had monitored his vital signs continuously. I played the game the way I am supposed to play it. Validate their concerns, keep them informed. Speak and chart neutrally and protect all medical staff from culpability.

It's just crazy to tar and feather a nurse who shut her mouth, gained a frightened patient's trust, and avoided crapping her pants. I really can't believe i didn't crap my pants that day. 😉

"Dr ____ could have just said, "hey, strong work with Mr _____ the other day. I heard he crumped in the ER after i went off shift and you didn't crap your pants." That "strong work" phrase means a lot, and we know when we deserve to hear it. What's really cool when one of you says it.
 
PennySaved said:
it was balls to the wallls, and when i assumed care, his condition was totally changed from the way it was understood by the admitting doc (who had not seen the patient but given telephone admission orders) The ER doc had dispo'd and gone home. There was no critical care consult at that time because in spite of a LLL infiltrate and a hx of MRSA, the ICU beds are only given to patients who are, like, hemodynamically unstable.

As far as the family is concerned-- complain they did!! I was sweating trying to get the intensivist on the phone, establish code-worthy IV access, apply for an ICU bed based on my assessment findings. Our unit clerk had called in sick that day. The patient was going down the F*ing tubes and he was a nice guy. In his 40's; it wasn't like he was some nursing home dementia patient with no quality of life. it was a scary moment for me, trying to convey by phone to the infectious disease doc, and to the intensivist, the cardiologist, and keeping my charting current throughout all of it.

The family watched everything go on. I did not pursue interaction with the wife because everything else had more priority. I was trying to prime the guy with fluids and hang the pressors and get him out of the ED. Drawing a whole new critical care panel, a grey on ice for the lactic acid level, calling RT to get ABGs, and all the while trying to be diplomatic with the wife.

She was afraid her husband was going to die. Not because I told her he was so sick. Any layperson could see he losing his reserve. I had him in Trandelenberg and I did give simple answers to the questions she asked whenever possible. What should i have done? sent her to the waiting room lest she think I was taking care of her husband?

Evidently you are implying that I am dishonest which is exactly what the ER doc did to me weeks later.

Every time the wife said "but they didn't check on him all night, i assumed he was fine! i need to transfer him to another hospital right now! " I would listen, validate her by saying that I could see she was frustrated, but telling her how great the intensivist is--And the intensivist that day was amazing. I never broke rank with my home team. I mentioned that night shift nursing staff had been stretched thin and I guaranteed her that her husband would be receive ICU level care in the ED while the ICU made a spot for him. I never once reinforced her belief that this could have been treated earlier if the admitting doc had rounded on him, or if the night nurses had monitored his vital signs continuously. I played the game the way I am supposed to play it. Validate their concerns, keep them informed. Speak and chart neutrally and protect all medical staff from culpability.

It's just crazy to tar and feather a nurse who shut her mouth, gained a frightened patient's trust, and avoided crapping her pants. I really can't believe i didn't crap my pants that day. 😉

"Dr ____ could have just said, "hey, strong work with Mr _____ the other day. I heard he crumped in the ER after i went off shift and you didn't crap your pants." That "strong work" phrase means a lot, and we know when we deserve to hear it. What's really cool when one of you says it.
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Now you're sounding like the nurses on that new mercy or whatever tv show :laugh:

All you had to do was find the attending and say "hey, you know Mrs. ______ is really upset, and the patients vitals are _______." I'm sorry, but all you did was follow protocol. It's a nurse's job to check vitals, start IVs, send off labs, get the ICU on the phone for bed availability. You simply did your job, however stressful it may be.

As far as the doctor ripping into you in front of everyone, yes that was wrong. If he had an issue, the least he should've done was talk to you in private.
 
WholeLottaGame7 said:
Perhaps I paraphrased poorly, but the point was that she had the right dose and seemed to pretty clearly understand that; she was basically telling me the paper order just needed tweaking. I agree, it's important to dot all your T's and cross all your I's; the reason I posted it was that it just seemed like an issue that could have waited until the morning to page the senior about. Or she could have paged the PA. No intern (I was AI).

And just FYI, I presented it cavalierly, but as I stated in my post, if anything I talked to her extra-empathetically because I didn't know the real motivation she chose to call at that hour. And judging from this thread, I will be in the bottom 5% of residents in the Rudeness to Nurses category. But since you seem pretty sure that you know me (and the chief resident) after one post, maybe you're the one with the attitude of superiority? Just a thought... (Translation: what's the point of the name-calling?)
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1. I never called anyone names.
2. Simply because I'm right doesn't mean I have an attitude of superiority.

What I wanted was a clarification, as your paraphrase did not indicate she had the right dose; it indicated that she had a pill that was a possible dose, an order that did not tell her the dose and a patient who needed his medication. Be it 2am or 2pm, if the nurse is unclear about the dose to be administered because the orders do not state it, it warrants a call. My whole point was that, in this case, the call (be it at what you feel is the appropriate time or not) came because the person writing the orders (presumably a physician) did not write them correctly. This fact eliminates the call from qualifying for the thread entitled Most ridiculous question from a nurse while on call, and you, still young in your career, need to recognize that when mistakes are made on the physician's part, a rebuttal from a nurse is completely justified and not ridiculous.

Whether or not the call came to the correct person (your paraphrase did not mention there was a PA, though, in my experience, many times the questions about orders come back to the physicians who write them or calls get bumped up the ladder when the junior on the team (your PA) isn't returning the pages) is pretty much immaterial to this thread that has basically devolved into a nurse-bashing fest. Let he who is without sin cast the first stone, I suppose, but that's why I haven't posted anything up to this point.

As far as your senior resident goes, I feel I can object to a senior resident handing off his/her pager to a medical student for the purposes of sleep, as the only calls that should be going to a chief are "patient X is crashing" or "patient Y is ready for the OR," both of which are probably coming from other residents and neither of which require an intermediary person answering the page. Perhaps things work differently at your program, so I'll concede the point.
 
Pennysaved,
I agree you deserve a cookie for that one.
How about a virtual cookie from me?
And it does seem that the ER attending's anger was displaced...in other words he was frustrated to have received a complaint against him (ER docs and nurses tend to get hit with those the most, I think, for various reasons) and was taking it out on you. It seems that the ball was dropped on the night shift, as sometimes happens in the ER or on the floor. The ER isn't really set up to deal with chronic issues or with unstable patients over a number of hours...it's supposed to stabilize people and triage them to an appropriate place for further care. As an internist I've seen stuff like this happen in the ER...it's just not ideal for a medicine admission to stay in the ER all night...the house staff (or hospitalist, other admitting doc, etc.) is less likely to go down there very frequently vs. seeing patients on the hospital floor, and once the patient is officially admitted, the ER docs tend to stop checking on him/her very much, even if the patient is still physically in the ER. For sure, the night shift nurse(s) should have been checking on the patient more often, too. So while pennys. wave technically just doing his/her job, I don't think it's untrue to think she/he may have saved the patient's life. These types of problems tend to be systemic, and maybe they wouldn't happen so often if the ER's weren't so overcrowded. At the teaching hospital where I work, it's not uncommon to see multiple patients being housed on gurneys in the hallways of the ER for hours.
 
1620: I get paged to a number. No one picks up and it goes to pharmacy voicemail.

1622: I try calling back. Voicemail.

16:24: I try calling back. Voicemail.

16:25: I get paged to a new number. It's a pharmacist trying to confirm that I really wanted the medication I just ordered. I say yes. While on the phone, my pager goes off again. She screams, "OH MY GOD, what's that beeping in the background? Are you there? Are you there?"

Me: Yes. I'm still here. That noise was you paging me for a 5th time in 5 minutes.

The "medication" in question? Benadryl.
 
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PennySaved said:
what a bizarre culture though. yes, aboslutely, the night shift RNs dropped the ball. The guy was being held indefinitely in the ED and while there, all patients regardless of their admission orders should be thought of as potentially critical. To chart "Pt condition stable" or "Vital signs stable" in the ED is something to be avoided, I think, because we don't hold patients long enough to establish a trend that defines what is stable.

This delay in care in this case was absolutely a nursing issue. (BTW, at no point would I credit myself with saving a life. The doctor's orders and the hospital protocols saved his life.) However, it struck me as weird that I was shamed by the ER doctor when I had actually implemented his orders and followed the protocols and delivered ICU level care in a Baker Act room in the ED on a no-lunch 12 hr Sunday shift. The patient's wife was unsatisfied with the care her husband received at the hands of night shift (in her mind that included the night shift ER doc and the ER nurse) and she excluded me from her complaint by name because she felt I delivered good care.

Cut to several weeks later, the ER doc yells at me in the middle of the nurse's station for "making it seem like you saved his life while the rest of us neglected him." He was pretty cruel about it, mocking the lady's positive comments about my actions in a falsetto tone, etc. Presumably he thought I must have made biasing remarks to the wife and cast myself as their savior. It jarred me that he'd yell at me and drew negative attention to me based on assumption. I would have preferred a gold star or a cookie.
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For some reason I noted ER physicians to be either really good or awful.
 
SocialistMD said:
1. I never called anyone names.
2. Simply because I'm right doesn't mean I have an attitude of superiority.

What I wanted was a clarification, as your paraphrase did not indicate she had the right dose; it indicated that she had a pill that was a possible dose, an order that did not tell her the dose and a patient who needed his medication. Be it 2am or 2pm, if the nurse is unclear about the dose to be administered because the orders do not state it, it warrants a call. My whole point was that, in this case, the call (be it at what you feel is the appropriate time or not) came because the person writing the orders (presumably a physician) did not write them correctly. This fact eliminates the call from qualifying for the thread entitled Most ridiculous question from a nurse while on call, and you, still young in your career, need to recognize that when mistakes are made on the physician's part, a rebuttal from a nurse is completely justified and not ridiculous.

Whether or not the call came to the correct person (your paraphrase did not mention there was a PA, though, in my experience, many times the questions about orders come back to the physicians who write them or calls get bumped up the ladder when the junior on the team (your PA) isn't returning the pages) is pretty much immaterial to this thread that has basically devolved into a nurse-bashing fest. Let he who is without sin cast the first stone, I suppose, but that's why I haven't posted anything up to this point.

As far as your senior resident goes, I feel I can object to a senior resident handing off his/her pager to a medical student for the purposes of sleep, as the only calls that should be going to a chief are "patient X is crashing" or "patient Y is ready for the OR," both of which are probably coming from other residents and neither of which require an intermediary person answering the page. Perhaps things work differently at your program, so I'll concede the point.
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Fine, character-calling. Just as bad. And the air of superiority comment was referencing you making a judgement on people you've never met, not on the issue at hand; I conceded the point that it was not THE most ridiculous question ever.

And I agree, I don't see why this thread had to turn into one bashing nurses. I think the original goal of the thread was perfectly legitimate; we could easily have another thread on "most ridiculous questions from an attending" or "most ridiculous questions from a pharmacist" or whatever. However, since most internet threads in general result in someone bashing someone else, I suppose it's no surprise this one did.
 
Let's move on. Any more back-and-forthing on the same case over and over again (name calling included) will lead to the thread being closed. Thanks.
 
PennySaved said:
Cut to several weeks later, the ER doc yells at me in the middle of the nurse's station for "making it seem like you saved his life while the rest of us neglected him." He was pretty cruel about it, mocking the lady's positive comments about my actions in a falsetto tone, etc. Presumably he thought I must have made biasing remarks to the wife and cast myself as their savior. It jarred me that he'd yell at me and drew negative attention to me based on assumption. I would have preferred a gold star or a cookie.
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The ER Doc yelled at you because he felt guilty for missing something when really, you were just doing your job.

You should have been complimented for catching something. Not chastised.
And you should not be chastised here either.

Anyways, I'm still laughing about the pancakes.

As for yelling and hanging up on people, it's just not necessary. However, I would probably yell if I got called more than once about the pancakes.
:laugh: I mean to be fair, it is our job too to make sure patients eat but from a common sense and practicality perspective doing it at 3 am when the kitchen is closed and no one can do anything about it is not a good idea.

Still laughing.
 
330 am I get paged

Nurse answers "hello doctor, I am reviewing the patient's records and find that she is rubella non immune can I have an order to give the patient MMR vaccine"

Why sure. But, umm nurse X do you plan on waking the patient up to give her the vaccine right now?! No in the morning with her meds. OOOO, I didn't but I wanted to scream..then why are you paging me at this awful hour for
something you could have asked me about when I did morning rounds?! The only reason I held back was fear of backlash. If I blew my top she would tell her nurse buddies and then they would page all night for misc stuff.

Suck!
 
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I swear to God nurses on the night shift get to going over the chart ad nauseum and feel the URGE to page at crazy hours to ask for **** that would be better asked during regular hours. If this was an attending I guarantee they would NOT be paging at 0300 hours, WTF!
 
It's funny how drs feel that their title gives them some authority over others. Those who feel the need to yell at nurses are more than welcome to come and yell at me. It has only happened once in 12yrs and he ended up giving an apology for the incident. Just a bunch of oversized egos that need a little deflating if you ask me. Its beyond rude and shouldn't be tolerated.
 
PICUPNP said:
It's funny how drs feel that their title gives them some authority over others.
Click to expand...

It's not the title that gives them authority over others, it's the 10+ years of schooling/training and vast knowledge that does.

I too love the night shift nurses who look over every detail in every chart and then page you for crap. It's like they think they're going to crack the case at 3am by going over the same chart that the medicine attending, cardiology consult, pulmonary consult, and ID fellow already reviewed several times. I swear, sometimes I feel like nurses shouldn't have access to charts between the hours of midnight and 6am.
 
PICUPNP said:
It's funny how drs feel that their title gives them some authority over others. Those who feel the need to yell at nurses are more than welcome to come and yell at me. It has only happened once in 12yrs and he ended up giving an apology for the incident. Just a bunch of oversized egos that need a little deflating if you ask me. Its beyond rude and shouldn't be tolerated.
Click to expand...

Kinda generalizing aren't you? "Titles" do give you authority. Now, whether that person should yell at another person is a different matter. But if a nurse called me at 0330 to ask about MMR vaccine, that is clearly an educational moment for a ******* nurse.

By the way, I'm a smart nurse and maybe you will be now! :laugh:
 
i have interacted with a couple of rude physicians but as a female new grad RN thrown into a high acuity ED full of much older female nurses, I learned to view the docs as my allies in the jungle lol. Direct communication, common sense implementation of the simple protocols, and close monitoring of patient condition is all my ER docs want from me. And it's a pleasure working with them. If not stupidly-timed, they will answer any question I have, especially if it's a well thought out question that gives them a chance to teach me the rationale behind why we did what we did.

It was the nursing culture that was inhumane towards me. Almost 3 years in now and I have earned my stripes by killing them with kindness and being 'Johnny on the spot' during a crisis. I guess they hated me because I was the only one my age and probably because I'm not overweight. And I think that's sad. The nursing prefession needs young blood; let's nurture the noobs.
 
I too have observed that nurses are much more likely to eat their young. I've never understood the rationale behind sabotaging your colleagues. There is a lot of petty bickering and infighting that goes on that results in depression and stress amongst the nurses in our ICUs. I've found that if you avoid treating people like crap they tend to reciprocate, so I haven't had too many issues with our nursing staff. They've also saved my ass quite a few times.
 
PennySaved said:
i have interacted with a couple of rude physicians but as a female new grad RN thrown into a high acuity ED full of much older female nurses, I learned to view the docs as my allies in the jungle lol. Direct communication, common sense implementation of the simple protocols, and close monitoring of patient condition is all my ER docs want from me. And it's a pleasure working with them. If not stupidly-timed, they will answer any question I have, especially if it's a well thought out question that gives them a chance to teach me the rationale behind why we did what we did.

It was the nursing culture that was inhumane towards me. Almost 3 years in now and I have earned my stripes by killing them with kindness and being 'Johnny on the spot' during a crisis. I guess they hated me because I was the only one my age and probably because I'm not overweight. And I think that's sad. The nursing prefession needs young blood; let's nurture the noobs.
Click to expand...


I wish the people at the hospital i work for had ur mind set.
I'm a new grad, in night shift. I try my best to be kind to all the nurses, i bring donuts, and bagels. I help those i can out, i help morning shift, by making sure my rooms are clean, patients comfortable, hag with new iv bags. When I receive a patient from AM shift, they sometimes don't give the 1700 meds so they give me some excuse and i give it.

But when I request their help, for example, i have trouble with placing iv's, but i will always try twice before asking someone else, when i ask another nurse for help, all she would say was ur on ur own now, u should be able to do this without asking for any help(luckily i was able to put it in after a third attempt). or when one patient absolutely refuses to take his 0600 meds(and yes, i try more than 3 times to give him the pills, i tell my charge nurse and she says its ok to endorse to am shift) because he is way too sleepy to swallow anything and will only take it after 0700, and i try to ask them to give it to him, they say no it's in your time, u have to do it, and these are the same people i give meds for.(i ended up staying past my hours just to give him the pills).

Or sometimes when a medication needs to be renewed and they chew u out for not having it done. Hey i wrote a note for the doctor, put it in the chart, called the md x many times and just received it this way from the am nurse, i'm night shift, no one is available in the night shift. what do you want from me? Sorry, im just ranting...but there are some nurses who u just can't win over even if u give them a giant solid nugget of gold.
 
Not a stupid question, but I'm in the unit this month and have a few patients who needs PO meds on an empty stomach, but are also being fed by tube feeds. In light of that, I asked nutrition to calculate their feeds as bolus feeds rather than 24 hour feeds so that they would have empty stomachs a few times a day. Not as common, I know, but far more physiologic. The nurses are OBSESSED and you would think that we are DROWNING these patients (all of whom are fairly hemodynamically stable for unit patients) with their bolus feeds.

Nurse: I have to give her TWO CANS (of formula). That's a lot.
Me: What are her residuals?
Nurse: 20-40 cc.
Me: Sounds like she's handling it just fine.
Nurse: but it's TWO CANS.
Me: [Picks up cans, reads label.] Well, it's about the equivalent of a large coffee.
Nurse: BUT THAT'S A LOT!
Me: No, it's not.
 
Also, it's 3 AM and I've finally kicked a sub-i out of my call room (yeah, WTF?) and have had my eyes closed for about 5 minutes. Beep beep beep beep beep!!!!

Me: I was paged.
Nurse: Mrs. D's calcium is 6.8!!! You need to come see her!
Me: Is she having arrhythmias?
Nurse: No.
Me: What was her calcium yesterday?
Nurse: 6.7
Me: What is her albumin?
Nurse: 1.7
Me: Ok, thank you, good night.
Nurse: Aren't you going to DO SOMETHING? Her calcium is CRITICALLY LOW.
Me: No. Goodnight.
 
SoCuteMD said:
Also, it's 3 AM and I've finally kicked a sub-i out of my call room (yeah, WTF?) and have had my eyes closed for about 5 minutes. Beep beep beep beep beep!!!!

Me: I was paged.
Nurse: Mrs. D's calcium is 6.8!!! You need to come see her!
Me: Is she having arrhythmias?
Nurse: No.
Me: What was her calcium yesterday?
Nurse: 6.7
Me: What is her albumin?
Nurse: 1.7
Me: Ok, thank you, good night.
Nurse: Aren't you going to DO SOMETHING? Her calcium is CRITICALLY LOW.
Me: No. Goodnight.
Click to expand...

You just summed up why nurses (nor nurse practitioners) will ever be doctors 👍
 
pumlittlekin said:
hey,

please don't generalize....there are some nurses i've met who would be fine doctors....
Click to expand...

i dont think that was ment 'post-physician' training. It was ment without physician training. You are right, a lot of nurses out there would have made fine doctors if they had the medical and residency training.
 
intern year, on call, admitting a patient who was choppered in, low BP, dehydrated among other things.

*trying to get summary of transfer from aircrew RN* Me: Did you give him any fluids?
RN: Yes, of course - 0.9 NS 1000ml
Me: *not seeing any PIV/access etc* Really how did you give it?
RN: I gave it myself... look. *she holds up a bag of IVF - with no tubing - it was never hooked up - just placed on the bed.*
 
Ok I finally got one worthy of posting here, happened fairly recently. An abridged version.

Got paged 1:01AM - One of the monitored floors, My current pager ring tone on my blackberry is the Imperial March from Star Wars, which awakens me from my slumber in a foreboding jolt of reality.

n00b: "Dr. T, you are taking care of Mr. ____?"
Me: "Yes, what can I help you with."
n00b: "Dr. T! You need to come here RIGHT NOW, he's having Intermittent Asystole!!!" 😱
Me: "What...huh? *throw my shoes on quickly at thought of running towards an impending code* What is the patient's status?" 😕
n00b: "Vitals are stable, he's sitting up here on the side of the bed talking to me now. He's kinda worried though." 😱
Me: "........"* 🙄
n00b: "Dr. T?" :scared:
Me: "...Did you check the leads and the battery pack on the monitor?" :idea:
n00b: "No....*long pause* Oh, battery is low and two of the leads are off." 😛
Me: "Oh, better swap out that battery pack then and replace those leads! Call me if ya need anything else, have a good evening. *holding back a snicker as I hang up the phone but happy it's not a code*" :laugh: :luck:


I love this thread, it warms my heart as I have the flu right now. I am blessed though. I get very very few dumb calls and I work at a place where people are kind and considerate for the most part.
 
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SoCuteMD said:
Also, it's 3 AM and I've finally kicked a sub-i out of my call room (yeah, WTF?) and have had my eyes closed for about 5 minutes. Beep beep beep beep beep!!!!

Me: I was paged.
Nurse: Mrs. D's calcium is 6.8!!! You need to come see her!
Me: Is she having arrhythmias?
Nurse: No.
Me: What was her calcium yesterday?
Nurse: 6.7
Me: What is her albumin?
Nurse: 1.7
Me: Ok, thank you, good night.
Nurse: Aren't you going to DO SOMETHING? Her calcium is CRITICALLY LOW.
Me: No. Goodnight.
Click to expand...

You could have briefly explained corrected calcium to her. Might save you a page in the future, AND you wouldn't have seemed like a jerk.
 
NarcolepticRN said:
You could have briefly explained corrected calcium to her. Might save you a page in the future, AND you wouldn't have seemed like a jerk.
Click to expand...


Why should a resident have to explain something like that at 3 in the morning? You think a resident wants to spend 5-10 minutes explaining something when they could be sleeping. Shouldn't it be the nurses job to know basics like that especially when the previous values were out of range as well. instead of taking multiple breaks a shift and playing on the computer and such, maybe a little continuing medical education on the nurses part is in order.
 
You think a resident wants to spend 5-10 minutes explaining something when they could be sleeping

It would take you 5-10 minutes to explain a corrected calcium? I was thinking maybe a sentence would do it.

Shouldn't it be the nurses job to know basics like that especially when the previous values were out of range as well.

Nope. Not an inherent part of the job description. Being able to catch a critically low lab IS part of the job, as is notifying the doctor about it. If you're not satisfied with how nurses are trained, don't work with them.
 
EternalMD said:
we don't get a choice


It's sad how a few bad apples can ruin one's opinion of a whole group
Click to expand...

still seems to me it'd be a lot easier to say "if the albumin is low, a normal calcium value is also lower than you'd expect" and get a response of "oh doctor, I didn't know that, sorry for the page" and then grunt and go back to sleep than to create potential problems down the line for yourself.
 
Rendar5 said:
still seems to me it'd be a lot easier to say "if the albumin is low, a normal calcium value is also lower than you'd expect" and get a response of "oh doctor, I didn't know that, sorry for the page" and then grunt and go back to sleep than to create potential problems down the line for yourself.
Click to expand...

I actually got a text page on Sunday night reporting (as the RN is required by hospital policy to do) a "Critically Low Calcium" as well as the albumin and the calculated corrected Calcium value (which was calculated correctly). It ended with a "Sorry to bug you." It may have been the best page I've every gotten.
 
Rendar5 said:
still seems to me it'd be a lot easier to say "if the albumin is low, a normal calcium value is also lower than you'd expect" and get a response of "oh doctor, I didn't know that, sorry for the page" and then grunt and go back to sleep than to create potential problems down the line for yourself.
Click to expand...

2 words: cross cover. They couldn't pick me out of a lineup if you held a gun to their heads! Also, they weren't reporting a "panic value" - that I understand is their obligation and not a choice. The value was not a panic value. It was someone calling cross cover about routine albeit abnormal labs when the regular team was going to be in within the hour.

Also, I just don't care. I try to be pleasant, but there's something about q4 that just...makes it impossible for me to be so.
 
SoCuteMD said:
I try to be pleasant
Click to expand...

Don't we all.

Maybe, during the moments where pleasantries escape you, you could just flash a photo of your cute lil puppy dog at whomever has incurred your frustration.
😍
 
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