nurses

[jl lin]

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"Hospital politics can be brutal." That's an understatement, which I think is why a number of docs choose to work outside the hospital. Inside can be interesting and exciting; but the sheer politics, after a while, it gets so old. You keep busy on your own work, but it's just enough stress already without the needless politics.

 

[QofQuimica]

Meh. Nurses are people like everyone else. Some are great. Some are annoying. Some can barely tie their shoes. But in no case is it acceptable to get into a shouting match with one in a professional setting. That goes double for those who are trainees and therefore vulnerable to being hammered if they stick out as "problem" residents. There's one in every group. The one in my residency class had to deal with three years of passive aggressive behavior because of a stupid incident our intern year. Don't let that be you.

 

[jl lin]

I understand what's
being ordered but am curious if there is any data to substantiate its routine use in animals.

While an elderly animal may be expected to have some renal insufficiency, how likely is a bleeding diathesis or other CBC anomaly which would change management? Not very in humans which is why we no longer order routine labs or to "just get a baseline". Couple that with making money off the labs, I'm honestly curious about the data to support such practices in animals. There may very well be some data for all I know.

This is based on a Cochrane Systematic Review

[The depth of the evaluation will depend on the type of surgery, said James E. Spicher, MD, ACP Member, an internist and geriatrician in private practice at General Internal Medicine of Lancaster in Lancaster, Pa.
“Any type of surgery that involves either general or regional anesthesia will require a presurgical visit, but in some situations, such as cataract surgery, it’s not as important,” Dr. Spicher said.
Research bears this out. A study appearing in the March 2012 Cochrane Database of Systematic Reviews analyzed 3 randomized trials and found no difference in adverse events between patients who received routine presurgical testing (complete blood count, electrocardiogram, electrolytes, blood urea nitrogen, creatinine, and glucose) before cataract surgery and those who did not. However, 1 study in the review found that the costs were 2.55 times higher for those who received the testing than those who did not, leading the Cochrane researchers to conclude that routine presurgical testing before cataract surgery is inefficient and not cost-effective. http://www.acpinternist.org/archives/2014/09/preop.htm]

Presurg testing before cataract surgery-OK. But for other procedures, forgoing pre-testing is concerning to me. Whatever is considered "what is done 'now,'" may turn around again--especially if there are issues with patients and other studies. Plus, so many people have comorbid issues. But a FP doc does labs on q 6 mo.s, well, if pt is stable, ideally they could be used as baseline, no? IDK. Very interesting to me.

[“The most thorough evaluations should be done for thoracic, abdominal, vascular, or other major surgeries,” Dr. Spicher said, adding that for these surgeries, internists are not typically tasked with ordering the tests. “Usually it’s the anesthesiologist and, to a lesser extent, surgeon who dictates the tests.”http://www.acpinternist.org/archives/2014/09/preop.htm]

I found this part of this article important:
[“In today’s day and age, despite beepers, cell phones, texting, and e-mail, direct person-to-person communication between internists and surgeons is the most important thing we can carry out on behalf of our patients. I can’t overemphasize the importance of a real-time conversation,” said Dr. Kane.http://www.acpinternist.org/archives/2014/09/preop.htm]

 

[jl lin]

Meh. Nurses are people like everyone else. Some are great. Some are annoying. Some can barely tie their shoes. But in no case is it acceptable to get into a shouting match with one in a professional setting. That goes double for those who are trainees and therefore vulnerable to being hammered if they stick out as "problem" residents. There's one in every group. The one in my residency class had to deal with three years of passive aggressive behavior because of a stupid incident our intern year. Don't let that be you.

LOL.

Shouting. Argh. Just no.

 

[jl lin]

It was a troponin in a r/o ACS patient who had a somewhat convincing story. I don't know if I was given a reason besides a "sorry."

A troponin? Wow. Missing that? Nah, it wouldn't fly anywhere I've worked, unless there was some problem, as I suggested before--in which case--they keep going until you get that blood somehow. Years ago, we'd hit just about anything for blood. Today, eh, it's all gotten quite conservative. Personally, I like being thorough as well as evaluating things ahead of time. I fear that it's going to go to the other extreme of defensive medicine--leading to greater amounts of ugly. So, yea, except in something pretty extreme, you don't need a coag panel to remove a wisdom tooth(for those DMDs out there)--maybe something rare like Factor XI deficiency. But there is a lot of other stuff that worries me, especially if the patient isn't routinely checking in with a good primary care physician--and especially if there isn't good H&P, etc, and poor communication. There is already a lot of fragmentation in care. I can't help but worry that cost control measures will only add to fractures in already impaired systems. This will may be something for our HC system, which is supposed to be one of the best in the world--well, at least in certain areas of the US. 😉

 

[jl lin]

OP, your story has other interpretations besides the one you present. The fact that you lump all the nurses together and paint yourself as a pure victim of their

You should probably keep being polite to the nurses, but not trying to educate them unless they need to know or ask you questions. You might also try learning from them, too. Their training may be different and not as comprehensive as yours, but they have a body of knowledge that you need in order to really excel at what you do. It can be a two way street.

I like being educated. Have had some awesome discussions with docs--often people like me the RRT and a doc or so at night--cause on day rounds, well, in the units it can go on and on--but then there are surgeries and recoveries, and you can't hear everything about every kid in there. But have had some downtime at work, where there has been some really interesting stuff. Or you will get a really awesome attending on evening rounds, when procedures have slowed down--if you aren't a late receiver--and it's just a pleasure to learn. On nights, sometimes a little sparring goes on when it's one or two on one, but it always ends on a good note--and then I am happy that I now had something to go home and read about. But I am a nerd nurse I guess. There's just a number of people that are all about bottom line--and then prefer to discuss shoes or gossip. It's tough for me to be that girl. Shoes, well, that's a once-in-a-while little chat. Gossip, I don't care. Really. I don't.

 

[Winged Scapula]

This is based on a Cochrane Systematic Review

[The depth of the evaluation will depend on the type of surgery, said James E. Spicher, MD, ACP Member, an internist and geriatrician in private practice at General Internal Medicine of Lancaster in Lancaster, Pa.
“Any type of surgery that involves either general or regional anesthesia will require a presurgical visit, but in some situations, such as cataract surgery, it’s not as important,” Dr. Spicher said.
Research bears this out. A study appearing in the March 2012 Cochrane Database of Systematic Reviews analyzed 3 randomized trials and found no difference in adverse events between patients who received routine presurgical testing (complete blood count, electrocardiogram, electrolytes, blood urea nitrogen, creatinine, and glucose) before cataract surgery and those who did not. However, 1 study in the review found that the costs were 2.55 times higher for those who received the testing than those who did not, leading the Cochrane researchers to conclude that routine presurgical testing before cataract surgery is inefficient and not cost-effective. http://www.acpinternist.org/archives/2014/09/preop.htm]

Presurg testing before cataract surgery-OK. But for other procedures, forgoing pre-testing is concerning to me. Whatever is considered "what is done 'now,'" may turn around again--especially if there are issues with patients and other studies. Plus, so many people have comorbid issues. But a FP doc does labs on q 6 mo.s, well, if pt is stable, ideally they could be used as baseline, no? IDK. Very interesting to me.

[“The most thorough evaluations should be done for thoracic, abdominal, vascular, or other major surgeries,” Dr. Spicher said, adding that for these surgeries, internists are not typically tasked with ordering the tests. “Usually it’s the anesthesiologist and, to a lesser extent, surgeon who dictates the tests.”http://www.acpinternist.org/archives/2014/09/preop.htm]

I found this part of this article important:
[“In today’s day and age, despite beepers, cell phones, texting, and e-mail, direct person-to-person communication between internists and surgeons is the most important thing we can carry out on behalf of our patients. I can’t overemphasize the importance of a real-time conversation,” said Dr. Kane.http://www.acpinternist.org/archives/2014/09/preop.htm]

I think perhaps you were not aware or had forgotten that I'm a surgeon. Thus I am well aware of all the data which is why I was asking whether not you've questioned your veterinarian as to whether routine lab work prior to dental surgery in your dog is necessary. I was curious as to whether there was animal data not human.

Despite the call for more evidence-based medicine in our practice, there is still a plethora of dogma and I still see people routinely ordering daily labs on stable patients or extensive preoperative workup's for low-risk patients having low risk surgery.

One of the hospital systems here in town will not reimburse for these test without extensive documentation from the ordering physician as to their utility. I agree that high-risk patients and those having major surgery may benefit from more extensive testing. I'm not arguing that.

My question to you was that your original statement made it sound like your veterinarian routinely orders labs just because the animal is having general anesthesia. Perhaps that is a misunderstanding on your part and there is something she specifically concerned about but I was wondering if there was any data in the veterinary literaturenot the human literature which I'm already well aware of (and includes higher risk surgery than cataract. I was rather amused by the comment above from the Cochrane review that the preop testing was usually ordered by the anesthesiologist. This was never my experience in academics or private practice.)

 

[Winged Scapula]

Do you order EKGs on all your pre-ops and then get pissed when they see their PCP who reviews the EKG 3d before surgery (because the patient thinks its going to be smooth sailing) and says, "Nope, you gotta see cardio/get an ECHO/get a stress test/etc"? 😉

That has happened but not very often.

Some of the patients will come with lab work and EKG in hand because the PCP knows they're going to get an operation. Others I will ascertain during the preop visit that they will need to see their cardiologist and I just send them there instead. Finally all of them leave my office with a surgery date and time and are told specifically by me that if the testing is not done and completed one week before surgery they will be canceled. That's usually enough to get these ladies with malignancies to not delay the testingbut I've definitely had a few who underplayed the significance of their comorbidities and were surprised when abnormalities were found.Asking them if they can walk up a flight of stairs without getting short of breath or having chest pain is a pretty reliable indicator of the severity of disease.

I've also learned that it's not good enough to ask the patient if they routinely see a cardiologist.It's better to ask if anyone has ever suggested they see a cardiologist. 😉

 

[Bacchus]

^My favorite is the BMP/CBC/Coags and EKG for cataract surgery when my criteria is: "Did you walk into the exam room on your own accord today?". 😆

 

[Winged Scapula]

^My favorite is the BMP/CBC/Coags and EKG for cataract surgery when my criteria is: "Did you walk into the exam room on your own accord today?". 😆

This morning's new patient was confused that I was concerned that her cardiologist did a 24 hour Holter, a stress test, and a CT angiogram last week.

For some reason she seemed to think that this was all routine and she was sure she was fine so I should go ahead and schedule her surgery without the above results.

 

[Gastrapathy]

Probably was routine. End of the month and the cardiologist was appeasing her business manager 😉.

 

[Winged Scapula]

Better get her surgery done ASAP - before that cardiologist puts a DES in her and you can't operate on her for a year...

Seriously… But most of these guys here are pretty good to me and if they are thinking of doing that they'll try to put a bare metal stent in, or let me know in advance so I can get them on my schedule ASAP.

 

[Winged Scapula]

Probably was routine. End of the month and the cardiologist was appeasing her business manager 😉.

Gotta afford those Christmas bonuses somehow!

 

[jl lin]

I think perhaps you were not aware or had forgotten that I'm a surgeon. Thus I am well aware of all the data which is why I was asking whether not you've questioned your veterinarian as to whether routine lab work prior to dental surgery in your dog is necessary. I was curious as to whether there was animal data not human.

Despite the call for more evidence-based medicine in our practice, there is still a plethora of dogma and I still see people routinely ordering daily labs on stable patients or extensive preoperative workup's for low-risk patients having low risk surgery.

One of the hospital systems here in town will not reimburse for these test without extensive documentation from the ordering physician as to their utility. I agree that high-risk patients and those having major surgery may benefit from more extensive testing. I'm not arguing that.

My question to you was that your original statement made it sound like your veterinarian routinely orders labs just because the animal is having general anesthesia. Perhaps that is a misunderstanding on your part and there is something she specifically concerned about but I was wondering if there was any data in the veterinary literaturenot the human literature which I'm already well aware of (and includes higher risk surgery than cataract. I was rather amused by the comment above from the Cochrane review that the preop testing was usually ordered by the anesthesiologist. This was never my experience in academics or private practice.)

Yes. I know you are. I'm not sure what kind of surgeon. 🙂

No, just about any vet, as far as I have seen, will pretty much want to do a lot of stuff for pets once they get you in there. I am not disrespecting them. I have a lot of respect for what they do and how they get there. Since I have multiple pets, usually it's this whole cordial back and forth deal about here's what I am going to do/or will have done or give--and then you have to ask for cost and even a prelimin invoice before you decide for them to do whatever--itemize everything. All the add-ons can add up quickly. So the vet has an experienced nurse come in with her pet, and particularly b/c of how quickly the costs can start to pile up and having multiples, well, I have to respectfully discuss everything and the costs ahead of time every single time.

This is different with humans. Except uncovered treatments and procedures for humans I guess--like special aesthetic procedures at the dermatologist (some of them are making a killing), you don't discuss costs and itemize--at least not here in the US. (Geez, my mom just had some aesthetic derm procedures. I have seen this derm's set up. She is doing alright for herself--seriously sitting on a goldmine.)

Anyway re: the vet, no, this time I didn't ask her about current literature in this situation. I have researched other things for another pet, but my 11 year old had some infections and had been on some anti-inflammatory meds. So, yea. She's probably being cautious and adding to her upcharges by doing this. Could he probably do OK without out the labs? Probably. But you know we love to anthropomorphize our pets. It can get pretty emotional when they are sick or have some kind of problem.

I mean I kind of get that vets have a hard road into and through MS, but often they are not compensated as human physicians. She's doing a solo practice right now, so I know she's got to make the business come out ahead. But yes. Even if you have animal health insurance, you really have to go over everything that will end up costing with the vet. They usually will negotiate certain things. But they even put a nice little upcharge on the basic antibiotics and meds that have been around for decades.

About the anesthesiologist, that's not been my experience either in general. Now certain areas I have worked, yes, the critical care anesth-intensivisits ordered things for post-op management while in the recovery area--it really depended on how the unit worked. One Cardiac Surgical ICU was only covered by CT surgery attendings, which, if the CT surgery attending was on top of his/her game on off hours was fine. If not, it became ethically and legally precarious to me. I didn't like not having a CT surg fellow or at least a surg resident in house for coverage at all times. Certain places do some weird things.
At another place, the CT-SICU was licensed by the state as a full fledged Post-Anesthesia Recovery Area, so the surg fellows/attendings would manage things; but when they were in OR or not around, the anesthesiologist covering would give orders. Of course if it was of a direct surgical nature, he'd have to contract the surgeon. But at least you had someone on sight during the busiest hours to get orders from. Usually, however, anesthesia didn't write or give pre-op orders in most cases, unless in their opinion there was something that needed to be addressed before surgery. Eh, it really depended upon the patient. Honestly I have worked in a number of these places, and I have seen different things. Teaching centers can have a number of people coming in and writing orders all the time.

Now in the kids' hospitals--seriously, in the units I've worked, usually it is often a critical care intensivist-fellow covering when the director was not around--which can be a lot due to administrative stuff. Surgery would come, do their thing, write their orders and go back to the OR. Again, if something was looking like it directly related to being a surgical issue, surgery be contacted and do whatever. Post-operatively, pretty much the CCI fellow would have to keep the surgeon apprised and be working closely with the covering attending CCI or director. I think with kids, it becomes a whole other world of mother-may-I for just about anything. It's very different with regard to decision-making compared with adults. At least, this has been my experience.

🙂 I will ask the vet about any current literature on this when I see her. But for this dog, I'll probably just fork over the bucks, since he doesn't have any recent lab work from this year.

 

[jakeislove]

Meh. Nurses are people like everyone else. Some are great. Some are annoying. Some can barely tie their shoes. But in no case is it acceptable to get into a shouting match with one in a professional setting. That goes double for those who are trainees and therefore vulnerable to being hammered if they stick out as "problem" residents. There's one in every group. The one in my residency class had to deal with three years of passive aggressive behavior because of a stupid incident our intern year. Don't let that be you.

Why do you think clogs are so popular?

I keed, I keed!

 

[QofQuimica]

Why do you think clogs are so popular?

I keed, I keed!

Heh. Better watch yourself there, jake. 😛

 

[jakeislove]

Heh. Better watch yourself there, jake. 😛

I wear 'em, too!

 

[Winged Scapula]

Yes. I know you are. I'm not sure what kind of surgeon. 🙂

No, just about any vet, as far as I have seen, will pretty much want to do a lot of stuff for pets once they get you in there. I am not disrespecting them. I have a lot of respect for what they do and how they get there. Since I have multiple pets, usually it's this whole cordial back and forth deal about here's what I am going to do/or will have done or give--and then you have to ask for cost and even a prelimin invoice before you decide for them to do whatever--itemize everything. All the add-ons can add up quickly. So the vet has an experienced nurse come in with her pet, and particularly b/c of how quickly the costs can start to pile up and having multiples, well, I have to respectfully discuss everything and the costs ahead of time every single time.

This is different with humans. Except uncovered treatments and procedures for humans I guess--like special aesthetic procedures at the dermatologist (some of them are making a killing), you don't discuss costs and itemize--at least not here in the US. (Geez, my mom just had some aesthetic derm procedures. I have seen this derm's set up. She is doing alright for herself--seriously sitting on a goldmine.)

Anyway re: the vet, no, this time I didn't ask her about current literature in this situation. I have researched other things for another pet, but my 11 year old had some infections and had been on some anti-inflammatory meds. So, yea. She's probably being cautious and adding to her upcharges by doing this. Could he probably do OK without out the labs? Probably. But you know we love to anthropomorphize our pets. It can get pretty emotional when they are sick or have some kind of problem.

I mean I kind of get that vets have a hard road into and through MS, but often they are not compensated as human physicians. She's doing a solo practice right now, so I know she's got to make the business come out ahead. But yes. Even if you have animal health insurance, you really have to go over everything that will end up costing with the vet. They usually will negotiate certain things. But they even put a nice little upcharge on the basic antibiotics and meds that have been around for decades.

Yes I'm aware (from personal experience) that there are probably things done which are done to increase the visit cost and could be done elsewhere for much cheaper. Like the special Renal diet my 16 year old cat is on. 😛

I know they work hard and they deserve better pay but ordering tests without some EBM or to subsidize their income doesn't feel right to me.

 

[Promethean]

I like being educated. But I am a nerd nurse I guess..

Oh! Agreed! I'm a nerd, too, and I love when my physician friends take the time to teach me.

I was speaking only to this one situation, where apparently OPs attempts to educate fell flat. Whether that is because of her audience or her delivery, it is hard to say. But she should probably stop doing whatever she was doing, either way, since it has already gotten her "spoken to about it" once.

I wouldn't want to discourage doctors generally from sharing their knowledge with nurses. When done well, that helps build the kinds of strong interdisciplinary relationships that make everyone's lives easier in the long run.

 

[fab4fan]

@jl lin - you surely understand that as a unit nurse you are a different breed.

I've had the same experience as @Bacchus with orders being ignored, including stat labs. The most recent was an order for a pre-op tox screen which is abbreviated by the hospital EMR as UTS.

The reason given for it not being collected and sent?
"I didn't know what UTS stood for."

The reason given for not calling and clarifying (or just reading the "order information tab")?
"I've never seen it before so assumed it was a mistake."

I'm not a unit nurse, but I've never done any of those things in the years I practiced. If I didn't understand something, it was my job to get it clarified. If I couldn't draw a lab/get an IV, and none of my co-workers could either, it was my job to let the doc know.

I think things are much different from how they were years ago. I'm appalled at some of the things I've seen my younger nursing peers say. It's scary.

I loved having docs share their knowledge with me. Education helps us give better patient care.

 

[Psai]

I'm not a unit nurse, but I've never done any of those things in the years I practiced. If I didn't understand something, it was my job to get it clarified. If I couldn't draw a lab/get an IV, and none of my co-workers could either, it was my job to let the doc know.

I think things are much different from how they were years ago. I'm appalled at some of the things I've seen my younger nursing peers say. It's scary.

I loved having docs share their knowledge with me. Education helps us give better patient care.

They get that nonsense drilled into them in nursing school. The things I've heard from nursing classrooms truly are appalling. "We have to protect patients from doctors" but then they don't understand the basics of the drugs they administer because they were too busy wasting time with group projects about nothing. But the worst thing is how their schools constantly call patients "clients". That's just shameful

 

[ferning]

Nurses are middle management

But they are the only staff required on site for hospitals to be credentialed by cms and thus every other payer body. They farmed out drawing blood to phelobotomists, techs to do all the dirty work and take vital signs, but keep the minor yet essential task of handing out pills to patients. You can read a bottle and hand out an object, then u still got ur foot in the game.

Their union is the pawn of healthcare corporate level heads and was bound to cause issues when they are the only employees with a voice

I think a higher than average rate have munchausens by proxy, sublimated dangerously to their job of taking care of patients

 

[FCMike11]

Nurses are middle management

But they are the only staff required on site for hospitals to be credentialed by cms and thus every other payer body. They farmed out drawing blood to phelobotomists, techs to do all the dirty work and take vital signs, but keep the minor yet essential task of handing out pills to patients. You can read a bottle and hand out an object, then u still got ur foot in the game.

Their union is the pawn of healthcare corporate level heads and was bound to cause issues when they are the only employees with a voice

I think a higher than average rate have munchausens by proxy, sublimated dangerously to their job of taking care of patients

Love the respect level you have for your nurses.
So many generalizations are being thrown out there is this thread. Sure some are true, but this is not how every nurse operates, thinking like this won't help relationships. Thankfully majority of physicians I work with don't have this viewpoint.

 

[dozitgetchahi]

It was a troponin in a r/o ACS patient who had a somewhat convincing story. I don't know if I was given a reason besides a "sorry."

Dude this nonsense happens all the time at our VA, where getting a stat lab usually involves either ordering it repeatedly and/or personally witnessing the nurse doing it and/or drawing it yourself.

Troponins? It's a common issue that one or more of the troponin levels during a ROMI gets completely skipped, resulting in multiple calls and reorders to actually get it done (if the resident happens to be on the ball and watching for it to happen). Then, long after the MI is ruled out a troponin level will randomly show up in the lab results several days later - which is when somebody finally bothered to draw the originally ordered troponin.

 

[Doctor Kiwi]

Why do nurses think that they know just as much as doctors? Some nurses think that the only difference between doctors and them is that a doctors degree confers to him/her the right to prescribe a medication, whereas theirs does not. I hate to be so brutally honest, but too many past experiences have forced my hand.
The reality is, doctors can get along without nurses just fine. All it takes is a little more physical effort on our part, and believe me, we have been conditioned to give a little extra. We should all understand that it doesn't take a specific skill set or knowledge base to perform tasks like emptying a urine bag, or changing an old man's diaper, or ADMINISTERING medications that the doctor has PRESCRIBED. However, it cant be said that a nurse could do a doctor's job. It takes such an in depth knowledge into the science of the human body, that a nurse just wouldn't be able to comprehend. This knowledge may not be overtly displayed for everyone to see, but you can be sure that it underlies each and every little decision we make.
Some doctors have a misconception that nurses are kind of like their secretaries. I can understand how this would anger a nurse, and I think that there is nothing further from the truth. Nurses have a very specific job to do, and it is not that. However, nurses should understand that ONE of their specific tasks is to carry out, unaltered, the orders given by the doctor. They are not a doctor's requests, nor are they a doctor's suggestion. They are the doctors ORDER. Nurses would do well to remember that they are compelled to follow the doctor's orders. If they have a doubt regarding a specific medication, they can simply ask the doctor, but they do not have the right to withhold it.
Please understand the plight of a doctor. We are open to legal consequences as a result of our actions. However, as long as nurses follow the orders of a doctor to the tee, they cannot be held responsible for what happens to a patient. Ever heard of vicarious responsibility?
That's all I have to say. Thank you.

 

[Promethean]

Why do nurses think that they know just as much as doctors? Some nurses think that the only difference between doctors and them is that a doctors degree confers to him/her the right to prescribe a medication, whereas theirs does not. I hate to be so brutally honest, but too many past experiences have forced my hand.
The reality is, doctors can get along without nurses just fine. All it takes is a little more physical effort on our part, and believe me, we have been conditioned to give a little extra. We should all understand that it doesn't take a specific skill set or knowledge base to perform tasks like emptying a urine bag, or changing an old man's diaper, or ADMINISTERING medications that the doctor has PRESCRIBED. However, it cant be said that a nurse could do a doctor's job. It takes such an in depth knowledge into the science of the human body, that a nurse just wouldn't be able to comprehend. This knowledge may not be overtly displayed for everyone to see, but you can be sure that it underlies each and every little decision we make.
Some doctors have a misconception that nurses are kind of like their secretaries. I can understand how this would anger a nurse, and I think that there is nothing further from the truth. Nurses have a very specific job to do, and it is not that. However, nurses should understand that ONE of their specific tasks is to carry out, unaltered, the orders given by the doctor. They are not a doctor's requests, nor are they a doctor's suggestion. They are the doctors ORDER. Nurses would do well to remember that they are compelled to follow the doctor's orders. If they have a doubt regarding a specific medication, they can simply ask the doctor, but they do not have the right to withhold it.
Please understand the plight of a doctor. We are open to legal consequences as a result of our actions. However, as long as nurses follow the orders of a doctor to the tee, they cannot be held responsible for what happens to a patient. Ever heard of vicarious responsibility?
That's all I have to say. Thank you.

0/10 for necrobump with a sockpuppet.

There is a reason that nursing is a licensed profession. There is a little more to what we do than just emptying urine bags and wiping asses, or else anyone off the street could do the job just as well.

It is called an order, but that doesn't mean that it comes from the mouth of God or a commanding officer. It is closer to placing an order for a service than to imposing your will on a subordinate. I am absolutely not compelled to blindly follow an order just because a doctor wrote it. It is my professional duty to question orders that don't seem right to me, or to refuse to follow them if they will cause harm to a patient. The doctor is not always right, and my refusal has prevented serious, possibly fatal, harm from coming to my patients more than once.

And you are absolutely incorrect that "I was just following orders" is a defense if something bad should happen. If I follow the order of a doctor, even though I know it is not safe to do so, I am just as liable.

You don't know what you are talking about, and may Heaven help any nurses who have to tolerate your ignorance in person.

 

[gutonc]

:troll:

 

[Promethean]

:troll:

So true. I shouldn't, I know.

I just... I fear that this might actually be what this person thinks and believes, and that compels an answer of some sort. Maybe s/he will listen? Fool's hope, I know.

 

[Doctor Kiwi]

0/10 for necrobump with a sockpuppet.
It is closer to placing an order for a service than to imposing your will on a subordinate. I am absolutely not compelled to blindly follow an order just because a doctor wrote it. It is my professional duty to question orders that don't seem right to me, or to refuse to follow them if they will cause harm to a patient.

There is a certain hierarchy in every profession. You are obviously mistaken. You are compelled to follow the doctor's orders, for the good of the patient. Only a ******ed doctor would try to harm a patient. You see, we've taken a hippocratic oath. You might have heard of it while you were studying nothing. Its nurses like you that let your pride come in the way of a doctor trying to treat a patient - your unwillingness to follow an order just because you dont like the way in which you were told to carry it out. Coming to the part where 'its your duty to question orders that you think will harm the patients'. The problem with this is that you dont really know even half as well as a doctor the effect a certain medication would have on a patient. You're just a nurse (forgive my brash manner). That's why I said that you are free to ask

 

[Doctor Kiwi]

n

 

[Doctor Kiwi]

OP, your story has other interpretations besides the one you present. The fact that you lump all the nurses together and paint yourself as a pure victim of their ignorance and gender discrimination suggests to me that you don't have a clear, objective perception of the situation.

Your PD made you a job offer for years from now? Doesn't sound like a firm offer. Any chance that he was just smooth talking you? Does he have the even have the authority to make an offer like that unilaterally?

Also, "sent home for a day off" has more than one interpretation. One way that this episode could be read was that other professionals have found you so difficult to work with that they actually complained to your PD. Also, he is aware that you have been violating policies, like the duty hour guidelines, and also failing to report your hours accurately. Nothing damning, but possibly problematic if there is a pattern of behavior. The organizational savvy that allowed him to become a PD tells him that he has a troublemaker on his hands, but that the best way to deal with it initially is to try to counsel you. He takes a friendly approach, hopeful that this will avoid future concerns and sends you home for a day. In his documentation of the incident, however, he writes up that he had to verbally warn and discipline you. Should additional complaints reach his ears, this becomes the basis for progressive discipline, potentially leading to termination.

My interpretation may be a little paranoid, but I have often seen these "friendly conversations" turned into ammunition to be used later. Hospital politics can be brutal. Be careful where you put your faith and never rock the boat unless a patient is at risk.

You should probably keep being polite to the nurses, but not trying to educate them unless they need to know or ask you questions. You might also try learning from them, too. Their training may be different and not as comprehensive as yours, but they have a body of knowledge that you need in order to really excel at what you do. It can be a two way street.

 

[ResQRN144]

It's a team effort. Learn this.

 

[DoctwoB]

A couple gems from this year:

Nurse supervisor demands transfer of patient from floor to icu because he has chest pain. I eval patient, it's costochondritis with negative ekg and trop, no dyspnea, stable vitals, etc. Nursing supervisor yells that a patient with "chest pain" can't be in a floor bed. I'm new at that hospital so check with intensivist, who confirms that's bollocks. She calls a condition. patient stays on the floor. Fun times.

Another nurse refuses to push insulin and dextrose in hyperkalemic patient. Demands I do it, so I say fine and go up. She then actually blocks the door because she thinks it will "cause harm" (without rationale). Had to call her supervisor and still got written up.

I'm just venting, most nurses ive worked with this year have been great. It just irks me that they have the power to make our lives miserable without any consequence on their part.

 

[link2swim06]

A couple gems from this year:

Nurse supervisor demands transfer of patient from floor to icu because he has chest pain. I eval patient, it's costochondritis with negative ekg and trop, no suspend, stable vitals, etc. Nursing supervisor yells that a patient with "chest pain" can't be in a floor bed. I'm new at that hospital so check with intensivist, who confirms that's bollocks. She calls a condition. patient stays on the floor. Fun times.

Another nurse refuses to push insulin and dextrose in hyperkalemic patient. Demands I do it, so I say fine and go up. She then actually blocks the door because she thinks it will "cause harm" (without rationale). Had to call her supervisor and still got written up.

I'm just venting, most nurses ive worked with this year have been great. It just irks me that they have the power to make our lives miserable without any consequence on their part.

Sometimes new nurses are confused by this but it should be solved by providing a quick explanation. But if after all that I'd be email the appropriate channels/making the the appropriate incident reports. That **** shouldn't fly. And by providing your own documentation initially it will show you are in the right to begin with.

 

[so721]

A couple gems from this year:

Nurse supervisor demands transfer of patient from floor to icu because he has chest pain. I eval patient, it's costochondritis with negative ekg and trop, no suspend, stable vitals, etc. Nursing supervisor yells that a patient with "chest pain" can't be in a floor bed. I'm new at that hospital so check with intensivist, who confirms that's bollocks. She calls a condition. patient stays on the floor. Fun times.

Another nurse refuses to push insulin and dextrose in hyperkalemic patient. Demands I do it, so I say fine and go up. She then actually blocks the door because she thinks it will "cause harm" (without rationale). Had to call her supervisor and still got written up.

I'm just venting, most nurses ive worked with this year have been great. It just irks me that they have the power to make our lives miserable without any consequence on their part.

What nurses actually expect you to push IV's and such? Wow, I've never done that. I mean I've put the IV in, but the actual tubing aspect and fiddling with the stopper, I've never touched that.

I've been lucky to work with sweet nurses. but i hate it when they talk small talk and expect you to waste time with them about sports, personal stuff etc. i needa work lol

 

[Doctor Kiwi]

Sa

A couple gems from this year:

Nurse supervisor demands transfer of patient from floor to icu because he has chest pain. I eval patient, it's costochondritis with negative ekg and trop, no suspend, stable vitals, etc. Nursing supervisor yells that a patient with "chest pain" can't be in a floor bed. I'm new at that hospital so check with intensivist, who confirms that's bollocks. She calls a condition. patient stays on the floor. Fun times.

Another nurse refuses to push insulin and dextrose in hyperkalemic patient. Demands I do it, so I say fine and go up. She then actually blocks the door because she thinks it will "cause harm" (without rationale). Had to call her supervisor and still got written up.

I'm just venting, most nurses ive worked with this year have been great. It just irks me that they have the power to make our lives miserable without any consequence on their part.

Same boat buddy