Nurses

[Psai]

So I've been having some trouble with getting some of the nurses to do what I want. I get that I'm an intern and I don't blame them for questioning what I what but it's really annoying when I want something and they don't do it which leads to a bad outcome. I don't like when they question my judgment not because they have a good reason against what I want to do but because they don't have the knowledge base to understand it.

The other side of this is when nurses want something that's not really necessary for patient care but they insist on it. For example, I've been asked repeat labs after a unit of product is given so that they can sign out the numbers to the next nurse. It's a waste of money, time and blood but sometimes I really don't feel up to explaining why I don't want to do what they want, especially if they will just go to the resident or attending and bother them about this nonissue. I'm not a fan of having traintrack vitals or attempting to reach euboxemia just to make the numbers look nice on the chart.

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[Rekt]

So I've been having some trouble with getting some of the nurses to do what I want. I get that I'm an intern and I don't blame them for questioning what I what but it's really annoying when I want something and they don't do it which leads to a bad outcome. I don't like when they question my judgment not because they have a good reason against what I want to do but because they don't have the knowledge base to understand it.

The other side of this is when nurses want something that's not really necessary for patient care but they insist on it. For example, I've been asked repeat labs after a unit of product is given so that they can sign out the numbers to the next nurse. It's a waste of money, time and blood but sometimes I really don't feel up to explaining why I don't want to do what they want, especially if they will just go to the resident or attending and bother them about this nonissue. I'm not a fan of having traintrack vitals or attempting to reach euboxemia just to make the numbers look nice on the chart.

Guess all those IPE courses aren't working out.

 

[Beezlebub]

So I've been having some trouble with getting some of the nurses to do what I want. I get that I'm an intern and I don't blame them for questioning what I what but it's really annoying when I want something and they don't do it which leads to a bad outcome. I don't like when they question my judgment not because they have a good reason against what I want to do but because they don't have the knowledge base to understand it.

The other side of this is when nurses want something that's not really necessary for patient care but they insist on it. For example, I've been asked repeat labs after a unit of product is given so that they can sign out the numbers to the next nurse. It's a waste of money, time and blood but sometimes I really don't feel up to explaining why I don't want to do what they want, especially if they will just go to the resident or attending and bother them about this nonissue. I'm not a fan of having traintrack vitals or attempting to reach euboxemia just to make the numbers look nice on the chart.

maybe they saw your avatar on SDN. On a serious note, I'm at the bottom of the totem pole so I dare not issue advice, but have you tried working with them? It's a people's world after all.

 

[ICUBlue]

As a nurse, I 100% know what you're talking about. Though I am not an intern yet, I can imagine it gets pretty frustrating at times.

Unfortunately, much of this is due to policy or "protocols" whether they be written or just engrained in the culture, and not so much that nurse actually thinking it's a good idea to once again recheck the lab. The problem is the protocol is in place and so the thinking is taken out of it- much like what sounds like is happening in some areas of medicine. What I mean is that the problem is likely on the systematic level as opposed to being on the individual level, in most cases.

 

[Beezlebub]

As a nurse, I 100% know what you're talking about. Though I am not an intern yet, I can imagine it gets pretty frustrating at times.

Unfortunately, much of this is due to policy or "protocols" whether they be written or just engrained in the culture, and not so much that nurse actually thinking it's a good idea to once again recheck the lab. The problem is the protocol is in place and so the thinking is taken out of it- much like what sounds like is happening in some areas of medicine. What I mean is that the problem is likely on the systematic level as opposed to being on the individual level, in most cases.

Thanks for your comment. I didn't even think of that; it is good to have a broad range of perspective to assess the situation.

 

[Taddy Mason]

So I've been having some trouble with getting some of the nurses to do what I want. I get that I'm an intern and I don't blame them for questioning what I what but it's really annoying when I want something and they don't do it which leads to a bad outcome. I don't like when they question my judgment not because they have a good reason against what I want to do but because they don't have the knowledge base to understand it.

The other side of this is when nurses want something that's not really necessary for patient care but they insist on it. For example, I've been asked repeat labs after a unit of product is given so that they can sign out the numbers to the next nurse. It's a waste of money, time and blood but sometimes I really don't feel up to explaining why I don't want to do what they want, especially if they will just go to the resident or attending and bother them about this nonissue. I'm not a fan of having traintrack vitals or attempting to reach euboxemia just to make the numbers look nice on the chart.

Putting some extra bubble wrap around your fragile ego might help.

 

[Silmaril]

It honestly sounds like your major problem is that you and the nurses hate each other. Despite all the education, training, and professional ethics in the world, plain dislike and disrespect will throw a monkey wrench into patient care like nothing else.

Nurses are not techs. They don't just do stuff because it shows up as an order on Epic. They are licensed professionals who, indeed, do not have the depth of scientific knowledge that you have (and they know that even if they don't show it), but they do have medical knowledge and nursing knowledge that is independent of the medical model and overlaps with it in places. Sometimes they need medical rationale before they will do something for the patient. They take their role as patient advocates extremely seriously, and in some cases, yes, they see themselves as protecting patients from errant doctors (which is not incorrect). I am not discounting bitchy, ignorant nurses (we have all met our fair share!), but an extra 30 seconds of an explanation will go very far in - ahem - assisting them with being gung-ho about your plan of care. You don't have to be nice and buddy-buddy, either! Knowledgeable, educational, respectful authority is a good relationship to have with the nurses, the team. Everyone knows the final outcome of the patient is your responsibility.

The next thing is hugely frustrating for both nurses and MDs: nurses are slaves to policies. Slaves. If the policy says that they have to order an H & H after a measly unit of blood was administered for someone who truly does not need to have it rechecked before the morning labs, management will hound the staff until they extract the order from an MD. The majority of nurses believe in these practice policies, of course, but cringe when they are so inflexible to the patient's situation. This is an issue that you would have to take to management if it is a big problem, because as an MD, you have the authority to override policies that conflict with appropriate patient management. And this is partially why I think you all just don't respect each other: going behind your back for nonsense orders show a complete lack of trust.

Sorry about the long post. I think you may be working with some bum nurses (they definitely exist!), but improving communication and fostering respect would go a long way. It's worth addressing, because it will make your life a lot easier and your orders more effective.

 

[LutGholein]

So I've been having some trouble with getting some of the nurses to do what I want. I get that I'm an intern and I don't blame them for questioning what I what but it's really annoying when I want something and they don't do it which leads to a bad outcome. I don't like when they question my judgment not because they have a good reason against what I want to do but because they don't have the knowledge base to understand it.

The other side of this is when nurses want something that's not really necessary for patient care but they insist on it. For example, I've been asked repeat labs after a unit of product is given so that they can sign out the numbers to the next nurse. It's a waste of money, time and blood but sometimes I really don't feel up to explaining why I don't want to do what they want, especially if they will just go to the resident or attending and bother them about this nonissue. I'm not a fan of having traintrack vitals or attempting to reach euboxemia just to make the numbers look nice on the chart.

 

[itscomplicateddd]

I like your name so much.

 

[@Hazel-rah]

Based on the mostly disrespectful comments I've seen you post in here, I'm not surprised.

Nurses are just people trying to do their job the best they can, not slaves. I don't think there is a quick fix for this problem. Your online persona may be completely different from your face-to-face persona, so maybe it's something simple. But if you truly possess the inner disdain for nurses that you have displayed in some of your SDN posts, you are in need of professional help...

Throw out some examples and maybe we can understand more clearly what kind of advice you need. What kinds of things do you want them to do and how did things go wrong in a way that hurt the patient?

 

[azmang108]

Start with your step score, end with your argument on the benefits of lactated ringers. They will sing your praises for generations to come.

 

[Psai]

Nurse: yeah there's a protocol about this situation
Me: oh interesting can i see it
nurse: sure let me look it up

20 minutes later
nurse: couldn't find it but I'm sure there is a protocol so we have to follow it
me: ???

One common example is the huge unwillingness to remove foleys. "Oh we need to track is and os". Yeah no **** ive been doing that for days and the foley needs to come out. "But the patient will be incontinent". So do you want them to have a Foley for the rest of their lives?

So far had a few utis and urosepsis from foley nonremoval and traumatic self removals because they refused to take it out. Don't we get dinged and pay taken away for that? Why do I get hounded about checklists if it won't change nursing behavior?

Also I'm pretty good with the majority of the staff. It's a very small number I'm having issues with. I do appreciate the responses.

 

[@Hazel-rah]

I don't know where you are but the foley removal sounds like something I'd go to the nurse manager about. It is becoming standard EBP to have nurse initiated foley removal as soon as possible and nurses are being educated about its importance. If they aren't on board with it they will be soon. Try emailing the infection control nurse. Getting your hospital on board with prompt foley removal would look great on your CV!

If they are questioning you about anything, answer their questions with a clinical explanation. Take the time to educate them and there will be less questions in the future. See it as an opportunity to discuss and educate, not as a personal attack. Always acknowledge their concerns first, I.e. "I hear what you're saying."

If there is one person in particular who is clashing with you and you're sure you're being a decent human being to them, standard behavior is to confront them in private. "Hey, I feel like our communication is hostile... What can I do differently? Have I offended you? If so, I'm sorry." (These communication techniques also work wonders with significant others!)

If the hostility is too great and you fear retaliation or the need for a witness, most hospitals have someone who can mediate a conflict resolution and if there isn't someone designated, the nurse manager should be trained in that.

Nurses work via "chain of command" so if I have a problem and I've tried talking to the person, I tell my charge nurse, then next in line is clinical team leader, then nurse manager, then admin. So it would be wrong to go straight to admin, for example. Each hospital is different but the chain should be available for you to see.

Lastly, remember that actual practice is often several years behind research. You are coming out of MS with all the latest research and clinical knowledge, but a lot of people have been out of school for years. Unfortunately the continuing education for nurses is not very rigorous. Some of the things that you may be expecting the nurses to do may not be consistent with their training... so be kind and try to be understanding and you will go far.

 

[libertyyne]

So I've been having some trouble with getting some of the nurses to do what I want. I get that I'm an intern and I don't blame them for questioning what I what but it's really annoying when I want something and they don't do it which leads to a bad outcome. I don't like when they question my judgment not because they have a good reason against what I want to do but because they don't have the knowledge base to understand it.

The other side of this is when nurses want something that's not really necessary for patient care but they insist on it. For example, I've been asked repeat labs after a unit of product is given so that they can sign out the numbers to the next nurse. It's a waste of money, time and blood but sometimes I really don't feel up to explaining why I don't want to do what they want, especially if they will just go to the resident or attending and bother them about this nonissue. I'm not a fan of having traintrack vitals or attempting to reach euboxemia just to make the numbers look nice on the chart.

You can take my advice or not.
Regarding them not listening to orders.You should 1. Discuss this with your attending, if they brush it off it is a lost cause. 2. If the attending is sympathetic create a game plan regarding calling the charge or the nursing director and letting them know each time an incident like this happens. 3. you could just enter an incident report every-time this happens. This is unacceptable and unprofessional behavior.
Regarding them hounding you for unwarranted care.
Treat them like a student and try to explain why that is wrong. If they say it is protocol, tell them to find the protocol, if they cant go up the chain of command to the nurse manager/charge/director.

Be friendly and curteous to the charge/director at all times and build some rapport with them. They will be able to crack the whip to get things done for you in a pinch.

 

[Dr. Death]

Sorry to derail your thread psai but I want to know why most nurses are fat and most doctors are not. Is this just a phenomenon I've observed?

 

[TooMuchResearch]

So I've been having some trouble with getting some of the nurses to do what I want. I get that I'm an intern and I don't blame them for questioning what I what but it's really annoying when I want something and they don't do it which leads to a bad outcome. I don't like when they question my judgment not because they have a good reason against what I want to do but because they don't have the knowledge base to understand it.

The other side of this is when nurses want something that's not really necessary for patient care but they insist on it. For example, I've been asked repeat labs after a unit of product is given so that they can sign out the numbers to the next nurse. It's a waste of money, time and blood but sometimes I really don't feel up to explaining why I don't want to do what they want, especially if they will just go to the resident or attending and bother them about this nonissue. I'm not a fan of having traintrack vitals or attempting to reach euboxemia just to make the numbers look nice on the chart.

You can either go with the flow and enjoy it or fight it and wait for burnout.

 

[Tenk]

I tell my nurses to do whatever the hell they want under my name so long as:

1) you don't kill the patient.

2) you don't order a d-dimer.

So far so good.

Medicine is a team sport. Better to be the guy everyone goes to than the guy nobody wants.

 

[AnatomyGrey12]

Sorry to derail your thread psai but I want to know why most nurses are fat and most doctors are not. Is this just a phenomenon I've observed?

Two things:
1. Lorna Doones
2. Pudding cups

There is also an inordinate candy brought to work by nurses it seems.

 

[W19]

I am a pre-med CSU RN BSN.

Nurses are not techs. They don't just do stuff because it shows up as an order on Epic. They are licensed professionals who, indeed, do not have the depth of scientific knowledge that you have (and they know that even if they don't show it), but they do have medical knowledge and nursing knowledge that is independent of the medical model and overlaps with it in places. Sometimes they need medical rationale before they will do something for the patient. They take their role as patient advocates extremely seriously, and in some cases, yes, they see themselves as protecting patients from errant doctors (which is not incorrect). I am not discounting bitchy, ignorant nurses (we have all met our fair share!), but an extra 30 seconds of an explanation will go very far in - ahem - assisting them with being gung-ho about your plan of care. You don't have to be nice and buddy-buddy, either! Knowledgeable, educational, respectful authority is a good relationship to have with the nurses, the team. Everyone knows the final outcome of the patient is your responsibility.

The next thing is hugely frustrating for both nurses and MDs: nurses are slaves to policies. Slaves. If the policy says that they have to order an H & H after a measly unit of blood was administered for someone who truly does not need to have it rechecked before the morning labs, management will hound the staff until they extract the order from an MD. The majority of nurses believe in these practice policies, of course, but cringe when they are so inflexible to the patient's situation. This is an issue that you would have to take to management if it is a big problem, because as an MD, you have the authority to override policies that conflict with appropriate patient management. And this is partially why I think you all just don't respect each other: going behind your back for nonsense orders show a complete lack of trust.

Sorry about the long post. I think you may be working with some bum nurses (they definitely exist!), but improving communication and fostering respect would go a long way. It's worth addressing, because it will make your life a lot easier and your orders more effective.

 

[libertyyne]

I tell my nurses to do whatever the hell they want under my name so long as:

1) you don't kill the patient.

2) you don't order a d-dimer.

So far so good.

Medicine is a team sport. Better to be the guy everyone goes to than the guy nobody wants.

I take it you are an ED Doc

 

[Tenk]

I take it you are an ED Doc

Indeed. I'd do the same if I weren't though. Probably 80-90% of the stuff we order and do doesn't matter so why stress over it.

 

[Cello]

Indeed. I'd do the same if I weren't though. Probably 80-90% of the stuff we order and do doesn't matter so why stress over it.

Maybe I misunderstand, but are you saying that 80-90% of what you do is a waste of time? Why are we blowing massive GDP on the ER if you guys are just going to do a bunch of stuff that doesn't matter? Madness I say!

 

[Tenk]

Maybe I misunderstand, but are you saying that 80-90% of what you do is a waste of time? Why are we blowing massive GDP on the ER if you guys are just going to do a bunch of stuff that doesn't matter? Madness I say!

No. In medicine.

 

[Cello]

No. In medicine.

Does allowing nurses to just order stuff and sign it under your name contribute to that problem? Also, is your role on the team simply to be a name to use when nurses fill out orders?

 

[Tenk]

Does allowing nurses to just order stuff and sign it under your name contribute to that problem? Also, is your role on the team simply to be a name to use when nurses fill out orders?

No, because that crap will probably be ordered anyways given our litigious society and acceptable miss rate of near 0%.

Sometimes when the department is busy, yeah.

I was actually referring more to the fact that we spend so much of our money on end of life care in an ICU rather than just letting people pass. Literally millions if not billions just to torture our elderly with lines and tubes and create super bacteria to infect our youth. Waste of everything.

 

[Cello]

No, because that crap will probably be ordered anyways given our litigious society and acceptable miss rate of near 0%.

Sometimes when the department is busy, yeah.

I was actually referring more to the fact that we spend so much of our money on end of life care in an ICU rather than just letting people pass. Literally millions if not billions just to torture our elderly with lines and tubes and create super bacteria to infect our youth. Waste of everything.

Time to become a dentist.

 

[Tenk]

Time to become a dentist.

I work in the ED. I practically already am... or at least that's what all these patients think for some reason.

 

[Psai]

Cry me a river.

I know I've reached a new low when I'm being insulted by premeds.

 

[Beezlebub]

I know I've reached a new low when I'm being insulted by premeds.

dammit I can see you being one of those future grumpy attendings out for revenge.

no amount of gluteus kissing will make up for this transgression.

 

[Psai]

dammit I can see you being one of those future grumpy attendings out for revenge.

no amount of gluteus kissing will make up for this transgression.

Nah I'm very nice to my med students and teach them. This poster won't be attending my institution so no worries

 

[Perrotfish]

So I've been having some trouble with getting some of the nurses to do what I want. I get that I'm an intern and I don't blame them for questioning what I what but it's really annoying when I want something and they don't do it which leads to a bad outcome. I don't like when they question my judgment not because they have a good reason against what I want to do but because they don't have the knowledge base to understand it.

The other side of this is when nurses want something that's not really necessary for patient care but they insist on it. For example, I've been asked repeat labs after a unit of product is given so that they can sign out the numbers to the next nurse. It's a waste of money, time and blood but sometimes I really don't feel up to explaining why I don't want to do what they want, especially if they will just go to the resident or attending and bother them about this nonissue. I'm not a fan of having traintrack vitals or attempting to reach euboxemia just to make the numbers look nice on the chart.

First, if you're an Intern starting threads about residency issues, you might get a better response in the residency forum (more residents, fewer RN premeds)

As to your question: it is a reality that as a resident the nurses are going to push back much, much more against your orders than as an attending. Part of it is a legitimate concern about your competence as someone who is still in training, but a much bigger part of it is that the system is set up in such a way as to give the nurses way more power than the residents. They can quit and leave a hole in the roster while you're an indentured servant. Their supervisors work a shift and have nothing better to do than call meetings to defend their staff until the shift ends, while your attendings stay until the work is done and will not stay late to defend you. So their supervisor has every reason to defend them, even if they're wrong, and your supervisor has a strong motivation to throw you under the bus, even if you're right.

There is no strategy for this other than to pick your battles. Attendings will always support you if there is a high risk (usually > 1/50) of serious patient harm that can be tied to them in a lawsuit. If your nurses aren't charting vitals or drawing labs on your DKA patient you can win that one. On the other hand when the 'harm' requires statistical models to detect a serious bad outcome (not just the UTI, but the UTI leading to urosepsis that leads to death) your attendings will almost always support the nurses to make the issue go away rather than fight to avoid a patient harm that will happen once a decade. It will be an interpersonal skills issue, rather than a patient care issue.

There are a lot of things we do in medicine that kill or maim people, but where the bad outcomes only occur in 1/1000 patients and are very hard to tie to a physician in a lawsuit. Putting every kid on 1/2NS is actually a pretty good example, and not pulling foleys is another. In academic medicine they very often keep doing those things because its easier than fighting a battle with the nurses to get them comfortable with the change. As a resident, all you can do is get through it and be a better attending than that when you come out on the other side.

 

[Winged Scapula]

Moving to General Residency

 

[Lostin_space]

So I've been having some trouble with getting some of the nurses to do what I want. I get that I'm an intern and I don't blame them for questioning what I what but it's really annoying when I want something and they don't do it which leads to a bad outcome. I don't like when they question my judgment not because they have a good reason against what I want to do but because they don't have the knowledge base to understand it.

The other side of this is when nurses want something that's not really necessary for patient care but they insist on it. For example, I've been asked repeat labs after a unit of product is given so that they can sign out the numbers to the next nurse. It's a waste of money, time and blood but sometimes I really don't feel up to explaining why I don't want to do what they want, especially if they will just go to the resident or attending and bother them about this nonissue. I'm not a fan of having traintrack vitals or attempting to reach euboxemia just to make the numbers look nice on the chart.

So this is an issue that happens all the time, in every setting across the nation I would say at one point or another. I think it's important for residents to be polite and professional but ultimately you are the physician, I assume you are making plans with your upper level residents and/or attendings and those decisions need to be respected. If your orders are not being carreid out, then you need to bring it up to your upper levels and a discussion might need to be had with nursing. It is not the nurse's perogative whether orders are carried out or not. Sometimes and what I have learned to do is if you have time- and time is not always present - to call, talk to, etc the nurses and be like hey we think Mr Smith has x, y, and z, we are going to be doing these labs/imaging/whatever to rule these things bla bla. Typically that will lead to a lot less issues. That has worked well for me in recent months. But there are always nurses that will try to create a power struggle and I think it's important to early on settle the boundaries of who is ultimately in charge. Sure they are part of the team but the physician's orders are the physician orders and they must be carried out. Making it official and putting it out there is importnat so that it goes on record that this is happening.

 

[Lostin_space]

Oh my goodness! this is fantastic! I love this!!!!!

 

[Lostin_space]

Based on the mostly disrespectful comments I've seen you post in here, I'm not surprised.

Nurses are just people trying to do their job the best they can, not slaves. I don't think there is a quick fix for this problem. Your online persona may be completely different from your face-to-face persona, so maybe it's something simple. But if you truly possess the inner disdain for nurses that you have displayed in some of your SDN posts, you are in need of professional help...

Throw out some examples and maybe we can understand more clearly what kind of advice you need. What kinds of things do you want them to do and how did things go wrong in a way that hurt the patient?

Nurses carry out orders like it or not. Good nurses will ask questions if they are truly concerned but much more than it, there are issues because residents tend to be young, and nurses don't like receiving orders as they get older from young doctors, especially if you are a woman and somewhat attractive. nurses are like permanent interns. They do things and carry out orders but at t th end of the day they don't frequently have that much knowledge - whether it is about the disease processes, medications, etc. If you ask many nurses about the mechanisms of things they will look at you blankly. They will also not question attendings because they know better. They will question residents, interns, etc because they know that interns in particular are under tremendous stress, typically put their head down bc they don't want conflict or trouble and because they know that they will always be nurses and there won't be much upward mobility other than being a nurse. So they pick on interns, women all the time. Has happened to me, to my fellow residents, in my specialty and other specialty, in every setting I know ever been in.

 

[caffeinemia]

Turns out if you really want a foley d/c-ed...all you need is a 10cc syringe...

Correction -- if you want a foley ATRAUMATICALLY d/ced...then all you need is a 100cc syringe....

 

[caffeinemia]

It honestly sounds like your major problem is that you and the nurses hate each other. Despite all the education, training, and professional ethics in the world, plain dislike and disrespect will throw a monkey wrench into patient care like nothing else.

I am a pre-med CSU RN BSN.

Nurses are not techs. They don't just do stuff because it shows up as an order on Epic....

I always wondered why there were so many nursing letters... one would think that if BSN > RN would preclude the need for a RN citation. I guess next time I am going to sign all my notes: Caffeinemia BA, MD... Maybe I'll add in BLS-C, ACLS-C, and ATLS-C for my CPR credentials as well. What about acronyms for licensed in the state of new york? NYS-MD?

Caffeinema, BA, MD, BLS, ACLS, ATLS, NYS.... that sounds pretty good.

Edit: pretty sure I made up a buncha these to illustrate the point.

 

[caffeinemia]

Even better once you get board certified!

Southernsurgeon, BA, MD, MS, BLS, ACLS, ATLS, PALS, NYS, BE/BC, FACS, CGSO

Hahahah Werd. But they'll still page you to ask about that foley order, in case you're trying to kill the patient!

 

[WholeLottaGame7]

Nurse: yeah there's a protocol about this situation
Me: oh interesting can i see it
nurse: sure let me look it up

20 minutes later
nurse: couldn't find it but I'm sure there is a protocol so we have to follow it
me: ???

One common example is the huge unwillingness to remove foleys. "Oh we need to track is and os". Yeah no **** ive been doing that for days and the foley needs to come out. "But the patient will be incontinent". So do you want them to have a Foley for the rest of their lives?

So far had a few utis and urosepsis from foley nonremoval and traumatic self removals because they refused to take it out. Don't we get dinged and pay taken away for that? Why do I get hounded about checklists if it won't change nursing behavior?

Also I'm pretty good with the majority of the staff. It's a very small number I'm having issues with. I do appreciate the responses.

This should be like a 10-15 second conversation. You gotta lock this kind of encounter down in residency. If you don't, you're going to end up a sad, bitter, and broken man.

A couple things:

1) Never let them see you get frustrated. When you do, they've already won. Kill them with kindness.
2) Understand your enemy*. The vast majority of nurses want 2 things: to not have anything bad to happen to their patient, and to do as little work as possible (in no particular order). They are likely motivated to keep the foley in because A) they don't have to go in and take it out, and B) they don't have to change diapers/linens as frequently. On the flip side, maybe the patient has a sacral decub you didn't know about that they don't want getting **** in or something. Hear them out.
2b) If they push back or make a counter-argument, address it in a reasonable fashion. To use your example, if they say "oh we need to track Is and Os," don't say "yeah no **** I've been doing that for days and the foley needs to come out," because you're just repeating the order you already put in. That's intellectually lazy and counter-productive to what you're trying to do, which is take care of the patient. Say "this isn't a heart failure patient, we don't need strict Is and Os anymore, I'm more worried they will get an infection from the foley staying in."
3) You don't have the need or the time to get into a literature argument. If a simple explanation doesn't work, bump it up to their charge nurse.
3b) Use their training against them. Figure out the buzzwords and use them. In our hospital, it was using CUS words. "I'm Concerned about leaving the foley in this patient" or "It makes me Uncomfortable that this patient still has their foley in." Or the coup-de-grace, "I think this is a patient Safety issue."
4) Remember why you went into anesthesia. The next 3 years if you want something done, you just do it yourself. Until you graduate and work in an ACT practice, then your nurse-management skills circle back around.

*Everyone in residency is the enemy. Nurses, attendings, sometimes your colleagues, the patients (usually unintentionally).

 

[RadOncDoc21]

This should be like a 10-15 second conversation. You gotta lock this kind of encounter down in residency. If you don't, you're going to end up a sad, bitter, and broken man.

A couple things:

1) Never let them see you get frustrated. When you do, they've already won. Kill them with kindness.
2) Understand your enemy*. The vast majority of nurses want 2 things: to not have anything bad to happen to their patient, and to do as little work as possible (in no particular order). They are likely motivated to keep the foley in because A) they don't have to go in and take it out, and B) they don't have to change diapers/linens as frequently. On the flip side, maybe the patient has a sacral decub you didn't know about that they don't want getting **** in or something. Hear them out.
2b) If they push back or make a counter-argument, address it in a reasonable fashion. To use your example, if they say "oh we need to track Is and Os," don't say "yeah no **** I've been doing that for days and the foley needs to come out," because you're just repeating the order you already put in. That's intellectually lazy and counter-productive to what you're trying to do, which is take care of the patient. Say "this isn't a heart failure patient, we don't need strict Is and Os anymore, I'm more worried they will get an infection from the foley staying in."
3) You don't have the need or the time to get into a literature argument. If a simple explanation doesn't work, bump it up to their charge nurse.
3b) Use their training against them. Figure out the buzzwords and use them. In our hospital, it was using CUS words. "I'm Concerned about leaving the foley in this patient" or "It makes me Uncomfortable that this patient still has their foley in." Or the coup-de-grace, "I think this is a patient Safety issue."
4) Remember why you went into anesthesia. The next 3 years if you want something done, you just do it yourself. Until you graduate and work in an ACT practice, then your nurse-management skills circle back around.

*Everyone in residency is the enemy. Nurses, attendings, sometimes your colleagues, the patients (usually unintentionally).

Excellent post! I just wanted to add on to your advice for the OP.

This will be the climate from here on out and kindness will (usually) get you further than confrontation. Get used to it, you will be questioned and challenged not only by nurses, but staff, colleagues, and of course patients.

Gone are the days, you can just say "because I'm the doctor, that's why." Sad thing is you do understand more and it does become frustrating having to explain something that is "simple." The position physicians once had as is gone and the sooner you can get together as a team, the easier it will be to make it through the day....welcome to modern medicine!

 

[Mr Roboto]

An attending I know says "M dot D dot baby" when nurses don't want to follow his orders.

 

[jw3600]

Start with your step score, end with your argument on the benefits of lactated ringers. They will sing your praises for generations to come.

Solid post to like ratio, brother.

 

[Siggy]

So 2 things that comes to mind for the OP.

1. Pick and choose your battles. Does the post transfusion H/H really need to be done? Well... it depends, especially if you're not looking at multiple units of blood. Regardless, two questions. First, is it at a time when you can plant your "daily labs" flag and call it a day? There's no reason to draw an H/H at 2am when daily labs is being drawn at 5. On the other hand, which is easier, fighting with a nurse or putting a CBC and chem 7 at 2am?

Second... is this the hill you're willing to die on? Me, personally? Nope. I've got more important things to do than discuss the merits of the post transfusion H/H, it's affect on patient's hemodynamics, and the cost to the system. So... no... not worth it.

2. Know your indications for interventions, and use that as your arguments. "But we're concerned about incontinence" needs a reply of "that's only an indication if the patient has a non-healing wound or is comfort care." Granted, at my hospital, the nursing staff is normally quick to either ask for a continue foley or D/C foley order once they're placed.

 

[Psai]

Turns out if you really want a foley d/c-ed...all you need is a 10cc syringe...

I actually did say that I will take it out because they didn't do it but she said NO we will handle it. Trust me, I'm all about doing things myself because then I know it gets done.

 

[iBro]

Correction -- if you want a foley ATRAUMATICALLY d/ced...then all you need is a 100cc syringe....

What kind of Foley are you using that you need a 100cc syringe to deflate the balloon?

Sent from my Nexus 6P using Tapatalk

 

[WholeLottaGame7]

An attending I know says "M dot D dot baby" when nurses don't want to follow his orders.

Note, this is hearsay, but supposedly one of my attendings held up his badge to a nurse and said, "You see those initials? You know what M.D. stands for? Makes Decisions." I would never say it, but it makes me laugh every time I think of it.

 

[Siggy]

Note, this is hearsay, but supposedly one of my attendings held up his badge to a nurse and said, "You see those initials? You know what M.D. stands for? Makes Decisions." I would never say it, but it makes me laugh every time I think of it.

MD = Makes Decisions

RN = Reads Notes.

 

[dpmd]

What kind of Foley are you using that you need a 100cc syringe to deflate the balloon?

Sent from my Nexus 6P using Tapatalk

Some have a 30 cc balloon so a bigger syringe will guarantee you fully deflate it without having to remove it and empty it a few times.

 

[Siggy]

Some have a 30 cc balloon so a bigger syringe will guarantee you fully deflate it without having to remove it and empty it a few times.

You don't even need a 10 CC syringe if you pull the plunger out.

 

[dpmd]

You don't even need a 10 CC syringe if you pull the plunger out.

You just blew my mind. Never would have thought of this, though then you have a bunch of water leaking out somewhere (which might be a good revenge if you had to resort to pulling your own foley because the nurses wouldn't).