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It's 0445 a couple of days ago and I'm rounding on my patient that just got moved up from the SICU to the Intermediate Care Unit (IMCU). And when I say "just moved out" I mean I wrote transfer orders at 2000 the night before. According to the chart, the IMCU nurses received the patient at 2200. This particular patient has a few orthopedic injuries to his LE; and by a few I mean distal femur fx, tibial plateua fracture, etc...he has a zipper from groin to maleolus. Now, even though the patient is GCS 9 he can still feel pain, right?

So, I spend 15 minutes checking the chart, chatting up the nurses, and then go examine him. He says he is in a lot of pain. "I'm sorry. When was the last time you had some pain medicine?" "A long time ago. I think it was before I got to this room." I tell him I'll take care of it.

So I go review my orders written 9 hours ago and sure enough, I had written for some pain meds: a PCA, some morphine for break through, some Vicodin. So I go back into the room expecting to explain to the patient he needs to push the little button on the...wait a minute...where is that little button thing?

I come out of the room and the two nurses that are sitting at the computers (1 playing solitaire, the other is surfing to find a cute tank and shorts to match) finally look up and say, "We were yelling at you but you didn't hear us. That patient is contact precautions for MRSA." :eek: I'm thinking in my mind, "You know, that might be something to get off your butt for and come into the room and make sure I hear you! You were really screaming as if my life was hanging in the balance, weren't you?!:rolleyes:" After scrubbing myself and stethoscope down, I politely ask if they could put up the usual signs that indicate we need to be a little more careful when we go into this patient's room and touch him. After the initial :confused: look, they were like, "Oh, you're right. We should put that up."

I ask which one of them has my patient... they say the nurse just went down for his nicotine break. So I ask them both if they knew what time the patient arrived. They said 0100. Now I'm irritated. "Well, the chart says right here in this nursing note, 'Pt received at 2200.' Even if he arrived only 4 hours ago instead of the 7 hours ago like it says in the chart, why isn't his PCA hooked up?" "Oh. Here it is," she says as she picks it up off the desk right next to her mouse. "It must have just arrived from pharmacy. He's a GCS 9 anyway...and he was moving his leg around alot so it can't hurt that much." "I understand that he's a GCS 9 and not all there, but he was complaining of pain from the big 69cm incision running down his leg and his multiple fractures. Can you please follow the orders I wrote for my patient 9 hours ago?" And what I want to say is, "How would you like to be treated like that?...or how about if we treated your spouse or another family member like that? You'd be outraged at the indifference and insensitivity.:boom:

Fast foreward to this morning....I was rounding on my patient and the nurse announces to everyone as I walk into the IMCU, "Look! There's our favorite doctor" spoken with condescending tone.

Whatever. At least I'm aware of my incompetence and can swallow enough of my pride to ask for help when I don't know the answer to something. And apathetic I'm not. It's not like we're affecting people's lives or anything.:idea: Sheesh!
 
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psychbender

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This is probably contained in another thread somewhere, but it is appropriate here so...

What is the difference between a military nurse and a bullet?

A bullet will draw blood? A bullet will only kill once? A bullet can be fired?

I know those are the jokes for VA nurses (rotating through a VA now...kind of frightening), but judging from the stories I read here, perhaps they apply equally well to military nurses.
 

Perrotfish

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I know those are the jokes for VA nurses (rotating through a VA now...kind of frightening), but judging from the stories I read here, perhaps they apply equally well to military nurses.

I´ve heard doctors share similar stories about civilian nurses as well. Anyone who has worked in both systems care to comment on the differences in nursing care?
 

AF M4

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Heh, the correct response to the "favorite doctor" crack is to smile your biggest cheesiest grin and announce in a loud voice, "Hey, just because I'm the best-looking doctor here it doesn't mean you can get out of doing work by hitting on me! (pause, then in a quieter voice) Oh yeah, how's Mr. X's PCA working?"

This works to your advantage on several levels:

1) Makes you more likable and lighthearted to the staff in general
2) Deflects the nurse's obvious attempt to get a rise out of you while...
3) Simultaneously reminding her that you know that she's being lazy while bringing up the exact reason why.

So by using humor you've publicly served notice that you're (a) not affected by her bull**** and so can look forward to much fewer of these little passive-aggressive snits from her and her buddies in the future and (b) that you remember exactly what she did last night and while you're not currently planning on making a fuss, the whole incident is stored in your memory for possible future use.

If you don't mind the naughty language, I watch this Deadwood clip every few days for edification:

http://www.youtube.com/watch?v=W67H4k-Asf8
 

alpha62

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Military tradition dictates that you recount such stories not with " There I was " but rather... " Now this ain't no **** "
 

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Nursing is a pretty crappy job, and you cant' possibley expect them to get all concerned b/c someone didn't get their pain meds. Honestly, I'd just be happy that those were only orders not followed.
 

mitchconnie

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Honestly, I'd just be happy that those were only orders not followed

This really is the take-home message for the entire thread. As irritating as the OP's encounter with nursing may have been, I'm sure that all the attendings have seen much worse. On more than one occasion, nurses have failed to start anticoagulation on my patients with an acute embolic event, potentially causing loss of life or limb. This is just one of many examples which we could all recount

But don't blame the inexperienced floor nurses, blame the nursing supervisors who have created a nursing culture where completion of paperwork, not patient care, is the main goal and doctors are the opponent, not the team leader. This nursing culture is very much like the VA or a poorly-funded county hospital, and far more frustrating than any private hospital I have worked in.

And please don't waste your time filling out "incident reports" or "1811's." These are NEVER acted upon, and will just set you up as the enemy, making life harder for you and your patients. Unfortunately, when it comes to incompetent nursing and support staff, you have to pick your battles carefully.
 

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Hell yeah! And many of those hours will be spent flying and finishing my outprocessing checklist. The house is sold, the next house is bought, all I have to do is not get court martialed in the next few days and I'm a free man.

Keep 'em on the range!:boom:
 

Homunculus

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Or you could be direct, ignore the comment, and ask, "Did you start that PCA like I ordered?"

That way you can avoid the indignity of pretending that you want to be friends.

this is the senior resident/attending technique. short, efficient and lacking in superfluous BS. i find than interns and junior residents get caught up in the social nursing issue kind of thing much too easily.

sometimes it helps to play along, but the longer i practice (i'm finishing my first year as an attending) the more i find less and less energy and tolerance for the games.

--your friendly neighborhood seasoning as an attending caveman
 

alpha62

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I entered the medical field in 1980. during this long strange trip, I banged my fair share of nurses, techs, pharmacy, ect.

they're all going to eventually hate you anyway, not because you are a doc, but because you have a penis.

If they're all going to eventually despise you anyway, don't you think it's at least worth tapping on it while the sun is still shining ?
 

DiveMD

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I entered the medical field in 1980. during this long strange trip, I banged my fair share of nurses, techs, pharmacy, ect.

they're all going to eventually hate you anyway, not because you are a doc, but because you have a penis.

If they're all going to eventually despise you anyway, don't you think it's at least worth tapping on it while the sun is still shining ?

HAHAHAHAHA! :laugh:
 

HackFuJones

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I entered the medical field in 1980. during this long strange trip, I banged my fair share of nurses, techs, pharmacy, ect.

they're all going to eventually hate you anyway, not because you are a doc, but because you have a penis.

If they're all going to eventually despise you anyway, don't you think it's at least worth tapping on it while the sun is still shining ?

this might be the best quote ive seen on these forums LOL
 

dtn3t

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I entered the medical field in 1980. during this long strange trip, I banged my fair share of nurses, techs, pharmacy, ect.

they're all going to eventually hate you anyway, not because you are a doc, but because you have a penis.

If they're all going to eventually despise you anyway, don't you think it's at least worth tapping on it while the sun is still shining ?

This advice should be passed on to every incoming intern.
 

AF_PedsBoy

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When I was on General Surgery I got paged in a trauma because the nurse couldn't get a blood culture from a 19 year old male trainee, which had been written for by the attending ...5 hours earlier... and said I had to go up and draw it. I walked back saying "WTF" at which point my attending said, "You shouldn't be doing crap like that." The nurse in the trauma said, "Are you joking? They paged you for that? Tell me where he is and I'll do it," and it was done 15 minutes later. (which tells you there are great nurses along with the, er, not so great ones) I was just going to drop it along with all the other screw ups, but my attending ordered me to write up an incident report and give him a copy afterwards, so of course I had do to it- next day when I was rounding the nurse said to a group of poor enlisted trainee technicians, "Better watch out or he'll write you up," to which of course I said, "Damn right, I'm laying down the hammer!" finished up my work and walked off. I find life is so much better once you stop caring what the incompetent nurses think (it's also much better when you get to be friends with the good nurses since it makes the day go by faster if you're not pissed off all the time) I think the thing that killed me was the nursing shift leader the next day was giving me a hard time because, "It got done eventually, didn't it? So what's the problem?" I don't bother talking to her either
 

alpha62

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take it from an old timer, find the nurse that the other nurses hate, sleep with her, trust me, she'll run her mouth.

Stand back, let the fire and forget bomb you just armed find it's target. Within about one week, all the nurses will start piling on Nurse Give-it-up and the focus will be off you.

Year two, burn off the first one, find a new one, and repeat step one.

By third year, harvest the bitter fruit you've planted and enjoy.
 
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