To SOME nurses out there...

[diel]

This is venting.... I have to let it out somewhere, and maybe some of you guys will understand.

This is a message from an overworked post call resident, to some RNs out there that simply spit on the work we do:

Stop paging me about the diet orders at 3 AM. Do you eat at 3 am if you're in a hospital? I don't care if the pt did not "have urine output" in 3 hours, we don't go to the bathroom every three hours. Stop following some automatic BS and sit down and think before you page when you hear the damn over page "trauma team to the ED now" and ask me about benadryl.
If I got somebody on low vasopressin gtt for their DI and suddenly their urine output went from 1L/h to 100, don't page me 3 times and try to convince me the pt needs boluses and that he is going into renal failure! Read ! for %$%^'s sake!
While you look over your THREE patient, sit down and look over which service your patient is on! Don't page me and ask for restraints orders on somebody I have never heard off and then try to prove to me that IT IS ME, covering that patient. Read the f%$#^$% on call coverage!
Don't bitch to my superior that I didn't say "please" when I yelled for the sterile gauze to stop the gushing blood from somebodies groin!
It;s not my fault you're in your forties and "you're not an MD". After 28 hrs of no sleep and no sit down, I DON'T GIVE A CRAP about your sentiments!
Try to get to know the residents and their life, since "you've been in this hospital forever and you know the way things work".
I am not your pal, buddy or whatever. I am responsible for the things you do, so I get to tell you what NOT to do, even if you read a page of wikipedia in your life, while browsing the facebook during your shift.

I am not going to stop and sit down at the computer and write orders for the 1L NS bolus, while I am greeting a red trauma coming in. Not even for the dulcolax or whatever da hell else routine stuff you think is important at 2 AM!

PLEASEEEEEEE! Wake up one day!!!




AAAAAAA........ I need a drink and a bed......
which i intend to do now........

sorry......... for all that.....but I feel better now.......

---

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[mig26x]

I "loved" the nurse that paged me 3 times with each pager specifying which pager it was (2nd pager, 3rd pager etc) in 15 minutes regarding patient requesting ambien for the next night ( this was nightfloat at 3am) because he was not sleeping well that night. Well it seems this nurse didnt HEARD the overpage call for "CODE BLUE" 3 times in a bed a floor below where I was for the last hour. And then she had the $%$@ to start yelling at me because I didnt answer her pagers even though she specifically wrote 2nd page, 3rd page etc etc.

the other day one of my co-residents mentioned that nurses should have beepers too, that wouldnt be a bad idea.

 

[VA Hopeful Dr]

I "loved" the nurse that paged me 3 times with each pager specifying which pager it was (2nd pager, 3rd pager etc) in 15 minutes regarding patient requesting ambien for the next night ( this was nightfloat at 3am) because he was not sleeping well that night. Well it seems this nurse didnt HEARD the overpage call for "CODE BLUE" 3 times in a bed a floor below where I was for the last hour. And then she had the $%$@ to start yelling at me because I didnt answer her pagers even though she specifically wrote 2nd page, 3rd page etc etc.

the other day one of my co-residents mentioned that nurses should have beepers too, that wouldnt be a bad idea.

The ones at my hospital all carry cordless phones around with them.

 

[typhoonegator]

We actually had a pilot program on one floor of my hospital during internship where all the nurses on the floor got pagers that the MDs could reach. The administration thought it would be nice if the residents could send brief communications to the nurses about new orders or pending discharges. The nurses rose up and got the program cancelled in 2 weeks. The reason? They felt like they got paged too much and it was preventing them from getting their work done! In our jaded intern-ness, we really thought that was rich.

Now, at the hospital where I did residency, all the nurses have pagers that are handed out at the beginning of shift, but only the unit secretary can send pages to them. All the pages are "patient or family initiated only".

 

[glade]

The problem is that there is no "standard" of nursing care. It's basically whatever the nurse feels like doing at any given time. So one nurse may be content to just collect vitals and ignore "stat" orders. Another nurse may be stellar and completely assess her patient from top to bottom in her shift. A third nurse may not know how to do anything except make sure that every patient has had a bowel movement -- that's her "thing." At some point in her career someone impressed upon her that everyone was negligent in making sure patients had bowel movements and so now she religiously ensures that they have one or else someone will be notified.

You'll find all three of these nurses at all hospitals and they all switch off their patients from day to day and they all get about four days off every week. There's no continuity in nursing. You may have a great nurse on day shift hand off to some "O" magazine-reading slacker on night shift. We would literally joke about how you can tell when shifts are over. We'd have one nurse who would harrass you all day about "can you come here and check this patient, I'm concerned, doctor" for everything. Then her shift would end and the next nurse wouldn't page you for anything and you'd find they had a fever and were vomiting all night and the nurse can't be bothered to draw labs or give fluid boluses because she's busy charting.

That's the problem. With nurses, their personal standard is the standard. If they feel something is important, then it suddenly IS important to everyone because she lets them know that it is. Everyone has to drop everything and deal with her "issue." Conversely, even if everyone is worried about something, if she feels it's no big deal, then it isn't. Suddenly "stat" means "whenever it happens, but you can pass it to the next shift because you're changing shift in an hour anyways."

I feel bad for our interns because I'll be with them and they'll get paged for each and every patient on the floor and it'll generally be about some inconsequential issue. Someone is itching. Oh, now they have an odd linear set of "rashes" where the itches were and they were scratching. Someone can't sleep. And so on. This will end once you start practicing in a non-unionized hospital.

I've had this discussion before with nurses. They hate working in non-unionized hospitals because you get reamed out if you bother the attendings at night. If they want to do a procedure at bedside, the nurse gets all the equipment and assists in any way required. There's no questioning of orders based on "being an advocate." These are also, in my opinion, some of the best nurses because they can handle issues and identify which are important. So this is just another test of residency.

 

[PostCall]

This is venting.... I have to let it out somewhere, and maybe some of you guys will understand.

This is a message from an overworked post call resident, to some RNs out there that simply spit on the work we do:

Stop paging me about the diet orders at 3 AM. Do you eat at 3 am if you're in a hospital? I don't care if the pt did not "have urine output" in 3 hours, we don't go to the bathroom every three hours. Stop following some automatic BS and sit down and think before you page when you hear the damn over page "trauma team to the ED now" and ask me about benadryl.
If I got somebody on low vasopressin gtt for their DI and suddenly their urine output went from 1L/h to 100, don't page me 3 times and try to convince me the pt needs boluses and that he is going into renal failure! Read ! for %$%^'s sake!
While you look over your THREE patient, sit down and look over which service your patient is on! Don't page me and ask for restraints orders on somebody I have never heard off and then try to prove to me that IT IS ME, covering that patient. Read the f%$#^$% on call coverage!
Don't bitch to my superior that I didn't say "please" when I yelled for the sterile gauze to stop the gushing blood from somebodies groin!
It;s not my fault you're in your forties and "you're not an MD". After 28 hrs of no sleep and no sit down, I DON'T GIVE A CRAP about your sentiments!
Try to get to know the residents and their life, since "you've been in this hospital forever and you know the way things work".
I am not your pal, buddy or whatever. I am responsible for the things you do, so I get to tell you what NOT to do, even if you read a page of wikipedia in your life, while browsing the facebook during your shift.

I am not going to stop and sit down at the computer and write orders for the 1L NS bolus, while I am greeting a red trauma coming in. Not even for the dulcolax or whatever da hell else routine stuff you think is important at 2 AM!

PLEASEEEEEEE! Wake up one day!!!




AAAAAAA........ I need a drink and a bed......
which i intend to do now........

sorry......... for all that.....but I feel better now.......

i find your attitude both "unprofessional" and detrimental to our "team". it doesn't matter if you're a doctor, i wear a long white coat just like you do and expect to be treated accordingly. i have been here 20 years and even though you will exceed my abilities within a few months of your internship i will still act like i own the place and you are only a guest here with the privilege of treating "my" patients. don't bother being nice, indifferent, or confrontational with me because none of it will overcome my closeted frustration of being middle aged and still having to take orders from a 20-something year old doctor. if you happen to be an attractive, young woman doctor then that magnifies the situation a million fold because you represent everything i am not. by the way when i come back from my third coffee break of the day i am going to write a long, histrionic, highly embellished letter to your chairman about your "unprofessionalism". i will also send a copy of the letter to the CEO of the hospital. because nothing says "team" like a teammate snitching on you over non-issues that they blew out of proportion or outright fabricated.

 

[surrender903]

lots of words without breaks for paragraphs

is there a joke im missing here? or was that bone dry sarcasm?

 

[PostCall]

is there a joke im missing here? or was that bone dry sarcasm?

i am going to overreact to your question and make it out like you don't take me seriously and then exagerrate it to you being "unprofessional" and compromising "patient care". when i get back from my now fourth coffee break of the day i am going to write you up too. also expect some non-essential pages in the middle of the night next time you are on call as a way for me to express my passive-aggressiveness. you better answer them promptly and personally even if you are in the middle of an emergency or scrubbed up doing a procedure or you will earn yourself another write up for not being a "team" player.

 

[diel]

Oh man..... just woke up...

Write ups.. haha... every single girl in my program has a collection of those, even the most sweet, shy girl intern we have.
Yes, between facebook browsing and that 3rd coffee there must be one of them written. I like it how they try to stare at my lab coat and try and decipher my name when I finally show up there and try to get to the bottom of the mistery rash or the missing bowel movement, while trying to wipe off the fresh blood of my another pair of destroyed snickers.
I got to this practice: I listen, eyeball the pt and the vitals which are all perfect of course and the pt is all annoyed cause the wanna sleep and not try to squeeze a poopie at 4am. Then I go back to the nursing station, take out a pen and my small notebook, and calmly ask: "and your name is .. ?".
RN : "Lindsay".. while staring at me with big questioning eyes.
Me: "I'm sorry, Lindsay, what is your last name? Can you spell that for me?" then I stare at their badge like Sherlock, take out a "hmm"... write it down and write down the time and the room number and then misteriously say "thank you" and walk away.

Oooooooooh......... the stupefied look on her face is priceless!!
What do I do with that piece of paper? Forget about it forever. I don't have the time nor the low self esteem for write ups.
But oh... what goes through her head? Like I said.. priceless...

 

[diel]

. So this is just another test of residency.

I know it is.. and I try and deal with it as politically correct as I can.
i love the majority of my hard working RNs and they like me too, after they spend some time with me and get to know me and what I do in this hospital.
There is no fix to this problem. I will always be the young tall blonde MD and nothing else to some of them.

I thank you for being the attending that advocates for us.

 

[mig26x]

Oh man..... just woke up...

Write ups.. haha... every single girl in my program has a collection of those, even the most sweet, shy girl intern we have.
Yes, between facebook browsing and that 3rd coffee there must be one of them written. I like it how they try to stare at my lab coat and try and decipher my name when I finally show up there and try to get to the bottom of the mistery rash or the missing bowel movement, while trying to wipe off the fresh blood of my another pair of destroyed snickers.
I got to this practice: I listen, eyeball the pt and the vitals which are all perfect of course and the pt is all annoyed cause the wanna sleep and not try to squeeze a poopie at 4am. Then I go back to the nursing station, take out a pen and my small notebook, and calmly ask: "and your name is .. ?".
RN : "Lindsay".. while staring at me with big questioning eyes.
Me: "I'm sorry, Lindsay, what is your last name? Can you spell that for me?" then I stare at their badge like Sherlock, take out a "hmm"... write it down and write down the time and the room number and then misteriously say "thank you" and walk away.

Oooooooooh......... the stupefied look on her face is priceless!!
What do I do with that piece of paper? Forget about it forever. I don't have the time nor the low self esteem for write ups.
But oh... what goes through her head? Like I said.. priceless...

I have a write up, from a nurse that paged me regarding a pt that was transfer on the oncology floor and it was transfer out of the MICU 1 week ago. The "nice" nurse had the guts to tell me "are you telling me you are denying this patient of her rigths to be treated medically" when I only answered to her "maa'm, the pt left the MICU one week ago, please page the corresponding medical team as I dont know the current pt medical condition and therefore in no place to answer your question". She went "Dr. how did you spell your last name?" I gave her my last name. A few hours after the incident I left the MICU and went to the ONcology floor and saw that she wrote a report in the chart regarding the incident. I, below her note which was the last one, left another one stating the nurse was refusing to call the corresponding medical team and demanding an answer from the MICU resident, were the pt was last seen one week ago.

 

[Winged Scapula]

I have a write up, from a nurse that paged me regarding a pt that was transfer on the oncology floor and it was transfer out of the MICU 1 week ago. The "nice" nurse had the guts to tell me "are you telling me you are denying this patient of her rigths to be treated medically" when I only answered to her "maa'm, the pt left the MICU one week ago, please page the corresponding medical team as I dont know the current pt medical condition and therefore in no place to answer your question". She went "Dr. how did you spell your last name?" I gave her my last name. A few hours after the incident I left the MICU and went to the ONcology floor and saw that she wrote a report in the chart regarding the incident. I, below her note which was the last one, left another one stating the nurse was refusing to call the corresponding medical team and demanding an answer from the MICU resident, were the pt was last seen one week ago.

I don't understand.

Was this patient now not on your service or were you not cross-covering the patient?

 

[mig26x]

I don't understand.

Was this patient now not on your service or were you not cross-covering the patient?

sorry, I have a 6am flight tomorrow and Im writting as I do my suitcase. I was the senior resident at the MICU when the patient was transfer from the MICU to the oncology floor (therefore my name was in some of the orders in the computer) so this "nice" nurse decided to page me and for me to answer her questions even though the patient was transfer from the MICU one week earlier. I told her I was not the person in charge of his care anymore and to page the medical team in charge of him that's when she went "so doctor, are you telling me you are denying medical attention to this patient". and the rest is hx.

 

[Winged Scapula]

sorry, I have a 6am flight tomorrow and Im writting as I do my suitcase. I was the senior resident at the MICU when the patient was transfer from the MICU to the oncology floor (therefore my name was in some of the orders in the computer) so this "nice" nurse decided to page me and for me to answer her questions even though the patient was transfer from the MICU one week earlier. I told her I was not the person in charge of his care anymore and to page the medical team in charge of him that's when she went "so doctor, are you telling me you are denying medical attention to this patient". and the rest is hx.

Ahhh...ok, that makes sense. I thought you were implying that you were the Onc resident and the patient was now on your service and you wanted her to call the MICU for the history. That was what was confusing me.

Enjoy your trip (hope its for pleasure)!

 

[typhoonegator]

Wow. That is rough. You were right not to write orders on a patient not on your service, although over the internet these disagreements tend to be very one-sided.

Malicious write-ups should come back to the author, in my opinion. Checks should have balances. There are nurses on my service who are well known for writing incident reports up every single night, for perceived slights or dubious "systems failures". Some people just need to have their voices heard...even if they aren't listened to.

Gah, I sound like a jaded resident! I love my nurses, I really do. I've seen just as many ridiculous residents. Well, almost.

 

[Thanatos]

We actually had a pilot program on one floor of my hospital during internship where all the nurses on the floor got pagers that the MDs could reach. The administration thought it would be nice if the residents could send brief communications to the nurses about new orders or pending discharges. The nurses rose up and got the program cancelled in 2 weeks. The reason? They felt like they got paged too much and it was preventing them from getting their work done! In our jaded intern-ness, we really thought that was rich.

Now, at the hospital where I did residency, all the nurses have pagers that are handed out at the beginning of shift, but only the unit secretary can send pages to them. All the pages are "patient or family initiated only".

Thats priceless!

 

[error404]

And for the last F$%&ing time... I don't care if the patient has "decreased urine output" if he's on dialysis. It's 4 in the morning.

Our nurses have portable phones each shift that they're supposed to pick up-- but it doesn't make a difference because they are ALWAYS, ALWAYS on break. Exactly how many breaks do you get? And if you get breaks, why do you get to call me out of every conference I've tried to attend this year?

 

[PostCall]

And for the last F$%&ing time... I don't care if the patient has "decreased urine output" if he's on dialysis. It's 4 in the morning.

it doesn't matter what time it is when i needlessly woke you up, it was your decision to be a doctor so i advise you to not raise your voice or i will include that in the incident report that i have already started writing up for your use of "unprofessional" foul language that is compromsing "patient care". as a doctor you are part of my "team" and that means when i follow protocols without actually thinking about what i am doing then you may get those kinds of calls. remember, as long as i call you i can simply write in the chart "doctor notified" and absolve myself of any responsibility while shifting it all on to you. that way if anything goes wrong i can just point to the chart where i "documented" that i notified you and thereby be blameless and free to abandon you as the lawyers have a field day on you alone. that's how strong our concept of "team" is.

Our nurses have portable phones each shift that they're supposed to pick up-- but it doesn't make a difference because they are ALWAYS, ALWAYS on break. Exactly how many breaks do you get? And if you get breaks, why do you get to call me out of every conference I've tried to attend this year?

in order to effectively deliver "patient care" our "team" must be adequately rested. that concept doesn't apply to you. sitting at the nurses station gossiping and giving attitude to anybody who asks me to do something is gruelling. unless the person asking is a powerful attending, then i will kiss their ass and do what they want right away. that is why i need half a dozen breaks before noon.

 

[mig26x]

We actually had a pilot program on one floor of my hospital during internship where all the nurses on the floor got pagers that the MDs could reach. The administration thought it would be nice if the residents could send brief communications to the nurses about new orders or pending discharges. The nurses rose up and got the program cancelled in 2 weeks. The reason? They felt like they got paged too much and it was preventing them from getting their work done! In our jaded intern-ness, we really thought that was rich.

Now, at the hospital where I did residency, all the nurses have pagers that are handed out at the beginning of shift, but only the unit secretary can send pages to them. All the pages are "patient or family initiated only".

I will pay for my nurses to have pagers. One time we were rounding and the nurse joined the rounds, and thankfully the intern presenting got like 4-5 pagers one after the other interrupting rounds multiple times. The nurse at the end of the presentation told me " how can you guys work", I almost laugh in her face. She's known as a pager-cholic!!! she loves to send stupid FYI.

 

[mig26x]

And for the last F$%&ing time... I don't care if the patient has "decreased urine output" if he's on dialysis. It's 4 in the morning.

Our nurses have portable phones each shift that they're supposed to pick up-- but it doesn't make a difference because they are ALWAYS, ALWAYS on break. Exactly how many breaks do you get? And if you get breaks, why do you get to call me out of every conference I've tried to attend this year?

dont get me going on breaks. at my MICU, nurses go on break at 9am or something around that time when we are rounding and they start there shift at 7am, and then they cry that they dont know the plan for the day etc.

But all this is call "UNIONS", they have them we dont that's why we are getting screwed.

 

[Buzz Me]

is there a joke im missing here? or was that bone dry sarcasm?

It's called deadpan. Well done, I must say!

 

[docdaname]

speaking of venting: my last call I had ordered IV iron for a pt (per renal, before they gave epo). I placed a "now" order around 3 or 4 pm. Around 9 pm i get a text page from a nurse (which is rare, they usually dont text page) that says, fyi: you ordered IV iron, but this can only be given during dialysis through i dialysis line. first thing i did was call pharmacy and clarify, and of course they said no, you can give it peripherally. I went to the nurses station and pointed out how the pt is not on dialysis, so how am I supposed to give them iron? She kind of looked at me stumped and just repeated it could only be given through a dialysis line during dialysis. I asked her who told her this. her response: she handed me her "manual of nursing" bood which stated this fact. I told her to get a new book, and then I had to call the nurse supervisor to get her to give the med.

 

[med2UCC]

My personal favorites are when you ask for a bolus and they ask at what rate you want that to run, or when you say to run the fluids in wide open and they ask for a rate. "There has to be a rate, Dr." What part of bolus or wide open suggests a rate slower than "as fast as it is possible to get it to run"? This always confuses me. My nurses are pretty awesome as a group, but I do occasionally run into a dud. Cheers,
m

 

[AbbyNormal]

My personal favorites are when you ask for a bolus and they ask at what rate you want that to run, or when you say to run the fluids in wide open and they ask for a rate. "There has to be a rate, Dr." What part of bolus or wide open suggests a rate slower than "as fast as it is possible to get it to run"? This always confuses me. My nurses are pretty awesome as a group, but I do occasionally run into a dud. Cheers,
m

You aren't serious?!?

Wow.

 

[Paseo Del Norte]

Unfortunately, this emphasises a problem I often see among nurses. Nurses are not being taught to critically think or make simple decisions and interpretations. Some of this is the result of a faulty educational mechanism and some the result of hospitals not allowing nurses to have even a basic level of autonomy. Of course this is difficult because of my first point. Now, we have a chicken and an egg discussion. However, I firmly believe focusing on educating a strong entry level provider instead of all this DNP's gone wild nonsense would do a world of good for my profession, but who wants to listen to an undereducated ADN?

I tend to interpret orders in specific ways. For example, a liter bolus means a litre via the pressure bag IMHO. An hour on the pump at 999 ml/hr or 15 minutes on the pressure infuser? Unfortunately, explaining this to fellow nurses can be quite difficult.

I cannot comment on breaks and such as my entire career has either been ER, flight, or remote medicine. Remote medicine being pretty much a several month long break with the exception of a few IED explosions and an occasional firefight. Regardless, you not getting a break is not my problem. However, I can understand the frustration with a nurse who does not bother to be around for rounds. Not really an ER problem, but I think I understand.

I cannot comment much on the "not a doctor" remarks. I am not a doctor and this does nothing to change my attitude about physicians. Nor do I have any specific sentiments as nursing is a job. The most efficient and effective way to complete my job while keeping my self employed and in good standing is the best way IMHO. This typically means getting stuff done as soon as possible.

I also agree that we are not pals and or buddies. Nothing personal and it's just a job at the end of the day. As long as your orders are not harmful or crazy, I am all about getting the job done as efficiently and effectively as possible. This also goes for not waking the doc up for BS at 0300. For example, I worked with a doc who loved to order enemas. Apparently, this offended the ER nurse Gods sense of fairness. Instead of waiting all day long, I would go in, do the deed, and kick the patient to the curb or transfer them. Pretty easy concept IMHO.

Sounds like a rough shift mate; go home get frisky with the wife or SO and B4 it (Beer, Burrito, Benadryl, & Bed). Better luck on the next go.

 

[group_theory]

to the nurse who thinks the phrase "you're a resident, you are not allowed to yawn in the morning" is funny and cute - it's not. Especially towards the postcall resident who spent the entire night dealing with unstable patients and new admission.

 

[bluealiendoctor]

You have to remember that nurses don't believe that we work 30hr shifts. They don't realize that when they see us in the a.m. we have been there since they last saw us....in the a.m. How a nurse can complain at 6pm how tired he/she is after that big 12hr shift only confirms this. When a nurse comes to me at 7am and says...'I feel like I never left this place' when we spoke at length how I'll be there from 6am to 12:00pm the next day confirms the denial. And when that same nurse asks, 'when are you leaving?' and I answer, "noon'...she follows with......must be nice.

 

[AbbyNormal]

Thirty hour shifts? Criminy that is crazy!!

I was one of those nutso nurses who worked sixty to eighty hours most weeks. Record was 124 hours which is just over seventeen hours/day. The hospital did not allow us to work more than twenty-four hours. I did a twenty-four hour shift then slept on a couch for four hours and then worked some more. I didn't have to work so much but critical care is exciting. And every fourth week I would work twenty-four hours on the weekend and I had the rest of the week off. Awesome schedule. I haven't done any of those marathon weeks for awhile though because I am starting to get old. Residents should have breaks mixed in with the marathon work sessions too because it made an enormous difference in my attitude.

 

[med2UCC]

You aren't serious?!?

Wow.

Dead serious, sadly.

 

[glade]

Unfortunately, this emphasises a problem I often see among nurses. Nurses are not being taught to critically think or make simple decisions and interpretations. Some of this is the result of a faulty educational mechanism and some the result of hospitals not allowing nurses to have even a basic level of autonomy.

My understanding from talking to nurses is that the newer generation of nurses, who get two-year degrees out of high school, are much worse than the older ones who used to get formal degrees. Of course, I don't think that's exactly true since I know plenty of older nurses who are sketchy at best.

I think it's a factor of the unionization of nurses. Basically, you're protected and allowed to be incompetent. As I said, at my place you can divide the vast majority of nurses into two groups. The first pages you for anything to express their concern over an issue and then they go on break while you deal with their patient. For example, they'll call and say "the urine is low" and then you come up and review the records, chase down the nursing student who is emptying the Foleys, go into the room and look at the Foley bag output, and so on. After all of that, you realize the urine output is fine, so you go to tell the nurse and she just shrugs and says, "oh, sorry, that's what I got in report." The second group of nurses doesn't page you for anything, but that's worse because you basically have to discover any problems on your own. And even when you do put in orders for things you discover, they'll just not do it or they'll page five hours later to tell you how they "can't" do it or "don't know how" to do it or "can you check this with Pharmacy?" Basically, it's a stalling tactic to not do any work during the shift.

That's literally perhaps 90% of nurses at my place, but nothing happens to any of them. You just have to work with them because there's a nursing shortage and none of them will get fired unless they're openly disrespectful to an attending or actively do something criminal. And I appreciate that nursing is a largely thankless job, but that is not an excuse to behave like that.

 

[gutonc]

You aren't serious?!?

Wow.

Outside of the ICU, bolus appears to mean 250ml/h at the max. Since I know they won't run it in off-pump and don't have a pressure bag outside of the code cart, I just say "1L bolus over an hour" which is better than nothing.

 

[smq123]

to the nurse who thinks the phrase "you're a resident, you are not allowed to yawn in the morning" is funny and cute - it's not. Especially towards the postcall resident who spent the entire night dealing with unstable patients and new admission.

That's complete BS. Until you have to do what I do, you don't get to "tease" me for how tired I look.

 

[Paseo Del Norte]

Outside of the ICU, bolus appears to mean 250ml/h at the max. Since I know they won't run it in off-pump and don't have a pressure bag outside of the code cart, I just say "1L bolus over an hour" which is better than nothing.

Tell them critical thinking is golden, a manual blood pressure cuff works quite well.

 

[deleted50541]

My personal favorites are when you ask for a bolus and they ask at what rate you want that to run, or when you say to run the fluids in wide open and they ask for a rate. "There has to be a rate, Dr." What part of bolus or wide open suggests a rate slower than "as fast as it is possible to get it to run"? This always confuses me. My nurses are pretty awesome as a group, but I do occasionally run into a dud. Cheers,
m

That happened to me last week in the MICU of all places. I was at a loss for words when the nurse asked me for a bolus rate as I stared at a pressure of 60/30 with a pulse in the 120s.

"What rate do you want for the bolus?"

"Um, how about wide open, RIGHT NOW PLEASE."

"Well, the pump needs a rate and 999 isn't working"

"... what if you run it off the pump?"

"Oh right, I could do that."

 

[gutonc]

Tell them critical thinking is golden, a manual blood pressure cuff works quite well.

It would be much easier to crack open the code cart or run to the ICU than to find a manual BP cuff.

If it's really hitting the fan, I can usually get someone to just squeeze the bag for me.

 

[Paseo Del Norte]

My understanding from talking to nurses is that the newer generation of nurses, who get two-year degrees out of high school, are much worse than the older ones who used to get formal degrees. Of course, I don't think that's exactly true since I know plenty of older nurses who are sketchy at best.

I think it's a factor of the unionization of nurses. Basically, you're protected and allowed to be incompetent. As I said, at my place you can divide the vast majority of nurses into two groups. The first pages you for anything to express their concern over an issue and then they go on break while you deal with their patient. For example, they'll call and say "the urine is low" and then you come up and review the records, chase down the nursing student who is emptying the Foleys, go into the room and look at the Foley bag output, and so on. After all of that, you realize the urine output is fine, so you go to tell the nurse and she just shrugs and says, "oh, sorry, that's what I got in report." The second group of nurses doesn't page you for anything, but that's worse because you basically have to discover any problems on your own. And even when you do put in orders for things you discover, they'll just not do it or they'll page five hours later to tell you how they "can't" do it or "don't know how" to do it or "can you check this with Pharmacy?" Basically, it's a stalling tactic to not do any work during the shift.

That's literally perhaps 90% of nurses at my place, but nothing happens to any of them. You just have to work with them because there's a nursing shortage and none of them will get fired unless they're openly disrespectful to an attending or actively do something criminal. And I appreciate that nursing is a largely thankless job, but that is not an excuse to behave like that.

I don't know mate? I went to a two year programme with a year or so of pre-requisites and it was not a bad experience. Our instructors were pretty good and the physician interactions were for the most part good. We even had a physician do some of our psych lectures (abnormal psych such as paraphilias) and they had use spend time with a paramedic team for our trauma lectures.

We even had the good old PA/NP discussion and my views of PA's were met with support. One of our clinical instructors was an RN who turned PA-C and he was well regarded by our instructors. I never felt any underlying hostility toward physicians and did not graduate with a hard on out for doc's. All in all it was a fairly pragmatic programme. However, I must admit current nursing programmes often seem more like shake n bake nurse mills.

I work in a non union area that suffers from the same problems, so I cannot see unions as the definitive cause. Honsetly, I think we need a pragmatic and clinical approach to nursing education. Clearly, a good didactic experience in basic sciences should be part of this education. I would like to see perhaps a programme that mirrors some of the aspects of PA school where you have an intense year of didactic and lab followed by a year of intense clinical rotaions.

I think a change in education and overall culture is warranted. Unfortunately, I am pretty much powerless to make changes. However, I have been able to assist in pushing for some positive changes at the local college based paramedic programme. Take what I can get.

 

[fab4fan]

My understanding from talking to nurses is that the newer generation of nurses, who get two-year degrees out of high school, are much worse than the older ones who used to get formal degrees. Of course, I don't think that's exactly true since I know plenty of older nurses who are sketchy at best.

I think it's a factor of the unionization of nurses. Basically, you're protected and allowed to be incompetent. As I said, at my place you can divide the vast majority of nurses into two groups. The first pages you for anything to express their concern over an issue and then they go on break while you deal with their patient. For example, they'll call and say "the urine is low" and then you come up and review the records, chase down the nursing student who is emptying the Foleys, go into the room and look at the Foley bag output, and so on. After all of that, you realize the urine output is fine, so you go to tell the nurse and she just shrugs and says, "oh, sorry, that's what I got in report." The second group of nurses doesn't page you for anything, but that's worse because you basically have to discover any problems on your own. And even when you do put in orders for things you discover, they'll just not do it or they'll page five hours later to tell you how they "can't" do it or "don't know how" to do it or "can you check this with Pharmacy?" Basically, it's a stalling tactic to not do any work during the shift.

That's literally perhaps 90% of nurses at my place, but nothing happens to any of them. You just have to work with them because there's a nursing shortage and none of them will get fired unless they're openly disrespectful to an attending or actively do something criminal. And I appreciate that nursing is a largely thankless job, but that is not an excuse to behave like that.

It must be the newer generation, because I'm reading through most of this and it just doesn't compute. I have zero envy of docs. I can think of about six other things right off the top of my head I would rather do than be a doctor, no offense intended. I'm glad someone is willing to do your job.

It saddens me when I read about some truly bad behavior from my colleagues. It doesn't reflect well on the rest of us, and there are those of us who do try to be reasonable. I hope some of the better nurses can make up for the bad ones out there.

I also appreciate that this is a venting thread. No criticism intended in what I said.

 

[AbbyNormal]

It saddens me when I read about some truly bad behavior from my colleagues. It doesn't reflect well on the rest of us, and there are those of us who do try to be reasonable. I hope some of the better nurses can make up for the bad ones out there.

I agree. I am glad that the OP titled the thread "some" nurses acknowledging we are not all intellectually challenged.

I think my experience as a paramedic before nursing school was a big help. My nursing school did not teach us how to insert IVs, how to interpret EKGs let alone how to manage cardiac arrest or god forbid how to intubate.

I got some pretty good classes in the hospital though. A six week critical care overview followed by classes focusing on specifics like 12 lead EKG interpretation, IABP management, et cetera.

But to think that a nurse would not know how to run an IV wide open frightens me. That is not a complex concept.

 

[fab4fan]

The thing is, no one ever taught me about bolus rates when I was in school. It was only when I worked in the ED that I learned about that. I can see how these days, with the push to get people through in accelerated programs, things get missed. There's a lot of stuff I never learned in school that I just learned OTJ. What I did learn in school was to think things through before just asking a question. So far, it's served me pretty well.

Re: the venofer issue: That's hilarious. I've given more venofer than I can begin to recall, and I don't work in dialysis. Compared to the other meds I run, it's relatively benign. Sounds like someone didn't feel like working.

 

[med2UCC]

99% of the nurses I work with are fantastic, and on any given day can teach me lots.
The other 1% make getting out of bed a chore and make you want to go work somewhere nice and quiet, like a primary school.
Those are the nurses we are venting about.
The rest of you we buy chocolates, and bake cookies for (I bake instead of studying). Cheers,
M

 

[FutureInternist]

Gotta love the 3 am barrage of calls as soon as the labs come back

Doc this pt's Ca is 5.
What's his albumin?
Don't know.....

Doc this pt's BUN/Cr is 79/2.9.
Isn't he the ESRD on HD?
Yes...
Click

I feel for them a little since depending on the shift & charge nurse's mood, it is either totally up to the individual nurse or it's "hospital policy" to inform us of ALL critical labs....the smart ones are the ones that apologise when they call....I already calculated the corrected Ca but I have to document that I called you.

 

[diel]

We have this new hospital recently built, attached to the old one. They have mostly young nurses there, and those are the ones that tickle my rage sometimes.
Page:
I call, there is answer: Dr. Bla is speaking.
Me: Dr. this here, covering this, you paged?
- yes, it looks like you ordered lasix for this pt. I am concerned. Pt's BUN is 21 and Cr has been climbing, I am afraid the pt is going into ARF. Are we sure about Lasix?
Me: (thinking that there was a consultant on the other line, giving me a courtesy call). Dropping everything, sitting down, looking at lab trebds: hmm, Cr is 1.01 today, 0.99 yesterday, 0.97 the day before. Hmm, BUN is bit high - 21 today, 19 yesterday.
Me: I'm sorry ma'am, but this just doesn't look bad to me.
Phone: Are you sure? I really think you are making a mistake. Pt's kidney's are failing. What about the BUN rise?
Me: kind of annoyed now. Ma'am, we recently started TPN. Straight protein in blood can rise BUN a bit. It's ok, and I am sure you know about this process.
Phone: What? BUN/TPN? ... pause...
Me: I am sorry, but are you the renal doc?
Phone: no, this is Stephanie.. (silence)..
Me: Huh? Stephanie? Who are you?
Phone: I am the RN.
Me: ???? so can you explain your theory again please? Why did you present yourself as Dr. when picked up the phone?

Hung up.


Me:..... damn... wtf?

 

[diel]

Pager: dinga danga, dinga danga... (3AM)
Me: Yep, Dr. Diel with trauma
Phone: Aha, calling pt X. I need ativan and ambien. Pt takes those at home.
Me: Pt X? Hmm... I don't cover for him.
Phone: ??? You're not covering ? Why not?
Me: looks like this is a private general surgeon's pt. Not mine. Not trauma.
Phone: Huh? And who do I call? '
Me: the surgeon. Or the NP, if he has one.
Phone: Look, he doesn't have an NP. And I am sure as hell not gonna call the attng at 3 AM for this small thing. Come'on! Give me an order!!
Me: Are you sh%&ing me? I don't know this pt, and I wont treat a private surgeon's pt. And you think it's ok to call me for BS, but not him?
Phone: you know what... you're a B$%&tch! click.


To some RNs like this out there: you don't respect me cause I'm just a resident, "2nd turd class of a doctor", please go suck on a nut.

 

[Rabbit Hole]

I think a change in education and overall culture is warranted. Unfortunately, I am pretty much powerless to make changes. However, I have been able to assist in pushing for some positive changes at the local college based paramedic programme. Take what I can get.

You don't need power to make changes. I think your emphasis on education is a great avenue for making a positive impact.

The thing is, no one ever taught me about bolus rates when I was in school. It was only when I worked in the ED that I learned about that. I can see how these days, with the push to get people through in accelerated programs, things get missed. There's a lot of stuff I never learned in school that I just learned OTJ. What I did learn in school was to think things through before just asking a question. So far, it's served me pretty well.

I like that approach.

You guys are great. I haven't read many of your posts (yet) but I think your cool headed response to this thread holds a lot of weight. Also, it's attitudes like that which make people feel more open to constructive criticism, suggestions, and healthy debates not laced with hostility.

(On a side note, I don't know if it's just me, but I get the feeling that some of the posts I read from "different people" are actually the same person. Maybe I'm just being paranoid. I've noticed this elsewhere in 'hot-topic' threads.)

 

[ResidentMD]

On a side note, I don't know if it's just me, but I get the feeling that some of the posts I read from "different people" are actually the same person. Maybe I'm just being paranoid. I've noticed this elsewhere in 'hot-topic' threads.)

I cant help but agree with you.

Some of the sub-forums on SDN have deteriorated after the match. And many of the threads, including this one, have deteriorated into mud-slinging matches between the two parties. Its glad to see people finding solutions, rather than just criticizing each other. Nurses are an integral part of the hospital, and God knows what we would do without them. It just takes an open mind on both sides to ensure that you keep getting better, and not repeating the same mistakes. Any sense of entitlement (while neglecting the fact that you need to work hard and keep improving) brings you down, whichever side you are on, regardless of what you are fighting for.

 

[maceo]

Pager: dinga danga, dinga danga... (3AM)
Me: Yep, Dr. Diel with trauma
Phone: Aha, calling pt X. I need ativan and ambien. Pt takes those at home.
Me: Pt X? Hmm... I don't cover for him.
Phone: ??? You're not covering ? Why not?
Me: looks like this is a private general surgeon's pt. Not mine. Not trauma.
Phone: Huh? And who do I call? '
Me: the surgeon. Or the NP, if he has one.
Phone: Look, he doesn't have an NP. And I am sure as hell not gonna call the attng at 3 AM for this small thing. Come'on! Give me an order!!
Me: Are you sh%&ing me? I don't know this pt, and I wont treat a private surgeon's pt. And you think it's ok to call me for BS, but not him?
Phone: you know what... you're a B$%&tch! click.


To some RNs like this out there: you don't respect me cause I'm just a resident, "2nd turd class of a doctor", please go suck on a nut.

did you actually call her a b@@ch?
impressive!!!!

 

[Buzz Me]

did you actually call her a b@@ch?
impressive!!!!

Actually it looks like the nurse called diel a bitch.

 

[diel]

Actually it looks like the nurse called diel a bitch.

Yeah she did.... SNAP!

 

[diel]

I like that approach.

You guys are great. I haven't read many of your posts (yet) but I think your cool headed response to this thread holds a lot of weight. Also, it's attitudes like that which make people feel more open to constructive criticism, suggestions, and healthy debates not laced with hostility.

I completely agree. Majority of my nurses are awesome, and I love them.
And they try to educate their colleagues about how screwed residents are and when to page and when not too. (Among other things).

But again, those SOME nurses will never disapear and this little venting place is dedicated to them.

 

[142348]

As a radiation oncologist, i love the nurses in my department. They are some of the most helpful people I have met and I couldn't do my job without them. The floor nurses in our institution can be another story. I preface these issues with the fact that I take home call.

Things that drive me insane:

1. Saturday evening phone call demanding I come in to speak with a patient's family. This happens all the time and despite my attempts to explain I am on call to handle new consults and emergencies this nurse feels it's my job to come in to explain to Patient X's family all about their radiation knowing that I am not inhouse and that this is not a urgent issue. Why..."because they keep asking me"

2. Calling me to ask if a patient is radioactive...seriously? I checked to see if the nurses got radiation safety training, which they did. A 2 AM phone call for this is out of line.

3. Calling me regarding a consult but then being unwilling to go over test results with me over the phone. If I'm on call out of the hospital and you call me about a possible spine met, I need to know if there is a cord compression. Is it that hard to take 5 minutes and read me the MRI Spine report?

Just venting a little. Love my rad onc nurses.