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Paseo Del Norte

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You don't need power to make changes. I think your emphasis on education is a great avenue for making a positive impact.
I wish I could agree. Unfortunately, as a nobody ADN, all I can do is spout off on forums like this, send email to people, and send letters to people. Clearly, my efforts have been met with extensive success. :D

In addition, another problem is the strict homogeneous nature of many nursing programmes. I think may well qualified instructors are often overlooked in favour of instructors with a strict nursing background. For example, one of the senior clinical educators I flew with put a resume in with a local ADN nursing programme. This person has been a nurse for over two decades, a paramedic for about as long, and has a doctoral in adult education with emphasis on educational technology. Not to mention years as a clinical educator for a flight company known to have highly involved physicians and progressive clinical practice guidelines, at that time. Unfortunately, she was completely ruled out as a candidate because she did not have a BS in nursing. So long as nursing continues to make crazy rules like this (IMHO), students, new nurses, other providers, and ultimately patients will continue to pay the price.

But again, those SOME nurses will never disapear and this little venting place is dedicated to them.
Totally understand and I have no wish to hijack your vent. Sometimes venting is healthy and allows one to decompress. My only concern was having people go overboard on the bash a nurse concept. I never thought that was your intent, however.

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.
A radiation safety class? I remember hearing something in chemistry about weak nuclear forces and nuclear decay. I vaguely remember something about conservation of energy and how a radioactive person would sort of violate that, being that those particles sort of pop their load so to speak upon transferring their energy to dividing cancer cells (hopefully). Clearly, a person massively contaminated with neutrons or somebody who decided to stick around an exploding nuclear reactor in order to pick up some radioactive shrapnel would be an exception. Not really a hard concept to understand. Do you think having an inservice with the nurses would be helpful?

Sorry if I keep posting, I do like to hear how things are experienced from the other side. I think it helps me interact and communicate better.
 

fab4fan

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Actually it looks like the nurse called diel a bitch. :(
OMG. I really hope that you wrote that nurse up for that. There is never, ever an excuse for that behavior...I don't care how mad you are. And this person was way out of bounds long before the name calling started. WTH are they teaching these kids these days? :rolleyes:
 

Laryngophed

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WTH are they teaching these kids these days? :rolleyes:
[Foghorn Leghorn] I say, I say, I RESEMBLE that remark! [/Foghorn Leghorn]

:smuggrin:
 

Buzz Me

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OMG. I really hope that you wrote that nurse up for that. There is never, ever an excuse for that behavior...I don't care how mad you are. And this person was way out of bounds long before the name calling started. WTH are they teaching these kids these days? :rolleyes:
Unfortunately I've seen the name-calling go both ways. Really, really unprofessional. :thumbdown:
 
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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
Believe me, I am a nurse and I run into the same resistance with nurses on the floor when I'm trying to get them at accept a patient. They make up policies and rules that don't exist. I have heard it all from "the nurse can't take report she is pregnant, to "the nurse can't take report she is getting ice cream". Lately I have been asking them to show me the policy that they claim exist (all of our policies are online) and that usually stops them once they can't find it.

Anyway, I see your frustration here, but technically, a bolus must have at the very least a volume of fluid to be given. In many facilities for a pediatric patient, boluses cannot be ordered wide open you have to specify a rate and volume, even if its 1 liter NS @ 999 mL/hr. The pumps will only go to 999, so if you order 1000 they will page you asking you to change the order. Unless I am that nurse of course :cool:
 

med2UCC

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Anyway, I see your frustration here, but technically, a bolus must have at the very least a volume of fluid to be given. In many facilities for a pediatric patient, boluses cannot be ordered wide open you have to specify a rate and volume, even if its 1 liter NS @ 999 mL/hr. The pumps will only go to 999, so if you order 1000 they will page you asking you to change the order. Unless I am that nurse of course :cool:
When I order a bolus, I order a volume of fluid to be given. When I order a bag of saline to be run in wide open, I specify 1 litre, 2 litres etc - also a volume. I just didn't think it necessary to replicate my order sets in entirety on a post on SDN :rolleyes:. And for paeds patients I always specify volume, since they are more prone to fluid overload than adults (in general - I'm also cautious with the elderly). Cheers,
M
 

glade

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They make up policies and rules that don't exist.
That's the problem with the hospital. There are a lot of people there who work hard at getting other people to do their work. I'm not saying that a "bolus" doesn't need a rate specified. But one nurse will be helpful and say "the fastest I can run it is at 999 mL/hr, doc, is that OK?" whereas another nurse will just stonewall and go "what's the rate you want? No, you tell me. OK, you don't know? Then I'll be at break." Where I work, we have a handful, literally just five to ten, nurses who are fantastic. If I ask them to do something, they'll either do it or if they can't they'll actually try to solve the problem. Most nurses will run into a problem and that's it for them. They're masters of the "college try." It's amazing how low some nurses set the bar, where they'll say "the patient told me he didn't want his blood drawn, so we didn't. And then we didn't tell you because we didn't want to bother you. But now that we're going off shift, we felt you needed to know immediately." And then they act bewildered when you snap at them.

When a nurse tells me it's "hospital policy," I make her produce the actual paper. She never can because it never exists. She'll keep paging me to do something and I'll just keep saying "you have the policy yet?"
 

illegallysmooth

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I work with some terrific nurses. Intelligent, motivated, helpful, fabulous nurses. I also work with some stubborn, moronic, know-it-all, lazy nurses who act like every patient is a personal insult that has interrupted their day which is full of vastly more importantly tasks like flipping through the Avon magazine. They will come up with every excuse for not processing an admitted patient, not taking the patient to begin with, blaming another department, looking for someone else in another department to gab about an issue instead of rectifying it, etc. There are simply too many people who enter the nursing field because they can be an RN in two years and make good money. It's as simple as that.
 
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I work with some terrific nurses. Intelligent, motivated, helpful, fabulous nurses. I also work with some stubborn, moronic, know-it-all, lazy nurses who act like every patient is a personal insult that has interrupted their day which is full of vastly more importantly tasks like flipping through the Avon magazine. They will come up with every excuse for not processing an admitted patient, not taking the patient to begin with, blaming another department, looking for someone else in another department to gab about an issue instead of rectifying it, etc. There are simply too many people who enter the nursing field because they can be an RN in two years and make good money. It's as simple as that.
Those same nurses you describe sit there while I'm running around like a maniac. I am on board with you to get them to retire/quit sooner rather than later. There ARE plenty of people that go into nursing for the $ and don't give a rats ***** about the patient.
 
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When I order a bolus, I order a volume of fluid to be given. When I order a bag of saline to be run in wide open, I specify 1 litre, 2 litres etc - also a volume. I just didn't think it necessary to replicate my order sets in entirety on a post on SDN :rolleyes:. And for paeds patients I always specify volume, since they are more prone to fluid overload than adults (in general - I'm also cautious with the elderly). Cheers,
M
If you in did specify a volume than I see your point. I think sometimes the doc forget that they have to spell it out so to speak in the order to cover themselves legally, even if it seems like common sense.
If you told some nurse to give a bolus to bring up b/p and this nurse was like one described in your situation, you will take partial blame if the nurse decides that your bolus order meant give 6 liters of fluid and the patient goes into overload. Any nurse with a brain will know you probably meant 1 liter, but those nurses that don't think at all will have no idea what you meant.
I'm aware of fluid overload in children, that is why I never hang a bag of fluid large enough that if the pump malfunctioned and the whole thing ran it, it would not totally overload the patient. One night an extremely overworked and tired resident ordered the volume in mL x lbs instead of kilos. In a 8 month old with cardiac issues. If I catch mistakes like this, I tell the resident to fix it before the attending sees it. No big deal. I don't go marching to the attending or charge nurse. Nobody is above making a mistake or a near mistake. Today I could be pointing out a near mistake to you, and tomorrow you could be pointing one out to me.
 
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If I catch mistakes like this, I tell the resident to fix it before the attending sees it. No big deal. I don't go marching to the attending or charge nurse. Nobody is above making a mistake or a near mistake. Today I could be pointing out a near mistake to you, and tomorrow you could be pointing one out to me.
A nurse like you on our floors is a blessing.
Thank you for your help and understanding.
I wish there were more great RNs like you, but for some reason, you guys are facing extinction. :(
 

Ashers

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A nurse like you on our floors is a blessing.
Thank you for your help and understanding.
I wish there were more great RNs like you, but for some reason, you guys are facing extinction. :(
I totally agree, and when I work with a good nurse, I try to thank them.

Right now, I'm on a floor with excellent RNs. They're great to work with. When I got up at 0500 today, they were like "why are you up, we haven't paged you, and all the labs aren't back yet."

This is after last month where a nurse called an attending on a consulting service without letting me know she was doing that. She ended up calling an attending who wasn't even on call when I had been speaking to the on call attending throughout the day for a plan for the pt. My senior resident was around when we found out and told her it was inappropriate to call an attending without even paging us. It was a huge mess. The RN had said it was because I was addressing her concerns, so she went above me. Fortunately, my sr res was there the whole time and knew the RN hadn't expressed her concerns to me. So she stood up for me. I felt so awful though that there was this mess that I had to clean up.
 
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This is after last month where a nurse called an attending on a consulting service without letting me know she was doing that. She ended up calling an attending who wasn't even on call when I had been speaking to the on call attending throughout the day for a plan for the pt. My senior resident was around when we found out and told her it was inappropriate to call an attending without even paging us. It was a huge mess.
I bet that nurse is the same nurse that calls the supervisor on me when I keep calling to give report and she keeps not coming to the phone. There are very few reasons to go above and call the attending. In the 7 years I have been a nurse I have only done that 3 times, and if I didn't the patients would have died. I'm surprised she didn't get in trouble for paging an attending who is not on call and had nothing to do with the patient.

Having worked in both a non-teaching and a large teaching hospital, I would never work in a non-teaching hospital again. I really do enjoy working with residents and med students. An MD learns not only from his/her fellow MD's but by the experienced nurses and other staff. You may have more schooling than me, but there are just some things that experience will teach you that school can't. Not that you won't learn it, but you won't really learn it in school. It takes at least a year for a nurse or an MD (without any prior healthcare experience) to be able to look at a patient from across the room, not know anything about them, and be like that patient is really sick. No schooling will teach you that, just experience.
Those that know me, know that if I call and say this patient is sick you need to get here now, they come ASAP. I don't cry wolf, and I know when something is wrong. All I ask is that if you don't know me and I tell you I think something is wrong, take it seriously until you prove otherwise. If you come and evaluate and find that the reason the condition changed is expected, baseline or not as bad as I think it is, we are all good. Just tell me now what we are going to do about it and we will get it done.

I don't ever get mad at a resident or med student for not knowing something. That is what residency is for, to learn. All I ask is that they don't go ahead and do things that they don't know how to do. Ask me, and if its something I don't know, I'll find out for you. If your not sure what the dose is, I'll show you how to look it up. If I know the attending is going to yell at you because he/she is a jerk, I'll ask in a way that doesn't make it look like you are asking. Like I said before, if I see a mistaken order, I'll call the resident and be like "are you sure you want magnesium citrate IVPB or rhogam on MR. jones?" we laugh about it, they change the order and all is good. Is the lab/pharmacy/blood bank giving you the run around? I'll call them and get results. I know the games they play and I have been here long enough to cut through the BS. My personal favorite is calling the nurses on the floor with you standing next to me listening on speaker phone to the nurse telling me that the doctor (you) said that we cannot send the patient until all labs are done, meds given, foley in, ass wiped, pt fed, whatever. It all adds up to you treat me with respect and help me out, I'll do the same for you. Its that simple.

When I was a new nurse in a ridiculously busy ED, the residents and attendings took the time to explain to me why they were doing what they were doing, and why the feel the patient had XYZ. I am no longer in ED, and now that I am working in a different specialty I take what I know from there and teach the residents I work with now, just as they teach me things that I have never dealt with in ED. I have learned a lot on my own since then, but I am very fortunate that I get to pick the brains of these highly educated people, and that they enjoy teaching as much as I enjoy learning. Without a doubt, the mentoring and teaching from the residents and attendings have taught me more than I could ever have asked for, and I try every day to give something back to them.

I love to teach. I will pimp the med students from time to time, but its never to make them feel stupid, its to teach them something. They know what I mean by it, and the med students always thank me. I ask them if they want to do simple procedures such as IV lines, blood draws, NG tubes, foleys ect. I'll show the new residents or med students how to use the defibrillator, the rapid infuser, the monitor, the IV pump, etc. Most of the time they admit they are happy I asked them to do it because the nurses on the floor won't let them (for the med students). No wonder they are scared, these old time nurses can be so rude to them. Now they are going to think we are all like them, they will carry this resentment into residency and beyond. These MD's and med students that I once mentored are now residents, fellows and attendings at my hospital. I respect them, they respect me and they know and trust my clinical judgement just as I do theirs.
 

Bubchik

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

Write ups.. :smuggrin: 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... :p
This is an awesome advice! Just did it with the most annoying nurse (she pages for K of 3.9 at 2 am, patient beeing too sleepy but responsive and appropriate at 3am; giving me 5 things to do for a patient NOT on my service; paging me saying that my pager says that I am out of the country: I wish as a night float to be out of the country; last one that just came BP of 88/50 when previous one is 90/50 4 hours prior and asking for a bolus). She was SPEECHLESS as I slowly walked away from the nursing station. And yes, doing a write-up takes 20 min in our hospital, however, nurses do it all the time and get paid for it (i mean their hourly sallary)!
 
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This is an awesome advice! Just did it with the most annoying nurse (she pages for K of 3.9 at 2 am, patient beeing too sleepy but responsive and appropriate at 3am; giving me 5 things to do for a patient NOT on my service; paging me saying that my pager says that I am out of the country: I wish as a night float to be out of the country; last one that just came BP of 88/50 when previous one is 90/50 4 hours prior and asking for a bolus). She was SPEECHLESS as I slowly walked away from the nursing station. And yes, doing a write-up takes 20 min in our hospital, however, nurses do it all the time and get paid for it (i mean their hourly sallary)!
by all means write up nurses that harm patients but if you are giving the nurses the impression you are going to write them up just for calling you, it will backfire on you. If K+ is 3.9 on a ccu/cticu/dka pt on insulin gtt that call would be appropriate. Nobody is above doing something wrong, you will make a mistake too. Why not help each other out and use it as an opportunity to teach when you can instead of looking to get people in trouble?
 

fab4fan

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Those same nurses you describe sit there while I'm running around like a maniac. I am on board with you to get them to retire/quit sooner rather than later. There ARE plenty of people that go into nursing for the $ and don't give a rats ***** about the patient.
Nice ageist comment there. There are plenty of lazy young nurses out there, too. It's not just older nurses who have attitude issues. Something you displayed in another post disparaging "old-time" nurses.
 
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Nice ageist comment there. There are plenty of lazy young nurses out there, too. It's not just older nurses who have attitude issues. Something you displayed in another post disparaging "old-time" nurses.
Not disagreeing with the fact that any nurse can be lazy, but they don't say nurses eat their young for nothing. There are dozens of threads on allnurses about this and my new grad friends are ready to quit nursing because of some of these nurses.
 

fab4fan

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Not disagreeing with the fact that any nurse can be lazy, but they don't say nurses eat their young for nothing. There are dozens of threads on allnurses about this and my new grad friends are ready to quit nursing because of some of these nurses.
And they don't say on AN that the young nurses are hostile to the older ones, either? eyebrow.gif

You never learned anything from the more experienced nurses, I get it. You came out of school knowing everything. No one needed to teach you anything.
 
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And they don't say on AN that the young nurses are hostile to the older ones, either? View attachment 14766

You never learned anything from the more experienced nurses, I get it. You came out of school knowing everything. No one needed to teach you anything.
I learned quite a bit from the ones that were kind and willing to teach. Unfortunately there are many who are so stuck in their ways that they make the job that much harder. The younger ones being hostile should not happen either.
 

mooshika

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This is an awesome advice! Just did it with the most annoying nurse (she pages for K of 3.9 at 2 am, patient beeing too sleepy but responsive and appropriate at 3am; giving me 5 things to do for a patient NOT on my service; paging me saying that my pager says that I am out of the country: I wish as a night float to be out of the country; last one that just came BP of 88/50 when previous one is 90/50 4 hours prior and asking for a bolus). She was SPEECHLESS as I slowly walked away from the nursing station. And yes, doing a write-up takes 20 min in our hospital, however, nurses do it all the time and get paid for it (i mean their hourly sallary)!
Good for you making that stupid nurse feel terrible and humiliating her. I hope you did it in front of a lot of people so she REALLY falt like a piece of crap.

Yeah, its probably better to wait until the patient is in a life-threatening arrhythmia before waking your precious ass up.

And God forbid, if a patient is NOT on your service, DO NOT MAKE ANY ATTEMPT TO OFFER ASSISTANCE!!!!

If you had pulled that **** on me, and I was a nurse, not only would I do a write up, I would wake up your supervisor with a phone call, and make sure you are never near another patient on my unit again.

You will not feel so put upon if you make it your priority to BE NICE TO PEOPLE. BE KIND. Be helpful. Find a way to be part of the solution, and no, not everybody is going to be as smart as you. But they can't help it. WHY DO YOU FEEL IT IS YOUR JOB TO MAKE THEM FEEL BAD ABOUT THEMSELVES? Just think about that. Maybe you can learn something from them that you didn't know that will make your job easier. Maybe you can ask them if there is anything that you can do that will help make their job easier?
 

dynx

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Good for you making that stupid nurse feel terrible and humiliating her. I hope you did it in front of a lot of people so she REALLY falt like a piece of crap.

Yeah, its probably better to wait until the patient is in a life-threatening arrhythmia before waking your precious ass up.

And God forbid, if a patient is NOT on your service, DO NOT MAKE ANY ATTEMPT TO OFFER ASSISTANCE!!!!

If you had pulled that **** on me, and I was a nurse, not only would I do a write up, I would wake up your supervisor with a phone call, and make sure you are never near another patient on my unit again.

You will not feel so put upon if you make it your priority to BE NICE TO PEOPLE. BE KIND. Be helpful. Find a way to be part of the solution, and no, not everybody is going to be as smart as you. But they can't help it. WHY DO YOU FEEL IT IS YOUR JOB TO MAKE THEM FEEL BAD ABOUT THEMSELVES? Just think about that. Maybe you can learn something from them that you didn't know that will make your job easier. Maybe you can ask them if there is anything that you can do that will help make their job easier?
:laugh: You tell em stud! When you leave your world of fluffy bunnies and gumdrop smiles if/when you enter residency, bump this thread with a self-reply to your post where you chew your own stupid-ass out...it will be SO much better/educational for the other pre-med/med students here if they see how people like you turn out when reality knocks these silly little notions clean out of thier heads.
 

dilated

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If you had pulled that **** on me, and I was a nurse, not only would I do a write up, I would wake up your supervisor with a phone call, and make sure you are never near another patient on my unit again.
You should definitely call the attending and breathlessly tell him a resident responded poorly to a 2am page about a K of 3.9. Great success awaits you! :thumbup::thumbup::thumbup:
 

J1515

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Yeah, its probably better to wait until the patient is in a life-threatening arrhythmia before waking your precious ass up.
Patients are generally asymptomatic until potassium levels hit 2.5ish Even with severe hypokalemia, it is generally something else that causes the arrhythmia (hypomagnesemia, dig toxicity). A nurse should not be waking anyone up for a potassium of 3.9, no ifs ands or buts. She didn't know what she was doing. You would be laughed out of the hospital if you made as big a fuss as you claim you would have.


You should definitely call the attending and breathlessly tell him a resident responded poorly to a 2am page about a K of 3.9. Great success awaits you! :thumbup::thumbup::thumbup:
I say she should've called a rapid response
 
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Patients are generally asymptomatic until potassium levels hit 2.5ish Even with severe hypokalemia, it is generally something else that causes the arrhythmia (hypomagnesemia, dig toxicity). A nurse should not be waking anyone up for a potassium of 3.9, no ifs ands or buts. She didn't know what she was doing. You would be laughed out of the hospital if you made as big a fuss as you claim you would have.
A K+ level of 3.9, not a big deal in most cases on the floors. If they called you for that, I would see that as inappropriate, but not worthy of a write up. In CCU and CTICU it is a big deal. They want the K+ on the higher side. Even the nurses know that. How many patients have you had with K+ that low that you know they are asymptomatic? So I guess a K+ of 3.9 isn't concerning for a cardiothoracic patient on a bumex gtt. What about the patient who is on insulin gtt for DKA or HHNK? How about this "doctor". If your patient has a blood sugar of 800, how much will the K+ drop for every 100 mg/dL the bs drops? The attending want the sugar below 120. Can you take a guess what you will be doing when you reach the optimal BS?

I think you should bring these things up when you are on cardiothoracic service. Be sure to tell the attending who spent hours operating on this patient to keep him alive that you are not concerned with low K+ levels at 2am. Don't forget to tell the MICU attending/fellow that you are not concerned with K+ of the insulin gtt patient either. I'll be laughed out the hospital? I promise both these attendings will team up to kick you out of both units, and ensure you never touch their patients again.
 
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Good for you making that stupid nurse feel terrible and humiliating her. I hope you did it in front of a lot of people so she REALLY falt like a piece of crap.

Yeah, its probably better to wait until the patient is in a life-threatening arrhythmia before waking your precious ass up.

And God forbid, if a patient is NOT on your service, DO NOT MAKE ANY ATTEMPT TO OFFER ASSISTANCE!!!!

If you had pulled that **** on me, and I was a nurse, not only would I do a write up, I would wake up your supervisor with a phone call, and make sure you are never near another patient on my unit again.

You will not feel so put upon if you make it your priority to BE NICE TO PEOPLE. BE KIND. Be helpful. Find a way to be part of the solution, and no, not everybody is going to be as smart as you. But they can't help it. WHY DO YOU FEEL IT IS YOUR JOB TO MAKE THEM FEEL BAD ABOUT THEMSELVES? Just think about that. Maybe you can learn something from them that you didn't know that will make your job easier. Maybe you can ask them if there is anything that you can do that will help make their job easier?
Boy oh boy, you need some growing up to do.
Ya think I got nothing else to do in my tornado-like residency than stop everything and start mocking RNs or being an ***** on purpose? After no sleep for 20 hrs, I treat all people just the way they treat me. Nice=nice, they annoy me=I will annoy back

Maybe you can ask them if there is anything that you can do that will help make their job easier?
What else can I offer? I got 60 pts on my list plus the whole ED incoming without any cap. Would you like my first born too?
Pre-med, go grab your sippy cup and keep dreaming.
 
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If you had pulled that **** on me, and I was a nurse, not only would I do a write up, I would wake up your supervisor with a phone call, and make sure you are never near another patient on my unit again.
This one just cracks me up!:laugh::laugh::laugh::laugh::laugh::laugh::laugh::laugh:
You are so dumb!
 

J1515

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A K+ level of 3.9, not a big deal <snip>
Oh enough already, if this, if that...why are you still posting here? You are a nurse, this forum is for residents. Nobody is buying your "i'm here for intelligent discussion." Anyone can make up scenarios when normal values would be considered abnormal. That's not what's being discussed here. Paging night float for a potassium of 3.9 is inappropriate, end of story. Nobody cares about your stories or all the mistakes you've caught or the interns you've gotten in trouble. You are posting here simply to stir up trouble. I have plenty of experience in the MICU and SICU. You are not impressing anyone throwing out your clinical situations. Nobody is impressed that you know what bumex or HHNK is. Just go to medical school already so you can drop this whole inferiority complex.
 
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jbz24

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A K+ level of 3.9, not a big deal in most cases on the floors. If they called you for that, I would see that as inappropriate, but not worthy of a write up. In CCU and CTICU it is a big deal. They want the K+ on the higher side. Even the nurses know that. How many patients have you had with K+ that low that you know they are asymptomatic? So I guess a K+ of 3.9 isn't concerning for a cardiothoracic patient on a bumex gtt. What about the patient who is on insulin gtt for DKA or HHNK? How about this "doctor". If your patient has a blood sugar of 800, how much will the K+ drop for every 100 mg/dL the bs drops? The attending want the sugar below 120. Can you take a guess what you will be doing when you reach the optimal BS?

I think you should bring these things up when you are on cardiothoracic service. Be sure to tell the attending who spent hours operating on this patient to keep him alive that you are not concerned with low K+ levels at 2am. Don't forget to tell the MICU attending/fellow that you are not concerned with K+ of the insulin gtt patient either. I'll be laughed out the hospital? I promise both these attendings will team up to kick you out of both units, and ensure you never touch their patients again.
3.9 is not a big deal for any cardiac problems. Sure we want K > 4, but the only people concerned with a value of 3.9 are those who practice (or nurse) medicine purely by algorithms and get scared when something deviates from the algorithm in even the slightest.
 

kemper6036

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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.
hit the nail on the head with that one......not just with nurses, but teachers and government workers also have incompetence proliferated by the practice of unionization
 
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3.9 is not a big deal for any cardiac problems. Sure we want K > 4, but the only people concerned with a value of 3.9 are those who practice (or nurse) medicine purely by algorithms and get scared when something deviates from the algorithm in even the slightest.
Not a big deal? Only nurses are concerned?? Maybe. The nurses and residents who will actually stop you from killing the patient will be concerned. When you rotate in CCU or CTICU, you be sure to tell the attendings and fellows what the K+ should be, you are an all knowing medical student after all. I want to be there on rounds when you tell him/her that. We get scared when something deviates in the slightest? No, I'll leave that to SOME of the medical interns who chase labs all day and never see the patient. After you rotate in MICU, CTICU or CCU, then come back and have this conversation with me.
 
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Oh enough already, if this, if that...why are you still posting here? You are a nurse, this forum is for residents. Nobody is buying your "i'm here for intelligent discussion." Anyone can make up scenarios when normal values would be considered abnormal. That's not what's being discussed here. Paging night float for a potassium of 3.9 is inappropriate, end of story. Nobody cares about your stories or all the mistakes you've caught or the interns you've gotten in trouble. You are posting here simply to stir up trouble. I have plenty of experience in the MICU and SICU. You are not impressing anyone throwing out your clinical situations. Nobody is impressed that you know what bumex or HHNK is. Just go to medical school already so you can drop this whole inferiority complex.
I am here for that purpose. There are people on here who do act like adults and are open to dialogue. Not everyone here acts childish like you and 1 or 2 other posters. You still didn't answer the questions. This page is giving the residents/fellows/attendings I work with a good laugh at people like you. They can't wait to meet a med student like you. You will have a hell of an intern year if you act like this in real life. Unlike you, my concern is the patient. What is really more important to you, making people think you are right at the expense of the patient? What interns did I get in trouble? The intern got himself in trouble. If you screw up and another attending has to fix the problem, he is going straight to your attending. That's how it works.
 

jbz24

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Not a big deal? Only nurses are concerned?? Maybe. The nurses and residents who will actually stop you from killing the patient will be concerned. When you rotate in CCU or CTICU, you be sure to tell the attendings and fellows what the K+ should be, you are an all knowing medical student after all. I want to be there on rounds when you tell him/her that. We get scared when something deviates in the slightest? No, I'll leave that to SOME of the medical interns who chase labs all day and never see the patient. After you rotate in MICU, CTICU or CCU, then come back and have this conversation with me.
Ummmm, I've already rotated through the MICU, CCU, and multiple cardiology services. I don't rotate through the CTICU. Tell me all-knowing nurse, why do we keep K greater than 4? How does K affect the heart? What is the difference between a K of 3.9 and a K of 4?
 

smq123

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Please, no more debating matches as to the clinical significance of a K+ of 3.9. Either move it back to the original topic, get off this one, or the thread will be closed.

Thanks.
 

Gastrapathy

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As for writing orders for a patient not on your service "since you got paged", I just had an intern on my service do that much to the detriment of the patient. He didn't notice surgical bleeding, just reordered a lab that "had to be wrong" and needed to be rechecked per the nurse.

If the correct intern had been involved, there's a chance that a serious complication would have been caught hours sooner.

The interesting question is whether my intern was practicing under my license or that of the attending on the surgical service.
 

J1515

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I am here for that purpose. There are people on here who do act like adults and are open to dialogue. Not everyone here acts childish like you and 1 or 2 other posters. You still didn't answer the questions. This page is giving the residents/fellows/attendings I work with a good laugh at people like you. They can't wait to meet a med student like you.
I'm a resident. And oddly enough the nurses and the NP in the ICU were laughing at you yesterday when I showed them your post bragging about how you always got the diagnosis correct as a triage nurse:laugh:. They too wanted to know why you're posting on a forum for doctors. In fact it was the NP there who used the term 'inferiority complex' in reference to you. Kinda sucks when your own kind says that, eh? There is nothing else to say. A potassium of 3.9 is not a big deal in 99.9% of situations as has been pointed out to you by others who actually understand physiology. Take a flip through the ICU book by Marino when you have a free second. Not as good of a source as some claim it to be but it's a good starting point.

You will have a hell of an intern year if you act like this in real life.
My intern year is over. It's nice to have a nurse tell me how residency will be though.

Unlike you, my concern is the patient.
:laugh:
 
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AbbyNormal

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They too wanted to know why you're posting on a forum for doctors.
Pardon me, Mr I-know-everything-in-the-universe Intern,

I believe when a thread is titled 'To SOME nurses out there...' that one would expect dialogue including 'some' nurses.


 

jbz24

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Pardon me, Mr I-know-everything-in-the-universe Intern,

I believe when a thread is titled 'To SOME nurses out there...' that one would expect dialogue including 'some' nurses.

I think the OP was just venting and not actually posting a message to nurses, although I personally don't mind nurses being on SDN and responding in the thread.
 

AbbyNormal

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I think the OP was just venting and not actually posting a message to nurses, although I personally don't mind nurses being on SDN and responding in the thread.
Oh. Okay.

I keep posting in the pre-vet forums because they are uber cool and so far nobody seems to care that I don't "belong" there. I am pretty new here, so is this 'posting in your own profession' desirable or does it matter? For instance I would like to go to grad school for CRNA (if I can get my kid raised) so I posted a question that was bugging me in anesthesia forum. They didn't seem to mind.
 
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I'm a resident. And oddly enough the nurses and the NP in the ICU were laughing at you yesterday when I showed them your post bragging about how you always got the diagnosis correct as a triage nurse:laugh:. They too wanted to know why you're posting on a forum for doctors. In fact it was the NP there who used the term 'inferiority complex' in reference to you. Kinda sucks when your own kind says that, eh? There is nothing else to say. A potassium of 3.9 is not a big deal in 99.9% of situations as has been pointed out to you by others who actually understand physiology. Take a flip through the ICU book by Marino when you have a free second. Not as good of a source as some claim it to be but it's a good starting point.



My intern year is over. It's nice to have a nurse tell me how residency will be though.

:laugh:

Yeah because ICU nurses how to function in an ER. Ever see them try? Give them 15 patients like an ER nurse and we will see. I didn't claim to know every diagnosis of a patient. What I said was, triaging is to put the pieces together to figure out what the problem might be, and many times I am right or in the right direction. I have yet to mistriage a patient to their detriment. That was the point I was trying to make. Put a few of your ICU nurses in there, give them 60 seconds to make a decision on how they are going to categorize this patient, and lets see what happens. When you work in a high acuity 100k+ ER, you learn a thing or two. Thats funny, the attendings and residents that see your posts are laughing as well. They would love to put a gunner resident like you in your place. Someone started a post about NP's. As a nurse, I think that would give me a right to post on this thread. I don't judge what they do, they should not judge what I do if they have never worked in an ER before.

I have no inferiority complex. Maybe she does, and she blindly does whatever the MD says, even if it will kill the patient. If I wanted to go to med school, I would have done so. Do you think that everyone who is a nurse wanted to be a doctor? Go tell your ICU nurses that. I work with real patients in different areas. The attendings and residents trust my judgement. Lets see, over the years, I have had maybe 3 residents that I didn't get along with. These residents, due to their highly inflated ego, dug their own grave when they killed patients. The residents and attendings, including program directors and chairpeople that know me and have worked with me treat me with respect and value my opinion. We have all worked well together and created a nice working environment instead of the hostile one you create. I don't understand physiology? That is why you couldn't even consider the possibility that 3.9 could be significant. You said that the number is normal and that is it.
 

jbz24

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I have no inferiority complex. Maybe she does, and she blindly does whatever the MD says, even if it will kill the patient. If I wanted to go to med school, I would have done so. Do you think that everyone who is a nurse wanted to be a doctor? Go tell your ICU nurses that. I work with real patients in different areas. The attendings and residents trust my judgement. Lets see, over the years, I have had maybe 3 residents that I didn't get along with. These residents, due to their highly inflated ego, dug their own grave when they killed patients. The residents and attendings, including program directors and chairpeople that know me and have worked with me treat me with respect and value my opinion. We have all worked well together and created a nice working environment instead of the hostile one you create. I don't understand physiology? That is why you couldn't even consider the possibility that 3.9 could be significant. You said that the number is normal and that is it.
Not at all. Plenty of RNs love what they do and would never consider being a doctor. A great RN goes a long way. I DO believe, however, that a large majority of NPs/DNPs had some desire to go to med school and were either not able to get in or didn't want to put up with the rigors of med school education and post-graduate training.

So why is a K of 3.9 significant?
 

J1515

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Yeah because ICU nurses how to function in an ER. Ever see them try?
:rolleyes: We get it, you're better than everyone else. For the record, I'll take a knowledgeable ICU nurse anyday over an ER nurse.

Thats funny, the attendings and residents that see your posts are laughing as well. They would love to put a gunner resident like you in your place.
Blah blah blah, everyone is laughing. God is laughing at your posts... Grow up.


I have no inferiority complex. Maybe she does, and she blindly does whatever the MD says, even if it will kill the patient. If I wanted to go to med school, I would have done so. Do you think that everyone who is a nurse wanted to be a doctor?
Nope. But the majority who clearly display an inferiority complex and think they constantly have something to prove wish they could've gone to medical school. Nobody said nurses should blindly follow what the physician said. But common sense and humility (something you seem to lack) go a long way. Thinking "will this 3.9 potassium kill the patient tonight, should I page the resident who has been here for 21 hours straight? or can this wait until morning?" will make you a lot of friends.

When nurses walk around talking about how they keep the doctors from killing the patients, question everything (wrongly) that the MD does, and says "I could've gone to medical school if I wanted" I have no respect for them. The fact of the matter is if you put an average nurse in charge of medical decisions and treatment for the floor things would get messy very quickly. Nurses catch the occasional error that physicians make. That's great that they do. But physicians make hundreds of sound medical decisions daily that the average nurse does not have the knowledge base to make.

Go tell your ICU nurses that. I work with real patients in different areas.
:laugh: Yup. There are no real patients in the ICU. Brilliant.

These residents, due to their highly inflated ego, dug their own grave when they killed patients.
More blah blah blah anecdotes anecdotes. I have stories where NPs would've killed their patient if the MD hadn't stepped in. Hell, I have a story about running into one of the Phoenix Suns a few years back at a bar in Arizona.

I don't understand physiology? That is why you couldn't even consider the possibility that 3.9 could be significant. You said that the number is normal and that is it.
Yup. Whether it's a 3.9 or 4.0, it's nothing that can't wait until morning. Night float covers floor patients and ER admissions. This is exactly what the OP was referring to when you tried to step in and infuse us all with your "medical knowledge."
 
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