Fine. Turnabout is fair play.
I've already made my point that "No new orders" doesn't mean "Do nothing," which is exactly how it comes across, which is why I don't care for it.
Listen, there is nothing to be adversarial about. You are right.
No new orders doesn't mean do nothing necessarily. This is why I note continuing to observe or monitor, etc.
If the issue is serious enough, I may include the rationale; but in general, it's not good practice to take a position on it either way. You will document your own stuff. Why would I document your plan necessarily? I mean I have, again it depends on what the issue is. I will write something like team's current plan is X,Y,Z. Observing for response from X. No new orders given at this time. That doesn't look bad necessarily for anyone, and it covers me. Basically I am documenting my actions to something that has come up in that I contacted you. That's it. If you are confident in your plan, fine. I may or may not be; but I don't use documentation to pass the buck or differ with you or anyone else. That's not the point of it. This is why it's best to just stick to the facts and limit commentary. Again, there may be times when one may need to expound upon the situation; but it's really bad form to get too much into this. That can get sticky. At the end of the day, we are both supposed to be there for the patient. I find adversarial interactions work against the patient; thus I try to avoid them; unless it's a serious issues of incompetence, negligence, or the like. It's a team thing; and it should be addressed as such.
The point of documentation, however, is not to defend one thing over the other. That's unwise from either end. So if you don't want to give some fluid or colloidal fluid, and the pt's SVRI is really up and his CI is going down, and the client is becoming more tachycardic and not making urine, as his CVP and CI goes down and his SVRI, etc continues to rise, well, I have to document that, b/c I am monitoring it very closely--no less than every hour, and/or more frequently. Else what they heck am I there for? So if you up the dopamine when some judicious volume replacement needs to be taken care of first, either way, I am documenting it. It makes no sense to up the pressor with its high inotropic/chronotropic response, when volume needs to be corrected first, even if it must be done judiciously. I mean there are obviously other values and considerations, depending upon the individual client, but you get my drift. I am not there to have an issue with anyone. I am there b/c you have a ton of other patients, and the ICU patient needs continuous surveillance of hemodynamics, vitals, etc. It's a team effort. But I still have to document in some format that shows - data: action: response: (all of these should be as quantitative as possible and come from the patient as much as possible.) In other words, I am documenting what the patient and his/her body is doing more than anything else. If there are no orders, and we are simply monitoring at this time, depending on what's going on and it's severity, I will document that the physician was notified of all the specified parameters--all of them--quantitative, what actions if any were taken, and what the PT RESPONSE is to treatment or lack thereof.
I mean it's pretty straightforward. Your plan note is your plan note. If in an hour the pt/ct crashes, I have to document all the quantitative and all that was done and the pt response with that as well.
Not sure why this is an issue. Again, it's supposed to be objective, data-based, and systematic. Again, pretty straightforward.
Now when nurses make an issue out of notes to try to object with the physician, that's unprofessional and very unscientific. They are missing the point of what documentation is about.
I don't know if I made things clearer; but again, it's not an issue where anyone needs to be adversarial in any way. It's important to understand also that when people work together, regardless of their various roles, in time, a trust is developed; such that you have worked with me enough to know that if I (Nurse Lin) am calling you; it's for a damn good reason. I feel like one of my goals is to limit problems as much as possible. I have seen nurses just wig out over codes. Experience and good sense teaches you that we are not there in an ICU to get an adrenalin rush. Of all places, the ICU is the place to control things such that we can effectively avoid the crash scenario--as much as that is truly possible. So I go out of my way to keep all the ducks in a row to avoid the crash--once again, else why the heck am I there?
I don't relish code experiences like the newer nurses do anymore. Often, by the time you get into a code situatuion, there can be a low probability of positive outcomes. If they can't be helped, they can't be helped. But I am damn well going to do my best to know I did everything in my experience, insight, and power to prevent the crash whenever possible. Once you work with me; you will see this. You will also see that I have a lot experience, and I don't panic over every little thing like newer or less experienced ICU nurses. It doesn't mean I don't care. I do care, and I am very vigilant; but I am smart enough to know that often providing only one data piece to a physician, who is expected to make a clinical decision, usually isn't the best way to go. The ICU nurse should get as much pertinent data as possible and present, objectively, the data and situation. Newer or less experienced nurses don't do this; thus they call the physician frequently over everything. Some nurses just need time to learn these things, just as resident physicians may need to time to learn things. We are all learning and growing and hopefully looking out for the patient. Again, if we aren't, what they heck are we there for?
I am sure you are a great doc, and we probably wouldn't have any trouble working together. I know my role, and I don't try to usurp yours. I do respect your role, and quite frankly, I am glad your there. (I have worked in units where there was no doc directly covering; and it often enough could be a nightmare; b/c there is a limit, as a nurse, as to what I can do.) But I am also responsibile to look out for the patient--especially when you can't be there, b/c you are dealing with 5 patients in the ED and trying to figure out which units they will go to, or whatever. I respect your work and time. But I have to show that I am looking out for the patients in my care as well. I try to stick with being as objective in documentation as is possible.
I think the data should speak for itself.
🙂