blood draws

[Dr JPH]

Lucky you. Here's how it went my first week:

1) RN can't get peripheral IV, so he/she calls the intern
2) Intern realizes he's no better at IVs than the nurses, so calls the resident
3) Resident tells intern to tell nursing they have to do it
4) Intern tells nursing to just get it
5) Nurse asks someone else to try, who also misses
6) Nurse calls intern again, argument ensues
7) Intern calls anesthesia, who says, "We're not an IV team" and refuses to come
8) Intern calls resident, who refuses to do a central line, since the patient doesn't need a line that bad
9) Intern calls back nursing, argument ensues again
10) RN calls ICU nurse, who also can't get line
11) RN calls back intern, argument ensues again
12) Intern brings ultrasound to floor, looks for vein, then realizes he has no idea what he's doing
13) Intern begs chemotherapy nurse to try, and she hits it on the first try
14) Resident calls intern two hours later, and instructs him to discharge patient

Stupid orthopod...you could have saved yourself ALL that trouble if you had just paged the Respiratory Therapist to come place a subclavian!

I hear some hospitals are letting Dieticians float Swans.

---

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[Tired]

I hear some hospitals are letting Dieticians float Swans.

I thought CRNAs were nurses, not Dieticians . . . ?

 

[umza]

Of course they do. They're the fluffy things that cushion the pre-osseous Ancef pump.[/QUOTE]

harhar

 

[snoopy brown]

2) Intern realizes he's no better at IVs than the nurses, so calls the resident

I've never understood why it's the responsibility of the physician to put in IVs if a nurse cannot get one. It makes no sense from any point including practicality. Nurses put in IVs much more frequently than physicians and are therefore much better at it. However there is a mentality in medicine that the physician is the ultimate resource. It's so bad that sometimes I was asked to fix broken medical equipment (I declined to attempt). The only thing it demonstrates is laziness. Are there times when a nurse cannot get an IV? Yes. But there are also times when (especially at night when the junior and/or worse nurses are on) they make the "college try" and then call you. Nursing duties should be nursing duties. If the physician is made to share their duties then they should also share their pay.

 

[Tired]

I've never understood why it's the responsibility of the physician to put in IVs if a nurse cannot get one. It makes no sense from any point including practicality. Nurses put in IVs much more frequently than physicians and are therefore much better at it. However there is a mentality in medicine that the physician is the ultimate resource. It's so bad that sometimes I was asked to fix broken medical equipment (I declined to attempt). The only thing it demonstrates is laziness. Are there times when a nurse cannot get an IV? Yes. But there are also times when (especially at night when the junior and/or worse nurses are on) they make the "college try" and then call you. Nursing duties should be nursing duties. If the physician is made to share their duties then they should also share their pay.

I agree, it's such a bunch of crap.

See, it's not that they're trying to get me to put in the IV. It's that they don't want to take the time to make the appropriate arrangements to get the IV done. Why the hell do I have to go around asking RNs in other departments to take a crack at the line? The only reason they get away with it is because, at the end of the day, they don't give a crap if the patient with osteo gets his Vanc on time, and I do.

 

[Dr JPH]

When I was a medical student the intern and I went to the floor to "see about starting an IV" that the nurse couldnt get. Intern asked "did you call IV team?" The nurse said "she couldnt get it either."

Well, no kidding. She was playing poker in the resident lounge with us when we got paged.

Oops!

 

[chimichanga]

stupid me...

I meant RTs put in Arterial lines, not central lines...

sorry

 

[Mman]

I've never understood why it's the responsibility of the physician to put in IVs if a nurse cannot get one. It makes no sense from any point including practicality. Nurses put in IVs much more frequently than physicians and are therefore much better at it. However there is a mentality in medicine that the physician is the ultimate resource. It's so bad that sometimes I was asked to fix broken medical equipment (I declined to attempt). The only thing it demonstrates is laziness. Are there times when a nurse cannot get an IV? Yes. But there are also times when (especially at night when the junior and/or worse nurses are on) they make the "college try" and then call you. Nursing duties should be nursing duties. If the physician is made to share their duties then they should also share their pay.

Probably because the physician is responsible for the care of the patient and that includes what is necessary for IV access. As an anesthesia resident, I start IVs on all kinds of people and sometimes it is damn difficult. If there is nothing promising on the hand, I move up the arm, then the other side, then the EJ, then maybe a foot, then the ultrasound is coming out to look for a peripheral. If nothing, might have to do a central line for access.

But the bottom line is you can't expect a nurse to spend hours trying to poke a patient for an IV when it might not be possible and they might need a line and a physician needs to make that judgment.

Don't get me wrong, everybody knows that paging the intern to put in a difficult IV is just pointless in all regards. If somebody with 20 years experience couldn't get it, you probably won't either. Then again, you might get lucky.

Nurses are busy people too with other patients to take care of. It is the rare nurse that seems overly lazy when it comes to starting an IV. If they can get it after a few tries, it is usually policy to get somebody else to try. If somebody else strikes out, gotta either see if a really good IV nurse can get it or ask the doctor to figure out what is necessary.

Getting paged for a peripheral IV sucks when you have a million other things to do. Unfortunately, IV access is necessary for the overwhelming majority of adult patients and the nurses can't always get it.

 

[snoopy brown]

Probably because the physician is responsible for the care of the patient and that includes what is necessary for IV access.

You jumped from a correct statement (physician is responsible for the care of the patient) and drew an incorrect conclusion (therefore he is responsible for a non-physician task). So if a patient doesn't get out of bed it is your job to walk them if the nurse never does? It happens. What about if the nurse doesn't get them a bedpan? Your job? That also happens. When does that stop? It's nice to say that they are busy people but aren't the physicians also? That's my point exactly, that it's not suddenly the physician's job just because a nurse is busy but that's how it works in most training programs in America. Even secretarial and social work is yours to do if they're too busy. (I've made phone calls to get people placed into nursing homes at infrequent times because a social worker kept saying "I'm really busy I can't get to it.")

Maybe you don't mind because at least placing IVs is tangentially related to your speciality but I bet if I made you do some other work on a patient you'd be pretty irritated. Bottom line is that if a physician is responsible for everything for a patient, then pay them the other person's salary. See how far that goes though.

 

[Tired]

It is the rare nurse that seems overly lazy when it comes to starting an IV.

You must not spend much time on the floors.

 

[snoopy brown]

He doesn't. He said he's in Anesthesia.

 

[Blade28]

The only reason they get away with it is because, at the end of the day, they don't give a crap if the patient with osteo gets his Vanc on time, and I do.

So true.

Many times, in the end, we're the only ones that care if the patients gets their CT scan with IV contrast, or gets their antibiotics, or necessary IV fluids.

 

[chimichanga]

So true.

Many times, in the end, we're the only ones that care if the patients gets their CT scan with IV contrast, or gets their antibiotics, or necessary IV fluids.

hopefully yours and Tired's experiences are n=2 when it comes to these nurse horror stories...

I've supervised many wards w/ rarely the apathy that's perceived and experienced by you two...

Is it really always that bad for you guys?

Do your nurses really blow off CT scans and miss vanco times (by more than 30 min)?


if what you say is true, then that's malpractice and neglect, and they should be disciplined...

and does the apathy run all the way to the (nursing) top?


hard to believe, as my n>15 in many years, and I have rarely seen it (on a large scale hospital wide), as you guys describe...

 

[snoopy brown]

I've supervised many wards w/ rarely the apathy that's perceived and experienced by you two...

In my experience nursing is fairly good with regards to drug administration so long as everything is straight-forward. That means if they can just go in and hang the drug or give it to the patient and leave. As soon as there is any and I mean any break in that there is almost zero effort to do anything. For example if you lose an IV, it's almost always the case where you may find out about it hours later and you'll ask "how did you give [med] at noon then?" "Oh, we didn't." Excellent. I've had one or two nurses take some initiative and place a new line and give the drug but generally it's more like "the IV is out and you need to get a new one, but if you don't do it fast enough we're going to be busy and so you'll have to wait until we're ready to give the med." Usually that means that they'll be ready right around the time the next dose is ready and then you'll get a page asking if you want both doses given. It would be funnier if it wasn't so sad.

 

[OB1🤙]

My contribution to this thread is: become comfortable with EJs. They're usually there, and they're usually easy to get. It has been mentioned before on this thread, but I think it's worth repeating.

Nurses at most hospitals (the ones I've been in anyway) aren't allowed to go for the EJ, which is a shame, because it'd be an easy stick for them. Most non-surgical residents and interns I've come across aren't comfortable with them, and if nobody can get a PIV, they'll look to call for a picc or central line next without even looking at the neck.

EJs save everyone time and hassle. Learn it and love it.

 

[chimichanga]

... For example if you lose an IV, it's almost always the case where you may find out about it hours later and you'll ask "how did you give [med] at noon then?" "Oh, we didn't."

wow!

just know that this is not the state of nursing...

N=20 in my world...hopefully these stories are n=1...

I was an ER supervisor for the last 5 years, before taking a house sup job for the last 2 (in addition to also being a nursing instructor for the last 3)...before that, a staff and charge in ER/ICU, and wards for 6 years...I would never behave this way, and certainly would never tolerate such apathy from a nurse or student...And I have worked in 3 teaching hospitals, where it was always the RNs' responsibility to start and maintain an IV...

No way I believe that what you describe is common nationwide...

And RNs, in most places, can start EJs if they have shown proficiency...Others flat don't allow it...

IVs are an easy skill to master, and even floor nurses should attempt to restart, before calling me...

 

[Mman]

You jumped from a correct statement (physician is responsible for the care of the patient) and drew an incorrect conclusion (therefore he is responsible for a non-physician task). So if a patient doesn't get out of bed it is your job to walk them if the nurse never does? It happens. What about if the nurse doesn't get them a bedpan? Your job? That also happens. When does that stop? It's nice to say that they are busy people but aren't the physicians also? That's my point exactly, that it's not suddenly the physician's job just because a nurse is busy but that's how it works in most training programs in America. Even secretarial and social work is yours to do if they're too busy. (I've made phone calls to get people placed into nursing homes at infrequent times because a social worker kept saying "I'm really busy I can't get to it.")

Maybe you don't mind because at least placing IVs is tangentially related to your speciality but I bet if I made you do some other work on a patient you'd be pretty irritated. Bottom line is that if a physician is responsible for everything for a patient, then pay them the other person's salary. See how far that goes though.

Sorry, having adequate IV access is ultimately the responsibility of the physician. I don't care if you are in medicine or peds or FP or whatever. Only the physician can decide what is adequate. If you've got a patient with a GI bleed and a crit of 27, do you call it quits when the nurse can only get a 22 gauge IV in the hand? I'm sure the lawyer would love to ask in court why you decided to let the nurse struggle for 3 hours trying to get IV access on the patient when something bad ended up happening.

It isn't the nurses responsibility to decide if the patient needs a central line for access. If the nurse can't get a peripheral, she can't get it. Sometimes it's impossible and the MD has to decide what path to take next (EJ vs PICC vs central line, etc).

I spent a year on the floor as an intern and probably got paged for an IV maybe 40-50 times. I can probably count 10 times when I thought the nurse was being lazy. The rest of the time it was damn hard and sometimes we had to order a PICC or go straight to a central line.

Putting an IV in isn't a "nurses job". It's patient care. It's the nurses job to try to get it. If they can't, they generally find another nurse to try. If 2 people can't, in many hospitals it is written policy to notify the physician to have the physician try or to determine the next couse of action.

 

[snoopy brown]

Only the physician can decide what is adequate. If you've got a patient with a GI bleed and a crit of 27, do you call it quits when the nurse can only get a 22 gauge IV in the hand?

Um, what? I suppose if you want to be that melodramatic you can rationalize anything. It's the physician's job to walk the patient, want them to get a DVT and then a PE and then die? I'm sure that'll stand up in court. It's the physician's job to change the bedpans, want the patient to soil themselves repeatedly and have skin breakdown subsequently get septic and then die? I'm sure that'll stand up in court.

Then again, you're saying this all from a perspective of not having any patients since you're in Anesthesia. Now don't get me wrong, I know that any patient you see is "yours" but let's be realistic you're never going to be asked to do these nursing tasks on "your" patients because you're never primary. (I've never seen anesthesia paged to put in IVs on random floor patients, but if that happens in everyone else's experience fine.)

 

[swpm]

(I've never seen anesthesia paged to put in IVs on random floor patients, but if that happens in everyone else's experience fine.)

Believe me, it's the experience of every single anesthesia resident on the face of the earth.

 

[Dr JPH]

I think what Mman is saying is that with every aspect of a patients care, the physician is the one ultimately responsible.

 

[snoopy brown]

I agree that is what he is saying, but I disagree with the statement.

 

[deleted109597]

It isn't the nurses responsibility to decide if the patient needs a central line for access.

Perhaps you should disseminate this tidbit to the nursing schools of America, because I sure as hell get this exact line pretty much weekly; "I think she needs a central line", and this is to be taken to mean "We don't like changing out the peripheral lines every 3 days".

If the nurse can't get a peripheral, she can't get it. Sometimes it's impossible and the MD has to decide what path to take next (EJ vs PICC vs central line, etc).

Often it isn't impossible, they just don't have the skills. For some dumb reason the IV team at a hospital I used to be at consisted of float pool nurses instead of people like peds/ED/Chemo nurses. If I can place a line, somewhere a nurse can place the same line. It isn't because I have this magical intimate knowledge of the venous system (at least not the peripheral one), it is because I have spent enough time as a phlebotomist to pick out thinks that will bleed and/or cannulate.

Putting an IV in isn't a "nurses job". It's patient care. It's the nurses job to try to get it. If they can't, they generally find another nurse to try. If 2 people can't, in many hospitals it is written policy to notify the physician to have the physician try or to determine the next couse of action.

As noted before, lots of things are patient care that don't move up to the doctors. If anything, they are usually demoted to the PCTs on the floor. For some reason, the stuff under "nursing" in the orders I give is left up to the techs to actually get performed (I&Os, Vitals, foleys, bedpans, logrolls, etc).
Also, nurses get really bent out of shape if you put the tourniquet on and point out the veins to them, and then give other excuses such as "it will come out, it is uncomfortable there, I don't like putting them there, etc". Such as life, we won't die for consulting for central lines, but remember, patients sometimes do (I've seen it happen twice, and I wasn't placing either of them).

 

[Dr JPH]

It bothers me how some people think central lines are a routine procedure and without risk.

"Oh, surgery can just put in a line"

or

"Why cant they just put in a central line?"

 

[chimichanga]

Many hospitals have a policy that requires the use of a central line with dopamine...

I enjoy IV placement, as it's a relatively easy skill to master...Venipuncture is even easier...

sorry to hear about these lame-a$$ nurses that exist...

 

[snoopy brown]

If I can place a line, somewhere a nurse can place the same line.

Since most physicians don't spend any dedicated time doing IV placement, I'd go further. If I can place a line then there better be a nurse that can do it. Conversely if nursing can't get one there is an almost zero percent chance that I can. That's just the facts.

 

[bryanboling5]

Since most physicians don't spend any dedicated time doing IV placement, I'd go further. If I can place a line then there better be a nurse that can do it. Conversely if nursing can't get one there is an almost zero percent chance that I can. That's just the facts.

YEP! I agree with the poster who is(was?) a nurse who said that they were sorry to hear about all the sorry nurses out there. I'm just a nursing student, but there have been very few IVs/sticks that I couldn't get and when I couldn't, (although I've got 5 years experience as a phlebotomist/ER Tech prior to school) an experienced ER/ICU/Peds nurse could. I've never understood nurses who want to page the doc to start an IV.

When I was a phlebotomist in the ER, I had a patient who was a VERY little baby who was going up to be admited for heart surgery. She needed labs drawn and I came in to draw them. Peds CT Attending is talking to mom and mom says she doesn't trust an ER Tech to stick her baby and wants the surgeon to do it. He says to her, "believe me, you WANT him to do it and not me. He does this 100 times a day, I haven't done it in years." sure enough, got it on the first try (it's good to be good, but it's better to be lucky!).

I agree, I've seen nurses on the floors who are really lazy. Luckily, they're the minority, especially after you get into the ICU. At least around here.

 

[Blade28]

hopefully yours and Tired's experiences are n=2 when it comes to these nurse horror stories...
...
hard to believe, as my n>15 in many years, and I have rarely seen it (on a large scale hospital wide), as you guys describe...

Nope. I probably deal with this problem at least 1-2 times a week, virtually every month, and have been doing so since I started residency.

Now bear in mind this happens in the units and step-downs as well as on the floors.

I should add that it sometimes irks me when I get consulted for central line placement - especially if (1) the person requesting is a higher PGY level than me*, (2) the PIV was unsuccessfully attempted earlier in the day but the resident didn't get around to doing anything about it until 6 pm, (3) an intern or resident hasn't at least looked at the patient (e.g. EJ vein) and tried themselves.

On a somewhat related note, can I also add that I hate it when I'm consulted for an emergent chest tube for a pneumothorax that was caused by a central line placement 3-4 DAYS PREVIOUSLY! Usually this happens when Medicine attempts a central line, orders a post-line CXR, but then WAITS FOR THE OFFICIAL RADIOLOGY DICTATION. If you're not going to look at the film yourself, at least ask for a wet read!

* Over the last 2 years, this has included three Medicine hospitalists, an Ortho chief, a Urology PGY-4, an ER PGY-3, and countless Cardiology fellows

 

[Mman]

Since most physicians don't spend any dedicated time doing IV placement, I'd go further. If I can place a line then there better be a nurse that can do it. Conversely if nursing can't get one there is an almost zero percent chance that I can. That's just the facts.

That is 100% correct. Unfortunately, after a nurse strikes out a few times and perhaps another nurse misses, they can't just keep calling every nurse in the hospital to poke the patient for an IV if they have no access.

It happens and you unfortunately have to get pulled into it at that point. It's part of being a doctor taking care of the patient.

 

[Mman]

Um, what? I suppose if you want to be that melodramatic you can rationalize anything. It's the physician's job to walk the patient, want them to get a DVT and then a PE and then die? I'm sure that'll stand up in court. It's the physician's job to change the bedpans, want the patient to soil themselves repeatedly and have skin breakdown subsequently get septic and then die? I'm sure that'll stand up in court.

Then again, you're saying this all from a perspective of not having any patients since you're in Anesthesia. Now don't get me wrong, I know that any patient you see is "yours" but let's be realistic you're never going to be asked to do these nursing tasks on "your" patients because you're never primary. (I've never seen anesthesia paged to put in IVs on random floor patients, but if that happens in everyone else's experience fine.)

I'll spell it out more slowly.

You admit a patient to the floor for whatever problem that has no IV access. 45 minutes later a nurse comes in and pokes a patient twice, but can't get an IV. She calls the IV team or somebody else to come try. 30 minutes later they show up and try for 30 minutes and can't get anything. It's now nearing 2 hours that the patient has been here, but doesn't have any access. How long should the nurses keep trying? 6 hours? 12 hours?

Keep in mind that some MD already decided this patient required hospitalization and some kind of treatment, but still doesn't have any IV access. At some point, bad things can start to happen and you have no way of treating them without an IV. That's why the nurses have to call the MD. It varies by hospital and by nurse as to when that happens, but at somepoint in the little algorithm of difficult IV placement it ultimately leads to calling the MD.


And no, I don't say this from the perspective of "not having any patients". I say this from the perspective of 12 months of being an intern doing medicine and surgery and peds and cardiology and pulmonary and ICU etc. I also say this from the perspective of getting called by residents on other services who can't get an IV in their floor patients and don't want a central line and want to see if I can try for them since they already missed.

As for being melodramatic, no, just realistic. I hate people that are lazy and try to push their work on to somebody else. So the nurse than can't get a tiny IV in a big juicy vein? Not my favorite person in the world.

 

[DropkickMurphy]

stupid me...

I meant RTs put in Arterial lines, not central lines...

sorry

Ah.....I was about to say. I've worked three hospitals that let RTs put in art lines.

 

[caroladybelle]

First of all, no IV contrast can be administered through a PICC either. Second, relying on other departments to get you what you need is the surest way to disaster.

Bard Power PICCs - you can use the power CT injectors on them.

 

[caroladybelle]

It isn't the nurses responsibility to decide if the patient needs a central line for access. If the nurse can't get a peripheral, she can't get it. Sometimes it's impossible and the MD has to decide what path to take next (EJ vs PICC vs central line, etc).

I spent a year on the floor as an intern and probably got paged for an IV maybe 40-50 times. I can probably count 10 times when I thought the nurse was being lazy. The rest of the time it was damn hard and sometimes we had to order a PICC or go straight to a central line.

For about the last 4 years, if I was not able to place the line, it ended up being an EJ, a central, or the MD calling the VAD team. But then I work Onco/Hemo.

In most places, nurses are not permitted to place any IV in the neck,and you have to have a written order to place an IV in the chest or the lower extremities. (A female Chrohn's patient 50+ years old that had a 22 gauge in a vein on the breast - I didn't place it).

 

[fab4fan]

hopefully yours and Tired's experiences are n=2 when it comes to these nurse horror stories...

I've supervised many wards w/ rarely the apathy that's perceived and experienced by you two...

Is it really always that bad for you guys?

Do your nurses really blow off CT scans and miss vanco times (by more than 30 min)?


if what you say is true, then that's malpractice and neglect, and they should be disciplined...

and does the apathy run all the way to the (nursing) top?


hard to believe, as my n>15 in many years, and I have rarely seen it (on a large scale hospital wide), as you guys describe...

chimi: You really need to change your screen name to "Don Quixote." You're tilting at windmills here if you think you're going to try to convince most of these people there are nurses out there who do give a damn about pt. care.

It makes reading things here a whole lot easier when you stop trying to argue otherwise.

 

[Dr JPH]

You're tilting at windmills here if you think you're going to try to convince most of these people there are nurses out there who do give a damn about pt. care.

Agreed. Most people dont need convincing.

 

[fab4fan]

I'll spell it out more slowly.

You admit a patient to the floor for whatever problem that has no IV access. 45 minutes later a nurse comes in and pokes a patient twice, but can't get an IV. She calls the IV team or somebody else to come try. 30 minutes later they show up and try for 30 minutes and can't get anything. It's now nearing 2 hours that the patient has been here, but doesn't have any access. How long should the nurses keep trying? 6 hours? 12 hours?

Keep in mind that some MD already decided this patient required hospitalization and some kind of treatment, but still doesn't have any IV access. At some point, bad things can start to happen and you have no way of treating them without an IV. That's why the nurses have to call the MD. It varies by hospital and by nurse as to when that happens, but at somepoint in the little algorithm of difficult IV placement it ultimately leads to calling the MD.


And no, I don't say this from the perspective of "not having any patients". I say this from the perspective of 12 months of being an intern doing medicine and surgery and peds and cardiology and pulmonary and ICU etc. I also say this from the perspective of getting called by residents on other services who can't get an IV in their floor patients and don't want a central line and want to see if I can try for them since they already missed.

As for being melodramatic, no, just realistic. I hate people that are lazy and try to push their work on to somebody else. So the nurse than can't get a tiny IV in a big juicy vein? Not my favorite person in the world.

Precisely. Or we can just keep sticking fruitlessly. Meanwhile, the sick pt gets sicker, treatment is delayed, the attending shows up and all hell breaks loose "Why did you spend all that time trying to get a line. Why didn't sombody call anesthesia/me/a resident/(insert whatever doctor the attending wants)?"

 

[fab4fan]

Agreed. Most people dont need convincing.

It amazes me that you can work collaboratively with anyone. Change your name as many times as you want, you're still the same.

 

[Dr JPH]

It amazes me that you can work collaboratively with anyone. Change your name as many times as you want, you're still the same.

You mean to tell me that you have never met a nurse who is completely apathetic about her job...and could therefore care less about what does and what does not get done? Come to Philadelphia. I can introduce you to a few.

 

[Tired]

You mean to tell me that you have never met a nurse who is completely apathetic about her job...and could therefore care less about what does and what does not get done? Come to Philadelphia. I can introduce you to a few.

Don't forget the other variant: Works really hard the first two hours of the shift, then spends the next 10hrs trying to put everything off until the next shift comes on.

 

[fab4fan]

You mean to tell me that you have never met a nurse who is completely apathetic about her job...and could therefore care less about what does and what does not get done? Come to Philadelphia. I can introduce you to a few.

Sure I have. That doesn't mean I paint the whole group as bad. I run into suboptimal interns and residents frequently; that doesn't mean they all are.

FWIW, I don't get into the hating on docs at allnurses either.

Anyway, this is a site for you guys to vent your spleens about your frustrations which include nurses. I just hope at some point you get to work with people who do take their jobs seriously.

 

[Dr JPH]

Sure I have. That doesn't mean I paint the whole group as bad. I run into suboptimal interns and residents frequently; that doesn't mean they all are.

FWIW, I don't get into the hating on docs at allnurses either.

Anyway, this is a site your you guys to vent your spleens about your frustrations which include nurses. I just hope at some point you get to work with people who do take their jobs seriously.

We do, and Im thankful for that.

 

[chimichanga]

You mean to tell me that you have never met a nurse who is completely apathetic about her job...and could therefore care less about what does and what does not get done? Come to Philadelphia. I can introduce you to a few.

Of course we have...

Last week I reported one of my nurses to the board for diverting Dilaudid...I don't run over to the clinician's forum, or allnurses, and throw all surgical nurses under the bus...

Las month, I was involved in discovering an anesthesiologist who was diverting...I don't run over to the gas forums and paint them w/ a broad brush...

We have an internal med doc on staff who was censured for telling a pt (in his office) to "keep his neck straight" and "drive to the ER" w/ neck pain, after a 10 foot fall...I don't run over to the DO forum, and blast all DOs...

I guess what worries me, is, for JPH and Tired (the two most vocal here), base their judgements on anecdotes (Tired's wife is a nurse?), and personal experiences from med school and residency...That makes N=2...Throw in jobs before that, and n=4...

Fab4 and carol have N>20...AND many years experiences (they are old )

Talk to me after you get out of residency, and have several years under your belt...You will see that: Most nurses love their jobs, will do what they can to help make the patients, and your lives easier...

What you describe just doesn't happen as widespread as you suggest...

 

[Dr JPH]

What you describe just doesn't happen as widespread as you suggest...

I dont think anyone ever said that it does.

Unfortunately to the patient whose care is being compromised it DOES only take one nurse.

 

[fab4fan]

Of course we have...

Last week I reported one of my nurses to the board for diverting Dilaudid...I don't run over to the clinician's forum, or allnurses, and throw all surgical nurses under the bus...

Las month, I was involved in discovering an anesthesiologist who was diverting...I don't run over to the gas forums and paint them w/ a broad brush...

We have an internal med doc on staff who was censured for telling a pt (in his office) to "keep his neck straight" and "drive to the ER" w/ neck pain, after a 10 foot fall...I don't run over to the DO forum, and blast all DOs...

I guess what worries me, is, for JPH and Tired (the two most vocal here), base their judgements on anecdotes (Tired's wife is a nurse?), and personal experiences from med school and residency...That makes N=2...Throw in jobs before that, and n=4...

Fab4 and carol have N>20...AND many years experiences (they are old )

Talk to me after you get out of residency, and have several years under your belt...You will see that: Most nurses love their jobs, will do what they can to help make the patients, and your lives easier...

What you describe just doesn't happen as widespread as you suggest...

Hey! Who are you calling old? Don't you know 44y is the new, uh, what is it? I forget. You're right, once you reach the "half your life" mark, you're old.

 

[chimichanga]

Unfortunately to the patient whose care is being compromised it DOES only take one nurse.

Indeed...

The same goes for all w/in the team...One person (PT, RT, MD, RN) can do much harm...Especially surgeons...

 

[Dr JPH]

Indeed...

The same goes for all w/in the team...One person (PT, RT, MD, RN) can do much harm...Especially surgeons...

Thats why the surgeon has such high malpractice...and the ultimate responsibility.

 

[snoopy brown]

I guess what worries me, is, for JPH and Tired (the two most vocal here), base their judgements on anecdotes (Tired's wife is a nurse?), and personal experiences from med school and residency...That makes N=2...Throw in jobs before that, and n=4...

Why are your experiences more valid than theirs? You are acting as if there is no problem when other people feel there is one. We've all had our experiences and they have shaped our opinions. You're busting JP Hazelton's backside but he's actually being more gracious than you realize. He said outright that it's not as widespread as you think, which is a lot more generous than I'd be because I happen to think it is. What is the point of this? Is it that if he stops talking that suddenly there is no problem with nurses? Come on grow up. Silence doesn't equal solution.

 

[hyperbaric]

exactly...you'll need a phlebotomist or a nurse...

Good thing I've got those skills from previous adventures!

 

[chimichanga]

Why are your experiences more valid than theirs? You are acting as if there is no problem when other people feel there is one. We've all had our experiences and they have shaped our opinions. You're busting JP Hazelton's backside but he's actually being more gracious than you realize. He said outright that it's not as widespread as you think, which is a lot more generous than I'd be because I happen to think it is. What is the point of this? Is it that if he stops talking that suddenly there is no problem with nurses? Come on grow up. Silence doesn't equal solution.

... In my limited experience, I know many interns and residents who have been told directly the line "I've been a nurse for 7 years and you're just an intern/resident" or something close to that effect...

mine aren't more valid...I'm over 40 and have been doing this 13 years...You guys are residents, and are probably under 30, and, as you said, have "limited" experience...
Fab4, carol, and I are far more qualified to paint an accurate picture of nursing...That's all I was saying...

I don't discount anyone's experiences...But when n=2, it hardly represents applicability to the ouside (of your) world...And my perceptions are farr different now than they were 15 years ago when I was a student...

 

[chimichanga]

Thats why the surgeon has the ultimate responsibility.

(paraphrased)

Over whom?

It's a different responsibility than every other member of the team...No one is more important than the other...That's what you (seem to - based on your posts) fail to realize...

Certainly you incur way more liability, and we respect that...

 

[Trifling Jester]

(paraphrased)

Over whom?

It's a different responsibility than every other member of the team...No one is more important than the other...That's what you (seem to - based on your posts) fail to realize...

Don't forget the nusing techs, nursing assistants, janitors, cafeteria ladies, security guards, and parking lot attendants. No one person is more important than the other. We all have the exact same responsibility since we all work at the hospital. We are all part of one team working together to serve the patient. We are all equals.

Your komrade,
The Trifling Jester