I wish my nurses would...

[CrazyPremed]

Hey folks,

Long story short - I'm working as a nurse on a cardiac floor while I finish the premed requirements.

For all you residents, fellows and attendings, what do you guys wish we would do to make your jobs easier?

CrazyPremed

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[BlackSails]

Hey folks,

Long story short - I'm working as a nurse on a cardiac floor while I finish the premed requirements.

For all you residents, fellows and attendings, what do you guys wish we would do to make your jobs easier?

CrazyPremed

Im not a doctor, but I do read these forums.

1. Pages at 3 AM for something important is ok. Pages at 3 AM to wonder if a certain medication is being renewed is not.
2. When a doctor orders something, dont not give it because you disagree. At the very least, you must tell him you didnt do whatever.
3. Stat means now.
4. Dont make up rules about what can and cannot be done.
3.

 

[colbgw02]

Don't page overnight for logistical issues if possible. Try to keep your pages confined to medically relevant issues. Sometimes the two overlap, like when PRN medication orders are about to expire. That's why it's called the art AND science of nursing.

Oh.....wait.

 

[Purifyer]

Are you hot? haha
Dont say it doesnt happen

meh
umm

Really basic things I guess.. like.. if you want me to insert a catheter.. you COULD get the set out and have everything prepared. If I know someone for example, is a nurse who will do something as small as that, if she rings me for a job.. it automatically goes up the priority list compared to some other non-urgent job.

Don't tell me how to do my own job.. If I would like to know what you think (I often do) I will ask. I get so pissed with (a grossly incompetent) HDB nurse who, for example, will say 'You should give adenosine.. if you're not confident enough to do it, I'll get your boss' (for a patient with fast AF.. lol.)

Try to get on well with doctors. If you have a concern about a patient, discuss it with someone... maybe other nurses or a charge nurse first if its a pretty borderline thing (I think I've been paged... around 10 times for a HR of 45-55 in stable sleeping non cardiac patients)

At the same time try to be diligent.. if there is a problem with a patient I want to know about it now.. not at shift change when my pages/min goes up about 4x.

 

[Tired]

Please don't contradict me or correct me in front of patients. Sometimes I am wrong, or doing the wrong thing, I get that. But if you have an issue with something I said or am about to do, ask to speak to me outside the room. Whether you're right or wrong, the moment you have that conversation in front of the patient, one of us will lose credibility, which ultimately damages our patients' trust in the whole team.

And many times, because I rotate through so many services, I have learned to do things differently than you are used to. That does not make it wrong. Do not presume that just because the two docs you are used to working with don't do it the way I'm doing it, that I am "screwing up".

 

[Pir8DeacDoc]

Please don't contradict me or correct me in front of patients. Sometimes I am wrong, or doing the wrong thing, I get that. But if you have an issue with something I said or am about to do, ask to speak to me outside the room. Whether you're right or wrong, the moment you have that conversation in front of the patient, one of us will lose credibility, which ultimately damages our patients' trust in the whole team.

And many times, because I rotate through so many services, I have learned to do things differently than you are used to. That does not make it wrong. Do not presume that just because the two docs you are used to working with don't do it the way I'm doing it, that I am "screwing up".

Very well said. All each of us has is credibility and it's never appropriate to call that into question in front of the patient.

 

[Castro Viejo]

Hey folks,

Long story short - I'm working as a nurse on a cardiac floor while I finish the premed requirements.

For all you residents, fellows and attendings, what do you guys wish we would do to make your jobs easier?

CrazyPremed

Doesn't make my job any easier, but it just makes me cringe...

Please address me as "Castro" (preferably) or "Dr. Viejo," but don't do something foolish like use the nickname that somehow EVERYONE on the floor decided for me.

 

[smq123]

Please address me as "Castro" (preferably) or "Dr. Viejo," but don't do something foolish like use the nickname that somehow EVERYONE on the floor decided for me.

And especially don't call a resident a stupid nickname in front of his/her med students or interns. And, for the love of God, don't call a resident by a stupid nickname in front of his/her attending!

One of the CRNAs would constantly call my chief resident by some dumb nickname that she randomly decided for him. He took it (more or less) in stride, but it was an extremely idiotic nickname. He's a good resident, an excellent teacher, and a talented surgeon, but, as a med student, it's ... embarrassing when you hear your resident called by a ridiculous nickname all the time. (To say the very least.) If he weren't such a good resident, it would have been very easy to lose a lot of respect for him.

One absolutely awful day, the CRNA called him this nickname in front of the attending (who, by the way, also happens to be the chairman of surgery.) The poor resident - you could practically see him blush through his mask.

Long story short - I'm working as a nurse on a cardiac floor while I finish the premed requirements.

For all you residents, fellows and attendings, what do you guys wish we would do to make your jobs easier?

Wow, that's amazing that you're asking this.

Don't use the phrase "But that's the way we've always done it" and expect the resident to accept that as a "good" reason for doing something.

 

[Chronic Student]

If you call with a question have the chart/vitals/MAR handy to answer questions.

There are few things on this earth more annoying than answering a page while your extremely busy/sleeping and asking for a crucial piece of info to get the dreaded "Hold on, let me find the chart".

Also, sometimes we do things differently for a reason. Please don't assume that its a mistake because "They never order that". Please ask me. I usually let people know when something is different, but I can't talk with everyone who may take care of my patient.

-Mike

 

[Winged Scapula]

Understand the call and paging system at your hospital.

Just because "Dr. X" wrote the last order in the chart or the last note you saw, doesn't mean:

he is on call that night
he is the primary service for the patient
that he is still on service for that patient

Few things are more frustrating that getting a page about a patient because you wrote a note on them at ONE POINT IN TIME, because you wrote an order earlier in the day, etc. when you are home post-call, or just home.

There is a call schedule...please familiarize yourself with its location and try to make sure you are calling the correct person for the correct team (ie, do not call a consult service about an order the primary service wrote).

When you do call, please allow for some time for the person to call back. If its not an emergency, do not "bomb" page 5 times in 10 minutes....we may be in the bathroom, in the trauma bay, doing chest compressions. Most residents are quite diligent about returning pages; we will call back when we can.

When you call, do not leave the phone area or go into a room to do a procedure. It is very frustrating to be paged, answer immediately, only to hear that "oh, she went back into the patient's room" or "hmmm, can't seem to find the person who paged you". I don't expect you to stay there forever, but a few minutes would be nice.

Do not flirt with the male physicians and ignore or be rude to the female physicians. You may be looking to hook up with the male physicians, but be nice to me and I might introduce you to my handsome brother (or just generally make your life easier).

 

[Faebinder]

Understand the call and paging system at your hospital.

Just because "Dr. X" wrote the last order in the chart or the last note you saw, doesn't mean:

he is on call that night
he is the primary service for the patient
that he is still on service for that patient

Few things are more frustrating that getting a page about a patient because you wrote a note on them at ONE POINT IN TIME, because you wrote an order earlier in the day, etc. when you are home post-call, or just home.

There is a call schedule...please familiarize yourself with its location and try to make sure you are calling the correct person for the correct team (ie, do not call a consult service about an order the primary service wrote).

When you do call, please allow for some time for the person to call back. If its not an emergency, do not "bomb" page 5 times in 10 minutes....we may be in the bathroom, in the trauma bay, doing chest compressions. Most residents are quite diligent about returning pages; we will call back when we can.

When you call, do not leave the phone area or go into a room to do a procedure. It is very frustrating to be paged, answer immediately, only to hear that "oh, she went back into the patient's room" or "hmmm, can't seem to find the person who paged you". I don't expect you to stay there forever, but a few minutes would be nice.

Do not flirt with the male physicians and ignore or be rude to the female physicians. You may be looking to hook up with the male physicians, but be nice to me and I might introduce you to my handsome brother (or just generally make your life easier).

You got enough symbols under your avatar there Coxie?

 

[Winged Scapula]

You got enough symbols under your avatar there Coxie?

I was playing around...(and it appears some of the other Admins were as well, because I didn't add ALL of the icons)...wondered when someone would notice.

 

[fab4fan]

Do not flirt with the male physicians and ignore or be rude to the female physicians. You may be looking to hook up with the male physicians, but be nice to me and I might introduce you to my handsome brother (or just generally make your life easier).

This is one of my pet-peeves. It's not "The Dating Game." It's unprofessional, not to mention it just reinforces the old stereotype about women only going into nursing to "catch a doctor."

That was a pretty impressive array of icons, Kimberli.

Reading some of this stuff makes me wonder what they're teaching/not teaching nursing students these days. Most of this should be stuff you learn in Nursing 101, if not good old common sense.

 

[smq123]

This is one of my pet-peeves. It's not "The Dating Game." It's unprofessional, not to mention it just reinforces the old stereotype about women only going into nursing to "catch a doctor."

 

[Blade28]

And, for the love of God, don't call a resident by a stupid nickname in front of his/her attending!

I've had this happen to me. Several times. By the same nurse.

There are few things on this earth more annoying than answering a page while your extremely busy/sleeping and asking for a crucial piece of info to get the dreaded "Hold on, let me find the chart".

So true!

There is a call schedule...please familiarize yourself with its location and try to make sure you are calling the correct person for the correct team (ie, do not call a consult service about an order the primary service wrote).
...
When you call, do not leave the phone area or go into a room to do a procedure. It is very frustrating to be paged, answer immediately, only to hear that "oh, she went back into the patient's room" or "hmmm, can't seem to find the person who paged you". I don't expect you to stay there forever, but a few minutes would be nice.

(1) I've given up on this one. I always assume that NO ONE knows the call schedule - I stopped arguing with nurses on this issue over a year ago. I expcet to get wrongly paged from now on. It's sad but true.

(2) One of my pet peeves! I almost got written up once because I was asking a nurse (who had disappeared TWICE right after paging me) to stay by the phone for a mere 30 SECONDS after she'd page me. 30 seconds! You can't stay by the phone for 30 seconds? Do you realize that I usually return my pages that quickly, and that if I had to wait 5 minutes each time I returned a page, I'd be wasting hours every day?

Several times, I've been paged by a nurse on the very same floor ward where I was located - and I'd glance over to the nursing station and see that no one was there. I'd pick up a phone and call the number on my pager anyway, and the phone would ring, but no one would answer. What the hell?

 

[CrazyPremed]

This is one of my pet-peeves. It's not "The Dating Game." It's unprofessional, not to mention it just reinforces the old stereotype about women only going into nursing to "catch a doctor."

That was a pretty impressive array of icons, Kimberli.

Reading some of this stuff makes me wonder what they're teaching/not teaching nursing students these days. Most of this should be stuff you learn in Nursing 101, if not good old common sense.

The truth is - they don't teach enough about this 'basic, common sense' stuff in nursing school. Maybe you can write a book, fab4fan. I'd definitely buy it! That's why docs have to put up with it year after year.


And - BTW - I'm a guy.



CrazyPremed

 

[Winged Scapula]

The truth is - they don't teach enough about this 'basic, common sense' stuff in nursing school. Maybe you can write a book, fab4fan. I'd definitely buy it! That's why docs have to put up with it year after year.

It shouldn't have to be taught...that's why its called "common sense". I guess its not so common.

When you call your mother, you don't walk away from the phone while waiting for her to answer.

If she doesn't answer the first time you call her, you don't call her 5 times in 5 minutes.

If you called your mother about a problem with a dinner recipe, you would have the recipe there in front of you, wouldn't you?

If your mother doesn't want to be called during her Bingo nights, and tells you to call her sister if you have a problem, and you have the Bingo Night schedule on your refrigerator, you don't ignore the schedule and continue to call Mom and then get mad at her when she doesn't answer, call your aunt and tell her how horrible your Mom is for not answering and then proceed to write a letter detailing how you called Mom over and over and she didn't answer.

And - BTW - I'm a guy.

CrazyPremed

That still doesn't excuse you from flirting with the male physicians.

 

[Blade28]

When you call your mother, you don't walk away from the phone while waiting for her to answer.

If she doesn't answer the first time you call her, you don't call her 5 times in 5 minutes.

If you called your mother about a problem with a dinner recipe, you would have the recipe there in front of you, wouldn't you?

If your mother doesn't want to be called during her Bingo nights, and tells you to call her sister if you have a problem, and you have the Bingo Night schedule on your refrigerator, you don't ignore the schedule and continue to call Mom and then get mad at her when she doesn't answer, call your aunt and tell her how horrible your Mom is for not answering and then proceed to write a letter detailing how you called Mom over and over and she didn't answer.

Those are great analogies!

 

[fab4fan]

It shouldn't have to be taught...that's why its called "common sense". I guess its not so common.

When you call your mother, you don't walk away from the phone while waiting for her to answer.

If she doesn't answer the first time you call her, you don't call her 5 times in 5 minutes.

If you called your mother about a problem with a dinner recipe, you would have the recipe there in front of you, wouldn't you?

If your mother doesn't want to be called during her Bingo nights, and tells you to call her sister if you have a problem, and you have the Bingo Night schedule on your refrigerator, you don't ignore the schedule and continue to call Mom and then get mad at her when she doesn't answer, call your aunt and tell her how horrible your Mom is for not answering and then proceed to write a letter detailing how you called Mom over and over and she didn't answer.



That still doesn't excuse you from flirting with the male physicians.

I think if some nurses had to carry a pager 24/7, they'd understand more clearly the difference between appropriate v inappropriate pages. When I was the on call nurse for hospice, I used to get all sorts of crazy pages at all hours from LTC nurses. Some of the stuff used to leave me speechless. It's one thing to get pages from panicked family members, but you expect at least a minimal level of competence from people who have a license. At least I did. (Note the use of the past tense). It was one of the reasons I left hospice.

I can't imagine the frustration of covering calls for multiple services.

 

[Blade28]

I think if some nurses had to carry a pager 24/7, they'd understand more clearly the difference between appropriate v inappropriate pages.

Some nurses here are supposed to carry an in-house mobile phone with them at all times, whenever they're working during a shift. Know what usually happens? Those phones get left on a desk somewhere at the nurses' station. Or they don't carry them around when taking a break, in the cafeteria, etc.

Wish we could do the same with our pagers.

 

[johankriek]

Hey folks,

Long story short - I'm working as a nurse on a cardiac floor while I finish the premed requirements.

For all you residents, fellows and attendings, what do you guys wish we would do to make your jobs easier?

CrazyPremed

DOnt talk to me? dont address me unless i address you

 

[gutonc]

Some nurses here are supposed to carry an in-house mobile phone with them at all times, whenever they're working during a shift. Know what usually happens? Those phones get left on a desk somewhere at the nurses' station. Or they don't carry them around when taking a break, in the cafeteria, etc.

Wish we could do the same with our pagers.

At the VA, the nurses carry the mobile phones but still page you to the nursing station instead of their direct # so you still have to wait for somebody to answer, find out who paged you and then wait for it to be transferred and for the nurse to pick up.

 

[f_w]

I wish my nurses would...

Put a pot of fresh coffee, milk, sugar and some mugs on the conference table for am conference (oh the good old days of Sr Aquilina...).

 

[Southpaw]

It shouldn't have to be taught...that's why its called "common sense". I guess its not so common.

When you call your mother, you don't walk away from the phone while waiting for her to answer.

If she doesn't answer the first time you call her, you don't call her 5 times in 5 minutes.

If you called your mother about a problem with a dinner recipe, you would have the recipe there in front of you, wouldn't you?

If your mother doesn't want to be called during her Bingo nights, and tells you to call her sister if you have a problem, and you have the Bingo Night schedule on your refrigerator, you don't ignore the schedule and continue to call Mom and then get mad at her when she doesn't answer, call your aunt and tell her how horrible your Mom is for not answering and then proceed to write a letter detailing how you called Mom over and over and she didn't answer.



That still doesn't excuse you from flirting with the male physicians.

Wow! Those are some serious analogies there Dr. Cox!

 

[Blade28]

At the VA, the nurses carry the mobile phones but still page you to the nursing station instead of their direct # so you still have to wait for somebody to answer, find out who paged you and then wait for it to be transferred and for the nurse to pick up.

Ah yes, that happens here too.

It's the tech/aide who pages you, so they can't take verbal orders over the phone. Then you have to hold AGAIN while they get the nurse.

Uh, if you're paging me for a verbal order, why not have the person who can take said order answer the phone?

 

[Tired]

And especially don't call a resident a stupid nickname in front of his/her med students or interns. And, for the love of God, don't call a resident by a stupid nickname in front of his/her attending!

There is a flip side as well: Just because the attendings/chiefs have nicknamed me something, it doesn't give you license to call me the same thing.

One of my attendings gave me a nickname that I cannot repeat here (suffice it to say it is a slang term for male genitalia, and does not start with a "d" or "p"). It's funny when the attendings and residents use it, because I know where I stand with them (a good place). When others use it who I don't know as well, it is not appropriate.

 

[Drogba]

There is a flip side as well: Just because the attendings/chiefs have nicknamed me something, it doesn't give you license to call me the same thing.

One of my attendings gave me a nickname that I cannot repeat here (suffice it to say it is a slang term for male genitalia, and does not start with a "d" or "p"). It's funny when the attendings and residents use it, because I know where I stand with them (a good place). When others use it who I don't know as well, it is not appropriate.

What about if people, say for example, myself, start calling you Dr.

around SDN? Would that be acceptable? It does have both nice assonance and consonance...

 

[Tired]

What about if people, say for example, myself, start calling you Dr.

around SDN? Would that be acceptable? It does have both nice assonance and consonance...

There can be only one Cox . . .

 

[smq123]

/

 

[tr]

When you call your mother, you don't walk away from the phone while waiting for her to answer.

If she doesn't answer the first time you call her, you don't call her 5 times in 5 minutes.

If you called your mother about a problem with a dinner recipe, you would have the recipe there in front of you, wouldn't you?

If your mother doesn't want to be called during her Bingo nights, and tells you to call her sister if you have a problem, and you have the Bingo Night schedule on your refrigerator, you don't ignore the schedule and continue to call Mom and then get mad at her when she doesn't answer, call your aunt and tell her how horrible your Mom is for not answering and then proceed to write a letter detailing how you called Mom over and over and she didn't answer.

Great post. I feel like printing it out and hanging up a copy in each of the nursing stations around here.

When you call, do not leave the phone area or go into a room to do a procedure. It is very frustrating to be paged, answer immediately, only to hear that "oh, she went back into the patient's room" or "hmmm, can't seem to find the person who paged you". I don't expect you to stay there forever, but a few minutes would be nice.

This one really drives me crazy. The thing is that at our hospital it seems to be standard practice. I can't think of a single instance in which a nurse who paged me was actually present at the phone. Other people are (docs, techs, social workers, etc), but not nurses. Invariably they use the text page system from a distant COW to page you to the nursing station, where they aren't physically located. You can basically expect a 5-10-minute wait when calling any paging nurse.

I tried calling them out on it once or twice by saying "you know, it would be much more efficient if you could stay by the phone when you page." I got these blank stares and replies of "we're busy, we don't have time to wait by the phone." wtf???

 

[Bitsy3221]

If you page me, please wait in the nurses station. It would also be nice if, in said nurses station if you are not going to answer the phone, you could tell the Unit Clerk (or whoever does generally answer the calls) that you paged me, so that when I call back and I say who I am, I don't have to go through the rigamarole of repeating my name and service several times. (And I do NOT have a complicated name)

Yes--please have the chart in front of you. If you are calling me about an abnormal heart rate, I am probably going to ask you about the BP, Temp, UOP, etc. Just knowing the one value is not enough.

We recognize that you are on the front lines in terms of dealing with patients and families, and we know that they can be difficult and demanding sometimes. But if you are going to page me, please page me about a legitimate issue that I might actually have some control over, or just use common sense. I know that some POD#1 pts from a big abdominal surgery want to eat a regular diet, but you should realize that we are not going to feed this pt (who still has an NGT in). Paging me to let me know that "he wants to eat" is about the equivalent of me calling you at home and telling you that I want a million dollars--both would be nice, but its not going to happen. You do not actually have to page me every time a patient asks you to, if you know the answer to the question!

We round on every patient, every morning at roughly the same time. Please do not call me at 6:45 am for routine things ("are you going to take out his Foley? are you going to advance his diet? can we make the IV Zantac PO?") if you know we haven't been by to see him yet.

Again, we round on every patient, every morning. Paging me with the "Mr jones is upset b/c he hasn't seen a doctor is three days" is ridiculous. You and I both know this.

Please don't instruct patients or family members how to use the paging system directly. Please also don't page me to a random, unidentified number that is going to end up being a family member. I am sometimes caring for upwards of 50-60 patients at any given time, and I don't have all their data committed to memory, or even on my list that I carry around. Still, I know that family members expect that I do know their loved one backwards and forwards, so having to do a cold call to a family member without the benefit of having the chart in front of me is painful for all involved.

Along those lines, if you are going to call me to tell me that a pt or their family member is irate or "has a lot of questions," please try to feel them out for me & find out what they want to know or what they are upset about. As a resident, I may not have a lot of leeway in dictating their care, so if I know they want to know about certain issues that we may not have yet discussed as a team, I can fly that by my senior or my attending, thus actually being able to ANSWER the questions they want to ask me.

 

[Blade28]

I know that some POD#1 pts from a big abdominal surgery want to eat a regular diet, but you should realize that we are not going to feed this pt (who still has an NGT in). Paging me to let me know that "he wants to eat" is about the equivalent of me calling you at home and telling you that I want a million dollars--both would be nice, but its not going to happen.

 

[oompaloompa]

I don't know if nurses realize this, but one the most painful calls when you're the Crosscover or Nightfloat resident is: "Family has arrived (always after 7pm) and wants an update."

As a nurse, you should realize that often crosscover or nightfloat residents are often in charge of 30-50 patients, and are NOT the primary, so they only have the most basic pt data readily available. The job of these residents is to "put out fires" so to speak, not engage in extensive long-term plan review.
I realize sometimes these calls are unavoidable and they demand to specifically speak to a doctor, but most of the time they just want general news about what went on during the day. As someone who knows almost nothing about this patient, I generally don't have access to some magical source of information that the nurse doesn't. She can open the damn chart and look at today's progress note, because that's exactly what I'm going to do.
She won't of course, because that would take away time from her online shoe shopping, but she'll become extremely irate if I tell her I've got 3 other more pressing issues to attend before coming. She's not mad on the family's behalf, of course, but because she might be disturbed again during said shoe shopping.

Also, as a sidenote: I know nurses are the firstline of healthcare, which is an extremely important job. By definition then, as the firstline person, you will hear a huge amount of bitching. Please don't be the nurse that kicks every single complaint up. Things that are inconvenient to you are regrettable, but don't expect an inconvenience to you to be an emergency to me. I'm a nice person and will often take measures to help a nurse out, but demanding immediate attention on a nothing issue is a fast way to turn me into a dick. The following are real calls I've gotten as a crosscover.

"The patient can't find anything they like on the low-sodium diet, can you switch them to regular?"

"Patient has pain." (Diffuse, nonspecific and unchanged for the past 22 days, not changed now, what do you expect me to do at 3am)

"I've been giving 4mg, but I just realized the order said 6mg, can you come and say it's okay to give 4mg." (Sorry, I'm not in the business of writing orders to retroactively cover your ass, start giving what's written)

Anyway, as they say "common sense ain't so common" but if as a nurse you just stop and think about things and avoid reflexive "protocol-driven" action, you can really help the docs out. Thanks for seeking input, it's very refreshing.

 

[Mad Dog]

what do you guys wish we would do to make your jobs easier?

CrazyPremed

Just keep thinking like that and you're already there!

If often seems the relationship with nurses in a teaching hospital was designed to be as aggravating as possible. ie. get your digs in while the doc is young and powerless. To be actually trying to make our lives easier -- unheard of! You’re like a secret double agent there, Crazy! Just wanting to help us out is gold.

 

[tr]

I don't know if nurses realize this, but one the most painful calls when you're the Crosscover or Nightfloat resident is: "Family has arrived (always after 7pm) and wants an update."
...
As someone who knows almost nothing about this patient, I generally don't have access to some magical source of information that the nurse doesn't. She can open the damn chart and look at today's progress note, because that's exactly what I'm going to do.

I refuse those. I tell the nurse to let the family know that I am just emergency cover and that they will have to speak to the primary team, available in the AM, if they want any information.

I think it is just easier for the nurses to page the covering doc and then tell the family "Sorry, x-cover said you'll have to speak with the primary" than to take the heat for why they won't page. That way they can just blame the absent doc and not have to deal with explaining the coverage system to the family themselves. I might do the same in their position, who knows.

Also, for the BS pages I think lot of times they are just paging to CTA anyway and don't really expect an answer... they just want to make sure someone has been paged so if something unforeseen happens they can pass the buck upstream... FYI text pages are good for that.

Anyway, and yeah, I echo the kudos for CrazyPremed. As others have said, if the idea of making the residents' life easier has crossed your mind at all you are already way, way ahead of most of the nurses I've met.

 

[Annette]

Crazy Premed, thanks for asking, and please don't be offended by some of the comments. Most of us hate our pagers.

My biggest pet peeve is nurses paging me to ask "when are you going to see . . ." For some strange reason, they get very upset with me when I won't give them a time. If I give you a time, and I don't make it because I end up having to see a crashing patient, then the family/pt gets upset.

I WILL eventually see the patient. Every time I get paged with this question delays me getting to see the patient. I have to stop what I'm doing, find a phone, wait for the call to be answered, and wait for the person who paged me. In all, it may take no more than 5 minutes. Having a consultant page me from his home to get me to see the patient faster isn't going to help matters any. But after 7 of these pages (yes, I have had that many in one day), I've wasted 35 minutes and a lot of patience! If the patient is in some discomfort (wanting diet change, puritis, etc), ask me for an order! If the patient is not doing well, ask me come see the patient sooner than later. I will get there asap. But if you are paging me to ask me when I'm going to see the patient because the family wants to know, forget it!!!!!!!!!!!!

 

[Winged Scapula]

Sometimes we actually ask for things to be done, which may seem to inconvenience you and the patient, but are for a good reason.

For example, when I ask for am labs to be drawn (on the floor) at 4:30 am this is because I know they will not be back until 6:30 am at the earliest and the results of those labs may decide whether or not the patient goes to the OR that morning.

I know it means waking up the patient.

I know that since phlebotomy doesn't come in that early that means you have to draw the labs.

I don't care.

On a related note, please don't page me at 5:30 am with normal labs unless I have asked you to.

Do not page me at 5:25 am with a non-urgent matter if you know that we round every day at the same time (as noted in another post above). You have worked here long enough to know what time we round in the am and that yes, we round every day, even twice a day.

We HATE the page, "are you going to see Mr. Jones today?" We see every patient, every day, at about the same time. There is no reason we would NOT see Mr. Jones, so don't bother calling and asking if we are going to. If we're a little late, its because another patient needed us more urgently.

Please understand the hours residents work. We do not work shifts. You may be wide awake at 0300, but it may very well be in the middle of a 30+ hour stint for me. Do not act suprised when I sound groggy and perhaps not a little disgruntled when you call me with a non-urgent issue at that time. Not all places have night float.

Do not lie to me and tell me you've really really tried to start an IV on a patient when you really haven't. Patients will tell us when you haven't and I know all the places you would try; if there isn't a needle hole and/or some bruising, I know you are lying and just didn't want to try.

 

[Blade28]

I refuse those. I tell the nurse to let the family know that I am just emergency cover and that they will have to speak to the primary team, available in the AM, if they want any information.

It's not even the immediate family, nor at 7 pm. It's often the patient's cousin's boyfriend, asking for updates at 10 pm the day before the patient is going to be discharged home. Never mind the fact that the patient has been in the hospital for the past 15 days.

Please understand the hours residents work. We do not work shifts. You may be wide awake at 0300, but it may very well be in the middle of a 30+ hour stint for me. Do not act suprised when I sound groggy and perhaps not a little disgruntled when you call me with a non-urgent issue at that time. Not all places have night float.

One of my biggest pet peeves. We don't work shifts. We don't work "8s" or "10s" or "12s." We don't work "7P to 7A." We don't work three 12-hour shifts a week.

 

[LovelyRita]

If I write an order, do it.

Take care of your patient between the med dispension and the end of your shift.

Go ahead and change that nasty foot dressing.

Or that nasty IJ catheter dressing.

Handle the IV pump when it's beeping.

Just the simple things.

 

[MR1]

On cross cover I hate when you get a page anytime after 5-6pm, esp when it happens at 2am about a patient with a HR of 105 and when I ask it has been like that all day, or hell like that for 3 days. Same with BP, the other night I got a 1am page about a BP of 150/100, so I ask is that new and what was his pressure earlier today, it was like that for the past 2 days and they wanted me to take care of it then. Please ask the primary team these questions. Of course a BP of 180/100 all of a sudden when it has been below 140/80 I will evaluate and treat.

On BP for that matter, I wish everyone wouldn't get so excited about HTN urgencies. Yes I know a BP of >180/100 is scary looking but if the patient is stable and doesn't have end organ damage going on you don't want to slam them with IV whatever and get their pressure down to 140/80 in 5 min which can actually be bad for these patients.

 

[Winged Scapula]

To defend the nurses regarding vital signs calls:

if you write an order which says "routine call orders" or do not otherwise specify parameters, you WILL get a call when the heart rate is above 80, or below 60 or the BP is above 140, etc. Take a little care to review these for your cross-cover colleague and for yourself and if you have a patient whose HR routinely runs below 60, modify your orders to specify a lower call parameter.

It is all fine and well that we ask our nursing colleagues to think a little when paging, but if they violate your orders and something goes wrong, they're in trouble.

Ok back to business:

it is not your decision about whether or not a patient needs a test. And it is certainly not your business to tell the patient they "really don't want that CT/MRI/blood draw, etc." if it has been ordered by their physician. When you question the order in front of the patient, as noted above it undermines the faith in the entire medical team.

if I've ordered a stat test for a patient and it isn't getting done (ie, because transport hasn't arrived, the lab hasn't come up, etc.), it is your responsibility to see that it gets done and now. If that means YOU wheel the patient down to the scanner or draw the blood yourself, so be it. If you really have a problem getting the test, let me know. I do not want to find out an hour later that nothing has been done yet.

 

[LovelyRita]

Don't interrupt me while I'm rounding with my attending to tell me that another patient's JP output looks funny. If I'm standing with an attending, do not interrupt our conversation unless it pertains to the patient whose room we are standing outside of.

 

[Ada2004]

Wow you guys seem really upset. Anyway I myself am a nurse starting medchool in Fall of 08. I do agree with some of the complaints. My biggest pet peeve of nurses is when they tell instead of suggest a medication or treatment mainly to interns. My sister is an intern and that happens all the time where she works, she calls it WHITE COAT SYNDROME.
For Kimberly Cox and the stat tests, pls remember nurses generally have more than one pt., so if someone cannot cover our patients while we are gone we cannot leave the floor. However, you can gladly take the patient down yourself or wait until time permits. On the contrary, I do think some resources can be sought to make sure that a pt who needs a test immediately will be able to get it done in a timely manner.

 

[f_w]

...don't make up a 'policy' if none such policy exists (but the putative policy is one that makes your life easier).

 

[Winged Scapula]

For Kimberly Cox and the stat tests, pls remember nurses generally have more than one pt., so if someone cannot cover our patients while we are gone we cannot leave the floor. However, you can gladly take the patient down yourself or wait until time permits.

I wasn't upset at all until I read this post. Honestly, the OP asked for suggestions about what sort of things bothered us and we were merely listing them.

But do you think the physicians are just sitting around doing nothing if they aren't standing right next to you or seen on your floor? I'm in the operating room. I'm not scrubbing out to do your job. If you have more than one patient and they are all sick enough to require STAT nursing care, then YOU have to find someone to take care of my patient that also requires it.

Its about priorities. I realize you have more than one patient. So do I and I've also got other things to do as well. If one of them needs something immediately, I expect you to decide whether or not whatever the other patients need is more important than what my patient does at that moment in time. If I am truly doing nothing else, then I have no problem taking the patient down to the CT scanner or drawing the labs myself - I've done it many times.

On the contrary, I do think some resources can be sought to make sure that a pt who needs a test immediately will be able to get it done in a timely manner.

Exactly. And that is YOUR job because if I don't know that you don't have the resources to get the test done immediately, I cannot help you. That is a problem for your nursing supervisor to fix...staffing issues are not my problem.

I'm sorry if this came off as harsh, but really, your post is quite upsetting.

 

[Bitsy3221]

For Kimberly Cox and the stat tests, pls remember nurses generally have more than one pt., so if someone cannot cover our patients while we are gone we cannot leave the floor. However, you can gladly take the patient down yourself or wait until time permits. On the contrary, I do think some resources can be sought to make sure that a pt who needs a test immediately will be able to get it done in a timely manner.

This brings up another point.....as a resident, I have many, many responsibilities outside of the particular floor that you work on. If I am not on your floor seeing patients, it does not mean that I am sleeping or sitting in a lounge somewhere. I do not get someone to relieve me for lunch, or give me a break. There is nothing that guarantees me even a chance to use the bathrooms some days. If I am not on the floor, I am probably in the OR, ICU, another floor or the ER with some new emergent consult or trauma patient. And yes, these these sometimes coincide with me needing a STAT test on one of your patients. It is not that I don't want to "gladly take the patient down myself"--it is that I simply can not.

More times than not, it is much, much easier for you or your supervisor/charge nurse to find coverage than it is for me to leave the OR to wheel a patient to CT. Sometimes, you are just going to have to call someone from another floor. You HAVE to figure out a solution yourselves sometimes.

As one of my chiefs always says in these situations: your staffing issues is not my problem to fix.

 

[BSN2DOC]

To defend the nurses regarding vital signs calls:

if you write an order which says "routine call orders" or do not otherwise specify parameters, you WILL get a call when the heart rate is above 80, or below 60 or the BP is above 140, etc. Take a little care to review these for your cross-cover colleague and for yourself and if you have a patient whose HR routinely runs below 60, modify your orders to specify a lower call parameter.

It is all fine and well that we ask our nursing colleagues to think a little when paging, but if they violate your orders and something goes wrong, they're in trouble.

So true. Nurses need to cover their own butts, just like physicians do. In regards to the biggest pet peeve I have about physicians is when they get IRATE when I call them about a critical value.

Our hospital has a policy where if the stat lab calls me with a critical value, we are REQUIRED to call the resident/physician immediately and document it. These "critical lab values" often need no interventions, but it is still required we call. If it requires no intervention, the resident/physician usually becomes irate that I called them at 3:00 a.m. I always explain that this is a hospital requirement (even though most of them know this already) but they still don't care.

 

[BSN2DOC]

Wow you guys seem really upset. Anyway I myself am a nurse starting medchool in Fall of 08. I do agree with some of the complaints. My biggest pet peeve of nurses is when they tell instead of suggest a medication or treatment mainly to interns. My sister is an intern and that happens all the time where she works, she calls it WHITE COAT SYNDROME.
For Kimberly Cox and the stat tests, pls remember nurses generally have more than one pt., so if someone cannot cover our patients while we are gone we cannot leave the floor. However, you can gladly take the patient down yourself or wait until time permits. On the contrary, I do think some resources can be sought to make sure that a pt who needs a test immediately will be able to get it done in a timely manner.

I have to defend the doc's on this one. It is NOT the residents/physicians job to do this. This is an RN's duty and we are expected to fulfill the orders written by the doc. It is upto the RN to figure out what resources are available to fulfill the orders.

 

[Winged Scapula]

So true. Nurses need to cover their own butts, just like physicians do. In regards to the biggest pet peeve I have about physicians is when they get IRATE when I call them about a critical value.

Our hospital has a policy where if the stat lab calls me with a critical value, we are REQUIRED to call the resident/physician immediately and document it. These "critical lab values" often need no interventions, but it is still required we call. If it requires no intervention, the resident/physician usually becomes irate that I called them at 3:00 a.m. I always explain that this is a hospital requirement (even though most of them know this already) but they still don't care.

There is generally very little reason to get irate but I can understand being displeased about being woken up with a critical value which requires no intervention.

Obviously the policy is there for your protection and that of your patients. Perhaps these physicians should learn not to order labs which will result in a middle of the night phone call.

 

[CrazyPremed]

That still doesn't excuse you from flirting with the male physicians.

I gotta get those LORs somehow!

CrazyPremed