I wish my nurses would...

[Tired]

I can overstand how someone without honor, integrity, perseverence, or intestinal fortitude would NOT understand my signature...

I understand it very well. I just think it's stupid to try to use your military service to justify a title that you didn't earn (ie - by going to medical school).

---

Members don't see this ad.

 

[Castro Viejo]

Sure... you continue to try to make this about me... but its pathetic, sad and weak...!!!

I can overstand how someone without honor, integrity, perseverence, or intestinal fortitude would NOT understand my signature...

I really hope YOU grow up before they let you loose on patients independently...

Relax... That 15 minute break is coming, "Doctor."

 

[swpm]

That's a good place too, but there you actually have to do some nursing. In pre-op, its mostly chart check, maybe start an IV here and there (or just page anesthesia to come and do it), page surgery to mark patient, page surgery because you can't find the consent ("oh, THERE it is...sorry), page anesthesia for consent, rinse, repeat all day.

As opposed to the OR nurses, who spend their time doing ... wait, what is it they do again?

 

[smq123]

As opposed to the OR nurses, who spend their time doing ... wait, what is it they do again?

They yell at residents and "keep them humble."

If they have some free time, they'll invent ways in which they saw you "compromise patient care."

 

[fab4fan]

I have been known more than once to say, without violating HIPAA, we have someone crashing...but I'll get to it as soon as I can, or...we have a situation with security, once the fires are out, I'll get right on it.

As for vital signs...please, please, please quit writing "notify MD for SBP>180 or <100, DBP>100, HR>110 or <60," on the cardiac floor when a pt is admitted for a diagnosis of cardiac arrhythmia or HTN, and
1. already has PRN orders for IV lopressor or apresaline for HTN
2. already has pacer pads on "just in case"
3. has amio or cardizem infusing.
You are setting yourself up for unnecessary pages, or you really hate the resident doing night call.

I mean seriously...I really don't want to call for a pulse of 38, BP 122/66 on a sleeping pt, when his baseline while awake is pulse 44 BP 130/72, diagnosis bradycardia...rhythm sinus with 1st degree AVB and inverted T waves, troponins negative, EKG shows old infarct. I won't call...but believe me...some idiot probably will.

And more than likely, your idiot co-worker will write you up for not having called.

 

[Faebinder]

And more than likely, your idiot co-worker will write you up for not having called.

No good deed goes unpunished

 

[telenurse]

No good deed goes unpunished

That's the truth...

 

[swpm]

They yell at residents and "keep them humble."

If they have some free time, they'll invent ways in which they saw you "compromise patient care."

I honestly don't understand why hospitals don't just hire Walmart greeters to do the the OR nurse job at 1/5th the cost. It's not like any medical knowledge or specialized skills are required to call timeout or fetch another pack of sutures, and at least the greeters have work experience with smiling and attempting to be helpful.

 

[smq123]

I honestly don't understand why hospitals don't just hire Walmart greeters to do the the OR nurse job at 1/5th the cost. It's not like any medical knowledge or specialized skills are required to call timeout or fetch another pack of sutures, and at least the greeters have work experience with smiling and attempting to be helpful.

I was thinking about this when I was on surgery.

If you were really mercenary about it, you technically wouldn't have to hire anybody to do the job of a circulating nurse. There must be dozens and dozens of pre-meds in your area who are DYING to go into the OR and gain "clinical experience." Most of them are fairly smart (if they can get an A in orgo, then they can do the job of a circulating nurse with minimal training - maybe 2 weeks, tops).

Plus, if you promise them a good LOR from the attending, they'll circulate through the whole case - if they complain that they didn't get a chance to eat lunch or take a break, just say "Well, the third year med student didn't get to go to the bathroom - so I guess you're not tough enough to be a med student...." That'll shut them up.

I was also thinking that a fourth year med student who is going to go into gen surg could also do the work of a scrub tech with 2 weeks of training, but I figured that that was going a little far.

 

[swpm]

I was also thinking that a fourth year med student who is going to go into gen surg could also do the work of a scrub tech with 2 weeks of training, but I figured that that was going a little far.

The difference between a good scrub tech (who's familiar with the surgeon, pays attention to the procedure, anticipates what's going to be needed) and a bad scrub tech (stares at the wall and waits to be directed to do everything) is significant. I have a lot of respect for good scrub techs.

I like the two-week premed circulator training program idea though.

 

[smq123]

The difference between a good scrub tech (who's familiar with the surgeon, pays attention to the procedure, anticipates what's going to be needed) and a bad scrub tech (stares at the wall and waits to be directed to do everything) is significant. I have a lot of respect for good scrub techs.

I agree - I also have a lot of respect for good scrub techs. But I've also had a few bad scrub techs, and it seemed like a 4th year med student who is going into surgery would do a better job than those bad scrub techs. Specifically, they would do exactly what you mentioned - pay attention to the procedure (purely out of interest), and anticipate what's going to be needed (which they will need to do as surgery PGY-1s).

But a 4th year med student could never do a better job than a good scrub tech.

******
If you're a nurse, I understand that it's nice to sit down with your friends and ooh and ahh over wedding pictures, baby pictures, etc. But please don't sit down in a huge gaggle in front of a computer, especially in the morning when we're pre-rounding on patients. Or, if you do sit down in front of a computer that you're not using, be a sport and move away for a few minutes - I'm not even asking you to give up your seat! I just need a computer to enter orders/check labs/look at x-rays. Please?!?

 

[doctawife]

I wish my nurses today would just freaking work together. We had a triage nurse basically refuse to escort (or find someone to escort) the patient from triage to the OBS unit. This is a problem, 'cause getting to OBS, and not Fast Track, can be kind of tricky. And, when the patient ends up in Fast Track by accident, it delays care by hours and hours. When she refused the first time, my OBS nurse very correctly called down to triage to address the problem. No heat from her side - she just wanted to make sure it didn't happen again.

The triage nurse threw a hissy fit. And ya know what? The second patient she sent up got lost too. Not as lost, and not for nearly as long (we suspected triage might do something dumb again), but still. I really shouldn't have to get involved in this ****. If the nurse manager hadn't been on vacation this week, I wouldn't have had to stick my nose into the situation. Grr...

 

[Farmer Jane]

So I'll just jump right into the lion's den...

Hi. I'm an RN, eventually hope to earn my MSN and teach, which is my absolute passion. A friend and I will graduate in May 2011 and intend to be the worst battle-axes our students have ever encountered. Reading here was interesting, I joined, and will hopefully snag my brother into joining, as he is pre-med.

Anyway, I agree with many here on both sides of the equation. I work in a sub-unit of the ER, doing the entire admission process on patients and transferring them to the floor. While there are a ton of great nurses out there, I am continually appalled and frustrated by so many nurses' lack of common sense, forward thinking, and professionalism. I could probably write a three page paper on the subject, but in short: So many problems between physicians and nurses could easily be solved by communication and consideration on both sides. For example, when I call the admitting doc for orders I have the chart in front of me, I've reviewed it, I've assessed the patient, have a complete medication reconciliation, and notes to myself on what orders I need. Something as small as making sure I ask the doc for prn meds such as milk of mag and acetaminophen saves a lot of hassle later on.

On the flip side, the difficult working conditions of nurses are far too frequent, very real, and cannot easily be solved. Regardless of how much a patient may need blood work done, if the lab is currently cleaning the machine for the test it's not going to get done and there is literally nothing I can do about it. I wish I was able to intuitively know a patient's platelet level, but if I had that particular talent I'd spend my days sewing and quilting and make all the money I needed via occasional phone calls to the high-risk L&D floor. There are many issues like that. While I would never insinuate that staffing issues are the problem of the physician, it's not a problem I can easily solve either.

There are many issues like this. I've had to call pharmacy multiple times before they prepare an urgent med. There is nothing I can do about this. I can call them, I can explain, heck I've offered homemade cookies (seriously). But that's it. So while I understand that you expect me to do everything in my power to make something happen, please understand when I truly cannot. Most of these issues have similar flip sides: I promise I will not contradict you in front of a patient. Please extend me the same courtesy.

To be honest, I think that many changes need to be made throughout the entire field of nursing: education, orientation, work environment including RN staffing and support staff, and systems that facilitate communication rather than hinder it (if anyone here is familiar with Vocera, you know what I mean).

 

[Tired]

On the flip side, the difficult working conditions of nurses are far too frequent, very real, and cannot easily be solved. Regardless of how much a patient may need blood work done, if the lab is currently cleaning the machine for the test it's not going to get done and there is literally nothing I can do about it. I wish I was able to intuitively know a patient's platelet level, but if I had that particular talent I'd spend my days sewing and quilting and make all the money I needed via occasional phone calls to the high-risk L&D floor. There are many issues like that. While I would never insinuate that staffing issues are the problem of the physician, it's not a problem I can easily solve either.

While these are real problems, bringing this up is also a common diversion used in nursing to obscure the real problems we have with certain nurses.

If you read over the litany of complaints on this board, you will see that we recognize the difference between a problem out of the control of the nurse, and a problem with the nurse herself/himself.

 

[Farmer Jane]

While these are real problems, bringing this up is also a common diversion used in nursing to obscure the real problems we have with certain nurses.

If you read over the litany of complaints on this board, you will see that we recognize the difference between a problem out of the control of the nurse, and a problem with the nurse herself/himself.

I do realize that many complaints about nurses are valid (believe me--I often share them, unfortunately). I do not mean this as a diversion but rather an explanation/assessment: I think some of what you see from nurses is frustration from a very non-supportive administration. I'm not saying that makes it okay to give substandard care. Just trying to point out that there are valid things we deal with and can't easily solve. That said, you are certainly justified in being aggravated when things really could be solved but no one is willing to expend the effort.

ETA: Again, I absolutely recognize that most physicians are not like this, but the example about lab equipment being down was real. I have been literally screamed at because the lab's machine was down so there was no way to do a CBC.

 

[doctawife]

I have been literally screamed at because the lab's machine was down so there was no way to do a CBC.

That's the kind of doctor that drives me nuts. That kind of doc also calls me up and yells at me to see the patient he sent to the EC IMMEDIATELY, despite the other 40 people in the waiting room. I personally think docs like that should do each of our jobs for a day - then see how he likes it.

 

[Orthonut]

Please don't tell the patient and/or his/her family that "Oh, Dr Orthonut will fix/cure your family member" when you haven't spoken to me, checked the call schedule/checked the day schedule, or checked with the attending/resident/intern/warm body-because I might be 3500 miles away at a professional conference, this particular client/patient/family member might be very...what's the word...NEEDY/crazy and that might delay/prevent/obstruct the proper patient care-this has happened to me/classmates/colleagues more than once. Just...know your limits I guess is what I'm trying to say.

I'm not talking about saying something like "the Dr will be in as soon as he/she is available" type things-I mean please, I beg you, don't tell them "Dr ABC will do _________ procedure at _______ time and ________ result will happen " (paging Murphy's Law)

or "Dr _________ will save/cure patient" (I actually had someone tell a client over the phone"oh don't worry Mr X, Dr you are pathologically attached to will fix everything" w/o checking with me (mind you I was standing right there and was frantically gesturing, even wrote a huge note "DR IS AT CONFERENCE IN FLORIDA!!!!!Pt needs to be transferred to (tertiary care center) STAT!!!! PT IS CTD!!!!!!!!!!" in red sharpie and shoved it in his face-ultimately delayed care which resulted in the demise of the patient and not only damaged the clinic's image in the client's eyes but emotionally scarred the technical staff permanently)


/rant, open apology:I'm sorry, I'm just still really worked up over that case. It was extremely traumatic. If only... (btw, person did get severely reprimanded)

But the OP isn't going to massively Foxtrot Uniform in the above manner, I can tell because he is actively seeking to gain knowledge on how to avoid errors.

 

[Farmer Jane]

I've often thought that a prerequisite to any nursing program should be a course in elementary logic and critical thinking. Just don't tell my coworkers I said that.

 

[fab4fan]

Dear God.

Please don't take this the wrong way, but I can't imagine anything that would induce me to say "Dr. So-and-So will cure your father/mother/wife/husb./etc." It boggles my mind that someone would say that out loud, even if he/she believed it. It's one thing to convey confidence about a physician to a pt/family, but what you described--yikes. Besides which, you weren't even there.

Sounds like a terrible situation.

 

[Farmer Jane]

Yup. These stories just make me want to scream, but unfortunately they don't surprise me. What possesses people to act like this??

 

[Tired]

Dear God.

Please don't take this the wrong way, but I can't imagine anything that would induce me to say "Dr. So-and-So will cure your father/mother/wife/husb./etc." It boggles my mind that someone would say that out loud, even if he/she believed it. It's one thing to convey confidence about a physician to a pt/family, but what you described--yikes. Besides which, you weren't even there.

Sounds like a terrible situation.

I've never heard of such a thing.

Notice that the post came from a Vet Student. What?

 

[fab4fan]

I've never heard of such a thing.

Notice that the post came from a Vet Student. What?

What? Are we talking about a human patient? I mean, I loved my pets, but if the brouhaha he described was over an animal, then that's a whole different ballgame.

Any way you slice it, it was weird.

 

[telenurse]

I wish my nurses would not tell the resident, "I don't think we'll need a femline telenurse will definitely be able to start that IV for the blood transfusion, she's a great sticker, she'll most likely get it on the first or second stick!"
when the pt has a 3 year hx of hemodialysis, LUE AV shunt, every peripheral vein on RUE blown by multiple attempts, severe PVD so can't go in legs, no vein left big enough for a 24 guage, much less something large enough to handle a transfusion. Telenurse has a migraine and can't see out of right eye r/t seeing scintillating scotoma.

Oh wait a minute...I am a nurse...that was my freaking coworkers...arrrgghhhh

 

[WhtsThFrequency]

if the brouhaha he described was over an animal, then that's a whole different ballgame.

It's the same concept. The support staff not communicating with the actual doctor, resulting in lack of proper care for patient...I've seen some pretty bad assisting in the clinic I worked in...

We can get a lot of people who like seeing certain vets, and they ask to see them in particular. Their horse may be downed with GI torsion/colic, their Hereford in acute acidosis from grain overload, their dog might well by HBC, hypovolemic and entering shock.... they want Dr. X, and if the assisting or technician is not informed and says "Oh yes..let me page him, I will find him".....instead of KNOWING that Dr. X was at a conference, only Dr. Y was here, and all the while, their dog needs to be hooked up to fluids and shot up with dobutamine absolutely stat....this equals the animal sitting around and possibly dying/becoming even worse off because technician or assistant is not up to date with who is available.

They spend 10 minutes paging and calling to no avail, instead of knowing what is going on and immediately transferring patient to Dr. Y. I heard so many stories from my fellows in their clinical rotations at local vets...this happen too often, sometimes with the patient becoming nonrecoverable...

 

[Farmer Jane]

Wow, that's so out of my frame of reference. You need a vet, you call the vet clinic, whoever is on call comes out. No hissy fits, end of story. I'm from BFE though.

 

[WhtsThFrequency]

You need a vet, you call the vet clinic, whoever is on call comes out

Usually it is that simple (I wish it always was!). It isn't, unfortunately, when you come to the huge teaching hospitals who not only have the local community, but everyone's referrals, emergencies, field services, etc. The licensed technicians (the equivalent of registered nurses in human medicine, I believe), assistants, and receptionists are key in keeping the correct communication flowing in such a (usually) frantic and fast-paced environment.

 

[Farmer Jane]

Forgive me, but I can't help but twitch--a vet tech is usually a one year program, so not equivalent to RN. Nothing wrong with vet tech, just having the two compared, what can I say?

I'm from a tiny, tiny town in rural Wisconsin (although I currently live in Milwaukee) so the idea of having such extensive veterinary care available just boggles my mind. Great that it exists though. It must be fascinating work.

 

[WhtsThFrequency]

Whoops! Sorry, I don't know what training an RN receives...I assumed (wrongly?) it was about the same as a licensed Vet Tech (which is actually 2 years, and sometimes 4 years depending on the school) What education/train reqs does a RN have? I am curious.

I made the correlation more in terms of where they "stand" in the heirarchy/admin of a hospital, i.e
Doctor > RN > Assistant
Vet > LVT > Assistant


OT - but yes....vetmed ed has changed SO much...human and veterinary medicine are having more and more overlap what with issues like zoonoses, public health, food safety, epidemiology, etc. It is amazing how the profession has broadened - much, much more now that just "giving Fluffy vaccines" - thank goodness.

I plan to do my residency in clinical pathology...so not quite so much patient-client work here, but since it is (a lot of the time) the LVTs physically drawing and transporting to me the blood/urine/body fluid samples...by golly the method of collection and paperwork and general communication had better be right or my end is at a loss.

 

[Farmer Jane]

Things have certainly changed. The vet techs I knew didn't have that much education. Good for them.

As for comparing/contrasting with nursing education, you can supposedly earn an ADN in two years but the program doesn't really fit into two years even though some schools present it that way. I looked here: http://matcmadison.edu/matc/ASP/showcurriculum.asp?ID=4323 for the vet tech curriculum and it's set up so differently from nursing it's hard to truly compare the two. Generally in nursing you're taking microbiology, A&P, biochem, etc before entering the program. The VT program above show taking animal A&P during the final year. Ultimately I don't think the two can really be prepared because the roles are very different and the educational structure is very different.

On another note, the way this discussion has turned reminds me that it's time for my two cats to have their check-ups.

 

[Orthonut]

Dear God.

Please don't take this the wrong way, but I can't imagine anything that would induce me to say "Dr. So-and-So will cure your father/mother/wife/husb./etc." It boggles my mind that someone would say that out loud, even if he/she believed it. It's one thing to convey confidence about a physician to a pt/family, but what you described--yikes. Besides which, you weren't even there.

Sounds like a terrible situation.

Yup, that particular dumb@$$ was rather lacking in common sense.

Sure I can't trick you into coming over to the dark side? Or maybe we could just clone you?

 

[Farmer Jane]

Not Fab4, but gah I can't imagine how many animals we would have if I worked in the veterinary field. The only time my husband had ever told me what to do was after I went to the humane society to adopt a cat, and came home with a cat AND a 100 lb. dog, he issued the "Jane is not allowed to go to the humane society" edict.

And then there was the time I saw a golden limping along the side of the road so I brought him home... and the time we fostered the kittens of two feral cats (we spayed the feral cats, btw) and at one point had 13 cats/kittens in our home. Poor guy.

 

[Anka]

if the brouhaha he described was over an animal, then that's a whole different ballgame.

It's the same concept. The support staff not communicating with the actual doctor, resulting in lack of proper care for patient...I've seen some pretty bad assisting in the clinic I worked in...

*sigh*
The STAKES are different between fluffy and mommy. No matter how advanced, tertiary care level things get, no matter how insistent the 'patient's' family gets about not seeing a particular vet -- it's still a dog.

 

[WhtsThFrequency]

The STAKES are different between fluffy and mommy. No matter how advanced, tertiary care level things get, no matter how insistent the 'patient's' family gets about not seeing a particular vet -- it's still a dog.

I mostly agree with you there (wow, never thought you'd hear a vet student say that, eh?). It is just troublesome trying to say "It's just a horse" that to the breeder/shower whose entire income depends on the prize hunter/stud stallion who is down in the field, for example No need for the *sigh*.....but I shall not derail the thread by lapsing into defending the validity of my profession to the reponse of the ubiquitous "it's just a dog/cat/cow/horse" comments....ahead with the original topic.

 

[Tired]

It is just troublesome trying to say "It's just a horse" that to the breeder/shower whose entire income depends on the prize hunter/stud stallion who is down in the field, for example

You should see the looks I get when I say, "It's just a baby."

 

[Anka]

The STAKES are different between fluffy and mommy. No matter how advanced, tertiary care level things get, no matter how insistent the 'patient's' family gets about not seeing a particular vet -- it's still a dog.

I mostly agree with you there (wow, never thought you'd hear a vet student say that, eh?). It is just troublesome trying to say "It's just a horse" that to the breeder/shower whose entire income depends on the prize hunter/stud stallion who is down in the field, for example No need for the *sigh*.....but I shall not derail the thread by lapsing into defending the validity of my profession to the reponse of the ubiquitous "it's just a dog/cat/cow/horse" comments....ahead with the original topic.

There was no "just" in my comment (read it again... I almost never use the word). I understand that pets have a large impact on human quality of life. Farm animals even more so. But fluffy still ain't mom. Now, not everything having to do with mom is equal. We were talking about all this in the context of people getting upset (i.e., losing their **** or nearly so) about interpersonal interactions around fluffy vs. mom. If mom nearly died because a nurse didn't interact appropriately, surely we all agree that it's a different level of error than if fluffy nearly dies. Just as we all agree the stakes are quite different if it were mom nearly didn't get her breast augmentation vs. mom nearly died.

Anka

 

[Anka]

You should see the looks I get when I say, "It's just a baby."

Oopps... Didn't know you weren't supposed to say that. Ya think that's why I didn't get honors in Ob/Gyn?

 

[WhtsThFrequency]

You should see the looks I get when I say, "It's just a baby."

Hahahaha...oh my....

Anka, yes I agree the stakes are different in many ways, whether it is human/animal and also with regards to the procedure (like you said, needed surgery vs cosmetic, etc). Sorry, I must have imagined and inserted a "just" in there - since so many times it seems like that sort of sentence contains it! Apologies, I think we are basically on the same page . I agree that in the big scheme of things, human life> animal life (hence my animal research interest). I was trying to say that many people (crazy clients in the clinic) don't think so, and sometimes a vet can get in as much trouble for a botched animal job as a doctor can for a botched human job -whether it is your fault or the RNs fault (mom) or the LVTs (fluffy) fault....

 

[Tired]

Oopps... Didn't know you weren't supposed to say that. Ya think that's why I didn't get honors in Ob/Gyn?

Yes.

Next time you use that line, bonus points if you throw in one of these at the end:

"C'mon, it's not like it had a job or anything."

"It didn't look like it was going to be very good looking anyway."

"At least small coffins are cheaper."

 

[fab4fan]

You should see the looks I get when I say, "It's just a baby."

This made me laugh more than I'd like to admit.

 

[Farmer Jane]

This may make me completely evil, but on more than one occasion I've held a dead baby, thought about its parents, and figured it was much better off.

 

[carrigallen]

These are my top three:

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. aka "page and run".

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." 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.

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.

On a side note, does anyone else find it ironic that family members are "too busy" to come in to the hospital during regular business hours, but demand to ask about their family member at 10 pm when any other legitimate business would be closed?

 

[Blade28]

On a side note, does anyone else find it ironic that family members are "too busy" to come in to the hospital during regular business hours, but demand to ask about their family member at 10 pm when any other legitimate business would be closed?

Not only do they only come in late at night or towards the end of the hospital stay, but often it's the uncle, or cousin, or nephew, or neighbor's sister's friend who comes in. And they demand a full, detailed report of the hospital course at 11 pm.

 

[fab4fan]

Not only do they only come in late at night or towards the end of the hospital stay, but often it's the uncle, or cousin, or nephew, or neighbor's sister's friend who comes in. And they demand a full, detailed report of the hospital course at 11 pm.

And God help you if you don't give it to them, because these days, it's all about "customer service." You can throw the HIPAA trump card, but in the end these annoying people just wear you down til you talk to them just to get rid of them and shut them up.

 

[Blade28]

And God help you if you don't give it to them, because these days, it's all about "customer service." You can throw the HIPAA trump card, but in the end these annoying people just wear you down til you talk to them just to get rid of them and shut them up.

Which is why, no matter who these visitors are - and no matter what time of night it is - we inevitably get paged with the "Please come talk to patient Smith's friend/cousin/uncle/neighbor/student now" message.

 

[Tired]

Not only do they only come in late at night or towards the end of the hospital stay, but often it's the uncle, or cousin, or nephew, or neighbor's sister's friend who comes in. And they demand a full, detailed report of the hospital course at 11 pm.

Oh oh, even better than that is:

"I don't care that his son signed a DNR! I expect you to do everything for him!"

 

[GoodMonkey]

You should see the looks I get when I say, "It's just a baby."

*snort*