Most ridiculous question from a nurse while on call

[LeemerDO]

+3000 miles puts you in either Pacific or Mountain time zone. Now, with and without daylight savings, that's anywhere between 3am and 5am in the time zone from which the nurse was calling. Ugh.

YES! Hence my frustration and utter contempt for them for calling me.

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[Miami_med]

I usually try not to have a standing order for tylenol on most patients. If I did, I wouldn't get called on the majority of new fevers. If a patient had a fever earlier that night, a fever work-up was already implemented, and they are uncomfortable, I will then order a tylenol PRN. If a patient has a known source of septicemia (say antibiotics on board and an abcess scheduled to be drained in the morning), then I might also order one. However, I'd be wary of ever putting tylenol in an admission order set, because there will always be someone who thinks that fever is a disease with tylenol as the treatment. I don't like hearing about fevers for the first time when a patient has line sepsis, a fever of 106, and I get called because the tylenol stopped working.

 

[waldenwoods]

Can you write orders for nurses to call the house officer for certain things, such as temp > 38.5 (or whatever temp you choose)? An order for blood culture prn temp > 38.5 not to be drawn more frequently than q(some duration of time). Then have a standing order for prn Tylenol. Nurses know to take the blood culture before giving Tylenol. It works pretty well. And it's nice to do for the on-call person who doesn't need to put in all those orders should a patient spike a fever.

 

[Miami_med]

It is nice, and many of the subsepcialty services at our hospital with no residents do just that. Unfortunately, compliance with the "notify" part is imperfect. It usually doesn't matter to me when I have to order the work-up myself. Most of our post-op patients end up getting a CXR ASAP that evening if they've had a fever more than 48 hours post-op, so I have to get up to read that anyway.

 

[doctorhouse]

So I finally have a couple to share. So far, I haven't been able to contribute because our nurses are stellar,

Even if it's not a super high priority page, I find myself returning the pages of the stellar nurses and the really nice nurses a bit faster than the other ones including the nasty nurses....anyone else find that?

 

[Tigerz_Fan]

Even if it's not a super high priority page, I find myself returning the pages of the stellar nurses and the really nice nurses a bit faster than the other ones including the nasty nurses....anyone else find that?

I return all of them; pages get filtered through the residents before me. So, theoretically, only the high priority pages (sick peeps) should go to me.

It doesn't always work, however. Today, I was putting in a line and had a nurse return my page for me (one of my fav RNs). Apparently, it was another nurse who wanted a restraint order. My nurse told the other to page the resident. The nurse wanting the order said that she doesn't believe in paging the lower levels (!!). So, my nurse had a few choice words to say on my behalf. Like I said, we have many stellar nurses!!!

 

[UCLAstudent]

Nurse: "Doctor! Doctor! Patient _____ hasn't peed in over 45 minutes!"
Dr. UCLAstudent: "Oh, really? Wow. Neither have I ..."

Thankfully this happened at 4 in the afternoon ... I would have been less entertained at 3 in the morning.

 

[error404]

I got called by a nurse at 4 am because a patient *felt* like his sugar was too low, but was 156 when checked. The nurse just wanted to let me know.

 

[dpmd]

This was during the day so it didn't bug me as much (although if I hadn't been able to give a telephone order I would have gone ape****)

Nurse: There wasn't an order for Mr. X to be NPO but we made him NPO anyway for his CT scan, ummm so can he resume diet now?

 

[Lacuna]

4:50 am, 15 minutes after falling asleep
Nurse: Doctor, I was just wondering what we were doing about this pt's UTI.
looking through the pt's record, he had 2+ bacteria on a UA 5 days ago with a negative urine culture:}
Me: Nothing.

I noticed that a lot of nurses say "You need to" when they want you to order something. Like "You need to put an order in for tylenol". Me, "Why?" "Pt has a temp of 101" I told the nurse to draw cultures, she hung up on me. Next day bottles grew out enterococcus.

I love being an intern.

 

[NarcolepticRN]

Nurses know to take the blood culture before giving Tylenol.

Why does it matter when Tylenol is given if you're treating a known temperature and drawing cultures? That doesn't make any sense.

 

[badapplestix]

Finally getting some sleep. Pager goes off:

"Can you write an order for a sleeping pill for Mr. Smith."

"Ok, what does he usually take at home."

"I don't know, he's asleep."

hahahahahahahahahahahhahahaha

 

[EctopicFetus]

While on call in the VA. Medicine wards.. cross cover patient at 4 am...

Nurse: Can the patient have pudding?
Me: uhh.. if he isnt NPO I dont care what he has.

 

[UCLAstudent]

While on call in the VA. Medicine wards.. cross cover patient at 4 am...

Nurse: Can the patient have pudding?
Me: uhh.. if he isnt NPO I dont care what he has.

I had something similar happen to me on neurology call. The patient was on a soft mechanical diet and the nurse paged me at 2 a.m. to ask if the patient could have custard. What a weird question!

 

[SocialistMD]

I usually try not to have a standing order for tylenol on most patients. If I did, I wouldn't get called on the majority of new fevers.

I have the same policy for Zofran (or your favorite anti-emetic). I want to know when patients develop nausea/emesis after the initial post-op (anesthesia-related) period. I usually limit the PRN dose to 24 hours.

 

[spacecowgirl]

I'm on-call as a pharmacist (rural hospital, pharmacy not staffed around the clock) and I get some pretty stupid questions too.

2 am
Nurse: I have an order for a clonidine patch and we don't have that strength in the Pyxis.
Me: You know that's not going to lower the patient's BP for a few days, right?
Nures: I just know I have an order from the MD and I need it STAT.
Me:

Sometimes it's just easier for me to come in and get it rather than page the doc again at 2 am.

 

[zenman]

I'm on-call as a pharmacist (rural hospital, pharmacy not staffed around the clock) and I get some pretty stupid questions too.

2 am
Nurse: I have an order for a clonidine patch and we don't have that strength in the Pyxis.
Me: You know that's not going to lower the patient's BP for a few days, right?
Nures: I just know I have an order from the MD and I need it STAT.
Me:

Sometimes it's just easier for me to come in and get it rather than page the doc again at 2 am.

1. I would think it would be your role to support those who provide direct patient care. Maybe you should have stocked the Pyxis with the needed meds.

2. If the M.D. ordered it stat, then the nurse had to call you or risk getting chewed out.

3. Bad pharmacist, bad, bad.

 

[dpmd]

See, a good nurse would have mentioned to the prescribing MD that the clonidine patch isn't stocked as a stat med because it takes several days to work. That way the pharmacist doesn't get an unnecessary phone call, the MD gets educated (I will admit to having thrown out the idea of a patch before, before I learned better), and the patient gets his BP treated (I'm assuming a stat med was being ordered in response to a call about a very high BP-otherwise the whole scenario is lame)

 

[zenman]

Yes, but in a perfect world, the physician should know all about the meds he orders, and have alternatives till the clonidine patch kicks in.

 

[smq123]

Yes, but in a perfect world, the physician should know all about the meds he orders, and have alternatives till the clonidine patch kicks in.

If the physician wrote for alternatives that would treat the patient until the clonidine patch kicked in, then the nurse didn't actually need the clonidine patch "STAT," and didn't need to bother the pharmacist at 2 AM.

*****

Was called by a nurse, who was frantic because a patient with bacteriuria grew out E. coli on urine cx. "She has...E. Coli...in her urine!! How did she get E. Coli in her urine??!!??"

She calmed down after I told her that most patients with UTIs have, in fact, E. Coli UTIs. Nothing a little cipro couldn't take care of.

 

[zenman]

If the physician wrote for alternatives that would treat the patient until the clonidine patch kicked in, then the nurse didn't actually need the clonidine patch "STAT," and didn't need to bother the pharmacist at 2 AM.

.

But the physician didn't write for alternatives till the clonidine patch kicked in and he probably wrote for a stat patch, otherwise the nurse probably wouldn't be asking for a "stat" patch in order to cover her a**.

 

[SoCuteMD]

But the physician didn't write for alternatives till the clonidine patch kicked in and he probably wrote for a stat patch, otherwise the nurse probably wouldn't be asking for a "stat" patch in order to cover her a**.

OMG. A doctor made a fairly not-harmful judgment error at 2 AM, likely after being up for close to 24 hours and being hammer-paged for the last 10. Someone alert the presses and fire teh doctor!!

(In my mind, the conversation went something like this...)
Nurse: The patient's blood pressure is 170/110!
Doctor: What was it earlier today?
Nurse: 160/100
Doctor: Um, what antihypertensives is the patient on?
Nurse: names about 5 different ones.
Doctor: Is the patient symptomatic? Headache? Chest pain?
Nurse: No, sleeping comfortably.
Doctor: Um, I'll put in for a clonidine patch.

 

[Rendar5]

lol, the doctor's the cause (albeit indirect) of someone else getting paged in the middle of the night pretty needlessly. gotta love the irony.

OMG. A doctor made a fairly not-harmful judgment error at 2 AM, likely after being up for close to 24 hours and being hammer-paged for the last 10. Someone alert the presses and fire teh doctor!!

(In my mind, the conversation went something like this...)
Nurse: The patient's blood pressure is 170/110!
Doctor: What was it earlier today?
Nurse: 160/100
Doctor: Um, what antihypertensives is the patient on?
Nurse: names about 5 different ones.
Doctor: Is the patient symptomatic? Headache? Chest pain?
Nurse: No, sleeping comfortably.
Doctor: Um, I'll put in for a clonidine patch.

 

[zenman]

OMG. A doctor made a fairly not-harmful judgment error at 2 AM, likely after being up for close to 24 hours and being hammer-paged for the last 10. Someone alert the presses and fire teh doctor!!

(In my mind, the conversation went something like this...)
Nurse: The patient's blood pressure is 170/110!
Doctor: What was it earlier today?
Nurse: 160/100
Doctor: Um, what antihypertensives is the patient on?
Nurse: names about 5 different ones.
Doctor: Is the patient symptomatic? Headache? Chest pain?
Nurse: No, sleeping comfortably.
Doctor: Um, I'll put in for a clonidine patch.

You guys are whiners. You want to rag on nurses yet the mods refuse a same type forum on fellow physicians. Most of the calls here, if I were to read them, are also probably "fairly not-harmful." I admit they are pretty funny though, almost as funny as an attending who looked at me with a grin on his face when a resident approached him about ordering PO meds on a patient on continuous NG suction.

Now, we don't have all the details from our pharmacist friend, but if the Pyxis had Clonidine in it, why not stock all three strengths? If it wasn't stocked then the pharmacist is just telling on himself.

Apparently the nurse had an stat order from a physician and was doing just what she was supposed to do. Whether the physician had been up 36 hours or if his mistress had just called his wife or if his pickup truck had a dead battery is all beside the point and is called "whining."

I see three potential issues here, all involving pharmacy, the physician, and a nurse who didn't have the backbone to tell the physician what to do. Oh wait, you guys don't like that do you?

 

[smq123]

Now, we don't have all the details from our pharmacist friend, but if the Pyxis had Clonidine in it, why not stock all three strengths? If it wasn't stocked then the pharmacist is just telling on himself.

Do individual pharmacists get to decide what goes into the Pyxis? Or is it a hospital bureaucratic decision, the same people who decide to stock certain antibiotics and not others? I honestly don't know, I'm just asking.

 

[Winged Scapula]

You guys are whiners. You want to rag on nurses yet the mods refuse a same type forum on fellow physicians.

SDN does have a Clinicians Forum where nurses and other allied health professionals regularly post. However, we do not have a nurses specific forum because nursing is not one of the 9 SDN core communities and there are other sites which serve those needs. The primary community is physicians and we add others when there is a need not being served elsewhere.

This has nothing to do with being whiners or "refusing" to allow nurses to whine about physicians. There are plenty of other places where they can do so. AllNurses.com doesn't have a physicians forum where we can whine and complain about nurses, so I'm afraid I don't see SDN falls outside the standard operating practice.

 

[zenman]

SDN does have a Clinicians Forum where nurses and other allied health professionals regularly post. However, we do not have a nurses specific forum because nursing is not one of the 9 SDN core communities and there are other sites which serve those needs. The primary community is physicians and we add others when there is a need not being served elsewhere.

This has nothing to do with being whiners or "refusing" to allow nurses to whine about physicians. There are plenty of other places where they can do so. AllNurses.com doesn't have a physicians forum where we can whine and complain about nurses, so I'm afraid I don't see SDN falls outside the standard operating practice.

SoCuteMD was the one whining and I was making a point that whining doesn't count when you have the responsibility for a patient's well-being. I really don't want a forum to post funny stories about physicians, I just thought it odd (double-standard perhaps) that recently a forum where physicians could post about other specialities was shut down rather quickly.

I'm also pointing out that what you may find a ridiculous call is, in some cases, one that a nurse has to make because of stupid policies.

 

[EternalMD]

At 3:30am
MD: someone paged the night float resident?
RN: yeah... i was wondering why the patient in rm 315 is NPO?
MD: (after looking through my signout sheets) umm that patient shouldn't be NPO
RN: oh nm, that order was from 4days ago. Sorry! *click*

 

[smq123]

I really don't want a forum to post funny stories about physicians, I just thought it odd (double-standard perhaps) that recently a forum where physicians could post about other specialities was shut down rather quickly.

Making fun of the ED for "stupid consults" is a pasttime that is better left alone. We all make stupid consults, whether it is consulting general surgery for a "stat Whipple" or sending a patient to the ED for something that is clearly a cold, but singling out the ED is unfair. If you'd read the thread, you might see why it was closed relatively quickly.

I'm also pointing out that what you may find a ridiculous call is, in some cases, one that a nurse has to make because of stupid policies.

Sure, we all understand that. But I think the point that others have tried to make is that sometimes a ridiculous call is one that a nurse makes because he/she also lacks common sense. I know, the blame goes both ways sometimes.

 

[jdh71]

Oh wait, you guys don't like that do you?

As it turns out nurses don't tell us to do anything, we tell them.

Now, go push my meds and wipe that patient's ass.

Kthanx.

 

[SOLDIER]

Can't we all jst get along at least for xmas?

 

[Rorympb]

As it turns out nurses don't tell us to do anything, we tell them.

Now, go push my meds and wipe that patient's ass.

Kthanx.

Ooooo...remember that when you're in that bed lol
Your colleagues aren't gonna come a runnin' lol
(btw, what's so wrong about taking physical care of a patient?)

 

[zenman]

As it turns out nurses don't tell us to do anything, we tell them.

Now, go push my meds and wipe that patient's ass.

Kthanx.

Ha, ha, some nurse is going to wipe yours. Actually, many years ago an ARMY nurse chewed out my corpsman's butt because I couldn't tell her if my patient had a freckle at 3 o'clock on his rectum. You can bet over 37 years later that I assess every inch of a patient's body.

I'll be glad to push your meds, especially since a few residents have asked me to push a deadly med because, "they didn't know how to do it." I really preferred that course of action to the few who have slammed an IV med in like it was saline. "Hey doc, can you just wait here with me for a moment in case this patient codes?"

I've only run into three physicians I could do without. All the rest have been a pleasure to work with and you can be sure we've both learned something from each other.

You, on the other hand are one of those guys who I like to challenge. Let's step into the jungle where there is no equipment (bare hands) or electricity and have us a clinic. I'll bet the line to me will be longer than the line to you.

 

[jdh71]

Ha, ha, some nurse is going to wipe yours. Actually, many years ago an ARMY nurse chewed out my corpsman's butt because I couldn't tell her if my patient had a freckle at 3 o'clock on his rectum. You can bet over 37 years later that I assess every inch of a patient's body.

I'll be glad to push your meds, especially since a few residents have asked me to push a deadly med because, "they didn't know how to do it." I really preferred that course of action to the few who have slammed an IV med in like it was saline. "Hey doc, can you just wait here with me for a moment in case this patient codes?"

I've only run into three physicians I could do without. All the rest have been a pleasure to work with and you can be sure we've both learned something from each other.

You, on the other hand are one of those guys who I like to challenge. Let's step into the jungle where there is no equipment (bare hands) or electricity and have us a clinic. I'll bet the line to me will be longer than the line to you.

lolumad

I'm just glad we all know our places in the world

And I'd take your jungle challenge any day of the week hoss, any - day - of - the - week

 

[ranmyaku]

For Crosscover ---> The worst at my hospital is the nursing staff paging at 3-4am (b/c morning labs start getting drawn) to let me know the patient has a K of 3.6, and wanting to know what I want to do?
um. let the morning team take care of it when they come in like 2 hrs...


I love it too when I get a frantic call b/c of a CRITICAL VANC TROUGH!!! (on a septic patient with empiric broad spectrum Abx) OMG OMG. Doc the Vanc trough is 15.2!!! Do you want me to hold the next dose? ...um no.

 

[zenman]

lolumad

I'm just glad we all know our places in the world

And I'd take your jungle challenge any day of the week hoss, any - day - of - the - week

You are smart enough to know that you can't practice medicine when the electricity is off don't you? Maybe we will need to start with some ayahuasca to clear the crap out of your head

 

[smq123]

If we could stop flinging insults and vague threats at each other, and go back to stories about questions we get on call, that'd be great.

Thanks.

 

[jdh71]

You are smart enough to know that you can't practice medicine when the electricity is off don't you? Maybe we will need to start with some ayahuasca to clear the crap out of your head

Are you ******ed? This is a yes or no question.

 

[jdh71]

If we could stop flinging insults and vague threats at each other, and go back to stories about questions we get on call, that'd be great.

Thanks.

Yeah. I suppose spending anytime paying attention to some silly bitter NP trolling the thread is party-foul.

I'm merely trolling the troll baby.

 

[SOLDIER]

Zenman hey I really think u should grow up
1 we all make idiotic mistakes and we can only laugh at each other if we don't joke around then u will see how depressing medicine can be

 

[taurus70]

At 3:30am
MD: someone paged the night float resident?
RN: yeah... i was wondering why the patient in rm 315 is NPO?
MD: (after looking through my signout sheets) umm that patient shouldn't be NPO
RN: oh nm, that order was from 4days ago. Sorry! *click*

HaHA! You must be on night float with me this month.

 

[VitaminJack]

At 3:30am
MD: someone paged the night float resident?
RN: yeah... i was wondering why the patient in rm 315 is NPO?
MD: (after looking through my signout sheets) umm that patient shouldn't be NPO
RN: oh nm, that order was from 4days ago. Sorry! *click*

haha classic. atleast she realized her mistake and atleast she apologized and realized she was bothering you vs. 'oh well, i woke you....'

 

[Eta Carinae]

Finally getting some sleep. Pager goes off:

"Can you write an order for a sleeping pill for Mr. Smith."

"Ok, what does he usually take at home."

"I don't know, he's asleep."

I don't know if I should be here but some of the responses are killing me!

 

[EternalMD]

haha classic. atleast she realized her mistake and atleast she apologized and realized she was bothering you vs. 'oh well, i woke you....'

I gotta say, night float has been the best time to get these types of calls - most of them are legit but every once in a while, you get the entertaining ones that get posted. for example, taking a little from the sleeping pill one:

At 3am
MD: night float resident... what's up?
RN: yeah, patient in Room x wants something for sleep
MD: okay let me go talk to her real quick (if I have time, i usually try to eyeball the patient before giving meds)

MD: so Ms. X, I hear you aren't sleeping?
Patient: yeah
MD: do you feel like sleeping right now?
Patient: not really. just wanted to watch TV

MD: so the patient said she doesn't feel like sleeping
RN: oh i know but doc, can you please write for something because she keeps harassing me every 5-10minutes

Needless to say, the patient didn't get anything to sleep. I have pretty much reached my threshold with night nurses trying to get me to give meds to patients who don't need them.... morphine for patients with no pain, ativan for non-agitation patients, etc. If something happens, they will always say "well, the MD ordered it and I just followed the orders".

 

[zenman]

Are you ******ed? This is a yes or no question.

I was trying to keep it simple. You are aware that you can't practice medicine these days without electricity, correct?

 

[jdh71]

I was trying to keep it simple. You are aware that you can't practice medicine these days without electricity, correct?

define "practice medicine"

 

[zenman]

Zenman hey I really think u should grow up
1 we all make idiotic mistakes and we can only laugh at each other if we don't joke around then u will see how depressing medicine can be

Actually I was grown up (and taking care of people) before you were born. I'm am afflicted with genetic hiliarity so I understand your point. Still confused why this forum exists when mods shut down similar one where you could do the same with your peers. I was looking forward to that one.

 

[zenman]

define "practice medicine"

You know what medicine is. Now, what can do you when you don't have a stethoscope, labs, x-rays, MRIs...without info you normally obtain with the aid of electricity or other devices.

 

[smq123]

Still confused why this forum exists when mods shut down similar one where you could do the same with your peers. I was looking forward to that one.

I'm not sure if you're trying to stir up trouble, or if you really are confused, but in case it's the latter....

This forum is a GENERAL RESIDENCY forum, and residents from ALL specialties are welcome. The thread that you were referring to was stupid consults that we, as residents, get from the ED. Now, that thread would single out EM residents who, as residents, also have a place in this forum. It would degenerate into a insult contest between IM/surg/FM and EM. That's not what this forum is supposed to be for.

Again, this is a RESIDENCY forum....not a "residency and nursing" forum. While attacks that denigrate nurses are not welcome, either, venting about silly phone calls that we get at 3 AM is appropriate.

Actually I was grown up (and taking care of people) before you were born. I'm am afflicted with genetic hiliarity so I understand your point.

If you want to continue your argument with jdh, both of you can take it to private messages. It otherwise distracts from what I feel is a pretty good thread.

 

[Charles_Carmichael]

You know what medicine is. Now, what can do you when you don't have a stethoscope, labs, x-rays, MRIs...without info you normally obtain with the aid of electricity or other devices.

What would nurses do without electricity then? From your posts, it seems that you think nurses/NPs > physicians in diagnosing/treating patients. Your posts are filled with disdain for physicians. Like others have said, this is a site mainly for premeds/med students/physicians and this particular forum is for residents, not nurses. You could go to Allnurses and contribute to the many physician-bashing threads there if you wanted.