Please reopen my thread

[doc02]

Lido or a pillow over the face.

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[justwondering]

I'm all for people being civilized towards one another, and I do appreciate the hard work nurses do and the help they provide us (especially as interns). I have had mostly very good experiences with the nursing staff at our hospital. I think our hospital is blessed to have very hardworking nurses who are generally pretty respectful and helpful (this wasn't true at my med schl hospital though).

However, I don't see why nurses should have any part in the "venting" type threads that people put up. I mean, most people who post something like that are not asking a question or trying to get feed back. They're just annoyed and want someone else to share in the frustration they experienced. It's probably better than taking out that frustration on the nurse that caused it in the first place. People keep trying to justify the input of nurses on these threads as helpful for understanding one another and having dialogue, but venting-type threads are not an appropriate place for it. That's not why those threads wer started.

 

[doc02]

That plus there's a big attempt at trying to pretend that stuff like this never happens. Or if it does happen, then it was YOUR fault and, actually, it's justified because you deserve to be taught a lesson because obviously you're too arrogent and someone has to teach you your place and once you learn and start groveling and doing whatever the nurses tell you to then we can all go back to being nice to each other. That's called compromise.

 

[Tired]

That plus there's a big attempt at trying to pretend that stuff like this never happens. Or if it does happen, then it was YOUR fault and, actually, it's justified because you deserve to be taught a lesson because obviously you're too arrogent and someone has to teach you your place and once you learn and start groveling and doing whatever the nurses tell you to then we can all go back to being nice to each other.

I'm seriously considering putting this in my sig.

 

[doc02]

 

[doc02]

You know what I noticed? ICU nurses like to make themselves feel superior by acting like they know more about a patient than you do. For example, I came in today to see patients and one guy had been on a pressor. I'm in the middle of rounding on some other patient on our service and the nurse comes up to me and starts talking about how the patient had an ABG ordered and asked if I really wanted it. I go, "yeah, what's the problem?" And she goes, "then you have to draw it." So I go, "OK, that's fine. But why can't you just draw it off the guy's a-line?" And she suddenly snaps (in a really b!tchy tone, not just a friendly conversational tone), "he doesn't have an a-line!" So I go, "oh, since when?" And she goes, "it was removed overnight!" So I'm like, "huh, and he's still on pressors?" And she goes, "NO!!" And by now, she's literally acting like I had committed a felony. She was looking aghast at me and her tone of voice was incredulous. So I go, "OK, I'll draw it in a second."

Now, last I knew we were titrating down his pressors but he was still requiring a low dose. But that was about twelve hours ago. A lot can change in twelve hours, especially on an ICU patient. In this instance, sure, the blame was really on my fellow resident who had done a very poor job on signing out to me (that's a different matter). But still, who cares if I don't know that he's off pressors before I see the patient? She knew I hadn't been there overnight because she was there and I obviously wasn't. And yet she was acting like some crime was committed because I didn't know everything about every patient. It's not every ICU nurse who does this, but the ones who do are invariably the old ones who try to "prove a point" like "we know the patient better than you." Yeah, you know that he came off pressors at exactly 1 AM because you were the one doing it. Am I supposed to be impressed?

 

[telenurse]

You know what I noticed? ICU nurses like to make themselves feel superior by acting like they know more about a patient than you do. For example, I came in today to see patients and one guy had been on a pressor. I'm in the middle of rounding on some other patient on our service and the nurse comes up to me and starts talking about how the patient had an ABG ordered and asked if I really wanted it. I go, "yeah, what's the problem?" And she goes, "then you have to draw it." So I go, "OK, that's fine. But why can't you just draw it off the guy's a-line?" And she suddenly snaps (in a really b!tchy tone, not just a friendly conversational tone), "he doesn't have an a-line!" So I go, "oh, since when?" And she goes, "it was removed overnight!" So I'm like, "huh, and he's still on pressors?" And she goes, "NO!!" And by now, she's literally acting like I had committed a felony. She was looking aghast at me and her tone of voice was incredulous. So I go, "OK, I'll draw it in a second."

Now, last I knew we were titrating down his pressors but he was still requiring a low dose. But that was about twelve hours ago. A lot can change in twelve hours, especially on an ICU patient. In this instance, sure, the blame was really on my fellow resident who had done a very poor job on signing out to me (that's a different matter). But still, who cares if I don't know that he's off pressors before I see the patient? She knew I hadn't been there overnight because she was there and I obviously wasn't. And yet she was acting like some crime was committed because I didn't know everything about every patient. It's not every ICU nurse who does this, but the ones who do are invariably the old ones who try to "prove a point" like "we know the patient better than you." Yeah, you know that he came off pressors at exactly 1 AM because you were the one doing it. Am I supposed to be impressed?

In my experience, ICU nurses like to make themselves look superior to anyone period. I had one try to chew me up a few weeks ago because I didn't have a BP on a pt...sorry but with a pulse of 19, there is no way in hell of getting a non-invasive BP...which is why this pt was going to the ICU. The best I could tell her was hey I can palp a femoral and a brachial pulse and pt is awake, a&o.

Then last week I had a pt flipping out, he was a transfer from the ICU, and whoever wrote his orders forgot his hs lantus. His glucose was low 200's, no biggie, I called the H.O. got coverage, the pt flipped out because he was still coming off his cocaine high and didn't think 2 units of regular was enough , when the H.O. came to talk to him, I told the H.O. if he wanted to write for lantus, I'd give it, but he was just night coverage, as long as he covered the highs and lows of the blood sugars that's his job, not to write for basal insulins. Besides there was no record of any lantus dosages in the chart, the MAR, or the EMR. One of the other nurses I worked with didn't agree with me, kept saying the pt needed his lantus, but I agreed with the H.O. that as long as the pt was asymptomatic, had adequate coverage for a blood glucose of 220, and was going to be a q4 check, and there was no record of the pt being on lantus, it was not the night call's responsibility to start the pt on lantus, that is for the primary team.
Sometimes I do see why residents dislike nurses, sometimes I dislike them myself.

 

[Winged Scapula]

it was not the night call's responsibility to start the pt on lantus, that is for the primary team.

This is something I fought over and over again during my residency and when moonlighting. Calls at night are for emergent or urgent needs ONLY. They are not for major changes in a patient's medical care (unless there is an urgent/emergent need for it), to discuss discharge planning with nursing or the family, etc.

I wished I had a recorder so that everytime I had to have this discussion, that whatever the call was about, it could wait for the primary service in the am, I could simple press "play." Not so sure why this is hard for the night shift to understand.

 

[Tired]

This is something I fought over and over again during my residency and when moonlighting. Calls at night are for emergent or urgent needs ONLY. They are not for major changes in a patient's medical care (unless there is an urgent/emergent need for it), to discuss discharge planning with nursing or the family, etc.

It's not just the nurses though, I continually have services sign out to me asking me to do things and check on things that have no business being done at night.

My favorite is the, "No rush on this CT scan, but if it comes back with X, go ahead and consult Gen Surg (or Neurosurg, or Ortho) and do whatever their recs are." Motherf*cker, if the scan wasn't emergent enough to do during the day, then why is the consult so urgent to get at night?

Or following up on Medicine recs. "See what medicine wants us to do about his blood pressure, and go ahead and write for it". Invariably they put in their recs at 6pm, and of course they want to d/c two old meds and start 3 new ones. Yeah, I'll write for it, I'll write "Start meds in a.m."

The worst though, is the idiots who try to titrate pain meds down overnight "because they'll be sleeping". That's the worst.

 

[doc02]

In my experience, ICU nurses like to make themselves look superior to anyone period.

Yeah, they think that because the patients are in "intensive care" that means they're awesome. In reality, it just means that the patient is being continuously monitored and is probably intubated. That's it. The problem is everyone acts in awe of the unit, like people are continuously coding literally one after the other. In reality, 99% of ICU patients are "stably unstable" -- they're not going to get up and start doing jumping jacks, but everything they're on is basically on cruise control (plus/minus titration, oooooo!). The toughest part of the ICU is literally the first few hours when the patient arrives and you figure out what you want to do, but that has nothing to do with nurses. After that, you could walk in on some of these patients three months later and they'd look exactly the same and be on exactly the same meds (slight exaggeration, but only slight).

 

[doc02]

It's not just the nurses though, I continually have services sign out to me asking me to do things and check on things that have no business being done at night.

There are a lot of residents who abuse the call person in that way. They'll deliberately leave ends loose for other people to clean up. For example, they'll admit a person and put them on antibiotics or whatever they need specifically for that admission ...then they'll leave everything else off and you'll find out when the patient hits the floor and you start getting bomb paged. Or when the person starts getting hypertensive or hyperglycemic or whatever. Once I found myself having to call around and find some guy's CPAP settings from another hospital because the team just left this guy without CPAP. That's not a joke.

In general, I'll do the best I can because I'm not going to screw over some patient because their team is composed of douches. It's the same reason I don't let ER patients drop dead just because the EM guys paged me to do their H&P. However, if people get too into this and it's a pattern, I'll forget all that compassion and reverse bomb them. I'll just get their patient through the night with Band-Aid medicine and let the primary team deal with things in the AM. Also, I won't sign out to them what happened overnight and let them figure it out on their own. Sometimes that's the only way people learn.

 

[Tired]

However, if people get too into this and it's a pattern, I'll forget all that compassion and reverse bomb them. I'll just get their patient through the night with Band-Aid medicine and let the primary team deal with things in the AM. Also, I won't sign out to them what happened overnight and let them figure it out on their own. Sometimes that's the only way people learn.

I've done that too, but I always kind of feel a little bad about it. Generally I limit it to things that won't actually cause problems for the patient, just the team.

Lately I just yell at the intern the next morning. I figure if it's good enough for the nurses, it's good enough for the interns as well . . . also when you call an intern a "ratf*ck ba$****" you don't get in trouble with your program director.

 

[Brixius]

I'm a prolific writer, so I can understand why my words might have gotten lost in paragraphs which you get lost in reading. So, in an attempt to curb my writing, I'll get it down to the bare bones:

1. I work in a hospital - specifically the ICU/OR, but I do rotate thru many services. One of my jobs is to orient interns in hospital medication usage.

2. Reading threads on interns is a good way to understand where an intern is coming from - both in understanding hospital policy as it relates to medications and the specifics of where is it, can I order it, how long does it take, what is the process?

3. I do provide an orientation to interns on how/when/where etc the pharmacy service functions. If you don't pay attention well - you get hung up on ordering something not on formulary (I give you quick ways around this if its a valid need), not being able to order a discharge, just messy paperwork - but time consuming for you and oh.....so very, very time consuming for me. By reading on here, I have changed how I approach some issues with medication & include or take out other information.

4. My hospital gets accredited every 3 years. OR/ICU is lumped with the ER when that happens. If you cause a mess that I need to fix, particularly if you are here during an accreditation year, I won't be happy - nor will my dop (Director of Pharmacy) who will get the Chiefs of Service, the CEO & the hospital accreditation nazi on my case. I try to avoid these circumstances - by teaching you how its done here, rather than having to make excuses later - or god forbid, having the issue caught by an inspector.

5. Now we come down to doing it our way. Yes....you'd like medicine to be done "your" way, but frankly, you work in an institution which has its own policies & procedures. There are many, many valid ways to get things done medically & yours, where you trained, I'm sure is valid - its just not the only way. But, when you come to my hospital, you do things the way my hospital has decided (not MY way - the hospital's way). I know that & I, as someone who helps to orient you, need to get you to know that. It doesn't make one better nor worse than another - its just different. And - these P&P have been decided on by many committees - for medications, often the P&T which have respresentatives from every medical service we have.

6. Getting you used to our system fast gets patient care accomlished smoother. We don't want you to continue to order Amikacin in October when we told you in July what the formulary aminoglycosides are.

7. Finally, altho I live & breathe this stuff daily, I know my hospital, altho large, is not like every other hospital. I read at these times for purely selfish reasons. My daughter will be applying to the match in one year. It is interesting to read how other institutions deal with their interns. Although I discuss it with my colleagues during our annual or state conventions, its easier just to read here.

So....does that help explain why I often will read & sometimes contribute here? Yep - I do read & contribute in anesthesiology, but about drugs used. They are complex, interesting & often I bring the chemical issues into the discussion. Anesthesiologists are also my colleagues I work with dailyl.

But, I rarely will go into forums I know nothing about - OB for example. Other than being a mother, I don't work on the OB service & have nothing to contributem, and nothing in common.

I just do work with interns A lOT, help to orient them & certainly help to address the confusion which usually arises regarding medication and all the issues which surround that.

I hope that clarifies.

Ding Dong, the witch is dead!
Which old witch?
The wicked witch!