The stupidest thing a nurse has ever paged you for...

[sdn1977]

That is how it should work and does in teaching hospitals.

Let me explain life in nonteaching hospitals.

Prior to JCAHO raising a stink about med recs, the MD admitting the patient was to assess what meds the patient was on, and write them all out and order them.

90% never did -they wrote "Continue home meds" with no clue what meds the patient was on. This was obvious to the nurse admitting a GI Bleed for FFP and vitamin K, and noting that the patient was on coumadin, ASA and prednisone. And the writing of CHM orders was not permitted anyway, so we had to call the MD, who was pissed and let us know that he was pissed and being required to review the meds, telling us to "use our judgement" - which is not permitted as nurses cannot "prescribe".

They also rarely addressed DC meds - if they did, it was merely the new prescriptions - never addressing the old. Necessitating multiple phone calls to the MD, many of whom, side stepped it, not wanting to deal with all the patients meds from different MDs.

Thus patients bounced back due to med issues. Or worse, suffered serious issues due to this.

Jcaho recognized it had a critical issue. Thus the regs on med recs at admission and DC. Nurses put in the meds and print a form, that MDs check the box and signoff on.

And it doesn't matter when the patient is admitted, if the MD "forgets" to check and sign (which they all KNOW that they have to do), the documentation nazi comes and harasses the nurse because s/he "let" this happen.

In addition, every night we carefully print out updated MR sheets and place them on the front of the orders, so that if the patient gets transferred/DC'd, all the MD has to do is check and sign.

Easy, right?????????????

THEN HOW COME THE VAST MAJORITY OF MDS LEAVE THEM BLANK, and make me phone/fax chase them across Palm Beach County, to do the darn things? It takes one minute to check and sign but they will not do it.

At any community facility, at least 50%-75% of them are not filled out - despite being right where the DC order is written.

PS, in WPB area, many forget to write "DC patient", though they conveniently tell the patient that they are DC'd. It doesn't occur to them to tell the nurse.

Very accurate on the west coast as well!!!

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[core0]

I think, although I may be mistaken, that you completely missed the joke

jd

Sigh just like where do they bury the survivors.

Dave

 

[core0]

"I'm not sure, but I think that the patient has decreased breath sounds on the left side, but just at the base."

"You know the patient has no left lung, right?"

"Oh. right."

/fortunately not the result of a page waking me up.

How bout - "We can't get his heart rate above 66 on the stress test."

"you do realize he had a heart transplant".

"Yes"

"Never Mind"

David Carpenter, PA-C

 

[Tired]

How bout - "We can't get his heart rate above 66 on the stress test."
"you do realize he had a heart transplant".
"Yes"
"Never Mind"

Raising the inevitable question of why a stress test was ordered in the first place . . .

 

[notherenorthere]

I have nothing to say about this thread except for these thoughts: It's a real shame that people can't or refuse to realize that everyone is human, therefore not perfect. In addition, it might be helpful for people to think of the current hospital model as being one that would be best utilized by thinking of all staff as members of a team, as opposed to this strange "us against them" mentality some of you seem to imagine with interns and nurses. It actually does not make any sense at all. Maybe some of you should think about the hospitals' orientation programs with their nurses. Are the nurses being trained comprehensively and correctly? If not, this could explain some knowledge deficits exhibited in the anecdotes cited here.

Everyone in healthcare has tough jobs. Let's face it, we're not living a glamour life. Lets all work together and be positive and think about the patients, rather than putting others down. I don't insult an intern in a code at 3 am when I am asking her or him what they want to do and they are staring with a blank look on their face, frozen in indecision and fear. Nope, you won't hear me bitching about that later. I care about patient outcomes - so it's onto the next thing, not dwelling on others' imperfections. have a good one!!

 

[core0]

Raising the inevitable question of why a stress test was ordered in the first place . . .

Not going to go there. Lets just say that was the final question in a long and exasperating day.

David Carpenter, PA-C

 

[rmh149]

How bout - "We can't get his heart rate above 66 on the stress test."

"you do realize he had a heart transplant".

"Yes"

"Never Mind"

David Carpenter, PA-C

I know you are thinking with post-heart transplanted patients the heart is completelty denervated. However sympathetic reinnervation is still likely to occur. So, them attempting to increase the heart rate for a stress test on a tredmill or with dobutamine is not unheard of.

The use of atropine, since it works on the parasympathetic nervous system as an anitcholinergic, is unlikely to work...but it sometimes does.

So....go apologize to that nurse for making him/her feel stupid for no reason.

 

[BlackSails]

I know you are thinking with post-heart transplanted patients the heart is completelty denervated. However sympathetic reinnervation is still likely to occur. So, them attempting to increase the heart rate for a stress test on a tredmill or with dobutamine is not unheard of.

You obviously dont have to page someone to tell them that something rare and unexpected has not happened.

 

[rmh149]

Raising the inevitable question of why a stress test was ordered in the first place . . .

....Maybe because there is a concern to how the transplanted myocardium is perfusing. HTX patients can have coronary artery disease too.

 

[rmh149]

You obviously dont have to page someone to tell them that something rare and unexpected has not happened.

It is not rare to achieve target heart rate in a HTX patient during stress test.

J Heart Lung Transplant. 2001 Apr;20(4):399-406. Impact of heart transplantation on the safety and feasibility of the dobutamine stress test.

225 heart transplant recipients. The target heart rate was reached in 82% of transplant recipients.

 

[LanceArmstrong]

Not stupid but very inconvenient...I had a nurse page me at 2 am for me to explain the pathological basis of a patient's condition. Even though this didnt have anything to do with treatment nor was the patient even curious - just the nurse was curious.

Also I get alot of pages like: mr johnson's blood pressure this morning was 130/80 should she still get her regular blood pressure medicine?

 

[Tired]

I got this one yesterday:

Nurse: "Mr. ______ was just transferred to the floor, and I just wanted to let you know that his temperature is 102F."

Me: "Yeah, he's getting worked up. He's also on Tyleonol scheduled. Has he gotten a dose recently?"

Nurse: " . . . um . . . I don't really know. I just got him. I was just notifying you about his temperature."

Me: "So you don't want to take any orders about it?"

Nurse: "Not right now, I'm really busy. It just said to notify you for temperatures over 101.5F, and that's what I'm doing."

Me: "Okay I guess."

--------------------------------------------------------------------------

In all fairness, I also got two calls last night from nurses that went like this.

Nurse: "Hi. You're the Surgery cross-cover?"

Me: "Yeah, what can I do for you?"

Nurse: "Mrs. _____ is being discharged, but her medicines aren't in the computer."

Me: "The intern who did the discharge didn't put her medicines in?"

Nurse: "Well, he said he did, but they're just not there. And when I called him about it, he said he already did it and won't put them in twice. But I can't discharge the patient if he doesn't put them in."

Me: "Seriously? He won't put the meds in?"

Nurse: "No, and now he went home. And the patient was supposed to leave three hours ago."

Me: "I'll be happy to put them in."

 

[deleted109597]

Doctor, did you write the "post-gastrectomy diet" order?
Yes
Ok, what does post-gastrectomy diet mean?
It means the diet the patient can take, that dietary needs to give them.
Yes, but the dietician is here and doesn't understand.
Go over to the wall across from your nurse's station and pick up the patient pamphlet entitled "post-gastrectomy diet" and hand it to the dietician please.

So, I'm still wondering, did she (dietician) miss that day of school or what? This was a bariatric floor of all things.

 

[Purifyer]

I cant think of too many ******ed nursing calls..

I guess the ones that piss me off most are when you are on nights and nurse x decides that even though the IV line is flushing well, it has been in 96 hours and must be immediately removed (and ergo immediately replaced). Also I get pissed that alot of nurses dont even try to jiggle an IV line to get it working, they will just call you and say its tissued. I also get pissed when I get paged because of a tachycardia or something, and I ask what the other vitals are, only to be met by 'oh I don't know, [I just started my shift] or [I'm just calling you on behalf on Jan because shes on a dinner break]'

I guess what irriates me most is when I get paged by a nurse, and then when I reply (within a minute) I wait a minute while the nursing station phone rings, then another nurse picks it up and spends a further five minutes trying to find the nurse who paged me then walked off. I've just started hanging up on bull**** like that. This irritation is closely followed by when you get paged, instantly ring the person back, but the number is engaged. I also get very pissed off when paged multiple times when in the middle of a 'procedure' (eg. difficult IV, chest drain etc) when its something incredibly minor that could wait.

Other night calls that piss me off include: (at 3am) "Doctor, I think this patient has oral thrush, could you examine him?" "Hi... I have this patient who I think could benefit from anti-spasmodics" "my patient hasn't passed urine all shift [patient uncatheterised, sleeping]. "Is a blood pressure of 150/80 normal?" "My patients post meal BSL is 11mmol/l, can you chart a sliding actrapid scale please"

 

[nabeya]

I sense a few cocky interns in here...

 

[fab4fan]

I cant think of too many ******ed nursing calls..

I guess the ones that piss me off most are when you are on nights and nurse x decides that even though the IV line is flushing well, it has been in 96 hours and must be immediately removed (and ergo immediately replaced). Also I get pissed that alot of nurses dont even try to jiggle an IV line to get it working, they will just call you and say its tissued. I also get pissed when I get paged because of a tachycardia or something, and I ask what the other vitals are, only to be met by 'oh I don't know, [I just started my shift] or [I'm just calling you on behalf on Jan because shes on a dinner break]'

I guess what irriates me most is when I get paged by a nurse, and then when I reply (within a minute) I wait a minute while the nursing station phone rings, then another nurse picks it up and spends a further five minutes trying to find the nurse who paged me then walked off. I've just started hanging up on bull**** like that. This irritation is closely followed by when you get paged, instantly ring the person back, but the number is engaged. I also get very pissed off when paged multiple times when in the middle of a 'procedure' (eg. difficult IV, chest drain etc) when its something incredibly minor that could wait.

Other night calls that piss me off include: (at 3am) "Doctor, I think this patient has oral thrush, could you examine him?" "Hi... I have this patient who I think could benefit from anti-spasmodics" "my patient hasn't passed urine all shift [patient uncatheterised, sleeping]. "Is a blood pressure of 150/80 normal?" "My patients post meal BSL is 11mmol/l, can you chart a sliding actrapid scale please"

The flip side of this is that I have paged docs and then stood at the desk waiting...waiting...waiting...waiting...waiting...15 min. later still waiting...

Believe it or not, it is entirely possible that after that nurse paged you, another pt needed her. Golly, I know that's so inconvenient for you, but these things happen. The nurse could have gotten another nurse to take care of the problem, <smacks head> what was I thinking? Half the time we're understaffed as it is, so no, there probably wasn't someone else available to check that pt for her.

Nurses call you to start IVs? LOL! The last time I watched an intern start an IV, he had to be coached every step of the way, including how to tear the tape, how to put on the tourniquet, how to look for the vein, etc. I don't mind teaching at all, that's how we all learn from each other, but if I can't get an IV, I call anesthesia, not the intern.

 

[fab4fan]

I sense a few cocky interns in here...

These are the kind of interns that tempt us nurses to resort to hazing. For all we kow, that may be what's going on. His attitude is earning him equally crappy treatment from the nursing staff.

I don't endorse that; it's unprofessional and it makes the nurses no better than the bad intern. But it does happen in some places, so some "stupid" calls may not be what they seem.

 

[toxic-megacolon]

Still one of my favorites:

"Doctor, the patient says he feels hypoglycemic; I checked his blood sugar and its 109. What should I do? (at 414am!)

 

[nabeya]

I love the nurses in the hospital where I'm at. At my program, interns have to cover all 12 floors, 650 beds of the hospital, 2 ICU's, admits coming from the ER, and be house officer covering all codes and reading any CXR's that come in.

My point is, being an intern that was just a 4th year med student a couple of months ago, nurses have really helped me along this "transition". I give them respect and they do the same to me even though they're probably thinking deep inside that I don't know my head from my @ss.

 

[fab4fan]

I love the nurses in the hospital where I'm at. At my program, interns have to cover all 12 floors, 650 beds of the hospital, 2 ICU's, admits coming from the ER, and be house officer covering all codes and reading any CXR's that come in.

My point is, being an intern that was just a 4th year med student a couple of months ago, nurses have really helped me along this "transition". I give them respect and they do the same to me even though they're probably thinking deep inside that I don't know my head from my @ss.

I work at a teaching hospital. At least where I work, you have do something spectacularly stupid before we say that. We know you're learning. We're all learning, no matter how long we've been practicing.

 

[Shinken]

I love the nurses in the hospital where I'm at. At my program, interns have to cover all 12 floors, 650 beds of the hospital, 2 ICU's, admits coming from the ER, and be house officer covering all codes and reading any CXR's that come in.

My point is, being an intern that was just a 4th year med student a couple of months ago, nurses have really helped me along this "transition". I give them respect and they do the same to me even though they're probably thinking deep inside that I don't know my head from my @ss.

So true.

I'm a newly minted 4th year med student, and I have no problem admitting that nurses have taught me and helped me quite a bit during 3rd year. Yes, they're not experts in physiology and pathology, but 3rd year is also about learning basic clinical skills, and nurses are great at those. No doctor taught me how to place a line, a foley, hook up an EKG or fill out those innumerable forms. It was all nurses.

Things I've noticed nurses absolutely love (and if you do them they'll treat you nicely):

- Be polite (yes, a simple "good morning!" goes a long way...don't just walk past the nurses, grab a chart off their station and walk away).

- Keep them in the loop

- Clean after yourself as much as possible

- Be civil to patients. Don't piss a patient off and then walk away expecting the nurse to do the damage control

- Let nurses do their job too. Don't walk in while the nurse is doing her intake, and start doing your H&P. You're busy, so are they

- Bring a treat once in a while (a box of donuts in the morning every other week works like a charm)

Sorry for the digression...carry on.

 

[Purifyer]

The flip side of this is that I have paged docs and then stood at the desk waiting...waiting...waiting...waiting...waiting...15 min. later still waiting...

Believe it or not, it is entirely possible that after that nurse paged you, another pt needed her. Golly, I know that's so inconvenient for you, but these things happen. The nurse could have gotten another nurse to take care of the problem, <smacks head> what was I thinking? Half the time we're understaffed as it is, so no, there probably wasn't someone else available to check that pt for her.

Nurses call you to start IVs? LOL! The last time I watched an intern start an IV, he had to be coached every step of the way, including how to tear the tape, how to put on the tourniquet, how to look for the vein, etc. I don't mind teaching at all, that's how we all learn from each other, but if I can't get an IV, I call anesthesia, not the intern.

Meh, I was just saying what irritates me in the hospital. If anyone else says the same things dont irritate them, well, they're either meek or a saint. At my hospital, nurses need accreditation to do IV lines (dont get me started on this one)... and only a handful have it (and why would they want it, its a ****ty job). So on an evening shift I may be putting in anywhere from 5-10 IVs on the wards (NOT including new ER patients). Hence my large rant about IVs.

On the whole I get on great with nurses. Understaffing is an issue and I suppose it was relatively egocentric of me to not even consider that as a possibility for these issues.

I do think its quite puerile of you to make some passing comment like 'These are the kind of interns that tempt us nurses to resort to hazing.' What kind of interns? It is a thread titled 'stupidest thing a nurse has ever paged you for', in the internship subforum, of the physician forums. I was letting off some steam that obviously I don't let off in the hospital environs.

I try as hard as I can to be polite, tell the nurse whats going on/any changes in plan, quite often I also ask the nurse after Ive made a plan what she thinks of it and if she agrees/wants to make a suggestion (not because I'm unsure, but because I want to make the nurse feel like we are part of a team). I clean up after procedures, hell, usually I even set things up myself as its faster than asking a nurse to do it. If they are way off the mark in terms of clinical judgement or reasoning (and I have the time) I will try to explain why I am doing what I am doing. Quite often I eat lunch with the nurses on my ward, and I go drinking with them as well.

But theres a difference between being a good doctor and being obsequious. Its too easy when you start to simply pander to your nurses' wishes. Fact of the matter is, they have vast mounds of experience but little understanding. Its very easy to get on very well with nurses if you simply do what they say, but it takes far greater skill to do something the nurse disagrees with, but still maintain a good relationship.

 

[colbgw02]

I do think its quite puerile of you to make some passing comment like 'These are the kind of interns that tempt us nurses to resort to hazing.' What kind of interns? It is a thread titled 'stupidest thing a nurse has ever paged you for', in the internship subforum, of the physician forums. I was letting off some steam that obviously I don't let off in the hospital environs.

Yeah, I love how when anyone posts anything remotely controversial about other healthcare professionals, there are automatically 3-4 people who circle the wagons and go into crisis defensive lockdown mode.

I think it's pretty stupid that nurses collectively use the tactic of "hazing". It's not like the doctors sit around thinking of how they can mess with Nurse X when he/she messes up or acts like a jerk.

We all need and rely on each other; everybody gets that. It's crazy that we can't swap a few stories on an internet message board without somebody getting huffy.

 

[Krisss17]

So here's one that hopefully doesn't offend all the unit secretaries lurking on this forum...

Background story: A patient had been getting ABGs so chronically that he had developed a pannus over his radial artery. One of my co-interns wrote him for a lidocaine jelly on the pannus prior to ABG. Of course, a unit secretary has no clue what a pannus is. But...

(one week later...)

Nurse: Can you renew Mr. B's lidocaine jelly to his penis?

Intern: Ugh... Why is Mr. B getting lidocaine jelly to his penis?

Nurse: I don't know.. it says in his medbook that he's been getting it for a week, just prior to his ABGs.

Intern: I guess it makes sense he hasn't complained...

I am a unit secretary, and while I did not know initially what a pannus was ...I do know where the radial artery is so...I think I would be in the clear.

 

[Tired]

These are the kind of interns that tempt us nurses to resort to hazing. For all we kow, that may be what's going on. His attitude is earning him equally crappy treatment from the nursing staff.

I don't endorse that; it's unprofessional and it makes the nurses no better than the bad intern. But it does happen in some places, so some "stupid" calls may not be what they seem.

Sorry, I guess we all forgot that all nurses are perfect, and would never page us unless it was absolutely necessary.

Good God, someone gets irritated at being called with normal lab values or incomplete information, and they must be "cocky"? How about you try staying up 36hrs straight, then take a couple of these calls during your one 30min chance to get a nap, and tell us how "things aren't always what they seem"?

Next time you get all righteous and start waking up your interns (and yes, they are yours) just to teach them a lesson, think about all the wonderful care your patients will get from a doctor you deprived of sleep.

 

[fab4fan]

Sorry, I guess we all forgot that all nurses are perfect, and would never page us unless it was absolutely necessary.

Good God, someone gets irritated at being called with normal lab values or incomplete information, and they must be "cocky"? How about you try staying up 36hrs straight, then take a couple of these calls during your one 30min chance to get a nap, and tell us how "things aren't always what they seem"?

Next time you get all righteous and start waking up your interns (and yes, they are yours) just to teach them a lesson, think about all the wonderful care your patients will get from a doctor you deprived of sleep.

Apparently you don't read carefully. I said that's not something I do.

I don't endorse that; it's unprofessional and it makes the nurses no better than the bad intern. But it does happen in some places, so some "stupid" calls may not be what they seem.

 

[toxic-megacolon]

.

Things I've noticed nurses absolutely love (and if you do them they'll treat you nicely):

- Be polite (yes, a simple "good morning!" goes a long way...don't just walk past the nurses, grab a chart off their station and walk away).

- Keep them in the loop

- Clean after yourself as much as possible

- Be civil to patients. Don't piss a patient off and then walk away expecting the nurse to do the damage control

- Let nurses do their job too. Don't walk in while the nurse is doing her intake, and start doing your H&P. You're busy, so are they

- Bring a treat once in a while (a box of donuts in the morning every other week works like a charm)

This goes both ways, there are so many times when a nurse hasnt even bothered to say "hi" to me when I preround, or wont let me do my work because s/he has something to do that's "more important"
As many residents there are that treat nurses like $#!^, there are twice as many nurses that treat residents even more poorly.
In my own experience of course...

 

[deleted109597]

How about paging me 3 times last night because there was a consult.
Only thing was I wasn't on call, so I didn't bother to call back when the pages awoke me. Paged me again in the morning, so when I called back I got a snotty tone saying "you didn't return your pages, so I just wanted to let you know that your consult is still upstairs". I walked to the floor and asked to see the call list, and sure enough, she had a copy of the day I was on call, which was the previous day, but couldn't be bothered to check the date on the page, or the daily updated computer call list that is on the desktop of every computer in the house. She also didn't ask anyone else on the floor who was on call, and to make it even worse, the consult had happened during day shift when she wasn't on, and had already been completed. Pretty much, I think she was told at checkout that surgery had been consulted, and she never even looked at the chart (no vitals were recorded for the entire shift at that point, later there were some placed in the chart).
I'm tempted to write her up, but because the other nurses will have her back, I know it will only hurt me.

 

[pharmer]

I got paged the other day from a nurse when I was on call to give a verbal order regarding the following around 2am
Nurse: The patient in room 5105 smells really and we were wanting to get a verbal order to apply peppermint oil to him.
Me: Peppermint oil?
Nurse: Yeah, the pharmacy has this peppermint oil stuff you can put on a patient and it completely takes any bad smells away.
Me: (still in total shock that Im getting paged for this "acute" problem) You're kidding me right?
Nurse: No he smells really bad and we can't do this w/o and order.
Me: You may apply peppermint oil to the patient for unpleasant orders. In fact you can prn that peppermint oil and put on as much peppermint oil you would like....click

 

[Doctor M]

I got paged the other day from a nurse when I was on call to give a verbal order regarding the following around 2am
Nurse: The patient in room 5105 smells really and we were wanting to get a verbal order to apply peppermint oil to him.
Me: Peppermint oil?
Nurse: Yeah, the pharmacy has this peppermint oil stuff you can put on a patient and it completely takes any bad smells away.
Me: (still in total shock that Im getting paged for this "acute" problem) You're kidding me right?
Nurse: No he smells really bad and we can't do this w/o and order.
Me: You may apply peppermint oil to the patient for unpleasant orders. In fact you can prn that peppermint oil and put on as much peppermint oil you would like....click

Im sorry, but that is funny as hell.

 

[johankriek]

So true.
- Bring a treat once in a while (a box of donuts in the morning every other week works like a charm)

.

they would love thisone..


seriously, they have too many ****ing treats.. cookies cakes hard candy .. geez... if i liked them i would bring them a subscription to the ****ing gym so they can work those fat asses off.

 

[johankriek]

How about paging me 3 times last night because there was a consult.
Only thing was I wasn't on call, so I didn't bother to call back when the pages awoke me. Paged me again in the morning, so when I called back I got a snotty tone saying "you didn't return your pages, so I just wanted to let you know that your consult is still upstairs". I walked to the floor and asked to see the call list, and sure enough, she had a copy of the day I was on call, which was the previous day, but couldn't be bothered to check the date on the page, or the daily updated computer call list that is on the desktop of every computer in the house. She also didn't ask anyone else on the floor who was on call, and to make it even worse, the consult had happened during day shift when she wasn't on, and had already been completed. Pretty much, I think she was told at checkout that surgery had been consulted, and she never even looked at the chart (no vitals were recorded for the entire shift at that point, later there were some placed in the chart).
I'm tempted to write her up, but because the other nurses will have her back, I know it will only hurt me.

next time a nurse gives you an attitude just pick up the phone and call the VP of nursing.. every hospital has one.. and ask her/ him Are the nurses in this hospitals supposed to help doctors or hinder them doing their jobs? and them complain about the nurse in question

 

[Tired]

next time a nurse gives you an attitude just pick up the phone and call the VP of nursing.. every hospital has one.. and ask her/ him Are the nurses in this hospitals supposed to help doctors or hinder them doing their jobs? and them complain about the nurse in question

Yeah, they'll love hearing that from an intern.

 

[Bevo]

this is my bs call.

i got woken up at like 6:30 am about a cross cover call. This guy has end stage COPD. DNR/DNI. Been refusing all sorts of treatments like bipap and what not. Running a pC02 of like 110-140.
I was told by the primary team that they had ordered the cxrs and abgs but nothing really changed with his management and frowned on me ordering such things saying it wasn't really all that necessary because unless he consented to being intubated there wasn't much they could do to help him.

So I get a call from the nurse and I'm half asleep. She says the pt's daughter is a nurse on the floor and wants her father to have a stat ABG and a stat portable cxr. So I ask if he's having a change in his status. She said no, but that the daughter demands I order them. So I said I'll be there in 2 mins to examine the patient. So she told me that wouldn't be necessary and hung up on me.


I found out that the med student covering the patient walked in at that point and had gotten bugged about calling her senior to do verbal orders on the patient to get the cxr and abg.

 

[snoopy brown]

I got paged the other day from a nurse when I was on call to give a verbal order regarding the following around 2am

That's obnoxious. Because nurses do one or the other. Half the time they act like the residents need to order "allow patient to breathe." I've had nurses make me order things like lotion for patients, which clearly is unnecessary. And the other half of the time you get nurses who do stuff at random and then tell (not ask) you to order it retroactively to cover them. For example, I've had nurses several times perform EKGs for random, unspecified reasons (it would blow your mind) and then tell me to order it and also by the way come there to interpret it. Or else they'd note that an EKG was performed and "MD refused to look at it" or something.

I'm sure that a nurse will write that this only occurs because I'm an evil, bad person and this is paybacks. I really don't care. I'm there to do work, not to recreate high school. It's really a sad state of affairs in the hospital sometimes.

 

[Dr JPH]

I love nurses. They have helped me so much in the past 2 months its unbelievable. 95% of them make my job easier and are absolute sweethearts. They have the toughest job in the hospital, aside from the nurses aides.

In that time only 3 calls really stand out in my mind...and all 3 happened on the same night within 2 hours of each other.

Call #1 (0300 ish)
RN: "Hey doc, just wanted to clarify something about Mrs. X. She says she is allergic to lopressor but she has orders for it."
Me: "She has been getting lopressor for a few days as far as I know."
RN: "Yeah, I saw that too but she says she is allergic to it."
Me: "Well, Im no too worried about it, she hasnt had a reaction."
RN: "Well, do you want to help me figure this out?"
Me: "Be right up."
=== On the floor ===
Me: "Ok...lets figure this out <yawn>"
RN: "Ok, so she says she is allergic to lopressor."
Me: "Lets go talk to the patient."
Me: "Mrs. X, what are you doing up so late?"
Patient: "Late late late late late late late late."
Me: "Mrs. X, the nurse says your allergic to lopressor."
Patient: "lopressor lopressor lopressor lopressor."
Me: "So youre not allergic?"
Patient: "allergic allergic allergic allergic."
Me: "I knew you were a joker"
Patient: joker smoker joker smoker joker smoker."
Me (to RN): "Patient is not allergic to lopressor."

Call #2 (0345 ish)
RN: "Hi doctor, I just wanted to let you know Mr. X's pressure was 130/90"
Me: "OK."
RN: "Well, he was 110/70 at 2200"
Me: "OK, what do you need me to do."
RN: "Nothing, I just wanted to let you know the bottom number was 90."
Me: "Thanks." click

Call #3 (0430 ish)
RN: "Doctor, this is ____ on 3 pavilion. Can you come up here?"
<< click >>
=== on the floor within 2 minutes expecting emergency ===
Me: "Whats up?!"
RN: "I cant read your writing here."
Me: "Thats not my writing."
RN: "Oh."
Me: "Is that it?" - starting to walk away... -
RN: "Wait, youre not Washburn?"
Me: "No."
RN: "I thought you were Dr Washburn?"
Me: "Nope."
RN: "Oh."
Me: "Is that it?"
RN: "I guess so!"
Me: ???? WTF ????

 

[smq123]

From the site hippocritis.com (http://www.hippocritis.com/february05/wallofshame.htm)

* Worst Page (occurs at 2 AM)
RN - "I was just showing the nursing student how the paging system works."

* Worst Page #2:
RN - "Yes doctor, he's bleeding out of his rectum, all over the place."
Intern - "What are his vital signs?"
RN - "There's no time for that Doctor, we've got to clean him up."

* Worst late night Page:
Nurse: "I was calling because Mr. X's diet says he can have two milks."
Resident: "And?"
Nurse: "He's only gotten one"

 

[Purifyer]

Not so much a page from a nurse, but a page from a hospital operator @ 4am (on my personal cellphone). NB I was not on call and due to go in at 7am that day.

Operator : "Hello, this is Jane, hospital operator, are you Dr. James X?

Me: No, I am Dr David X (same last name)

Operator : "Sorry to bother you Dr. James X but the police need to speak to you urgently"

Me: "(*^^%(( I already told you I am not Dr James X!!!!"
*click*

It's a pity I was too tired, I should have played along and possibly found out some gossip haha.

 

[Tired]

This one isn't so much stupid, but was kind of irritating.

RN: "Yes, is this the Gen Surg cross cover?"
Me: "Yup, what can I do for you?"
RN: "We have a patient here in Short Stay who just got out of surgery an
hour ago. He's kind of nauseous, and I'd like to give him Phenergan."
Me: "The primary team didn't write a prn for nausea?"
RN: "They wrote for Zofran."
Me: "That didn't help?"
RN: "I didn't give it. I'd rather give Phenergan."
Me: "How come?"
RN: "Zofran doesn't really work post-op."
Me: ". . . . um, just give what they ordered, and call me if that doesn't work."

I didn't get called back. Guess it does work after all.

 

[Smurfette]

This one isn't so much stupid, but was kind of irritating.

RN: "Yes, is this the Gen Surg cross cover?"
Me: "Yup, what can I do for you?"
RN: "We have a patient here in Short Stay who just got out of surgery an
hour ago. He's kind of nauseous, and I'd like to give him Phenergan."
Me: "The primary team didn't write a prn for nausea?"
RN: "They wrote for Zofran."
Me: "That didn't help?"
RN: "I didn't give it. I'd rather give Phenergan."
Me: "How come?"
RN: "Zofran doesn't really work post-op."
Me: ". . . . um, just give what they ordered, and call me if that doesn't work."

I didn't get called back. Guess it does work after all.

No, that is stupid.

#1, they shouldn't call and ask for something else unless the first med DIDN'T work, is not available, or the patient has some sort of reason to not get it, and #2, IMHO Zofran is the superior, stronger drug for nausea, especially for people who have no relief with other antiemetics.

Not regarding RN pages (of which I have had many weird or irrelevant pages while on call, including ones similar to other folks ("patient is febrile to 99.5, doctor! what do you want to do? NOTHING?!! Well, I'm going to document that you failed to take action!".) In our county hospital, RNs often record "strict Is & Os" as "foley" or "hat" or "void x 3" without recording the actual volumes. They especially seem to believe that the word "foley" equals an output volume. If you question it, they just look at you funny and don't seem to understand why the urine volume is important. My personal favorite urine "volume" recording ever was "green" (patient got dye intra-op which was excreted in the urine).

 

[Purifyer]

4am

Nurse : Hello, do you know Mr. X?

Me: No

Nurse : Really? He has a necrotic toe and is scheduled for surgery tomorrow
[this is something that bugs me, that nurses presume you know every single patient in the hospital while doing cross cover nights]

Me: No. How can I help?

Nurse: Well, he is Nil By Mouth, but I just did his glucose and it was 6.1(mmol/l - normal glucose). Can I give him something to eat?

Me: Why are you measuring his glucose at 4am? Is he diabetic?

Nurse: No, but hes NBM. Do you know if hes going to have surgery today? Because if he isn't, I'll give him something to eat

Me: What do the notes say?

Nurse: Plan : Surgery in morning. But do you know if he really is?

Me: No idea. Keep NBM. Stop measuring glucose. Thanks for calling.

 

[snoopy brown]

"patient is febrile to 99.5, doctor! what do you want to do? NOTHING?!! Well, I'm going to document that you failed to take action!"

Classic.

 

[Dr JPH]

I got the "evil eye" yesterday from a new nurse for failing to give a patient pain medication. She thought the patient needed some percocet for her abdominal pain. I determined the patient didnt need any percocet for her nonexistant abdominal pain, with completely normal abdominal exam.

 

[fab4fan]

I got the "evil eye" yesterday from a new nurse for failing to give a patient pain medication. She thought the patient needed some percocet for her abdominal pain. I determined the patient didnt need any percocet for her nonexistant abdominal pain, with completely normal abdominal exam.

And I will be she informed you that "Pain is whatever the patient says it is and occurrs whenever the patient says it does."

 

[Bevo]

in my hospital, a temp isn't really significant unless its 103 or higher.

Chief of ID doesn't want us giving Tylenol out to anyone with a temp of less than 103. Nurses actually warn us if we give tylenol with a lesser temp, esp if the ID doc is consulted. He'll write us up or something if he finds out we gave tylenol for temp less than 103.


I've had a few calls with temps of 102. something or 101. something by morning when I follow up with the next set of vitals, the temp has always come down.

General rule is to get the cultures. Resp, blood, urine. I may be missing one.

 

[Dr JPH]

in my hospital, a temp isn't really significant unless its 103 or higher.

Chief of ID doesn't want us giving Tylenol out to anyone with a temp of less than 103. Nurses actually warn us if we give tylenol with a lesser temp, esp if the ID doc is consulted. He'll write us up or something if he finds out we gave tylenol for temp less than 103.


I've had a few calls with temps of 102. something or 101. something by morning when I follow up with the next set of vitals, the temp has always come down.

General rule is to get the cultures. Resp, blood, urine. I may be missing one.

You have to pan culture everyone who is febrile?

Are there exceptions for white count, diagnosis, postop, etc?

 

[raidermedic]

Still a med student and have only had one call but that one was plenty.


Nurse: Hello is this Dr Raidermedic?

Me: No this is medical student Raidermedic.

Nurse: Yeah I'm taking care of Mr Smith and I'm not clear on what you guys want. Can you please clarify?

Me: Mr Smith? I don't have any patients on my list by that name. Who's the attending?

Nurse: Dr. X

Me: Yeah I work with Dr Y, I don't even know Dr X and I'm not on his service.

Nurse: Yeah there is another med student name on the chart but we couldn't make it out so we saw your name in another chart and decided to page you.

Me: Well I'm not on that service so I really can't help you.

Nurse: Well I know what we usually do for patients like this maybe I'll just do that.

Me: I really can't tell you anything sorry.

Nurse: So I'm going to just go ahead and do x, y, and z. Can I document that you approved of this?

Me: No..........

click.

 

[Dr JPH]

Still a med student and have only had one call but that one was plenty.


Nurse: Hello is this Dr Raidermedic?

Me: No this is medical student Raidermedic.

Nurse: Yeah I'm taking care of Mr Smith and I'm not clear on what you guys want. Can you please clarify?

Me: Mr Smith? I don't have any patients on my list by that name. Who's the attending?

Nurse: Dr. X

Me: Yeah I work with Dr Y, I don't even know Dr X and I'm not on his service.

Nurse: Yeah there is another med student name on the chart but we couldn't make it out so we saw your name in another chart and decided to page you.

Me: Well I'm not on that service so I really can't help you.

Nurse: Well I know what we usually do for patients like this maybe I'll just do that.

Me: I really can't tell you anything sorry.

Nurse: So I'm going to just go ahead and do x, y, and z. Can I document that you approved of this?

Me: No..........

click.

Peculiar.

I don't see why a nurse would ever page a medical student.

1. Nurses are piss poor at reading progress notes...so it would be a miracle if they came across your name in the chart
2. Med Students cant sign orders...so they wouldnt see your name there
3. Med Students cant write orders...so nurses have no use for calling you
4. Nurses know that med students always turf questions up the line, as well they should

 

[snoopy brown]

Peculiar.

I don't see why a nurse would ever page a medical student.

</p>
I've had nurses ask medical students for orders (but never page them). It doesn't happen often but when it does it's the nurse just wanting anyone to say something so she can document she did it "on their say-so." It's extremely inappropriate. More commonly I've had lots of nurses give medical students a message to relay to the team, which is also inappropriate because it's also basically just passing the buck. Say the medical student forgets to pass on the message or just doesn't, then the issue is not addressed but if something bad happens the nurse can just say that she told "someone on the team."

 

[raidermedic]

Peculiar.

I don't see why a nurse would ever page a medical student.

1. Nurses are piss poor at reading progress notes...so it would be a miracle if they came across your name in the chart
2. Med Students cant sign orders...so they wouldnt see your name there
3. Med Students cant write orders...so nurses have no use for calling you
4. Nurses know that med students always turf questions up the line, as well they should

That was my thinking as well.
As for this particular case they were able to find my name because after I sign each of my notes I print my name. Although I was shocked that they even read the note.

I've actually had similar incidents where there wasn't a page but I would be prerounding and they wanted to give patient XYZ drug and asked if it was ok.
I told them I couldn't tell them anything because I was a student. They said "Yeah but we don't want to page the attending to ask him, so can we just put down that you approved of it?" A lot of times I wound up paging the attending myself.

Like Snoopy Brown said sometimes all they want is to document that they had someones approval. A resident warned me of them sometimes doing it and told me to never tell them anything because if anything goes south they could simply say I misrepresented myself as a resident and I would be screwed.