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

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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.

more than likely, the notes were being perused to find a legible name, and once found, that name was called. at times, progress notes are read by nurses for other reasons (such as actually reading the physician's thought process), but it seems more often than not, it's to find a legible name.

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but it seems more often than not, it's to find a legible name.

Probably true!

At my hospital they put a sticker on the front of the chart with all the house officers on that service, including consultants, along with their pager number.

So Ive been paged dozens of times for a patient who is on my service but not well known to me (another resident is managing them)...but my name was stuck on the front of the chart!

I need to change my name to Zazelton...put me down at the bottom of the list alphabetically. Maybe I wont get called.
 
Probably true!

At my hospital they put a sticker on the front of the chart with all the house officers on that service, including consultants, along with their pager number.

So Ive been paged dozens of times for a patient who is on my service but not well known to me (another resident is managing them)...but my name was stuck on the front of the chart!

I need to change my name to Zazelton...put me down at the bottom of the list alphabetically. Maybe I wont get called.

that sticker seems like it could be a good thing or a bad thing. i get a number of pages when i'm on inpatient service regarding patients who aren't mine, and i could see how this sticker could help... but then again, it's not as though the nurses know residents days off, or when service is switched, so perhaps the sticker could be detrimental... of course my last name starts with a w, so i guess i'd be at the bottom of the list, lol.

in all seriousness, did your institution put this sticker in place to combat random/wrong people getting paged, or for some other reason?
 
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that sticker seems like it could be a good thing or a bad thing. i get a number of pages when i'm on inpatient service regarding patients who aren't mine, and i could see how this sticker could help... but then again, it's not as though the nurses know residents days off, or when service is switched, so perhaps the sticker could be detrimental... of course my last name starts with a w, so i guess i'd be at the bottom of the list, lol.

in all seriousness, did your institution put this sticker in place to combat random/wrong people getting paged, or for some other reason?

The nurses are pretty good. They know that between 4:30pm and 7:30am they must page the intern or resident on call. Weekends is the same.

Occasionally I will get a page post-call but if it goes unanswered they just move to the next person on the list.

Also, each service has its own pager so more often than not the service pager is used before our private, long range pagers.

I think they started the sticker system because of the large number of teaching services at the hospital. Depending on who is consulted there may be 4 or more housestaff writing notes on the chart (primary, nephro, surgery, GI, pain management, cardio, etc)

It does make it easier when a nurse needs to reach someone on the primary team...it works best when the nurse flips to the most recent progress note to see which specific intern is covering that patient. Also, our hospital requires a pager number after every signature...at least by the housestaff.
 
My institution has a color-coding system, whereby the patient's name on the status board has a particular colored label based on who the primary team is. Thus Gyn is Green, Surgery is red, Ortho pink, etc.

Nonetheless I get paged at least 3-4 times a week for patients that my team isn't primary on, or isn't even seeing.

I finally asked last week why they decided to page me, instead of the intern from the primary team on the case. The answer was, "Oh, your's was just the last name I saw in the chart." Not a big deal at noon, but just f-ing brutal at 2:30am.
 
1. Nurses are piss poor at reading progress notes...

So am I. It would help if the chart didn't look like my kid's coloring book.

If there's one thing I can't stand, it's illegible handwriting. What's the point in consulting someone when you can't read their recs? I can't blame nurses too much for this, unless they obviously just never read the chart.



I had a nice page the other day:

Me: Hi, I'm Dr. SJS, answering a page.

Nurse: Hi, are you the resident who wrote for the liter bolus and the Urology consult on patient X?

Me: No. That was whoever had the chart before me.

Nurse: Oh, okay... because they didn't sign the order, and I saw your pager number somewhere else in the chart.

:)
 
I had a nice page the other day:

Me: Hi, I'm Dr. SJS, answering a page.

Nurse: Hi, are you the resident who wrote for the liter bolus and the Urology consult on patient X?

Me: No. That was whoever had the chart before me.

Nurse: Oh, okay... because they didn't sign the order, and I saw your pager number somewhere else in the chart.

:)

This seems pretty legit to me. I would probably do the same thing. The alternative is to call the resident or attending on the team, which will only get your coworker in trouble. Sounds like the nurse was trying to protect the intern, which is always appreciated.
 
This seems pretty legit to me. I would probably do the same thing. The alternative is to call the resident or attending on the team, which will only get your coworker in trouble. Sounds like the nurse was trying to protect the intern, which is always appreciated.

Perhaps some backstory is in order: Another service wrote the order, and the accompanying note (which was signed, with the appropriate pager number). She wasn't trying to protect the intern or anybody else, she was trying to call the first pager number she saw to get the dang thing signed. I give her credit at least for that, but she should have 1) checked the note and 2) not called some unknown intern trying to get an order signed. Decent intentions, poor execution.
 
Perhaps some backstory is in order: Another service wrote the order, and the accompanying note (which was signed, with the appropriate pager number). She wasn't trying to protect the intern or anybody else, she was trying to call the first pager number she saw to get the dang thing signed. I give her credit at least for that, but she should have 1) checked the note and 2) not called some unknown intern trying to get an order signed. Decent intentions, poor execution.

Ah, I see now. When you said that it was "the person before you" I thought you meant the intern covering the service before you came on.
 
When I was a final year med student nurses were always on my ass to sign for fluids and chart panadol etc (which as much as I'd like to have obliged, I couldn't have).

Stupidest call I got last night was "patients IV line tissued, needs another IV", the nurse hadn't even checked the other arm (which had a lovely 18 gauge sitting there in the AC fossa).

Also got a page ~3am

"Orthopaedic patient day 2 post op in severe pain.. only panadol is charted can you please chart some pain meds?"
me: "?? That sounds a bit odd are you SURE there are no PRN pain meds?" nurse: "Oh wait, morphine is charted"
me: "*heavy suicidal sigh* ok, thanks"
[NB these patients are borders on non surgical wards, never met these nurses before, so this is not hazing :) ]

Just an inane side point... what do you guys do with the "old gomer with whole swollen arm" post IVF running through that arm? Nurses like to stop it and resite IV claiming this is evidence of 'tissuing' - its not necessarily, surely its just frank starling in action (ie. increased pressure in veins due to q8h fluids with low oncotic pressure simply causing extravasation). I can't be bothered arguing over such inane points at 2am and so just resite. Surely if it was 'tissued' there would be a localised oedema as opposed to entire limb? Kind of irritates me.
 
NB these patients are borders on non surgical wards, never met these nurses before, so this is not hazing

Don't you guys find it sad that nurses have so ingrained everyone with the false belief that these pages are your fault? Hats off to them though, it's worked. People are afraid to complain about nurses even informally amongst themselves because everyone else will immediately question what you did to "cause" the call.
 
Just an inane side point... what do you guys do with the "old gomer with whole swollen arm" post IVF running through that arm? Nurses like to stop it and resite IV claiming this is evidence of 'tissuing' - its not necessarily, surely its just frank starling in action (ie. increased pressure in veins due to q8h fluids with low oncotic pressure simply causing extravasation). I can't be bothered arguing over such inane points at 2am and so just resite. Surely if it was 'tissued' there would be a localised oedema as opposed to entire limb? Kind of irritates me.

Since Frank-Starling involves cardiac preload and correlated changes in stroke volume, I don't think that is what you mean.

As for the extravasation of fluid, that is going to depend on what exactly the extremity looks like. Yes, there will be localized edema, but "localized" is going to mean different things if you have a liter versus 10 ml in there. If the edema isn't global, then I'd have to consider the IV.

In terms of what to do about it, see if the IV flows well and draws back. If so, it is likely still a well functioning IV. If not, you can't rely on it and it should be replaced. Then elevate the swollen extremtity. It isn't worth it to have a poorly functioning IV, since it won't help you anyway.
 
When I was a final year med student nurses were always on my ass to sign for fluids and chart panadol etc (which as much as I'd like to have obliged, I couldn't have).

Stupidest call I got last night was "patients IV line tissued, needs another IV", the nurse hadn't even checked the other arm (which had a lovely 18 gauge sitting there in the AC fossa).

Also got a page ~3am

"Orthopaedic patient day 2 post op in severe pain.. only panadol is charted can you please chart some pain meds?"
me: "?? That sounds a bit odd are you SURE there are no PRN pain meds?" nurse: "Oh wait, morphine is charted"
me: "*heavy suicidal sigh* ok, thanks"
[NB these patients are borders on non surgical wards, never met these nurses before, so this is not hazing :) ]

Just an inane side point... what do you guys do with the "old gomer with whole swollen arm" post IVF running through that arm? Nurses like to stop it and resite IV claiming this is evidence of 'tissuing' - its not necessarily, surely its just frank starling in action (ie. increased pressure in veins due to q8h fluids with low oncotic pressure simply causing extravasation). I can't be bothered arguing over such inane points at 2am and so just resite. Surely if it was 'tissued' there would be a localised oedema as opposed to entire limb? Kind of irritates me.

Um . . . what?

I'm not totally sure this is English.
 
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So am I. It would help if the chart didn't look like my kid's coloring book.

If there's one thing I can't stand, it's illegible handwriting. What's the point in consulting someone when you can't read their recs? I can't blame nurses too much for this, unless they obviously just never read the chart.


This is usually a big issue.

I have worked in facilities that required MD ID numbers.

No one actually uses them.

I have worked for facilities that require and provide stampers.

No one actually uses them.

I have worked with facilities that require printing.

No one actually does it.

I get really tired of interpretting one MD consultant's notes/orders to another MD, because they are illegible. Can't y'all talk to each other and tell each other that your fellow MD has illegible handwriting. It is a serious safety issue.
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As far as the med student/intern/resident/fellow...many nurses do not know the difference nor really care, by looking at you. All that BS about coat lengthes ....a coat is a coat. And policies from place to place vary widely as to calling med students "doctor", and whether they can "order" (to be cosigned in time) and what requires immediate approval/cosign. The rosters change every two/three weeks, with some members of the team rotating in and out at different times. And often the lists or the page number do not specify the degree.

Thankfully, my current assignment has only PAs/NPs/Fellows/Attendings. And I rarely deal with Med Students in my department (Hem Malignancies) in my teaching hospitals.
 
many nurses do not know the difference nor really care, by looking at you.

Same for us. As long as you follow the order on the chart then Im happy. I dont care if youre a BSN, MSN or whatever else there is. Just hang the fluids please before my patient dries up like a raisin.
 
Don't mean to hijack this thread, but....

"Can Miss L have something to sleep tonight?"

"Sure, ya'll like zolpidem on that floor?"

"Actually, I'm more familiar with Ambien."
 
This is usually a big issue.

I have worked in facilities that required MD ID numbers.

No one actually uses them.

I have worked for facilities that require and provide stampers.

No one actually uses them.

I have worked with facilities that require printing.

No one actually does it.

I get really tired of interpretting one MD consultant's notes/orders to another MD, because they are illegible. Can't y'all talk to each other and tell each other that your fellow MD has illegible handwriting. It is a serious safety issue.
-------------------------------------------------------------------------

As far as the med student/intern/resident/fellow...many nurses do not know the difference nor really care, by looking at you. All that BS about coat lengthes ....a coat is a coat. And policies from place to place vary widely as to calling med students "doctor", and whether they can "order" (to be cosigned in time) and what requires immediate approval/cosign. The rosters change every two/three weeks, with some members of the team rotating in and out at different times. And often the lists or the page number do not specify the degree.

Thankfully, my current assignment has only PAs/NPs/Fellows/Attendings. And I rarely deal with Med Students in my department (Hem Malignancies) in my teaching hospitals.

I was cross covering a pt and saw a consultant had written an illegible order for the AM that began with a P then had some scribbles next to it. I figured it was just a Profile 1 (PF1), which is our BMP. There hadn't been one for a while so i figured it was good to check his lytes anyways. The next morning I got called and yelled at by said consultant for ordering the wrong test, how it was a waste of money and how he had actually written for PFT's and the lab was already sent blah blah blah blah blah

I kind of felt bad for 30 seconds and then was happy when the K came back at 2.4 and needed to be replaced. His note was much neater the next day
 
I kind of felt bad for 30 seconds and then was happy when the K came back at 2.4 and needed to be replaced. His note was much neater the next day

I come across this line of thinking a lot and it never fails to amaze me. You weren't right because of any reasoning, you just happened to "luck out" so to speak. Therefore it doesn't prove that the attending was wrong or that you were right and there's nothing to "be happy" about.
 
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.

Ya know I do have some pet peeves about pages. I am very, very good about returning my pages. I figgure if it was important enough for you to page me then it is important enough for me to get back to you ASAP. Most times it's within 30 seconds unless I am scrubbed in a case/placing a line etc.

My biggest pet peeve is being put on hold. Now I will hold for exactly 1 minute and hang up. If it was important enough to page me it's important enough for you to wait on me to call back. I hate the busy signal too, don't page me and then get on the phone to someone else. Don't repeat page in less than 10 minutes because I WILL get back to you, it's very rare that the return is not immediate and if it's not then there is a reason (most nurses learn this about me the first day and they stop them of their own volition I am happy to say). Lastly DON'T PAGE WITHOUT THE CHART/VITALS. I seriously don't have time to hold while you go get them. Really it just makes both of our lives easier in the end.

PS, not to pick on nurses the peeves I have with other doctors are similar. I hate to page and wait for exceedingly long periods of time, I expect them to return the pages ASAP as well. I wouldn't have paged if I didn't need to speak to them. I won't hold for them either, If the ER doc wants to talk to me and decides to see another patient while waiting for me to call back he'll just have to page again cause I can't wait on him either.
 
It's 1AM and I'm just about to fall asleep...Beeper goes off
"hello, I'm returning your page."
-Yes, Doctor, I want to let you know that Mr. S might be depressed
"Oh, what happened"
-Well, he was crying earlier tonight about something
"Ok, do you think he's suicidal?"
-Oh no, he just seems a little depressed
"How's he now?"
-He's sleeping
:confused:"So why are you paging me?"
-I thought you might want to start him on an anti-depressant
:eek: "You want me to wake him up and start him on an anti-depressant NOW?"
-Oh...I guess not. I just wanted you to know he might be depressed.
:mad:.....
 
This amused me last night on float.

3AM, nothing's going on, catching some sleep while I can.

Pager goes off- "Yes doctor, Mr. X's BP is 180/90."

"Mmmmmm, lemme find this guy in my signout stack..."

"Well doctor, he just got into a big fight with his roommate about something. I'll move his roommate to another room and remeasure."

"Fantastic idea. Thanks."
 
I come across this line of thinking a lot and it never fails to amaze me. You weren't right because of any reasoning, you just happened to "luck out" so to speak. Therefore it doesn't prove that the attending was wrong or that you were right and there's nothing to "be happy" about.


yet i failed to mention i had asked said attending if he wanted a profile ordered on this pt bc they had been on tube feeds, cystic fibrosis pt with virtually no pancreatic function and liver damage. I asked if lytes were in order and was told not to order unecessary tests.

So actually, my reasoning was quite correct and proven correct. But, its ok you can still be a prick :sleep:
 
*sigh*


10:12pm ... I am NOT on call. Chilling at home, 97 degree Georga weather, note the time. Pager goes off......


Me: Hello this is Dr. Solid returning a page.

Nurse: Yes hi, I'm calling you because I can't find page one of the H&P on a patient you admitted from the ED this afternoon.

Me: Um, it should be in the chart.

Nurse: Oh yes, here it is. That's all thank you.

Me: *click* Grrrrrrr.


Why would it matter at 10pm if the nurse couldn't find the first page of the H&P? Why call me I signed out the patient to the on-call resident. Uh UH?
 
I come across this line of thinking a lot and it never fails to amaze me. You weren't right because of any reasoning, you just happened to "luck out" so to speak. Therefore it doesn't prove that the attending was wrong or that you were right and there's nothing to "be happy" about.

I don't know, I might "be happy" to catch something that could kill my patient; whether by dumb luck or not.

If you read carefully they were happy that they had gotten the test with the result mentioned, not necessarily that they ordered the "wrong one" per the consultant.
 
This one happened to me on thursday, thank god it was 8pm otherwise I woulda been PISSED.

Pt was complaining that her arm hurt when the nurses drew blood for labs and she didn't have an IV. She had a portacath and asked me if she could get the blood drawn out of that instead b/c its less painful. I oblidged and wrote a short order the chart "May use portacath for blood draws if possible".

8pm rolls around and my pager goes off.

Nurse: We don't know how to draw the blood out of the portacath, can you come down and draw the blood for us?
Me: (Smacks hand to head) Why don't you just use the a/c?
Nurse: Your order said to use the cath, I didn't know we could draw peripherally. Could you write an order so that we can use peripheral access?
Me: Sure why not.

Theres a reason I used the words "may" and "if possible" in my order. I'm just thankful I didn't get woken up for that.
 
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'm a CCU nurse; I always read progress notes. As do my colleagues in my unit. I wouldn't expect a floor nurse to have the time to do that, but with a 2:1 pt/nurse ratio (or 1:1 if it's bad), I like to have a comprehensive view of whats going on.


I don't know about other units, but the attending intensivists in our unit demand a lot of autonomy from us - especially weekend nights.

If I haven't gotten the PCXR, ABG, and enzymes before I call a physician at 2am about my desatting pt with chest pain I'll be on the phone 20 minutes getting lectured at.

HOWEVER: dumb nurse story (about me)
When I was a new grad nurse (straight into ICU), I paged the on call pulmonologist at 2 AM for a PRN sore throat lozenge. Hilarity ensued.


I've learned a lot since then. I'm looking forward to med school next year.
 
I read the progress notes too, I like to see if my thinking is anywhere on par with what the Drs are thinking, since I'm on the NP track.

Also I HATE paging doctors. While most of ours are very normal and we have a working relationship as colleagues, we have one or two that just have no phone manners whatsoever, and still, I figure between the Dr's office hours and family life and other inpatients in the hosp, it isn't like they have nothing to do, so I hate having to page for something.

I always make sure I have the wall chart, the patient chart, note paper to write down anything they say, and the MAR with me before I page, and I only page if none of the other nurses can come up with a solution and they agree I need to page.

We get a lot of medical overflow, aside from our ortho patients, now our ortho patients, we can pretty much write whatever we need and the surgeons will come up and cover it later, and they have very extensive standing orders as well, which is nice.

But on the medical overflows, we get a lot of different doctors, and some of them you know who you can write and wait til they come on, and others with critical lab values, or meds you just need... ex: n/v, pain you just have to page, and I hate it.

But my one pet peeve is our hospitalists. We have one who is American in the entire Hosp, and while that really doesn't bother me, the problem is the accents, which are very thick and I can't understand in person, let alone over the phone. So you can't read what they write, let alone understand what they say, and then they get frustrated when you ask them to repeat it, and that does irritate me I will admit even if it makes me a horrible person.

I mean at least understand about having an accent and that people probably have difficulty understanding it, and write more legibly, and speak slower and don't get frustrated when asked to repeat it. That's all I'm saying.
 
2. From the PHARMACIST today:
"You wrote an order for unfractionated heparin 5000 q12, but the patient has renal failure. You have to use heparin."

I was noting orders today on a post-op patient. Noticing that the antibiotic was not showing up on the MAR, I went and checked the accudose to see if it was shown there, thinking maybe it just wasn't on the MAR yet and it had been printed too early.. no dice..

Phone call to RX

Me- I don't show the Ancef on the Mar for pt blah blah in 667, and before you ask, I checked the accudose and it isn't listed there either
RX- One second....
Moments pass
RX- Yeah I don't have an Ancef for that person
Me- I have it right here on the order sheet , it was written and given in the OR at 1030, and is Q8 times 24 hours.
RX- I don't see it
Me- Next dose should be due 1830
RX- No it's for 2100. It was charged at 1330
Me- How is it timed and charged out, if you don't have the order?
RX- For Cefazolin right?
Me- Yeah... Ancef.....
RX-I don't have an order for that
Me- Sigh
RX..........
Me- How about I refax it to you on the stat line, the order sheet, where it shows the order for Ancef, and the time given in the OR, 1030, hence making the next dose for 1830
RX-Sure...
:beat:
 
I read the progress notes too, I like to see if my thinking is anywhere on par with what the Drs are thinking, since I'm on the NP track.

Also I HATE paging doctors. While most of ours are very normal and we have a working relationship as colleagues, we have one or two that just have no phone manners whatsoever, and still, I figure between the Dr's office hours and family life and other inpatients in the hosp, it isn't like they have nothing to do, so I hate having to page for something.

I always make sure I have the wall chart, the patient chart, note paper to write down anything they say, and the MAR with me before I page, and I only page if none of the other nurses can come up with a solution and they agree I need to page.

We get a lot of medical overflow, aside from our ortho patients, now our ortho patients, we can pretty much write whatever we need and the surgeons will come up and cover it later, and they have very extensive standing orders as well, which is nice.

But on the medical overflows, we get a lot of different doctors, and some of them you know who you can write and wait til they come on, and others with critical lab values, or meds you just need... ex: n/v, pain you just have to page, and I hate it.

But my one pet peeve is our hospitalists. We have one who is American in the entire Hosp, and while that really doesn't bother me, the problem is the accents, which are very thick and I can't understand in person, let alone over the phone. So you can't read what they write, let alone understand what they say, and then they get frustrated when you ask them to repeat it, and that does irritate me I will admit even if it makes me a horrible person.

I mean at least understand about having an accent and that people probably have difficulty understanding it, and write more legibly, and speak slower and don't get frustrated when asked to repeat it. That's all I'm saying.


I love you.
 
. . . now our ortho patients, we can pretty much write whatever we need and the surgeons will come up and cover it later, and they have very extensive standing orders as well, which is nice.

Once again proving our superioriority . . . :D
 
I can't really say whether other surgeons cover the standing orders at our hospital as well, because all we get is the ortho surgeries and medical overflows. But our ortho surgeons rock.

Of course my very favorite surgeon ever is fictious.... Dr. McDreamy.. mmm wish we had a neurosurgeon that looked like that running around.

All our surgeons are frumpy ;)
 
yet i failed to mention i had asked said attending if he wanted a profile ordered on this pt bc they had been on tube feeds, cystic fibrosis pt with virtually no pancreatic function and liver damage. I asked if lytes were in order and was told not to order unecessary tests.

So actually, my reasoning was quite correct and proven correct. But, its ok you can still be a prick :sleep:

So he told you not to get lites, then you saw his note and thought that LFTs were lites so you ordered them? What? Huh?
 
I can't really say whether other surgeons cover the standing orders at our hospital as well, because all we get is the ortho surgeries and medical overflows. But our ortho surgeons rock.

Of course my very favorite surgeon ever is fictious.... Dr. McDreamy.. mmm wish we had a neurosurgeon that looked like that running around.

All our surgeons are frumpy ;)

You should check out Tired. He is frumpalicious.
 
Since Frank-Starling involves cardiac preload and correlated changes in stroke volume, I don't think that is what you mean.

He messed up his Starling. I believe he was refering to the Starling-Landis equation with hydrostatic/oncotic pressure and all that rubbish.
---
I think one of the big philosophy differences between nurses and physicians is there's a big difference in camradarie. Having extensive experiences with nursing myself (working as an aid prior to med school, having family members in the profession), nurses tend to have a LOT more camraderie than doctors and ESPECIALLY bad nurses.

I think because of medical school being so brutal with grading and evaluations, doctors aren't shy to judge one another and are more individualistic. When doctors disagree it's not always in the most pleasent or polite ways, but we're used to jousting it out in the open.

Nurses have this group dynamic thing going. They don't want to disrupt that group dynamic so you'll not only will y ou find two bad nurses covering for eachother, but you'll find the GOOD nurses doing extra work to make the group as a whole look good.

This means that if nurses start picking on an intern, he's not going to have many interns come to his aid, ESPECIALLY if they think the intern is not as smart or its his own fault for provoking it. If one intern picks on one nurse though, the nurses circle wagons and every nurse defends.
 
<me, getting a 1hr mid-day-while-on-call-preemptive-sleep nap>

pager: *beep* only a number displayed.
me: *dialing*
nurse: DOCTOR G$! THIS IS NURSE X AND THE PATIENT IN ROOM 8A DOES NOT LIKE OUR FOOD!
me: um.
nurse: DOCTOR! she also says she rarely even eats red meat!
me: ok?
nurse: BUT DOCTOR! you wrote to discharge after lunch and patient doesn't want to eat the lunch we're offering!
me: um, i was loosely referring to "the lunch hour."
nurse: DOCTOR WHAT TIME IS IT OK TO DISCHARGE THE PATIENT THEN?!
me: when did i write the discharge orders?
nurse: 9am
me: and it's now 2:30pm?
nurse: yes but she's NOT LIKING OUR FOOD OR WANTING TO EAT LUNCH!
me: please discharge the patient. kthxbye.

(yes, there was much yelling on the part of the nurse; she is rather expressive. i was laughing too much at this page to be angry. i have a pretty high tolerance for stupid pages, as i'm sure i make more than my share of stupid f-ups that cause nursing to laugh, so it evens out. :) at least in my book.)
 
This means that if nurses start picking on an intern, he's not going to have many interns come to his aid, ESPECIALLY if they think the intern is not as smart or its his own fault for provoking it. If one intern picks on one nurse though, the nurses circle wagons and every nurse defends.

I think we all recognize this but it's a good point nonetheless. There's also a lot of ego wars going on because especially the older a nurse is the more she dislikes being given orders by someone younger. It becomes where it has to be a request or you have to become close friends with the nurses before you're allowed to "tell" them what to do. I saw a piece on the business workplace where it is much the same, where baby boomers are extremely resentful of finding Gen Xers or Gen Yers be their boss, like their "kids" are in charge of them. I find this attitude is very prevalent amongst nursing where they feel that because they are older or have been there longer they have a right to not be told what to do by younger doctors. That attitude leads to a lot of the problems that occur and I'm sure a lot of nurses feel justified in having that attitude.
 
Well, yeah, if you saw it on TV it must be true.

I couldn't care less how old the doc is who gives me orders. Just make sure the pt. is taken care of, for Pete's sake. Of course, I don't look at doctor's orders from the perspective of "being told what to do." It's just a component of patient care. I don't want/need to be close friends with the docs...a good working relationship is quite enough.

You must work in a real rat hole, snoopy. Either that, or you make a lot of assumptions, and haven't really taken the time to try to get along with the nursing staff. In most cases, it really isn't as insurmountable a task as you describe, but if you go into it with so much antagonism, yeah, you're probably going to fail.

I think we all recognize this but it's a good point nonetheless. There's also a lot of ego wars going on because especially the older a nurse is the more she dislikes being given orders by someone younger. It becomes where it has to be a request or you have to become close friends with the nurses before you're allowed to "tell" them what to do. I saw a piece on the business workplace where it is much the same, where baby boomers are extremely resentful of finding Gen Xers or Gen Yers be their boss, like their "kids" are in charge of them. I find this attitude is very prevalent amongst nursing where they feel that because they are older or have been there longer they have a right to not be told what to do by younger doctors. That attitude leads to a lot of the problems that occur and I'm sure a lot of nurses feel justified in having that attitude.
 
Well, yeah, if you saw it on TV it must be true.

I know you're being sarcastic, but that wasn't my point. I was using it as an example, not as proof. In my limited experience, I know many interns and residents who have been told directly the line "I've been a nurse for 7 years and you're just an intern/resident" or something close to that effect. I've also seen it on SDN so it's not just some fictional thing that I made up.

Let me say this and I'm not just kissing up to you. If you actually act like what you say then you sound like a great nurse. You have said that you don't need people to be your friend, that you understand the working relationship, that you don't cancel out orders, that you don't question people's judgement, and so on. That's perfect! If I worked with nurses like that I would have no complaints. But you need to understand that unfortunately a lot of other people's experiences are quite different.

You know what, nurses are at training hospitals longer than doctors. But you know what, that also means that nurses and the way they treat doctors shape those doctors. At many places the nurses basically pummel interns with abuse and then never see them again because the seniors have less interaction with them. Then the next year they do it again to the "new crop" of interns. In reverse, this does not occur. You may not like how a resident treats you, but that's an interaction where you're a "seasoned vet". How many attendings pummel nursing students or fresh nurses where it's a rite of passage and survival and they feel it's their right to do that? Few to none.
 
Yes, I actually do act exactly like I post. I am not perfect, but I do not have the time to get into stupid power games with interns/residents, whatever. My first responsibility is for my patients. And I was, for lack of a better word, just not "raised" that way, neither at home nor where I did my training. That's why I said in a previous post that deliberately ignoring orders or foot-dragging on orders just didn't even compute with me. If I think there's a problem with the order, it's my job to ask for clarification. That's how it works. Or how it's supposed to work.

Are there docs I go out of my way for more than others? Yes. Should I do that? No, but like I said, I'm not perfect. I could probably spend pages listing my flaws, but the stuff you guys describe--nuh uh. Not if it is going to compromise patient care.

Nursing students don't get attention because they aren't even deemed worthy of consideration from most medical staff. Please. But nursing staff have been abused by medical staff, new nurses and veteran nursing staff. So sometimes what happens is a bit of lashing out at the next new guy that shows up; unfortunately, sometimes the new guy is the new intern/resident. I'm not saying it's right. It's wrong for any staff member to feel like he/she can be abusive to someone else, whether a med-student, nurse, intern/resident, etc.

ETA: I never said I don't question someone's judgement. I have, on many occasions. It's my job, believe it or not. I just don't question it without taking it up with that person. And cancelling orders without an order is a HUGE no-no. That can get you disciplinary action. Besides just being a cowardly thing to do.
 
In my limited experience, I know many interns and residents who have been told directly the line "I've been a nurse for 7 years and you're just an intern/resident" or something close to that effect. I've also seen it on SDN so it's not just some fictional thing that I made up.

At many places the nurses basically pummel interns with abuse and then never see them again because the seniors have less interaction with them. Then the next year they do it again to the "new crop" of interns. In reverse, this does not occur. You may not like how a resident treats you, but that's an interaction where you're a "seasoned vet". How many attendings pummel nursing students or fresh nurses where it's a rite of passage and survival and they feel it's their right to do that? Few to none.

Ahhh, the irony.

How many times do we get the, "I'm the MD....you're just the nurse, so what do you know about the patient" crap????

And I've seen plenty of interns try to pummel nurses - and continue to do so, rotation after rotation. There reputation begin to proceed them and not in a good way.

And I have seen plenty of Attendings with the G-d complex trash nurses, nursing students. Seen that, quit putting up with that, and moved on to better job.

The real kicker came when Dr. Piranha, found I was leaving, wanted to know why I was leaving and tried to get me to stay.
 
But nursing staff have been abused by medical staff, new nurses and veteran nursing staff.

And I've seen plenty of interns try to pummel nurses - and continue to do so, rotation after rotation. There reputation begin to proceed them and not in a good way.

We can talk about which came first, the chicken or the egg, all day and all night. But what I do know is that there is a big difference in terms of timing and power. As I said you can talk about interns abusing nurses all you want and it does occur. But as you well know an intern can't "abuse" a nurse other than to give her attitude. A nurse can abuse an intern with attitude and action.

Have I seen interns insult nurses? Absolutely. Have I seen nurses insult interns? Equally as much and just as much on purpose. You've seen interns talk down to nurses? I've seen nurses treat interns like they were babies, telling them not to touch things, don't move their seats, harrassing them with bullcrap that you wouldn't do to your kids. So let's just say they cancel out even though, just my opinion, they don't. Put on top of that the fact that nurses deliberately harrass interns and residents with pages. There's no denying it because nurses have copped to it all over the place and are proud of it because it represents their "power." A resident can't do that and really doesn't want to because usually we want as little contact with nurses as possible. Nurses are the opposite, when they're harrassing residents they want to get in their face, page them a lot, see their reactions.

Also like I said, it's a culture. All interns know their going to get it from nurses. Why do you think there are so many posts warning people "be nice to the nurses"? Any thread where there is advice to interns, that's number one and it's all over the place. It's a rite of passage and you just determine how much or little of it you'll see. If residents did the same to nurses, you guys would be ten times as bitter as you are now. If we jumped all the new nurses who weren't "polite enough" or whatever there would be a revolution.
 
We can talk about which came first, the chicken or the egg, all day and all night. But what I do know is that there is a big difference in terms of timing and power. As I said you can talk about interns abusing nurses all you want and it does occur. But as you well know an intern can't "abuse" a nurse other than to give her attitude. A nurse can abuse an intern with attitude and action.

Have I seen interns insult nurses? Absolutely. Have I seen nurses insult interns? Equally as much and just as much on purpose. You've seen interns talk down to nurses? I've seen nurses treat interns like they were babies, telling them not to touch things, don't move their seats, harrassing them with bullcrap that you wouldn't do to your kids. So let's just say they cancel out even though, just my opinion, they don't. Put on top of that the fact that nurses deliberately harrass interns and residents with pages. There's no denying it because nurses have copped to it all over the place and are proud of it because it represents their "power." A resident can't do that and really doesn't want to because usually we want as little contact with nurses as possible. Nurses are the opposite, when they're harrassing residents they want to get in their face, page them a lot, see their reactions.

Also like I said, it's a culture. All interns know their going to get it from nurses. Why do you think there are so many posts warning people "be nice to the nurses"? Any thread where there is advice to interns, that's number one and it's all over the place. It's a rite of passage and you just determine how much or little of it you'll see. If residents did the same to nurses, you guys would be ten times as bitter as you are now. If we jumped all the new nurses who weren't "polite enough" or whatever there would be a revolution.

Its hard not to get frustrated with some of the ridiculous pages and phone calls when nurses freely admit (both here and nursing websites) that they do this to "haze" new interns.

You think its funny to keep us up all night or wake us up at 3am to be funny? Wait until its your mother or father who needs that central line at 5am...after we have been up all night. ;)
 
I'm a CCU nurse; I always read progress notes. As do my colleagues in my unit. I wouldn't expect a floor nurse to have the time to do that, but with a 2:1 pt/nurse ratio (or 1:1 if it's bad), I like to have a comprehensive view of whats going on.


I don't know about other units, but the attending intensivists in our unit demand a lot of autonomy from us - especially weekend nights.

If I haven't gotten the PCXR, ABG, and enzymes before I call a physician at 2am about my desatting pt with chest pain I'll be on the phone 20 minutes getting lectured at.

HOWEVER: dumb nurse story (about me)
When I was a new grad nurse (straight into ICU), I paged the on call pulmonologist at 2 AM for a PRN sore throat lozenge. Hilarity ensued.


I've learned a lot since then. I'm looking forward to med school next year.

congrats on your admission to med school......i hope to be in your shoes in a 2-3 years.
 
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