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

[Winged Scapula]

just read your tag line.....very interesting, indeed.

Indeed...

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[fab4fan]

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.

And yet here's a thread about "stupid nurse pages." Granted, many of them are stupid, but bear in mind that new nurses are learning and unfortunately, they may page you for dumb reasons. Just as you are learning and want people to be patient with you, be patient with the new nurses.

The "be nice to nurses" is good advice. I have seen some people let that transition from med-student to intern make them a little overly impressed with themselves and become overbearing. One guy managed to alienate the entire staff in under 45 minutes. That was pretty impressive. But to think that we're just sitting there rubbing our hands together plotting how to make your lives miserable--come on. I've got patients to take care of. To be totally honest, you're making yourself far more important than you really are. Most of us just don't spend that much time thinking about you (interns/residents). If we know things are going on in your life e.g. getting married/having a baby, etc., yes, we'll take interest. We like to get to know the people we work with. But we don't spend all day dwelling on you.

As far as revenge-paging, I've already made my position clear on that more times than I can count: I don't play that way either, and neither do the nurses on my unit. Maybe this is behavior that goes on at certain facilities, maybe it's more likely to happen in certain units. I know some people talk about it on nursing websites I belong to. I'll tell you exactly what I post when I see people bragging about it: "That is unprofessional and only serves to create hostility between staff. You have nothing to brag about, and you ought to be ashamed." I hate that it goes on because it gives those of us who don't do it a black eye. It's like guilt by association.

Any dissatisfaction I have has less to do with doctors than it does with other issues. I'm not bitter--just discouraged.

 

[elwademd]

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 had an icu nurse tell me that when dr. h (the icu attending) orders something, she does it without hesitation or question. however, if an intern or resident orders something, she'll question it and, at times, will want the reasoning and physiology behind it. she then went on to say she does it this way, because dr. h has been doing it for "so long", and you guys are new.

of course, this line of thinking is irrational and potentially dangerous, but i suppose its besides the point.

do all nurses page for stupid things? no.
do some nurses page for stupid things? yes.
do all doctors have ego trips? no.
do some doctors have ego trips? yes.

now, lets get along and play nice.

 

[fab4fan]

i had an icu nurse tell me that when dr. h (the icu attending) orders something, she does it without hesitation or question. however, if an intern or resident orders something, she'll question it and, at times, will want the reasoning and physiology behind it. she then went on to say she does it this way, because dr. h has been doing it for "so long", and you guys are new.

of course, this line of thinking is irrational and potentially dangerous, but i suppose its besides the point.

do all nurses page for stupid things? no.
do some nurses page for stupid things? yes.
do all doctors have ego trips? no.
do some doctors have ego trips? yes.

now, lets get along and play nice.

Sounds like a plan.

I admit to asking for reasoning behind orders, but I ask that of any doc, and it's for my education, not some sort of challenge. Unless I think someone's really off base, then it's my polite way of asking for an explanation to see if the person actually has one (this happens rarely, but it has happened).



Back at ya!

 

[BlackSails]

fab4fan, just comparing your posts on the forum to other nurses, I think that you do a service to all nurses with the way you present yourself.

 

[snoopy brown]

Granted, many of them are stupid, but bear in mind that new nurses are learning and unfortunately, they may page you for dumb reasons. Just as you are learning and want people to be patient with you, be patient with the new nurses.

I would be much more understanding with many of these pages if they were done by nurses who actually were new.

The "be nice to nurses" is good advice.

Yes and it's also insulting. Because people are really saying "be nice to nurses...or else." It's patronizing because it's not a suggestion for you to be a better person, it's a threat that you will act the way nurses want you to (and sometimes that has nothing to do with "nice" and more to do with "do what we want") or you will suffer. You don't see people telling each other to be nice to technicians, I bet if I go to your nursing forum you don't see nurses telling each other "the first rule is always be nice to doctors."

 

[fab4fan]

Well, I say it, and so do others. I've seen moderators shut down "anti-doc" threads. But since you're determined to keep up this wall, there's really not a whole lot more I can say to change your mind. I'm sorry that dealing with nursing staff has been such a bad experience overall for you.

 

[snoopy brown]

Well, sorry, but I can't really pretend it hasn't been unpleasant in general. I'm in an urban area, so that may be contributing because there's baseline 'tude to begin with and a generalized lack of care about quality. This is going to sound harsh but I've worked with only two nurses ever that I've found to be great and they were the best. Unfortunately for them because of that all of the residents went to them when we needed stuff to actually get done. I always thought they should get the other nurses' salaries because they deserved it. The rest of the nurses I have worked with range from extremely average to "I would kill them if it wasn't a crime."

 

[Tired]

Yes and it's also insulting. Because people are really saying "be nice to nurses...or else." It's patronizing because it's not a suggestion for you to be a better person, it's a threat that you will act the way nurses want you to (and sometimes that has nothing to do with "nice" and more to do with "do what we want") or you will suffer. You don't see people telling each other to be nice to technicians, I bet if I go to your nursing forum you don't see nurses telling each other "the first rule is always be nice to doctors."

My experience with nurses seems to be far better than yours, but you're dead on the money here. There is definitely a retaliatory threat in the "be nice to nurses" movement.

The reason why you never hear "be nice to the interns" is because we don't retaliate. A nurse can blow up my pager all night with no reprocussions (which sucks), but suppose I started writing for q1h neuro checks on aggressive/demented patients? Or morphine 0.5mg IV prn q10min for drug addicts? Or q20min turns for patients at risk of bed sores? The ability of the interns/residents to retaliate against nurses far exceeds the reverse. But, at least as far as I have seen, you will never see this strategy employed.

Again, it just goes back to oversight. If I get bomb-paged all night or my orders are conveniently "forgotten", a kindly house supervisor might have some stern words for the RN on his way home after a greuling 8hr shift. But if I engaged in the reverse after 40 frustrating hours on call, I would be tossed out of my program within a day.

 

[Noble Gas]

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.

FYI almost every hospital has a computerized record of pages available from the operators. Therefore, when the nurse documents in the chart that "surgery" or "dr smith" was paged five times and did not respond, you have a backup. Because half the time they are either paging the wrong number or exaggerating about the number of times they paged. I always make sure when they say this to me (I answer every page immediately, from my cell in the bathroom if needed), I let them know there is a record (In a "Oh really, that's odd. I never receieved the page" manner.) This usually elicits an "oh ****" reaction. Been burned too many times...you learn the ropes.

 

[Noble Gas]

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.

Be extremely careful because she will be documenting in the chart that you were notified (the ubiquitous "MD aware"), and if there's no note that you examined the patient, you will look lazy or that you don't care about your patients.

I don't know if you've ever had a family member in the hospital, but try to respect your medical colleagues that do. Sure, they may be a little irrational but for god's sake her dad is tubed, dni, and not going to last long and she's probably been awake for a week. So humor her. If she wants the damn gas, get it. It will be you some day, asking to look over your dad's CT with the attending radiologist or generally just annoying the snot out of the residents. Just see the patient and write the note. It's professional courtesy (and karma).

 

[Noble Gas]

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.

Those are good suggestions. Also remember that familiarity breeds contempt. I've been friends with them (knowing their kids' names etc), and at other places been more formal. Just my experience, but I think the latter approach will command you a little more respect and professionalism in response from the nurses.

 

[Noble Gas]

i had an icu nurse tell me that when dr. h (the icu attending) orders something, she does it without hesitation or question. however, if an intern or resident orders something, she'll question it and, at times, will want the reasoning and physiology behind it. she then went on to say she does it this way, because dr. h has been doing it for "so long", and you guys are new.

of course, this line of thinking is irrational and potentially dangerous, but i suppose its besides the point.

do all nurses page for stupid things? no.
do some nurses page for stupid things? yes.
do all doctors have ego trips? no.
do some doctors have ego trips? yes.

now, lets get along and play nice.

i see what you're saying. I try not to be too irritated/threatened when they question the orders. I was saved many times during internship by this kind of questioning. Or sometimes they are trying to learn. I've found that nurses are very adept at recognizing patterns- if you mix up the routine they will question you.

On the other hand
Paged
RN: Do you REALLY want to give Mr. Johnson Dilaudid?
MD: Yes. Why, what do YOU want to give? (Because that's really why she's calling)
RN: (Pissy tone): Well, YOU'RE the doctor!

(Then don't question the g-dam order!)

 

[Noble Gas]

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.

and wtf were you doing sleeping at 6:30am???

 

[OB1🤙]

Last night, finally on my last night float shift:

Beepbeepbeepbeep. 2AM.

"Hi it's Dr. HB, I was paged?"

"Yes Dr, I wanted to let you know that Mr. Z is on the floor."

"You mean, he had a fall??!? Is he OK?"

"No, no, I mean he's physically here. On the floor. On the ward."

"Uh... OK. (Thinking: where the hell else would he be???)"

"Just thought you should know."

"Kthnxbye."

This guy had been on the ward all night, and hadn't gone anywhere for any imaging/procedures. Nor is he one of our characters who likes to sneak outside for a cigarette either. I remain baffled as to why I got this call.

 

[KSUJedi]

Internal Medicine Night Float
3AM - Beep Beep Beep

Hi, it's Dr. So & So, I was paged

Yes, Mr. So & so's blood culture gram stain has come back showing GPC in clusters, I see in the physican notes that the plan was to take out Mr. So & So's ICD if his blood cultures come back positive.

Ok......

So could you come do that.....

Come take out his ICD.....?

Yes......

Ummm, no

 

[snoopy brown]

Nobody showed you how to do that bedside with Jedi mind maneuvers yet? Well, it's only August so don't worry.

 

[Tired]

Be extremely careful because she will be documenting in the chart that you were notified (the ubiquitous "MD aware"), and if there's no note that you examined the patient, you will look lazy or that you don't care about your patients.

I don't know if you've ever had a family member in the hospital, but try to respect your medical colleagues that do. Sure, they may be a little irrational but for god's sake her dad is tubed, dni, and not going to last long and she's probably been awake for a week. So humor her. If she wants the damn gas, get it. It will be you some day, asking to look over your dad's CT with the attending radiologist or generally just annoying the snot out of the residents. Just see the patient and write the note. It's professional courtesy (and karma).

Hmm, don't know how you practice, but when the patient tells me he doesn't want a test or treatment, I don't give a damn who his kids are or what they do, I'm not forcing him to get it. Patient's desires come first. If the daughter doesn't like it, oh well, I'm not here for her.

 

[Mallory Weiss]

When you graduate from nursing school and get your first job, they (usually) put you on the night shift. So you don't know anything AND you have to wake people up if you need something. You may have to explain to the new nurses what you expect - i.e. having the vitals and chart nearby when they page you. Yes, it sounds like a no-brainer, but didn't you do stupid stuff when you were new? 99.9% of nursing knowledge is job experience. Nursing school does not teach most of what a nurse needs to know. Where do nurses get much of the knowledge they need? From doctors. The ones who teach, not the ones who yell. If you take the time to explain something to a nurse now, that nurse will be a better nurse, which will help you in the future.
Also, sometimes the nurse isn't being stupid, there's just a miscommunication. So try to be tolerant. Yeah, sometimes they are just being stupid. No sense in overreacting, though.
I remember the doctors who were jerks, and I steer my family and friends away from them. I imagine that I won't be consulting them often, either, when I get out of school. Karma will get you.


OK, now, funny things I have been paged for: A pharmacist once called me at the office because we had written a prescription for 600 mg of mucomyst p.o. (no strength specified) for a patient who was going to have a heart cath. She wanted to let me know that they didn't have a 20% solution, that they only had the 10% solution, and she wanted to ask what she should do about it.

Most interesting moment dealing with a nurse as a med student:
Me: I just had a quick question. How much dopamine is Ms. Smith on right now? RN (snippily): well, HONEY, if you go LOOK at the pump, you can figure it out. It's written in small print on the bottom of the screen!
me: oh....okay.
Resident who walked in behind me but missed that whole exchange: Hey, how much dopamine is the patient on?
RN: She's on 1 mcg right now but I'm about to wean it off.

 

[dynx]

When you graduate from nursing school and get your first job, they (usually) put you on the night shift. So you don't know anything AND you have to wake people up if you need something. You may have to explain to the new nurses what you expect - i.e. having the vitals and chart nearby when they page you. Yes, it sounds like a no-brainer, but didn't you do stupid stuff when you were new? 99.9% of nursing knowledge is job experience. Nursing school does not teach most of what a nurse needs to know. Where do nurses get much of the knowledge they need? From doctors. The ones who teach, not the ones who yell. If you take the time to explain something to a nurse now, that nurse will be a better nurse, which will help you in the future.
Also, sometimes the nurse isn't being stupid, there's just a miscommunication. So try to be tolerant. Yeah, sometimes they are just being stupid. No sense in overreacting, though.
I remember the doctors who were jerks, and I steer my family and friends away from them. I imagine that I won't be consulting them often, either, when I get out of school. Karma will get you.


OK, now, funny things I have been paged for: A pharmacist once called me at the office because we had written a prescription for 600 mg of mucomyst p.o. (no strength specified) for a patient who was going to have a heart cath. She wanted to let me know that they didn't have a 20% solution, that they only had the 10% solution, and she wanted to ask what she should do about it.

Most interesting moment dealing with a nurse as a med student:
Me: I just had a quick question. How much dopamine is Ms. Smith on right now? RN (snippily): well, HONEY, if you go LOOK at the pump, you can figure it out. It's written in small print on the bottom of the screen!
me: oh....okay.
Resident who walked in behind me but missed that whole exchange: Hey, how much dopamine is the patient on?
RN: She's on 1 mcg right now but I'm about to wean it off.

So when they weaned it did they turn it down to like half a mcg or what?

 

[snoopy brown]

If you take the time to explain something to a nurse now, that nurse will be a better nurse, which will help you in the future.

So what did you explain to that nurse in order to help her become better? And afterwards did you hug and become pen-pals?

 

[Tired]

So what did you explain to that nurse in order to help her become better? And afterwards did you hug and become pen-pals?

Uh-oh, better watch out of the nurses will complain to the mods and get this thread shut down too. After all, it is their forum.

Got this one the other night (2:30am):

RN: I just wanted to let you know that the patient's temp is 100.1F
Me: Okay, thanks. Give me a call back if it goes over 101.4F.
RN: Oh, well can you come down and see him? I'm worried he's got an infection.
Me: . . . um, he does have an infection. That's why he's in the hospital.
RN: Really?
Me: Yup. That's why he's been having fevers.
RN: Oh. Do you want to send cultures?
Me: Nope. He already has positive cultures from this morning.
RN: So you're not going to work up his fever?
Me: Nope. He doesn't have a fever.
RN: So you're not going to do anything? Maybe you should call your resident about this.
Me: I'll think about it. Have a good night. Call me if anything changes.

 

[Dr JPH]

I think the nurse bashing has gone far enough. Afterall, they dont understand the frustration we experience in most of the above interactions.

 

[elwademd]

When you graduate from nursing school and get your first job, they (usually) put you on the night shift. So you don't know anything AND you have to wake people up if you need something.

that's not quite accurate. "new grads" choose when and where they want to work. however, "night shift" nurses get a pay differential over "day shift" nurses... add in this pay increase, plus the other bonuses that may be received (work 12 hour shifts and thus get 4 hours of overtime every shift, increased pay rate every 6-12 months, signing bonuses etc.), working at night soon becomes attractive to those newly out of nursing school.

You may have to explain to the new nurses what you expect - i.e. having the vitals and chart nearby when they page you. Yes, it sounds like a no-brainer, but didn't you do stupid stuff when you were new? 99.9% of nursing knowledge is job experience. Nursing school does not teach most of what a nurse needs to know. Where do nurses get much of the knowledge they need? From doctors. The ones who teach, not the ones who yell. If you take the time to explain something to a nurse now, that nurse will be a better nurse, which will help you in the future.

the nurses i know (including my mom and, gasp, my girlfriend) would argue with you on that one. the nurses i know explain that nursing school prepares them quite well (as the last 2 years of nursing school is nothing but doing lvn/lpn work in a hospital setting). they also tend to equate the higher salary of a 1st year nursing school grad over that of a 1st year med school grad (intern) with the experience gained in nursing school.
for example, my girlfriend made 100k in her first year out of nursing school while i made 40k. she claims she's job ready out of nursing school, while i'm still learning!

RN: I just wanted to let you know that the patient's temp is 100.1F
Me: Okay, thanks. Give me a call back if it goes over 101.4F.
RN: Oh, well can you come down and see him? I'm worried he's got an infection.
Me: . . . um, he does have an infection. That's why he's in the hospital.
RN: Really?
Me: Yup. That's why he's been having fevers.
RN: Oh. Do you want to send cultures?
Me: Nope. He already has positive cultures from this morning.
RN: So you're not going to work up his fever?
Me: Nope. He doesn't have a fever.
RN: So you're not going to do anything? Maybe you should call your resident about this.
Me: I'll think about it. Have a good night. Call me if anything changes.

we either work at the same hospital, or the same nurse works at two different hospitals!

 

[Dr JPH]

she claims she's job ready out of nursing school

Then why the ridiculous 3am phone calls?

 

[snoopy brown]

I think the nurse bashing has gone far enough. Afterall, they dont understand the frustration we experience in most of the above interactions.

I think the problem is that a nurse has never been in the situation of having the roles reversed where they can be paged by any of upwards of forty or fifty people all day every day any time they have a question or want a clarification or disagree with something or plain just don't want to deal with something. And that doesn't count, as mentioned, if someone gets a bee in her bonnet and decides to harrass someone for days or even weeks on end. And they'll never experience it so they'll never understand it. They just write it off as us being petty or rude or jerks for saying there's any difference between what they experience and what we experience and ask why we can't just get along.

 

[snoopy brown]

for example, my girlfriend made 100k in her first year out of nursing school

That's ridiculous because I think that's more than the average pay of some specialties (I'm not absolutely sure but I believe the last time I checked the average pay of a psychiatrist and pediatrician were below $100K). I realize it's largely due to unions and the fact that nurses can strike. However I always hear nurses say that they don't pity us for what we complain about because (they think) "you're all rich". Well, if they're making about 2.5 times of what I'm making working substantially fewer days then I don't mind making them do their work (e.g., if they call and say they can't get an IV in just telling them to find another nurse who can). Like I said before if you expect me to do their work then I expect some of their pay.

 

[Dr JPH]

I think what bothers me is the lack of accountability.

If I dont respond to a page in a timely manner (or what is deemed a timely manner by the nursing staff) you better believe they write it in the chart in an attempt to hold me accountable.

But during my morning rounds if I write "labs still pending because nursing did not draw them at 0400 like ordered" I get hell for it.

Just this past week I had a nurse fail to enter a radiology order because "he just had an obstruction series last night in the ER." So that nurse made the medical decision that this patient did not need a follow up study and she did so without contacting the intern, resident or attending. But when we are making rounds Im the one who looks like an idiot for not having the study available.

There are too many nurses who think they have more autonomy than they do.

They page us for ridiculous reasons yet they fail to page us when its necessary.

I dont hear a word about positive enzymes or a K of 2.5 (despite the fact that the lab calls the nurse with values like this), but you bet your ass they will call for a Tylenol order for temp of 100.6 or when they need a sleeping pill for a patient.

Why? Because unless there is something that is giving THEM a problem...like a patient bitching about pain, fever or constipation....they dont care. Lack of understanding plus a desire to make their job easier...bad combo.

Ready for their job right out of nursing school? No way.

 

[Tired]

If I dont respond to a page in a timely manner (or what is deemed a timely manner by the nursing staff) you better believe they write it in the chart in an attempt to hold me accountable.

But during my morning rounds if I write "labs still pending because nursing did not draw them at 0400 like ordered" I get hell for it.

Bingo. If you do that, you get a lecture about the importance a good relationship among the "team". Of course, we are solely responsible for the maintenance of that relationship. In nursing, people are permitted to behave however they choose, leaving us to pray that our critically ill patients get one of the good nurses, not the bored agency nurse who spends her whole night talking on her cell phone.

Sometimes I think about all the times I've heard, "Oh sorry, the order wasn't taken off, so her Dilantin hasn't been started" or "Oops, I guess we didn't draw a second blood culture" or "Gosh, we couldn't get the CT scan done because we didn't have any techs to take him down to Radiology." I just smile, say it's okay, and do their work for them if I can.

Meanwhile, on my last block I was called for the 8th time on a known drug addict who would wake up from his PCA-induced sleep just long enough to tell the RN that "the pain meds aren't working". I had already been in to talk to him five times that night. Finally at 5am, I informed the nurse that the patient had received too much dilaudid already, that I wouldn't be giving him any more, and that I was busy on rounds but that the primary team would be around in 30min to see him.

Of course, the chart now reads, "Paged Dr. Tired for patient's pain. Dr. Tired says that he will not see the patient or treat his pain. Will page primary team for further assistance."

Go teamwork!

 

[snoopy brown]

But during my morning rounds if I write "labs still pending because nursing did not draw them at 0400 like ordered" I get hell for it.

I wrote a note similar to that once and not only was my note expunged from the chart (it was on a new sheet of paper) but I was reprimanded informally for it. Meanwhile the nurses continued to put "MD aware" and random names of who was aware all over the chart and that was allowed. Not only were most of these people not aware, sometimes they weren't even at that hospital. And the nurses don't care because all they know is their butt is off the line. That's a big reason why I get angry at "stupid" pages because it's not an innocent or accidental occurrance by a new nurse as the nurses like to say. It's usually an experienced nurse who knows what she is doing and is paging you in order to document something. For example once when I was an intern a nurse kept paging me about once every two hours and would just start reading me vitals or lab values as soon as I picked up. Finally, after the third time, I just interrupted her and said, "what's your point, you concerned about something?" And she says, "oh, no, doc, I just wanted to let you know." So I told her that if she ever paged me again like that I'd write her up and report her for incompetence to her supervisor. She stopped the calls. But guess what, most nurses would say that I was acting inappropriately and arrogantly by "talking down" to a nurse who was just doing her job or whatever.

 

[Tired]

But guess what, most nurses would say that I was acting inappropriately and arrogantly by "talking down" to a nurse who was just doing her job or whatever.

So did the nurses get you on Probationary Status in real life too?

 

[snoopy brown]

Nope. But if they did, guess what I would be allowed to say why without getting disciplined for that too.

 

[Noble Gas]

Bingo. If you do that, you get a lecture about the importance a good relationship among the "team". Of course, we are solely responsible for the maintenance of that relationship. In nursing, people are permitted to behave however they choose, leaving us to pray that our critically ill patients get one of the good nurses, not the bored agency nurse who spends her whole night talking on her cell phone.

Sometimes I think about all the times I've heard, "Oh sorry, the order wasn't taken off, so her Dilantin hasn't been started" or "Oops, I guess we didn't draw a second blood culture" or "Gosh, we couldn't get the CT scan done because we didn't have any techs to take him down to Radiology." I just smile, say it's okay, and do their work for them if I can.

Meanwhile, on my last block I was called for the 8th time on a known drug addict who would wake up from his PCA-induced sleep just long enough to tell the RN that "the pain meds aren't working". I had already been in to talk to him five times that night. Finally at 5am, I informed the nurse that the patient had received too much dilaudid already, that I wouldn't be giving him any more, and that I was busy on rounds but that the primary team would be around in 30min to see him.

Of course, the chart now reads, "Will page primary team for further assistance."

Go teamwork!

A. it's unprofessional to get involved in chart wars and state that 'nurses did not draw labs as ordered.'

B. when they starting writing stuff like "Paged Dr. Tired for patient's pain. Dr. Tired says that he will not see the patient or treat his pain." - copy the page of the chart and fax it to risk management, anonymously.

it works. btw this is why i always read the nursing notes (it's not because they provide valuable information to doctors).

 

[snoopy brown]

A. it's unprofessional to get involved in chart wars and state that 'nurses did not draw labs as ordered.'

But like so many things that we are saying professionalism apparently goes one way only. I do like your suggestion of the fax but it's not really anonymous unless you are faxing random "MD aware" notes to risk management. That would be funny. What happened after you did that?

 

[Tired]

A. it's unprofessional to get involved in chart wars and state that 'nurses did not draw labs as ordered.'

Agreed. But the dilemma comes in when a nurse makes a potentially actionable error, but fails to document her own error. For example, a critical lab comes back and no one calls you. All the chart shows is that the sodium was 120, and no one did anything for two hours. Do you pretend the delay never happened, or do you document that while the lab notified nursing, nursing never notified you?

B. when they starting writing stuff like "Paged Dr. Tired for patient's pain. Dr. Tired says that he will not see the patient or treat his pain." - copy the page of the chart and fax it to risk management, anonymously.

In all honesty, I think that's more likely to get me in trouble than the nurse who wrote it. Now all risk management knows is that I refused to see a patient who was in distress.

 

[snoopy brown]

BTW let me clarify. If you point out that the nurses are charting something, I would bet you any amount of money that 9/10 times if you get any response it's going to be on you. Either "why are you being so petty, stop this battle now and get along" or "if you would just evaluate the patient (for the seventh time that night) then the nurse would have nothing to write, correct?" And it's always with the implication that you have failed, either interpersonally or professionally out of lack of concern for a patient (which is what the nurse was attempting to imply with her note). Reverse the situation and it still comes back on you only now it's "getting into battles is unbecoming and unprofessional" and so on. I wish people would just say the truth and the truth is that it is cheaper to reprimand a resident for doing nothing wrong than a nurse for doing something wrong because the nurse will change jobs or her union will go all nuts and go on strike for her or something. It's insulting to pretend that it's about professionalism because it's not really.

 

[snoopy brown]

In all honesty, I think that's more likely to get me in trouble than the nurse who wrote it. Now all risk management knows is that I refused to see a patient who was in distress.

That's what I'm saying. Let's say a nurse doesn't tell you about a critical lab? So? Isn't it your responsibility doctor to check them? And let's say she calls you for normal values? So? Are you saying you don't want to know about your patient doctor? It's B.S.

 

[Dr JPH]

How about this one...

Order @ 7pm: STAT V-Q Scan

Response @ 11pm: "Doctor, the tech who does the V-Q scans already went home for the night. Do you want to have him come back in or do you want the scan done in the morning?"

 

[snoopy brown]

Stat usually means "whenever convenient" to nurses.

 

[Dr JPH]

Stat usually means "whenever convenient" to nurses.

My hospital uses written orders instead of computer entry.

So if I want something STAT I need to:

1. Write the order
2. Give the chart to the unit clerk and ask her to enter it STAT (which often comes with a loud sigh)
3. Track down the nurse to tell her there is a STAT order
4. Followup to make sure the STAT order got done

 

[Tired]

My hospital uses written orders instead of computer entry.

So if I want something STAT I need to:

1. Write the order
2. Give the chart to the unit clerk and ask her to enter it STAT (which often comes with a loud sigh)
3. Track down the nurse to tell her there is a STAT order
4. Followup to make sure the STAT order got done

I'll do you one better. To get a STAT CT, I have to:

1) Write the order
2) Put the order in the computer myself
3) Call the Radiologist to explain why I want a STAT CT scan
4) Track down the nurse to tell her the pt needs to go for a STAT CT scan
5) Call the CT Tech to ensure the Radiologist told him to do the scan, and remind him that it is STAT
6) If an ICU patient, take the guy down to Radiology myself

 

[snoopy brown]

You both lose. If I wanted a V/Q scan over the weekend I'd have to:

1. Discharge the patient.

2. Arrange an ambulance ride to the local social center.

3. Bribe the tech to adopt the patient.

4. Readmit the patient under his new name


5. Call the tech and inform him that his son was in the hospital and had a possible PE.
6. Bribe the tech to come in.

7. Bribe the nurse just because of commission.

 

[smq123]

You both lose. If I wanted a V/Q scan over the weekend I'd have to:

1. Discharge the patient.

2. Arrange an ambulance ride to the local social center.

3. Bribe the tech to adopt the patient.

4. Readmit the patient under his new name


5. Call the tech and inform him that his son was in the hospital and had a possible PE.
6. Bribe the tech to come in.

7. Bribe the nurse just because of commission.

Oh please. Wimps!

If my resident wants a scan, we have to...

1) Tell the patient, and get him to sign the informed consent form. As a witness, I have to sign the consent form in blood.

2) Discharge the patient.

3) Carry the patient, piggy-back style, down the mountain.

4) Hike for 4 hours to get to the radiology hut over in the next village, on the sunny side of the neighboring mountain. (Patient's still on my back.)

5) Pedal a stationary bike that's hooked up to hut, so that we have enough power to operate the CT scanner.

6) Write down the radiologist's report as he's dictating it to me.

7) Carry the patient back into the hospital and re-admit him.

 

[Dr JPH]

Funny.

But this is true.

If I want an MRI I need to call a transport ambulance to come get the patient, do all the transfer paperwork, load them into an Ambulance and DRIVE THE PATIENT ACROSS THE PARKING LOT.

Let me clarify for those of you hitting your heads on the desk.

The MRI machine is located in a semi trailer parked in the ER parking lot. BUT because the patient is leaving the hospital we need an outside agency to do the leg work.

Nurses walk past this trailer all day to get to the smoking hut outside, but I need to have an ambulance bring the patient out there.

Oh...and I can only get an MRI 3 days a week.

 

[Noble Gas]

Agreed. But the dilemma comes in when a nurse makes a potentially actionable error, but fails to document her own error. For example, a critical lab comes back and no one calls you. All the chart shows is that the sodium was 120, and no one did anything for two hours. Do you pretend the delay never happened, or do you document that while the lab notified nursing, nursing never notified you?



In all honesty, I think that's more likely to get me in trouble than the nurse who wrote it. Now all risk management knows is that I refused to see a patient who was in distress.

Agreed. You do not document that the RN did not do her job. I think, if it's that important, check it yourself. Is this fair? No. Does it create 10 or 100 times more work for you? Yes. You are not shift work. You are the captain of the ship. Expect nothing from the nurses- some of them are 2 years out of high school with an associates degree. You are the professional. Don't lower yourself.

Just overheard the ICU staff at one of the cushy hospitals where we rotate, talking about grey's anatomy. "Can you believe this? Residents don't transport their own patients!" Say what??? wtf world are you living in???

Keep risk management in the loop with chart wars. They go nuts over anybody documenting POTENTIALLY damaging comments in the chart. I've seen, "Paged Dr. Smith to examine bleeding on dressing and he was 'not impressed.'" This referred to an ortho resident on a shared patient- you can bet your ass this got faxed. They can torture us all we want, but when they start giving plaintiff's attorneys leverage (perceived or real) over the hospital, you bet your ass they have a sit-down with the RN. imagine if we quoted, as just happened to an intern on my service, when the RN was asked to hang blood ("I'm going to lunch").

Residents will never win games with nurses. That's why you play your own game. It truly is about the patient and that's why we win. They're trying to teach you a lesson based on their own f-ed up pecking order. We don't need to be passive-aggressive because we are the professionals and these are the patients that will live or die based on our performance. Sound like a god complex? You're g-damn right, because it is. We screw up and people die. We do the right thing and that might just save somebody.

We are too busy to screw nurses the way they try to screw us. We don't work "three 12s" and have the rest of the week off. Look at our reimbursements. Look at our malpractice. Look at the procedures taken by other specialties or mid-levels. Look at crnas slowly eroding our practice. This is our gift and our curse. Nobody puts himself through all of this without laying it all on the line. We go through too much and nobody can understand except people who have been through it.

 

[Dr JPH]

Agreed. You do not document that the RN did not do her job. I think, if it's that important, check it yourself. Is this fair? No. Does it create 10 or 100 times more work for you? Yes. You are not shift work. You are the captain of the ship. Expect nothing from the nurses- some of them are 2 years out of high school with an associates degree. You are the professional. Don't lower yourself.

Just overheard the ICU staff at one of the cushy hospitals where we rotate, talking about grey's anatomy. "Can you believe this? Residents don't transport their own patients!" Say what??? wtf world are you living in???

Keep risk management in the loop with chart wars. They go nuts over anybody documenting POTENTIALLY damaging comments in the chart. I've seen, "Paged Dr. Smith to examine bleeding on dressing and he was 'not impressed.'" This referred to an ortho resident on a shared patient- you can bet your ass this got faxed. They can torture us all we want, but when they start giving plaintiff's attorneys leverage (perceived or real) over the hospital, you bet your ass they have a sit-down with the RN. imagine if we quoted, as just happened to an intern on my service, when the RN was asked to hang blood ("I'm going to lunch").

Residents will never win games with nurses. That's why you play your own game. It truly is about the patient and that's why we win. They're trying to teach you a lesson based on their own f-ed up pecking order. We don't need to be passive-aggressive because we are the professionals and these are the patients that will live or die based on our performance. Sound like a god complex? You're g-damn right, because it is. We screw up and people die. We do the right thing and that might just save somebody.

We are too busy to screw nurses the way they try to screw us. We don't work "three 12s" and have the rest of the week off. Look at our reimbursements. Look at our malpractice. Look at the procedures taken by other specialties or mid-levels. Look at crnas slowly eroding our practice. This is our gift and our curse. Nobody puts himself through all of this without laying it all on the line. We go through too much and nobody can understand except people who have been through it.

Amen

 

[smq123]

If I want an MRI I need to call a transport ambulance to come get the patient, do all the transfer paperwork, load them into an Ambulance and DRIVE THE PATIENT ACROSS THE PARKING LOT.

Hahaha...we needed to get a voiding scan for one of the patients. We had to arrange for a van to come and get her and drive her to the radiology department. But, because we're in Philadelphia, we had to follow the flow of traffic, and took this long circuitous route to get there. End result? - we drove for 15 minutes to get somewhere that was less than half a block up the street.

On the plus side, we could have done that any day of the week.

 

[elwademd]

Then why the ridiculous 3am phone calls?

i didn't say i agreed with their own assessment of themselves! but seriously, ask a nurse, and i'm sure you'll hear something similar, if not the same. they feel they're ready out of nursing school... and that we're not ready out of medical school. i'd argue that it's probably about the same.




very funny stories about the difficulty in getting mri's and ct's. and to think, there was a time when neither modality didn't exist... and we have attendings who remember those times!

Agreed. You do not document that the RN did not do her job. I think, if it's that important, check it yourself. Is this fair? No. Does it create 10 or 100 times more work for you? Yes. You are not shift work. You are the captain of the ship. Expect nothing from the nurses- some of them are 2 years out of high school with an associates degree. You are the professional. Don't lower yourself.

Just overheard the ICU staff at one of the cushy hospitals where we rotate, talking about grey's anatomy. "Can you believe this? Residents don't transport their own patients!" Say what??? wtf world are you living in???

Keep risk management in the loop with chart wars. They go nuts over anybody documenting POTENTIALLY damaging comments in the chart. I've seen, "Paged Dr. Smith to examine bleeding on dressing and he was 'not impressed.'" This referred to an ortho resident on a shared patient- you can bet your ass this got faxed. They can torture us all we want, but when they start giving plaintiff's attorneys leverage (perceived or real) over the hospital, you bet your ass they have a sit-down with the RN. imagine if we quoted, as just happened to an intern on my service, when the RN was asked to hang blood ("I'm going to lunch").

Residents will never win games with nurses. That's why you play your own game. It truly is about the patient and that's why we win. They're trying to teach you a lesson based on their own f-ed up pecking order. We don't need to be passive-aggressive because we are the professionals and these are the patients that will live or die based on our performance. Sound like a god complex? You're g-damn right, because it is. We screw up and people die. We do the right thing and that might just save somebody.

We are too busy to screw nurses the way they try to screw us. We don't work "three 12s" and have the rest of the week off. Look at our reimbursements. Look at our malpractice. Look at the procedures taken by other specialties or mid-levels. Look at crnas slowly eroding our practice. This is our gift and our curse. Nobody puts himself through all of this without laying it all on the line. We go through too much and nobody can understand except people who have been through it.

well said!

 

[deleted87716]

I think the nurse bashing has gone far enough.

I agree.

 

[chimichanga]

Just overheard the ICU staff at one of the cushy hospitals where we rotate, talking about grey's anatomy. "Can you believe this? Residents don't transport their own patients!" Say what??? wtf world are you living in???.

I won't try anymore to convince you that what you guys describe isn't commonplace in the nursing world (at least in Arizona)

But, in 13 years, I have never asked a doc (resident, med student, attending) to transport my patient, and have never seen any of my peers do this...

I did work at UCSD ER years ago, and it was hospital policy for the residents to accompany the nurse for all ICU admits...

BTW, I have seen nursing "go to war" w/ the medical staff, and chart inappropriate "stuff" that should only be placed in an incident/variance report, not the MR, and handled w/ a sit down if need be...I won't allow my nursing staff to do this crap...