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  1. Jan 14 by JennyAS
    VENT

    Why are some ED docs so averse to actually writing orders? I understand it's the ED, and they get spoiled by how much ED nurses are willing to do without a doctor's order (lines, labs, fluids, etc), but if you tell me to give Dilaudid, I'm gonna need an order for it. And if I come to you 15 minutes later and again ask you to please put the order in, don't get angry. It's your job.

    Yes, you need to order that foley, as insignificant as it may seem, because when the patient gets a UTI 3 days later, I'm not going to lose my license over it. And yes, you need to order all those NS boluses, because there's no other way for me to document their intake. And yes, you have to place an order for some stupid Tylenol, because the almighty Pyxis won't let me pull it out until you do.

    And no, I won't place a verbal order, because you are a resident whom I barely know, let alone trust. And also, I have enough sh*t to do.

    What kills me is that it takes them 10 seconds to place an order electronically, while that same order may take me 30 minutes to actually complete.

    woo! love to vent.
    Lovely_RN, hoopschick, Sehille4774, and 1 other like this.

  2. 14 Comments so far...

  3. Guide
    Jan 14 by Altra
    You can always *update* the attending on the patient's status -- that you are awaiting orders for a Foley, pain meds, etc. I suspect you'll get the orders quickly after that.
    canoehead likes this.
  4. Jan 14 by MADDOG70
    those are the Drs we all team up against and ask for orders on every little thing just to **** them off and put them in their place! LOL
  5. Jan 14 by whichone'spink
    ED doctors don't like to be slowed down by having to enter orders in the computer. It's all about throughput and seeing more patients at a time. At my hospital, the ED doctors have pretty much been forced to use the computer. They're not happy of course. They used to be able to have scribes (like me) do all the order entry stuff, but that changed this year. They have to put in for everything, including meds.
  6. Jan 15 by Sehille4774
    Uhh Amen Sista!

    Though my comment will apply to Dr's in general. I work in home care..Dr's give me the hardest time sometimes to give me the actual orders I need, written the right way, so that I can do my job..

    It blows my mind that I feel I have to explain..."Hey...I really can't do very many things (even apply OTC lotion) unless you write me an order.....

    Then their are the ones that insist on making the parents take off and drive over an hour to see the specialist...for silly things they could easily put in electronically.

    I also hate when the wording of an order makes it basically useless for what we needed it for...AKA.".May remove NC 02 for 15-20 minutes, during baths: Ok well great now the only way I can remove it is if she is getting a bath...we asked so we could take it off while doing respiratory therapy such as the coffalator or neb tx, as tolerated.

    OR Albuterol 0.083%, Neb, Give one vial every 4-6 hours, PRN for SOB....Now, this Dr's Intent that he told us was so we could give them for thinning increased congestion, rhonchi, wheezes, s/s cold, decreased spo2...But becasue he wrote it the way he did, I cant give it unless I can document or witness evidence of SOB...(at oleast according to my agency it works this way.


    Lol. Why should I have to explain any of this to a DR...don't they know how HC scripts work yet? They are not real concerned about my license, esp. if they view your request as trivial..and a waste of their busy time.

    But...I feel these little things ARE important to us...if they catch us (if it came to a court case or investigation) doing some small things outside of our scope, then that goes to our character...why wouldn't we do that with larger issues too?
  7. Guide
    Jan 15 by CapeCodMermaid
    They are everywhere. In SNFs the orders have to be very specific but some of the docs don't seem to get it. We spend an extraordinary amount of time writing clarification orders. If the doc or NP writes "Give Lasix 20 mg qd" we have to write a clarification order to read "Give Lasix 20 mg daily." We're converting to EMR next month and the system doesn't allow for 'bad' orders. Can't wait!!
    We had a doc who tried to titrate people from 2 to 1 liter of 02 or get rid of it altogether. He'd write "Discontinue all oxygen." I asked him if he wanted my to put a pillow over their face so ALL the oxygen was discontinued. He did have a great sense of humor. He asked me how he should write the order so it didn't look like he had written an order to smother someone. "Discontinue all SUPPLEMENTAL oxygen" worked.
    Last edit by CapeCodMermaid on Jan 15 : Reason: clarification
    Sehille4774 likes this.
  8. Jan 15 by KelRN215
    It's not just ED docs. Getting our residents to put in/update orders is like pulling teeth sometimes. Yesterday I had a patient who had been transferred out of the ICU several hours earlier who still had an order for an IA heparin drip. We do not use A-lines on the floor and they are always dc'd prior to the patient's transfer. Is it that hard to click "discontinue" on the order before the patient leaves the unit? Actually, the ICU docs are the ones that should be doing this since it's their order to begin with.
  9. Guide
    Jan 15 by Esme12
    Mostly....they feel it is beneath them, they " Are NOT Secretaries". Second, they now have no one to blame but themselves.
    Sehille4774 and whichone'spink like this.
  10. Jan 15 by whichone'spink
    Quote from Esme12
    Mostly....they feel it is beneath them, they " Are NOT Secretaries". Second, they now have no one to blame but themselves.
    True story. But they have to get used to using the computer.
    Sehille4774 likes this.
  11. Jan 15 by Calabria
    It depends on the resident, for us, regarding putting orders in. Some of them, it's really bad.

    I've had to call the same resident multiple times for different patients before about missing orders... why? They were all fresh, post-op C-sections and had no pain medication orders put into the computer (none, nada, zilch). Ouch.