Gave the MD the best answer ever!!

  1. 25
    So last night was a terrible night..ran around like usual. But I had this pt. who I had the previous night also. She's a Nephro RN and was on my unit for pulm. HTN and eval for lung transplant. So we got to talking the previous night and that's how I found out she was a RN. No one knew, which I found odd b/c our admission databases that we do for every pt. has their occupation/former occupation..the line was blank. So either the nurse who admitted her wasn't paying attn or no one asked. Any way...

    So we start talking, and I find out she's an RN at one of the hosp. I was thinking about transferring to in the past, that is owned by the hosp I work in now, she worked at one of the affiliate hospitals. Our healthcare system owns like 40+hosp and healthcare facilities. So we are chatting and she's such a GREAT patient, but very very sick...

    So last night I had her as a patient agian. She aske if I had anysleep in b/t shifts I said not really..she works nights also..we laughed..and then we started talking about how much snow we are susposed to get.

    Well she knew I live almost an hour away from the hosp. She said, "Ang, if the snows too bad in the morning, you can bunk up with me for a few hours just as long as you don't snore..." I just started laughing..so was she but she was serious...she began to tell me how she's been there since sometime last week and she still hasn't seen this cardiologist that was reffered by the lung transplant team. I said I will look who it is..I look in the chart, no physician referral form for a cardiologist...I began looking through her chart, which was HUGE, b/c she was transferred fromanother hospital for higher level of care...Ok I finally find out who the cardiologist is susposed to be...when I saw the name I almost dropped the chart....

    Her Cardiac MD is the CHIEF of Cardiology..who I see at 5:50am every morning I work. He always has his flock of tele residents and med students with him. Great guy, and AMAZING MD. So I said to my pt. are you sure you didn't met him? She said no...hummmm....

    Now this MD always says to me, "Ang for working all night and you run and make sure your pt's are very well taken care of all night long, you always look so put together at 5:50am after a long night of marathon running." yea yea yea I have been hearing this for almost 2 years now....I always fire back..hey I am young, drinklots of caffiene and when you arrive at 5:50am I am just starting my 4th cup of coffee so I am getting my morning buzz before my shift ends....anyway

    So I am in another pt's room at like 6:15a this morning trying to untangle this octopus of feeding tube lines, IV lines and O2 tubing. I see him walk onto the floor. I ran out of the pt's room and said, "are you going to see the pt. in room XYZ? I was told she was tentative or a RHC today as an add on case, I just want to make it a yes or no ans so I can tell her"...he says "well since there is a foot of snow on the ground I forsee an opening" I said "did you little magic cardiac ball tell you that, or did some of your outpatient patients leave a bunch of messages saying how they are not going to drive in 12 inches of snow, and to re-schedule the cath.." Now there were 2 surgons with him who looked at me like how dare you say that to him...and then he asks me how the pt. is doing..I give him the run down. As I am telling him about this pt. the 2 surgeons are scrambling to write it all down.

    He says, "Ang, I have sen this pt. but every time I see her she is sleeping, and she has met me before, she's just seen so many MD over the last few days..." I said..."Wait..ok did you know she's an RN at XYZ hosp?" He said, "No I didn't, but I am very happy that you just told me..."

    Now get this...he pulls me aside with these 2 surgeons, why they were with him I have no idea, and says, "Do you think the pt. is improving?" I said, "well over the last 48 hours that I have had her as a pt, she is ambulating more often, b/L breath sounds are much better, edema in the Lower extremities has marked improvement. Her O2 sat has improved drastically in the last 2 days." He said...."Now do you think her improvement is because or the Doctors, or the Nurses?" I said , "Since I had her as a pt. all weekend, and you don't make weekend rounds, but I give you updates on the phone in the AM on the weekends, I am going to say that it's the collaboration of health care professionals and communication that has improved her health." Helooked at the 2 surgeons and said, "this is the RN that all of my patients talk about months after they have left the hospital."

    So he brings up a story about a pt. I had like 2 weeks ago. It wasn't his pt. but he happend to be on the unit when I admitted the pt. from the ER at 5:55am. The ER never checked the pt's rhythm and sent the pt. to me in rapid A-fib..HR is in the 160's, I call the tele resident, she comes, dosen't know what to give the pt. He overheard me taking about the problem, and how I caouldn't get a single person on the phone to evl this pt. the tele resident was clueless.

    He comes over..and I say, "Doc can you please help me out, I have this pt. in rapid A-fib that just arrived about 5 min. ago. I need an order for..." He looks at the tele resident and his med studens and says ok gang what do we do for a pt. in rapid a-fib with a stable blood pressure. What ar the 2 drus we can give...some one says lopressor IV, yea if the BP was elevated adn the pt was in rapid a-fib but it was 110/50..some says Dig IV, ok good....he says come on guys what's the other med we give for rapid a-fib...they are all scrambling through their books...he says ANG, what is the other med we give?

    "Cardizem, there's the other drug so can I please get an order to either give her dig IV or start a cardizem gtt" He gave me a high 5 and said, "I knew she knew the answer that's why I stopped her from asking for the meds at first and wanted to see if you guys knew and how the 2 meds affect the body differently..." he said "ang what does dig do" I said "increases myocardial contraction, slows a-fib and a-flutter and proves to be ineffective in pt's with CHF...this pt isn't a CHF'r her K+ is normal her renal function is normal and her dig level in the ER was almost nill, so she was on dig at some point but she dosen't know"

    He looked at the tele resident who looked soo clueless, and said, "you can learn alot from this girl she's knows what she is doing..." So I got the order for IV dig stat and I also said "the pt's has never had a 2-d eccho, and nothing was ordered in the ER so can I add it on to the orders you just told me?" He said, "ang you know what to do..." and made me rattle off all the orders that I thought the pt. should have had but were not ordered..I began "OK, CXR r/o infiltrate, labs cbc bmp mg phos cpk trop flp, 12 lead ekg, 2-d eccho, cortodid doppler, ct of the chest, EPS consult...and a few other things, but does that sound about right?" His med students just stood there and stared at me...he said, "I think you got it.." I got another high 5. He's only like that with me and no ther RN's on the floor he grills me about pt's, meds and why we give them and blah blah blah and procedures. He said, "Now she's only been a nurse a little under 2 years,, I have seen her progress, and my patients love her. So never dismiss a nurses sugestion about pt. orders."

    I am thinking about going back and getting my APN in Cardiology. He aid he would write me a letter of reccomendation...the chief of cardiology...I know he does it on purpose b/c I am young, I am always willing to learn new things and he trusts me, and his pt's trust me...
  2. 23 Comments so far...

  3. 2
    What a wonderul story! You must feel so good! Isn't it great when the "higher-ups" notice and then acknowledge us nurses? Great job, Morettia2. You SHOULD be proud of yourself.
    Morettia2 and rabbitgirrl like this.
  4. 3
    You should totally go for your APN in cardiology. You're good at it and you're being recognized for it! Go for it!
    Jarnaes, Morettia2, and rabbitgirrl like this.
  5. 2
    Wow, I learned something from ya. Keep those educational posts coming. They make for good reading.

    Take Care!
    Morettia2 and rabbitgirrl like this.
  6. 2
    God, that's such a feel good moment for you I hope to be there someday when I have some experience!! Great job and way to give major points to nurses and their knowledge base!!
    Morettia2 and rabbitgirrl like this.
  7. 1
    congrats!!!! great job and I wish there were more MDs that would realize what we really do and need to know to take care of our patients.
    Morettia2 likes this.
  8. 1
    Hey, in another solar system people might call you a self promotor or even overly proud. But I call you a terrific nurse and when I go to a cardiac floor I want you as my nurse!!!!
    Morettia2 likes this.
  9. 1
    You deserve a million pats on the back.
    Morettia2 likes this.
  10. 1
    Can someone tell me why Dig was ordered instead of Cardizem? Isn't Dig effective with CHF pt's? I'm confused, sorry
    Morettia2 likes this.
  11. 1
    I'm shocked that they didn't know the correct med to give was cardizem...I thought this was pretty much the gold standard for Afib with RVR?
    Angie O'Plasty, RN likes this.


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