Some of our residents scare me. . . . .

  1. So. . . .two days ago I float off my happy little unit to a medical telemetry unit. No sooner do I take report on my patients than I get a phone call from Pharmacy.

    "About that fentanyl order for Ms Smith in Room 4. . . . ."

    "Hang on," I say, "Let me grab her chart, I just got report and haven't taken a close look at it yet."

    I grab the chart, flip through to the last order written (about 10 minutes before shift change) and say, "You mean that order that Doctor Jones wrote for 2 MILLIGRAMS of fentanyl?"

    The pharmacist says, yes, that was exactly the order she was talking about.

    I told her that I would contact the doctor immediately and get a clarification.

    So I call the doc. . . . . . . . .

    "Hi, Doctor Jones, this is KC from unit **. I'm taking care of Miss Smith, and I wanted to talk to you about the 2mg order you wrote for fentanyl."

    "Yeah, what's wrong with it?" (This said in a very surly, belligerent tone of voice.)

    At this point, I thought I had heard wrong. "I'm sorry, what did you say?"

    "I *asked* you what was wrong with the order??!!" the doctor replied.

    "Well, since the usual range of a fentanyl dose is 25-50 MICROGRAMS in this type of situation we may want to re-write your previous order for 2 MILLIGRAMS."

    "Why would I want to do that? I was just up on the floor and wrote you an order!!" The doctor is sounding very angry at this point.

    At this point, I'm afraid I quit being nice.

    "Well Doctor, since the dose you wrote would kill the patient, I thought you might want to give me a different one."

    And July was months and months ago. . . . . . . .

    I'm sure she was probably sleep deprived and was thinking morphine instead of fentanyl when she wrote the order, but still. . . . . . . . .

    This is why I love floating. It makes me so very appreciative of my home floor's patient population, our PAs, our Residents, and our Attendings.
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  2. 18 Comments

  3. by   Christie RN2006
    What about the patient we had one time that had severe chest pain and her EKG showed major ST elevation, her BP was in the 70's after the first 2 SL Nitro... the doc ordered 1in Nitro patch and a narcotic pain pill (I can't remember which one, but it was something like oxycodone)?!?!
  4. by   Misty1
    I share your concern. Had one resident order 15 cc's of Torodol then argue with me when I told him that was wrong. Gotta say I wasn't as nice as you.

    I've seen many scarey things just too tired to bring them all up now.
  5. by   time4meRN
    Ohhh yeh, that's why we have to be on our toes and be advocated for the pt's. I work er and surgical ICU. I was talking one day in the ER about tiratring gtt's in OHRU and all the standing orders we have and how different they are between Dr's. Talking about pulling swans , extubating etc... A resident said, "man that's scary, letting nurses do all of that ". I quickly said, " no what's scary is letting you residents any where near a open heart pt, if you notice the surgeons don't want you any where near their pt's . infact if their coding most would rather talk to us on the phone while it's going on because they have a trust in us, we very seldom call a resident to come down ". He had a blank look on his face, as if to say, "yeh, why don't I ever get calls from Open heart recovery ?" Or the resident yelling in the er because we sent an inmobilized pt to Xray for a possible Fx without doing a urine preg first. He was absolutley irate. Until I stopped the ranting and asked , " Labor will be easier if she can't feel her lower half because of a Fx.That will save money on an epidural. Guess the sheilds they use in xray are overated". The attending just smiled and made a funny face the the resident.
  6. by   jmgrn65
    I don't take that from residents, they so haven't earned any right to treat nurses that way. ( I am not really saying that any doc should treat someone that way).
    I would have simply told him that is all right I will your attending and get the correct order, click. Residents are learning too, unfortanatly some think they know it all.
  7. by   Dalzac
    How about the resident that orders 2 mg of Demerol on a 250 lb man. When he was called on it he thru a fit saying that was the appropiate dose and DO NOT change it or call the attending. The attending was called and the order was changed. The resident came back to the unit and and started screaming an inch from my face. I called security and the attending. A few months later this yahoo was fired for dozens of bad calls.
  8. by   TazziRN
    It ain't just residents, guys! I had a doc who'd been in practice for years (badly, I might add) INSIST that I start a lido protocol on a pt with a junctional rhythm. My charge talked to him. My ER doc talked to him. He insisted. I refused. He stomped off to ICU, where I was sending the pt. The ICU nurse refused. Believe it or not, he tried to write us up for insubordination!!!

    Or the time I ran a medic call on a chest pain (this was years ago, before standing protocols...medics had to call before giving narcs). The pt's private doc happened to be in the ER and heard me order morphine titrated to 10 mg IVP for the chest pain. He freaked and said we would snow the woman and demanded I change it to 1-2 mg. I stared at him and held out the receiver and told him "If you want to take over the pt's care, YOU tell him to change that and you finish the call."
  9. by   EmmaG
    Yeah, it's scary; and even scarier is that I've known nurses who would have carried through with these orders. Not many, thankfully, but one is all it takes...

    This is why it is imperative that we know usual, safe doses and standards of care and practice.
  10. by   Jo Dirt
    A doctor nearly killed my mother prescribing diuretics with no potassium. She would come to his office shaky and weak and he would send her home and tell her to keep taking her meds. After several episode of this my sister took her to the ER one night and the doctor looked at what she was taking and said it was no wonder she was spasming.
  11. by   kessadawn
    A few shifts ago in my PICU the resident ordered SCDs on my 6 week old patient, then looked surprised when I told her we don't have them to fit!
  12. by   EmmaG
    Oh. My. Gawd.
  13. by   leslie :-D
    i dealt w/a resident who wanted my pt's fentanyl and dilaudid, quadrupled.
    when he saw my reaction, he carefully explained his rationale:

    "well, she's dying anyway".
    :stone:stone:stone

    i ended up telling him, what i would give the pt.
    and put a stat call into the chief.
    chief backed me up.
    and i never saw this resident again.

    leslie
  14. by   EmmaG
    Quote from earle58
    i dealt w/a resident who wanted my pt's fentanyl and dilaudid, quadrupled.
    when he saw my reaction, he carefully explained his rationale:

    "well, she's dying anyway".
    :stone:stone:stone
    And then there are the ones who won't so much as order a tylenol.

    Sheesh

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