Anna Flaxis, ASN 19,500 Views
Joined Oct 15, '10.
Posts: 2,787 (67% Liked)
All4NursingRN, what do you hope to accomplish?
His behavior was definitely rude, but did it impact patient care in any way?
What do you think a union rep or HR might do about a co-worker butting in on a conversation that had nothing to do with patient care?
You could try to talk to the physician in question, but I'm not certain how constructive that would be.
I would suggest letting it go. The best time to deal with things like this is in the moment, and the moment has passed.
I must say it sounds like he has the world's crappiest schedule. That doesn't excuse him acting like a horse's behind, but taking call every day for a month? I. Just. Can't. Even.
Once in awhile this ER doc calls the nurses monkeys. Being as I'm new, I haven't heard it for my self yet. The subject just came up when I was telling another nurse that this doc had just explained to another doc on behalf of our new ER Physician Assistant that 'PA school is like nursing school, but for smarter people.'
How would you interact with someone who such an apparent disdain for nurses and other health care personnel?
We do this quite often, as we are a small hospital and specialties are frequently unavailable. How we handle it depends. For instance, if it's an interfacility transport, we handle it like an EMTALA transfer except they go POV. If the specialist wants the person to come to their clinic, or meet them at the ED of the other facility, then we discharge them. We only ask them to sign AMA if the physician does not agree with their wish to go POV. If the physician thinks it is safe to go POV, then we do not ask them to sign AMA.
I helped start our unit practice council. Processes, since they relate to nursing practice, are very much within the scope of a unit based council. Is there a specific process you'd like to start with? I suggest attending the next unit based council meeting and getting it on the agenda.
^^ Ugh, Ambien comes to mind...
I was just curious how others handled this type of situation.
Selemat datang allnurses! :-)
I'm going to preface my comments with the disclaimer that you may not like what I have to say-but I'm going to be candid and share my impression of what I see here.
For example, I was preparing an IM injection of Haldol Dec, which is very thick and syrup-like and she told me that I was using the wrong gauge needle. I was using a 20 gauge and she told me I needed to use a 25 gauge. I would be there for days drawing it up if I used a 25 gauge. She also told me that I could give 2.5 ml in the deltoid per patient request and that she does it all the time. I refused....
she told me I needed to brush up on my nursing skills and told me that I was, "being stupid and insubordinate."
Does anyone have any tips in dealing with this?
My experience is that physicians, no matter what specialty, are just like everyone else and put their pants on one leg at a time just like everyone else. You will have physicians in the ED that you only speak to when you have to, some that you enjoy a collegial relationship with, and some that are just downright wonderful human beings that you feel proud to work elbow to elbow with, and everything else in-between. Just like on the inpatient unit.
Agree with above ^^^
Also, I'd like to add that complaints about food or other things speak to the patient's mood, which is a part of a behavioral health assessment. If behavioral health is called in to see the patient, it's really helpful to have some information on the patient's mood and behaviors. Quoting the patient in their own words is good practice.
As a House Supervisor, I get called when patients are threatening to leave AMA. It's really helpful when there is documentation of behavior leading up to that point, ie what the patient said or did, what the staff said or did, whether we attempted to make reasonable accommodations, etc. When the patient is found dead from an acute GI bleed under a freeway overpass, it's really important that we be able to show that we did our due diligence to meet the patient's needs. It's really frustrating when there is not a single note in the chart for an entire shift or two leading up to that moment when the patient walked out the door.
Or if Grandma falls while trying to get back into bed from the chair, where is the documentation that somebody spoke to her about safety, made sure she was wearing nonskid socks, made sure the room was free of clutter, and made sure the call button was within reach? What was her mental status at that time? Was she known to be impulsive, or was she completely A&O and able to make her needs known?
So again, observations about behaviors are not necessarily irrelevant, and the person making the observation (RN, CNA, Tech) is qualified to enter it into the record in accordance with institutional policy.
I can't answer "yes" or "no" in your poll, because I don't think this is a black or white issue.
If your institution has an hourly rounding policy, and documentation requirements include an observation note, then I don't think it's necessarily inappropriate for the tech to follow institutional policy by entering a note. If the entries are truly riddled with errors, I don't think it would be unreasonable to gently coach the tech to use the spell-check function.
As far as the content, this information *could* be relevant. If the patient's behaviors are disruptive to the unit, if the patient's mentation is in question, if the patient is a fall risk, if the patient's dietary preferences have not been addressed in the plan of care, etc etc etc, then this is all relevant information.
I think that in this day and age of click-boxes in the EHR, that the narrative note serves an essential function. The narrative note paints a picture of the patient and their situation that all the click-boxes don't. I think hourly observations should be charted, even if it's just a brief "resting quietly, denies needs at this time". It only takes a few seconds to do, it is helpful for charge nurses, physicians, house supervisors, and other folks who might be needing to know what's going on with any given patient and don't have time to go digging through the chart to look at all the click boxes and decipher what they could mean about the patient's condition, and it could really save your bacon in the event that a patient or a family member claims that you were never in the room or that you didn't address certain issues, etc.
Some people argue that it is double charting; ie if my neuro assessment says they were A&Ox4, my musculoskeletal assessment was WNL, then why should I document a narrative to that effect? Or, the record shows I was in the room giving a medication, why should I also document that I was in the room in a narrative note?
The reason is that notes paint a picture of the patient's course of illness and the notable events during their stay in a way that click-boxes do not. The chart might show that you did an assessment or that you were in the room giving meds, but it does not give an impression of what the patient looked like at that moment in time. No, you don't have to chart every time they fart sideways or have an itch on their backside. The narratives should be relevant to the patient's specific situation.
So, in a nutshell, if the tech's notes do not contain relevant information, then they need a little coaching on what should and should not be a part of the hospital chart. But if the notes are relevant to the patient's situation, then your narrative notes need to contain relevant observations too, and show that you followed up on anything the tech might have noted.
Something that drives me nuts when people chart, is when they chart subjective feelings, like "patient is angry". Don't do that. Chart behaviors, like "patient pacing back and forth with fists clenched, states loudly "This place is horrible! I can't get any rest!" (and document what you did about it). Another one is when nurses chart "patient aware" or "doctor aware". How do you know what the patient or doctor is aware of? Instead, chart "plan of care explained to patient, patient verbalizes understanding", or "doctor notified, new orders received (or no new orders received, whichever is the case)".
Anyway, I support the tech entering a brief observational note, if hourly rounding documentation is required at your facility, and I support you coaching the tech in using spell check and making sure the content of their notes is relevant and appropriate. For hourly rounding, typically you just want to show that the "Five Ps" (or whatever criteria your institution has laid out) were addressed.
Put in your vacation request and don't pay for your vacation until your time off is approved.
I've been currently working at a LTC facility since mid-January 2016. We are quite short-staffed. My boyfriend and I are wanting to go to Cancun in July. I plan on putting in my vacation request this week. My facility has been known to be stingy on accepting time-off requests... and I'm kind of worried. What if I've already paid for my vacation, and they decline my request?
Has anyone have any experience on this? Thanks!
Okay, so I'm a nursing student about to start externship in a physicians office. I recently was a patient at my gynecologist's office, my doctor was female, and they are required to have a chaperon. This particular nurse likes to stand between my legs right next to the doctor and watch the whole procedure. The second time I was there a different nurse stood opposite the doctor to where she could not see what was going on. So my question is; do you have to watch what is going on during a pelvic exam as the nurse? Because it made me very uncomfortable to have so many people down there and I don't want to have to make my patients feel uncomfortable. Where do you all stand during an exam?
This thread is about treatment of suicidal patients in the ED. Not the woulda-coulda-shoulda that may or may not have occurred prior to the patient arriving in the ED, or the various modalities of mental health treatment across the entire spectrum of care ... just what happens once a patient presents to the ED expressing suicidality or at risk.
The baseline expectation is safety of the patient. Procedures are designed to maintain the physical safety of the patient, to allow for evaluation of what the best next steps are.
Thank you. Your post has done much to explain some misconceptions I had. Are you familiar with a training program called "Living Works?" Also known as "ASSIST." It is, in essence a suicide prevention and intervention training program open for anyone willing to pay to get it. I do not know if it is available in the United States, but I am sure there must be something equivalent. I have received this training and have used it in a few occasions. I will not claim I deal with many suicidal persons (I don't think I would be able to handle it), but I have. Most of my comments, especially with risks assessment are, derived from this training.
Part of that training taught me how to assess those risks (in order to make a decision as to how to best help a suicidal person). It's not that hard, really. You just have to be committed to ask the right questions. The issue is that I don't think that every suicidal person is best treated at the hospital. The more severe cases, with high risks? Sure. But low risks? No. I wouldn't and I haven't, except in one occasion.
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