Kind of a rant, sorry! - page 3

by MECO28

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I work on a short stay unit so the bulk of our patients are coming to recover from minor surgical, GI and interventional radiology procedures and then we send them on their merry way once they are walking, talking, peeing and not... Read More


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    I used to work nights at a SNF. One of my co-workers called the on-call doctor about a patient with an elevated BP. Her response was "I don't think it's that high. Just don't check his BP anymore". The patient did have a history of elevated BP and the day shift was trying to get standing orders out of his primary MD but sometimes that takes time and we can't just ignore it in the meantime.
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    Oh my gosh... the stories I could tell. O2 sat in the 70s? "She runs like that." Or... *silence silence silence* "Put in a hospitalist consult for [original reason you called]". Sigh.
    NevadaFighter likes this.
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    Does your unit have any kind of rapid response team? Your patient would meet my hospital's criteria for a rapid response, especially if you can't get help from the primary. Rarely, we'll have a hospitalist that doesn't want to come see a patient that is deteriorating. One of our charge nurses will basically tell them they need to get up there or a rapid response will be called (which they're required to respond to), just so they understand the seriousness of the situation.
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    It's frustrating. Physicians are well aware of protocols, but still act like you commit a severe transgression when you ACTUALLY FOLLOW it. So my question is: "How in the world would you act if I chose to ignore protocols, not notify you, and placed YOUR patient at risk for serious harm?" I can answer that. The same physician who admonishes you for following protocol by contacting him over patient concerns (which are not within the specialty of their practice) would absolutely JUMP at the chance to ensure that you receive the appropriate disciplinary action for the one time you DON'T contact them. Lesser of two evils prevails in my book. I'd rather have my face ripped off by a cavalier physician than place my patient at risk. You could always file a grievance if the same physicians consistently refuse to acknowledge your concerns and respond in an unprofessional manner.
    teeniebert likes this.
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    Quote from MECO28
    I work on a short stay unit so the bulk of our patients are coming to recover from minor surgical, GI and interventional radiology procedures and then we send them on their merry way once they are walking, talking, peeing and not crying in pain.

    One of the frustrating things about working on this unit is that the attending doctors who do the procedures are often unwilling to deal with situations that arise that aren't directly related to the procedure they have performed and they often refuse to consult with the hospitalist teams.

    For instance: yesterday I had a patient who had a minor interventional radiology procedure. I called the MD because the patient's BP was in the 90s to 200s systolic and the patient c/o headache, dizziness, etc. He adamantly declined to treat it and told me to "keep an eye on it; it's just pain-related". I kept an eye on it for the next 4 hours and it got progressively worse. Even though the pt's pain improved, the BP did not and the headache and dizziness grew more acute.

    I called the MD again and got the on-call who tore me several new ones for bothering them with this again. His exact words "Why are you calling about this again?She is on two anti-hypertensives already; what are you asking- for us to give her more and have her bottom out?" My reply (as my face is growing tomato-red and I am struggling to maintain compsure) was "I'm calling because this is a reportable symptom and is cause for concern. I am doing my job and keeping you updated on the patient's condition." He was rude and told me not to call again and to make a note for others not to call about it.

    As I was angrily writing a note quoting the exact words of the MD he sheepishly called back twice both times asking me what we would normally give in this situation. I told him I do not feel comfortable advising about cardiac meds and told him I would be happy to find out who the hospitalist on duty is. He finally agreed, thankfully and I gave report to the next nurse, amended my note, and went home to a much-needed beer.


    Any of you have similar issues when dealing with specialists?



    Have had similar experiences. A few in a Surgical Cardiac Recovery Unity that didn't have direct surgical coverage on off hours. What a joke. I will never work in another unit like that again, and since I primarily work with kids now, I don't have to. This unit was such a joke for post-open heart patients and the like fresh out of surgery. I can't go into too many details, but suffice it to say that I PRAY that unit runs differently.

    Try having a CT surgeon tell you to let the poor patient with an augmented pressure of 40 code. Mind you, off-hours, no surgeon or even anesthesiologist to cover the unit. Try hearing that I am let a bleeding patient continue to dump 200-300 mls of blood per hour out of her chest tubes, b/c what else do I want him to do--he's not taking her back into the OR, and every other option and blood unit, DDAVP, you name has been given.

    I DETEST recovery areas that don't have anyone playing Harry Truman directly working them. I'm not a surgeon, and I am not an anesthesiologist, and some of this stuff that comes into play gets beyond the scope of the mid-level or advance nurse practitioner. I just won't work in them, b/c of liability issues. I can't take the patient back into the OR and expore for bleeders. There are too many complications and variables for which I don't want to be and should not be liable.

    That crappy little open heart unit I worked in without coverage--never did it again. I again plead to God that they fixed that situation with at least an appropriate hospitalist. Those nurses thought they were so great working off of protocol orders. The sad joke was, when the patient took a turn off the protocol orders, there was no one around or willing to deal with those sad situations. Fortunately, though I got grief from some people, I busted by arse, got yelled at by some, but my patients survived. Can't speak to what happened to them in the long-run; but I swear I will never work in a place that functions like that again. 20+ years in nursing, and I have never even been mentioned in a lawsuit. Knock on wood. Hope it stays that way. I'm sure not going to work against the trend by working in idiotic places like that one. There isn't enough beer and wine on the planet for that crap.
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    Quote from Aurora77
    Does your unit have any kind of rapid response team? Your patient would meet my hospital's criteria for a rapid response, especially if you can't get help from the primary. Rarely, we'll have a hospitalist that doesn't want to come see a patient that is deteriorating. One of our charge nurses will basically tell them they need to get up there or a rapid response will be called (which they're required to respond to), just so they understand the seriousness of the situation.

    Yes! I so wish we had this at the time I worked in that surgical unit I spoke of. Problem is, since it's a critical care unit, people would question a call fro RR--or something like it--at least back then. Regardless, I think they should go wherever--even if it happens to be a critical care unit.

    At the same time, no unit with people as critical as I was referring to should run without direction surgical coverage--at least direct medical coverage--like an anesthesia-critical care physician or the like.
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    Happens all the time, and yes, they usually call back after they've thought about it. However, if no response, and patient is really tanking I'd call a RRT.
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    We do have a rapid response team, however that is usually reserved for patients less stable than this one. Although her BP was sky-high and she had been dealing with the headache/dizziness all day, the patient was calm, interactive and there was no chest pain/SOB/change in LOC. While in theory a RR call would have been justified, in practice I would have gotten a big "what the you-know-what?!" from the team if I had called. Nevertheless, that would have been the next step had the MD not had a change of heart and called me back.
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    We are a stand alone facility and we don't have rapid response, we have to call 911 or ship them out if they are unstable. He was actually pretty stable. It was "just his thing". Generally with those patients we have orders with treatment parameters (ie give x for bp over y/z or don't call unless above x). But this guy was fairly new so we hadn't gotten parameters yet (it takes a couple of days to realize we need them sometimes and then time to get them). Usually we are given an order for a one time/additional dose or an early dose depending on the situation. But this doctor didn't know it was his thing (she wasn't his doctor), she just chose to disbelieve the reading completely.


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