R U annoyed by some ancillary staff too?

[eriksoln]

Situation: I am finishing working an eight hour night shift. It is 0715, I am done in 15 minutes. I usually don't care about getting out on time, but my facility is asking people to "please finish your duties on time and do not accrue OT". I have a pt. in one room who Occupational Therapy is going in to see, but there is only one of them and she is a max assist of three. I am imagining him dropping her on the floor. In another room, a pt. who is trying to finish her second dose of barium has begun to vomiting despite having received zofran. Also, a CNA has just informed me that another pt's saturation is "lower than usual".

How I thought I'd handle it: Poke my head in the door of the room with the OT staff who is about to make a huge mistake and inform him he needs more help, thus averting a "fall" occurring on my watch and even more importantly, avoid an injury to him or the pt. Then get to the desaturating pt., check their oxygen level. Once that is solved, go to the pt. with N/V due to barium, inform them they don't have to finish the second dose and inform CT.

What actually happened: Cant find a pulse ox to check the saturation of the pt. I am most worried about. Run around like a mad man trying to find it. All the while, the nurse replacing me is taking her time going through report (she has not even started yet). Said nurse then informs me the CNA who just left (yeah, same one who told me "That pt's saturation is lower than usual, but I dont remember the number exactly"), didnt do her daily weights and they need done, the doctor who is known for flipping out about this is just down the hall. I see Respiratory Therapy approaching, figure I will use their pulse ox and proceed to poke my head in the door to warn him the pt. he is working with is too much for one person, he should call for help. His response "I need help with this pt. then, you need to get the bedpan for her and help me move her." I tell him I have issues in other rooms and cant spare any time at the moment. The response "So what, I don't care, get in here and help like U R supposed to." At this point I try to tell him not to squabble in front of the pt. and that I have pressing matters I need to attend to. His solution, instead of contacting his dept. to get help, was to throw a hiss fit, cursing and swearing in the hall "Unbelievable, never in my life, anyone around who can help this guy, ALL HIS PT'S ARE DYING AND HE NEEDS HELP, SOUND THE CODE ALARM." So I ignored him and continued with my plan. Checked the guy, and yeah, he was 88%, fixed that with Resp. Therapy. Then checked the vomiting pt. She was alright, CT was contacted and not worried about it. Then as I am updating the nurse who is coming on (she just decided to listen to report about the time the OT guy was throwing his temper tantrum). As I am updating her, the OT guy is storming the halls screaming about lack of teamwork.

Now what gets me here is, how ancillary dept's always end up thinking they are the only one's with duties/responsibilities to manage. Whats even best is, nurses don't have the luxury of approaching one pt at a time. We have a team of 6 patients, and must attend to them all at once, round the clock. Can't just hide in one room and pretend the world begins and ends at the door. But other dept's (PT/OT, security, housekeeping, radiology.....all of them) throw temper tantrums when we cant drop everything and attend to something they want done.

I didnt write him up, I wanted to sleep on it, but I will be when I return tomorrow. As much as I am against writing people up, this guy needs to go.

[leslie :-D]

you know, it just may not be a bad idea to write him up anyway, erik.

leslie

[PageRespiratory!]

RT forgot to put end stage COPD patient back on his O2 after a neb tx. I was in the room preparing PO and IV meds, and noticed when the patient started to convulse and gasp like a fish out of water. I had just started IV abx, so at first I thought that was it, but when I went to check the O2 flow, saw that it was not even on.

Immediately turned NC (because our simple masks are not even in the room, and I wanted to get him on Os *immediately*, and the NC was right there) up to 6LPM, attached pulse ox. He was at 78%, and immediately started to gain. Our orders were to keep him at 88% or better (CO2 retainer). Since his sats were coming right up with the NC, I saw no need to go grab a simple mask.

About the time he was up to 84-85% and his distress was visibly decreased, RT came back into room, saying she had remembered that she had not put him on Os. She then asked me how much O2 I had him on, I told her 6, and she began to lecture me about how NCs don't provide adequate O2 flow past 5LPM, and we should put him on a simple mask. I ignored her and continued to reassure the patient, with my hand on his shoulder, as we watched his sat climb steadily back up to 88%.

He was back up to 90% when the RT brings the simple mask in and proceeds to place the patient on simple mask. I informed her that he was already recovered, and our orders were 88%. She ignored me and switched him over to simple mask at 10LPM for a couple of minutes, while I bit my tongue because I really wanted to tell her to get away from my patient and get out of my room.

Later, she had the gall to confront me about an inhaler I had charted on. It was a once daily inhaler, which he had been given prior to admission that day, and should not even have been on the MAR. So I charted it "not needed" and in the comments, wrote that he had already had it that day. Perfectly acceptable for the admitting RN to do. She accused me of having charted it "given", which only RTs are allowed to give inhalers unless the patient has an MD order that they may self admin.

I didn't write an incident report, because IRs are not supposed to be punitive, and I was majorly ticked off, and writing it up would have been out of anger.

But now I am thinking I might write it up anyway, because this is not the first time I've had to deal with RTs coming in and doing things that interfere with my patient care. There have been many instances where I have a cupfull of PO meds that I am preparing, and the RT will swoop in and start a routine neb tx, causing me to have to wait at least ten minutes before I can give the pt. their meds, or when I call for a PRN for a patient who's having some difficulty, they'll tell me they won't be able to come for a couple of hours because they're busy.

>

How about when you do things that interfere with RT's Pt care? Next time try stopping the neb and giving the PO meds and then turning the neb back on. I've got 27 Pt's under my service tonight, and when they recieve care from me I'm just as responsible for them as the RN is. I can honestly say that 60% of the time when nursing calls for a PRN Tx....it's completely unnecessary. Some nurses will even claim the Pt asked for it, only for me to find out the Pt did no such thing, but I usually give it anyway moreso to satisfy the nurse than anything else. Many times I'm called while in the middle of something urgent, I ask the nurse to give the treatment. Somehow, miraculously, the Pt didn't need it after all. One hospital I worked in we delegated administration of nebs on the med surge floors to nursing, incredibly PRN nebs decreased by ~75%!! If I developed an opinion of the entire nursing proffession based on the actions of the few moron nurses I've worked with over the years, it would'nt be a pretty picture. BTW - Aerosolized medication delivery is about 0.5% of our expertise, yet somehow many nurses assume thats all we do. Quite frustrating.

[Batman24]

you know, it just may not be a bad idea to write him up anyway, erik.

leslie

I agree. Never hurts to have a paper trail and as the patient reported him I think you should document it as well.

[eriksoln, BSN, RN]

I did document heavily on what went on during that very long 15 minute span. For the most part, my phone conversation with the manager of PT was just him asking if "Is this true, is that true............OK, just wanted to be clear before I move forward." None of the questions evolved around "Why didnt you do this, did you really say that" stuff. Mostly just asking me about the OT guy's actions.

I try so hard to fly under the radar and avoid bucket heads like this. Somehow, they find me.

[eriksoln, BSN, RN]

>

....yawn.....

How about when you do things that interfere with RT's Pt care? Next time try stopping the neb and giving the PO meds and then turning the neb back on. I've got 27 Pt's under my service tonight, and when they recieve care from me I'm just as responsible for them as the RN is. I can honestly say that 60% of the time when nursing calls for a PRN Tx....it's completely unnecessary. Some nurses will even claim the Pt asked for it, only for me to find out the Pt did no such thing, but I usually give it anyway moreso to satisfy the nurse than anything else. Many times I'm called while in the middle of something urgent, I ask the nurse to give the treatment. Somehow, miraculously, the Pt didn't need it after all. One hospital I worked in we delegated administration of nebs on the med surge floors to nursing, incredibly PRN nebs decreased by ~75%!! If I developed an opinion of the entire nursing proffession based on the actions of the few moron nurses I've worked with over the years, it would'nt be a pretty picture. BTW - Aerosolized medication delivery is about 0.5% of our expertise, yet somehow many nurses assume thats all we do. Quite frustrating.

I used to travel nurse. I worked on such a unit. I LOVED IT. Didnt have to rely on someone else to assist you with a pt who is SOB...........when a simple PRN breathing treatment would solve it. I felt it was much more efficient.

Now I am on a pulmonary unit. Not sure I could completely take over all the treatments. Giving us PRN duties and continuing to allow Resp. Therapy to do scheduled ones seems doable to me.

:p"Next time try stopping the neb and giving the PO meds and then turning the neb back on." I do this all the time if narcotics are in the meds I am delivering. I'll hold onto a cup of meds 10 minutes, but I wont walk around with narcs in my pocket. I always wondered if RT would be annoyed with me doing that if they saw me lol. It didnt stop me from doing it, I was just prepared to get holl'erd at.

[PageRespiratory!]

I used to travel nurse. I worked on such a unit. I LOVED IT. Didnt have to rely on someone else to assist you with a pt who is SOB...........when a simple PRN breathing treatment would solve it. I felt it was much more efficient.

Now I am on a pulmonary unit. Not sure I could completely take over all the treatments. Giving us PRN duties and continuing to allow Resp. Therapy to do scheduled ones seems doable to me.

:p"Next time try stopping the neb and giving the PO meds and then turning the neb back on." I do this all the time if narcotics are in the meds I am delivering. I'll hold onto a cup of meds 10 minutes, but I wont walk around with narcs in my pocket. I always wondered if RT would be annoyed with me doing that if they saw me lol. It didnt stop me from doing it, I was just prepared to get holl'erd at.

>

Honestly, I'd expect that to be done. It only makes sense to me, if the Pt is scheduled for PO meds and he/she is in the middle of a Tx how long would it take to typically swallow a few pills? 2 - 3 minutes? Any RT (or anyone else for that matter) that would let something as trivial as that annoy them seems a little unreasonable to me. I'm in a much smaller hospital these days and only have on RT one at a time for the whole house, it's definatley a shared task. Of course some people will spend more energy trying to get out of doing something, than it would take to do it!

[Virgo_RN, BSN, RN]

>

Next time try stopping the neb and giving the PO meds and then turning the neb back on.

Seriously? That seems kinda disrespectful, but if the RT doesn't mind, that's not a bad idea.

[Virgo_RN, BSN, RN]

Sorry, Erik, I didn't mean to derail your thread. Just had to vent too.

I agree you should write an incident report, if you haven't already.