Sweating The Small Stuff

Have you encountered physicians who makes an ocean out of a drop of water? Well, this article is one of those non-sense moments in which you'll realize as a nurse, that not all hospital duties start or end the way we wanted since there are such people to test us. Nurses Announcements Archive Article

Sweating The Small Stuff

As my remaining months in the hospital comes to a close (for my 2-year work experience goal), a few disturbing happenings occurred during my hospital duties. The following are the scenarios in which the consultants SWEAT THE SMALL STUFF.

Scenario 1 (July 2013)

A 39-week pregnant mother was scheduled for CS or Caesarian Section at 4 am in the morning. Yes, it was 4 am since the morning OR theater rooms are filled for the morning's schedule. This OB-Gyne wrote a prophylaxis medication of Cefazovit1.5 gms IV 1 hour prior to OR. This prewritten order was brought by the pregnant woman upon the arrival at ER. Then, it was endorsed at the pm shift and this was endorsed to us since we were the nightshirt that time. To cut the story short, I carried out the doctor's order and endorsed it to the OR nurse after reading the order per line. After an hour, the nurse supervisor called me and asked me why I gave 1.5 grams where in fact it was only 1.0 grams that was ordered. The OB-Gyne was angry inside the Delivery Room. I came inside the OR to explain my side and she told me (while yelling and getting angry) that I better read orders before injecting medications. The fact is, almost 5 nurses saw the order of the doctor from ER up to the OR as well as the nursing supervisor who double-checks special procedures that would occur in the hospital. Also, the number apparently looks .5 since it was superimposed with double strokes over zero as far as we can remember. I don't know if it was a matter of misunderstanding but everyone was at my side including the Chief Nurse who saw the order as well. It really looked like a .5 superimposed over zero. But to think of it, it's not actually a stuff to sweat about if it we're really just 1 gram. Besides, it was just a prophylaxis and the patient is well-off, kind and not demanding. The anesthesiologist even told the OB-Gyne to just brush it off and I just give the remaining .5 to the patient at the ward. End of story.

Scenario 2 (First week of August 2013)

We had a Korean patient who was in an accident who can understand and speak little English. The surgeon who was at deck that time was known to be a demanding and greedy one. During the morning rounds, he met with the patient together with her Korean interpreter who was quite demanding as well. To cut the story short, I gave the prescription to the interpreter for the medications that would be used and she would just to pick that up in the Pharmacy. After 30 minutes, I received a call and this surgeon was yelling at me, asking why I gave them the prescription and so on and so forth. His point was, there's a language barrier that might occur. I told him I gave it to the interpreter and not directly to the patient's husband who was Korean as well. In short, the surgeon wants us nurses, to get the medications directly to the pharmacy, which isn't our responsibility by the way. Since we are kind nurses, I just accepted so no further arguments would follow. Why there's a need to yell and be angry where in fact the surgeon was asking for a favor at the same time? One of my worst days.

Scenario 3 (Last week of August 2013)

sweating-small-stuff.jpg My favorite surgeon from scenario 2 had a patient again who was scheduled for EGD. My partner carried out his orders and brought the notification to the operating room at around 10 am. To cut the story short, the surgeon got angry because he was notified at 3.30 pm that the scope was defective. It was an honest mistake of the OR nurses but what they did was to scapegoat and put the blame on us ward nurses by saying that we brought the notification at 3.30 pm. The surgeon called me at the phone and for the second time, yelled at me, telling me the patient should have been discharged already before the cut-off at 1 pm. At first I didn't know, what time my partner brought the notification to the OR since I was busy doing other stuff. But then, the nursing supervisor called my partner and she told the supervisor that the midwife brought the notification at around 10 am. The truth is, again, it seems to be not a big deal at all since this surgeon is always known to always extend the patient's admission to charge bigger professional fees based from first-hand experience from us nurses. At the phone, he was like a Saint acting like a patient's advocate who wants to discharge the patient ASAP. Second, the patient has an HMO who really don't care about their hospital charges. Our ward by the way is a private ward with a few semi-private rooms. Another non-sense duty.

These were one of my major hurtful circumstances at the hospital which made a stronger nurse by the way.

I think God wants to teach me things that I need for the future:

  1. For me to be more patient with these kinds of situations
  2. For me to be more faithful that God is still working his way even at such inevitable and unfair circumstances
  3. For me to develop my Emotional Quotient
  4. And for me as well to NOT TO SWEAT THE SMALL STUFF as these are just also petty problems not to take seriously.
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cool_nurse

About cool_nurse, LPN

Cool_Nurse is a male nurse who holds license in the Philippines and NY, USA. He is currently working as a staff nurse in a medical-surgical ward of a Private Tertiary Hospital in the Philippines. He was a former writer and a student-journalist.

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Specializes in LTC Rehab Med/Surg.

Unfortunately, in the hospital the MD decides what's small stuff and what's not.

I would have been sweating plenty if I gave the wrong dose of any med. Especially if the MD was making an issue out of it.

After almost 20 years, an MD on a rant still makes me "sweat".

Maybe more, since I'm an older nurse.

Having said all of the above, I hope you become strong enough to shrug off an MDs tantrum. I hope you become smart enough, and confident enough, to stand toe to toe with a doctor who's wrong.

Just don't always expect the hospital to back you up.

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Specializes in ER.

I agree about the previous poster and doctor's rants. I rarely have been on the receiving end of a rant until recently. I've been in nursing for 11 years, ER for about 8. I triaged a man who had used ear drops for his eyes. He wasn't complaining of pain, discharge, trouble with his vision, or anything. His complaint was that he needed eye drops for his ?conjunctivitis. It was a busy night, he had to wait. Fast forward to the high strung attending... he comes unglued. I mean U N G L U E D. He wanted a visual acuity. I hadn't gotten one. I was so taken aback and I was triaging a person with chest pain who could hear this doctor laying into me on the phone. I was quiet and said, "Ok, I'm triaging a chest pain and it's really busy right now. Sorry and next time I'll remember to get one." I know from others that this doc is all about visual acuities. He wasn't satisified with my apology. He wanted me to feel terrible, I suppose. When I saw him later, he put a hand on my shoulder (he's younger than I am) and admonished me much the same way a parent would to a child. He said "now it had to be said." I said "that's fine. I understand your point and lesson has been learned. You do not need to speak to me in the way that you are." He refused to accept that he was speaking to me in any way, and I told him that I understood him and yelling at me, especially in front of someone, is unacceptable and he need not ever do that again. Ever. I explained to him, again, that one time talking to me about a standard is all I need to be told. Everyone makes mistakes, which I expressed to him, but the manner in addressing was horrific and I couldn't let him get away with his behavior. I am a good nurse and I triage well, handle our critical care room and am trusted by my doctors and colleagues. He knows this.

Turns out the guy was fine, the doc thought it was a chemical exposure and should have been triaged as an ESI2. I made him an ESI 4, which I would still do to this day. I never was triggered for any concern in my triage, and I have been doing this for a long time. He had stable vs, eyes were clear, pupils equal, no vision change or pain, no drainage, nothing. I still think experience is key. I don't like to be yelled at, ever, as I'm sure no one does. When you have done something that may not have been the correct sequence or swiftness, it doesn't call for yelling. Doctors need NEVER yell at anyone (except drunk, rude, or disrespectful patients who are belligerent), but especially not nurses. He did apologize, though very very unwillingly, and said that he didn't realize he yelled. I think we both agreed we learned something and we moved on. He did say he was more mad when I told him I was busy (which I was alone triaging, rooming patients and dealing with the jungle of unhappy patients in the waiting room with about 50 people) Yeah, I was busy. He was too, I get it.

There's always a way to handle an issue. Other than a blatant negligent act that could kill someone (which we could all agree would lead to some yelling), there's always a better way to handle an issue.

Though, "sweating the small stuff" I would not count with medication variances.

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What do you mean by "my 2-year work experience goal"? Also, where are you from?

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Thanks for the comment imintrouble!

Indeed, the MD decides what's to be angry about and what's not. They're always in control. Since the consultants in our hospitals are a bit old and the staff nurses are very young (22-25 y.o. range), probably they just feel very powerful.

Yes, I'm able to shrug off those petty stuff. They're not an issue. LOL

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I agree about the previous poster and doctor's rants. I rarely have been on the receiving end of a rant until recently. I've been in nursing for 11 years, ER for about 8. I triaged a man who had used ear drops for his eyes. He wasn't complaining of pain, discharge, trouble with his vision, or anything. His complaint was that he needed eye drops for his ?conjunctivitis. It was a busy night, he had to wait. Fast forward to the high strung attending... he comes unglued. I mean U N G L U E D. He wanted a visual acuity. I hadn't gotten one. I was so taken aback and I was triaging a person with chest pain who could hear this doctor laying into me on the phone. I was quiet and said, "Ok, I'm triaging a chest pain and it's really busy right now. Sorry and next time I'll remember to get one." I know from others that this doc is all about visual acuities. He wasn't satisified with my apology. He wanted me to feel terrible, I suppose. When I saw him later, he put a hand on my shoulder (he's younger than I am) and admonished me much the same way a parent would to a child. He said "now it had to be said." I said "that's fine. I understand your point and lesson has been learned. You do not need to speak to me in the way that you are." He refused to accept that he was speaking to me in any way, and I told him that I understood him and yelling at me, especially in front of someone, is unacceptable and he need not ever do that again. Ever. I explained to him, again, that one time talking to me about a standard is all I need to be told. Everyone makes mistakes, which I expressed to him, but the manner in addressing was horrific and I couldn't let him get away with his behavior. I am a good nurse and I triage well, handle our critical care room and am trusted by my doctors and colleagues. He knows this.

Turns out the guy was fine, the doc thought it was a chemical exposure and should have been triaged as an ESI2. I made him an ESI 4, which I would still do to this day. I never was triggered for any concern in my triage, and I have been doing this for a long time. He had stable vs, eyes were clear, pupils equal, no vision change or pain, no drainage, nothing. I still think experience is key. I don't like to be yelled at, ever, as I'm sure no one does. When you have done something that may not have been the correct sequence or swiftness, it doesn't call for yelling. Doctors need NEVER yell at anyone (except drunk, rude, or disrespectful patients who are belligerent), but especially not nurses. He did apologize, though very very unwillingly, and said that he didn't realize he yelled. I think we both agreed we learned something and we moved on. He did say he was more mad when I told him I was busy (which I was alone triaging, rooming patients and dealing with the jungle of unhappy patients in the waiting room with about 50 people) Yeah, I was busy. He was too, I get it.

There's always a way to handle an issue. Other than a blatant negligent act that could kill someone (which we could all agree would lead to some yelling), there's always a better way to handle an issue.

Though, "sweating the small stuff" I would not count with medication variances.

Hello MassEd! True enough! There's always a better way to handle an issue! Not by shouting though!

I just hate it when you are being shouted at. Very disrespectful. At least your doctor apologized even with hesitation.

Let's just keep the faith fellow nurses! =)

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What do you mean by "my 2-year work experience goal"? Also, where are you from?

My goal is to have a 2-year work experience so that I can go to abroad. I'm from the Philippines. Why?

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Specializes in Intensive care unit.

can very much relate to your story, only in my case the ER ROD is the one very much like your surgeon. greedy. and all powerful. no apologies as well and shouts at you just to shame you when it's not your fault.

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can very much relate to your story, only in my case the ER ROD is the one very much like your surgeon. greedy. and all powerful. no apologies as well and shouts at you just to shame you when it's not your fault.

God bless these kinds of PROFESSIONALS. I just HATE THEM!

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Specializes in NICU, OB/GYN.

Regarding scenario one, if the doctor wrote the order in accordance with standards set by the Joint Commission, she would've written it as "1 gram" instead of "1.0 grams", if that's what she really wanted. Adding ".0" leads to increased risk of error.

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About Scenario 1, I'm not clear on what you meant when you said you gave the extra 0.5 later on the ward. Saying "It's just prophylaxis" and "the patient is well-off" isn't any kind of an excuse.

In scenario 2, it would have been inappropriate to give the prescription to anyone but the patient; it would have been much more appropriate to send it to the pharmacy directly. I don't see any reason to call this an unfair circumstance or turf your responsibility to God.

In scenario 3, I have a hard time following your narrative, but if it was your responsibility to deliver a message but someone else did because you were "busy with other stuff" -- really? And your speculations about the physician keeping people in the hospital for reimbursement, it doesn't matter because the pt has an HMO, and all that about private ward and such-- nothing to do with anything.

I am aware that you are very new at this and you are in a different culture and English is not your first language. However I find your lack of interest in taking any responsibility or understanding underlying issues to be troubling. You will not do well in the US (if you get here) if this does not change.

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Regarding scenario one, if the doctor wrote the order in accordance with standards set by the Joint Commission, she would've written it as "1 gram" instead of "1.0 grams", if that's what she really wanted. Adding ".0" leads to increased risk of error.

Indeed! Another doctor told me the same when I showed him the doctor's order!

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