Are physicians that thick?

[nynursey_]

This is not by any stretch a constructive thread, but more of a rant ...

Why is it impossible for *some* physicians to understand the plight of the floor nurse? Your patient is *not* a critical care patient and I have a 1:5 ratio on a 33 bed unit with 2 PCA's. Yes, I see his H&H weren't drawn post-procedure, but I'm waiting on phlebotomy and have failed twice to retrieve his draw. There is no one else available at this time to try. If you're that concerned, please, feel free to grab some tools and try yourself. I'll assist you to the supply closet.

Please do not speak down to me at the nurses' station and rattle off to me what *my* responsibilities are when the H&H order states "q6hr." Furthermore, if your patient requires such timely and strict monitoring, perhaps they ought be on the CCU. Additionally, you are the consulting service. The primary MD wishes to stick to the q6hr schedule.

[Patchouli]

I would suggest a PICC line on a pt that is a difficult draw that has a necessity to get frequent labs/possible blood. Getting q 6 H&H's is not enough reason to warrant a CCU. Med/Surg nurses are fully capable of drawing from a PICC and giving blood.

[VANurse2010]

I would suggest a PICC line on a pt that is a difficult draw that has a necessity to get frequent labs/possible blood. Getting q 6 H&H's is not enough reason to warrant a CCU. Med/Surg nurses are fully capable of drawing from a PICC and giving blood.

I agree re: need for critical care placement, but that's not really the point. Physicians need to be aware that a floor nurse cannot drop everything to tend to their individual patient, and if they have a problem with labs not being drawn (especially after the nurse has tried) they need to take that up with phlebotomy.

[Patchouli]

I agree, but ultimately we are responsible for missed orders and labs. Even in the best hospital, most physicians don't grasp the concept of juggling multiple pt orders/labs/care/I&Os/ etc...

[SionainnRN]

I agree re: need for critical care placement, but that's not really the point. Physicians need to be aware that a floor nurse cannot drop everything to tend to their individual patient, and if they have a problem with labs not being drawn (especially after the nurse has tried) they need to take that up with phlebotomy.

I understand that you're frustrated, but to be so blasé about post op H&Hs is a little worrisome. The docs don't write for serial labs unless they're pretty worried about something. So if you can't get the stick you need to go to your charge to get them. Blaming it on phlebotomy is just passing the buck. Ultimately it's your responsibility and up to you to see the orders carried out in a timely fashion.

[VANurse2010]

I understand that you're frustrated, but to be so blasé about post op H&Hs is a little worrisome. The docs don't write for serial labs unless they're pretty worried about something. So if you can't get the stick you need to go to your charge to get them. Blaming it on phlebotomy is just passing the buck. Ultimately it's your responsibility and up to you to see the orders carried out in a timely fashion.

I work in critical care, so I understand perfectly well what my responsibilities are. The problem is a system that devolves responsibility to the point the nurse has almost no control over the situation but retains the accountability. One reason I no longer work the floor!

[SionainnRN]

I work in critical care, so I understand perfectly well what my responsibilities are. The problem is a system that devolves responsibility to the point the nurse has almost no control over the situation but retains the accountability. One reason I no longer work the floor!

The OP absolutely had control over the situation. If she didn't get the stick she needed to get her charge or another nurse, or call the head of phlebotomy. There were way more options than passing the buck, being dismissive about the orders and taking it out on the ordering doc. Nursing is all about prioritizing and post op serial H&Hs are pretty high up there.

[NickiLaughs, ADN, BSN, RN]

Her post said that no one else was available at this time to draw, it sounds like she exhausted her options and the physician is aware. Perhaps there was something more critical?

It's not uncommon in our ER to be over an hour late on blood draws because something much more critical occurred or it takes 5 different people trying to get the blood in the first place.

I'm not a floor nurse, but when I did float, emergencies happen everywhere. While blood tests are important, they unfortunately can be put on standby. I had a situation where a second troponin was due (first was normal). Not able to get because I had two brand new patients roll in, both ICU players, and I was in those rooms well over the next hour. My stable patient with the now overdue troponin, got assigned a bed and went upstairs. I felt bad about not getting the lab done, but we had no staff available to draw the test. I was with my other patients, one of who got intubated and the other who was an acute gi bleed. Obviously, priorities lowered the lab test as that pt was breathing and in no distress. Our entire ER was slammed and I reported it through the IR system as the issue was staffing, not quality of nursing. This could be a similar scenario.

[Esme12, ASN, BSN, RN]

Sounds to me like she exhausted her/his resources...I have an idea maybe admin should hire more phlebotomists.

OP in the future call and ask for an arterial stick to get the labs then call respiratory...make them stat. OR start a positive change...ask if you can look into a positive patient improvement that you can use ICU/ER, radiology nurse or the rapid response team as a back up

[Karou]

I understand your frustration. It sounds like you tried what you could and alerted the right people for assistance, but no one was yet available. It would be nice if physicians realized that we have more than one patient, each equally important and requiring care. Not saying that the blood draw isn't important, but it might not be top priority if you have more critical things going on.

I would love to inform the doctor that I had attempted the blood draw and failed, lab is aware but not yet available. Then sweetly ask him, "since you are here and such an excellent physician, would you like to try?"

[classicdame, MSN, EdD]

they feel the same way you do when something or someone interferes with your productivity. They want to make rounds, get the info needed, make a decision and go on to the next stop. But I do not believe that gives anyone the right to be rude. Get with your supervisor about suggestions to improve time flow, if possible.

[SionainnRN]

I'm sorry but nowhere does the OP say she asked anyone else? Just that no one was available. If she had stated what else she has tried, that would be a little different. And honestly her attitude is what's making me see that, the whole "if it's so important do it yourself" is so rude and disrespectful. I get that this is a vent thread, but the attitude expressed really rubs me the wrong way.