Are physicians that thick?

Nurses Relations

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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.

:banghead:

Sounds like she just doesn't not care honesty. Is there an IV team or RRT team that could have tried the labs? Why not page the MD before he rounds to let him know you are having trouble getting labs and ask for picc placement as the labs are frequently drawn. Be proactive not reactive

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Geeeezzzz so many judgemental people here! This happens all the time. MD's get all ***** about labs not being drawn on time. I mean I can understand timed tests. But post op h&h on stable pt. Sorry Im not calling Iv team or Rapid to draw it. As nurses we have to prioritize and critically think. MD was probably in a hurry and didnt want to wait on labs. I get it. I hate waiting around too. But thats how the cookie crumbles. On the floor with 6-7 pts and charge nurse that has full load of 7-8 pts. Thats just the way it is. Maybe MD should have a conversation with nurse manager about how staffing issues impact the care of his post op patients. No need to belittle the nurse at the nurses station!

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You did what you could, sounds like you were in an impossible situation. Unfortunately, our work depends on other departments doing their's as well. I like Karou's response best. You should make the blood draws q 6 hrs. stat (although this usually costs more for the pt) and I would start a process when phlebotomy is not available so that there is some type of trail that may indicate shortage of staff in the lab. Also, you discussed how the MD was upset, but did you notify him when the labs were not able to be drawn?? This would have at least let him know you were aware of it and doing what you could. That might have saved you from being blasted. No, they have no idea of how overwhelmed nurses are and how the "system" is broken. Better luck next time, and there will be a next time!!

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Specializes in Emergency Room, Trauma ICU.

I'm seriously surprised by the comments on here. Two failed sticks and that somehow equals "you did everything you could"? That's the minimum the OP could have done. I guess where I've worked we use our resources, other nurses, charge, etc. We don't just give up and tell the doc to do it themselves. Man this makes me happy to work where I do.

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Specializes in SI/CV ICU and ER.

If the patient somehow has a bad outcome that could have been prevented by knowing an h&h (transfusion etc) and you go to court, it will be you sitting in the hot seat and not the lab tech. Just my .02, get the blood and don't put it on the backburner

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Confused as to the timing here.

How were the labs initially ordered. ? Was there a procedure done that required new post-op orders?

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Seriously! So your tell me that if your other pt going into vtach or has a BP of 70/30 that RN should have done everything she could to get that q6hr h&h on a stable post op pt??? Wow some of you need to work on your prioritization and critical thinking skills. If I cant get it after two sticks I ask charge RN. If charge is busy call lab. Ask them to come up stat to get it. How many times do yall go sticking the pt? Each stick is a risk for infection. And why did the MD order q6hr h&h on post op pt. The docs I work with do cbc bmp qday x 3 days post op. If hgb

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How would the nurse be sued if the lab was late? The main reason nurses get sued is failure to assess and intervene. Failure to notifed provider of significant changes in pt condition. If nurses got sued everytime a lab was late. We would have no nurses. I can understand if lab was late and pt showed s/s of bleeding but nurse didnt intervene. But seriously! Come on! Always assess the pt first and then intervene! If pt is stable no s/s bleeding stable HR stable BP and all previous q6hr h&h were stable. Call lab and let them get it. As nurses we can not do it all. That is why we have to prioitize critically think and delegate!

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If the patient somehow has a bad outcome that could have been prevented by knowing an h&h (transfusion etc) and you go to court, it will be you sitting in the hot seat and not the lab tech. Just my .02, get the blood and don't put it on the backburner

That would really depend on the facility. At my old hospital where I worked the floor, the floor nurses were literally *not allowed* to draw peripheral labs. It was against policy.

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Specializes in Anesthesia, ICU, PCU.

RN1 x2 sticks, better RN2/PCA x1 stick, notify MD. That's our commonly accepted algorithm. Not phlebotomy team where I work and the charge nurse is just a randomly assigned staff nurse so they aren't necessarily anything special. As for a stat order being placed in the computer and being neglected, I blame the physician for any lateness as long as they DO NOT call to notify the RN when it's ordered. We don't just sit at the computers. To answer the title question, no physicians are certainly not thick.

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Specializes in Critical Care.

Based on the information given I don't see any reason to believe the nurse wasn't taking appropriate actions. The nurse did make arrangements to have the draw done after she failed by putting the patient in line for a phlebotomy draw. Unless there's additional information not included that would suggest the patient was unstable or otherwise warranted a more emergent effort to get the blood I don't see the problem. And Post-op H&H's are by no means an emergency just because they are a post-op H&H.

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Specializes in SICU, trauma, neuro.

Why NOT utilize all resources, including RRT nurse or float? (referring to your other reply "sorry I'm not calling IV team or RRT") Most of us here use our heads quite well, thanks. How would you know if the hgb was

Seriously! So your tell me that if your other pt going into vtach or has a BP of 70/30 that RN should have done everything she could to get that q6hr h&h on a stable post op pt??? Wow some of you need to work on your prioritization and critical thinking skills. If I cant get it after two sticks I ask charge RN. If charge is busy call lab. Ask them to come up stat to get it. How many times do yall go sticking the pt? Each stick is a risk for infection. And why did the MD order q6hr h&h on post op pt. The docs I work with do cbc bmp qday x 3 days post op. If hgb
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