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:

Specializes in Med/Surg/ICU/Stepdown.

If you re-read my original post, I stated that I had tried twice myself, and no one else was available. And by no one else, I mean the charge was in assignment, and the other nurses' were occupied. I paged a clinical support RN who was also not available as she was responding to a Code Blue. The head of phlebotomy was notified and stated she'd send the next available phlebotomist, but that could take some time.

Tell me again how I had control over the situation?

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Specializes in Med/Surg/ICU/Stepdown.
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

Au contraire ... I care very much.

The patient was made a "lab draw" when the order was first entered. At 1403, when phlebotomy had not shown up, the lab was placed as "STAT" (by myself, I may add) and phlebotomy was again notified. By 1415, they had still not shown up, and I attempted to draw the patient twice with no success. I searched for other available nurses and there were none at the time. Clinical support was paged. They were unavailable as they were responding to a Code Blue. Primary MD was notified and stated "well, I guess we wait." And THEN urology rounded and proceeded to speak condescendingly to me at the nurses' station.

After all the hoops I jumped through, hell YES they can do their own ******* draw.

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Specializes in Med/Surg/ICU/Stepdown.

I'll clarify even further:

The q6hr draws had been ordered since the patient had been admitted (24-hours prior). The patient went for a scheduled procedure after 2-units of PRBC's and the q6hr draws remained. It is not policy at our facility to draw a post-procedure/post-transfusion H&H--it's at the discretion of the primary MD. The physician had been asked (by myself) if he wanted post-transfusion H&H, to which he stated he did not. The 1400 H&H that was due was late after I tried to stick the patient twice and no other floor nurses were available. Clinical support was also not available. Our RT's do not respond to page out for draws that are not ABG's. They just don't. Phlebotomy was notified many times. The issue is the urologists' behavior at the nurses station after having no idea what all I went through to be able to obtain this 1400 draw.

The patient was in stable condition post-surgically. No where did I state a low H&H means the patient requires critical care. What I said was that if it is a desperate need that he be monitored so closely with draws that are on the minute, perhaps he should go to CCU where they are better able to make that happen.

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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

personally, I don't consider an arterial stick appropriate for a law draw for a stable patient on a floor. (Edit: I read the original as wanting respiratory to draw an arterial sample for this lab)

OP, the only thing I think you maybe could have done differently is paging the MD sooner rather than later - but even then it really depends on the policies and unit culture as to whether that would even be appropriate

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Specializes in Med/Surg/ICU/Stepdown.
personally, I don't consider an arterial stick appropriate for a law draw for a stable patient on a floor. (Edit: I read the original as wanting respiratory to draw an arterial sample for this lab)

OP, the only thing I think you maybe could have done differently is paging the MD sooner rather than later - but even then it really depends on the policies and unit culture as to whether that would even be appropriate

The primary MD was made aware after I tried twice to get the patient and failed. Maybe 15 minutes after the draw was late? Our attendings are stationed on the floor. I didn't feel the need to notify urology as they weren't the physicians placing the orders.

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The primary MD was made aware after I tried twice to get the patient and failed. Maybe 15 minutes after the draw was late? Our attendings are stationed on the floor. I didn't feel the need to notify urology as they weren't the physicians placing the orders.

If urology didn't order it, I wouldn't have notified them either.

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Specializes in Emergency/Trauma/LDRP/Ortho ASC.

I don't really enjoy my ER job too much, but I've got to hand it to ER docs...if you tell them you can't get blood or can't get a line many of them are willing to take a try at it.

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Specializes in Med/Surg/ICU/Stepdown.
I don't really enjoy my ER job too much, but I've got to hand it to ER docs...if you tell them you can't get blood or can't get a line many of them are willing to take a try at it.

I was honestly dumbfounded. The conversation literally went like this:

Uro Attending: Can you tell me a bit about Patient X?

Me: Well, he's just returned from [insert procedure here] on [insert fluids/medication here] and his vital signs are stable. The patient has family at the bedside. Presently, he's on [insert number of liters of O2 here] and appears comfortable. We're waiting on his H&H draw right now ..

Uro Attending: (cutting me off) When was it due?

Me: 1400 (it's now 1430) but ...

Uro Attending: (cutting me off again) Well, what's the hold up? It's kind of important we know his H&H at this juncture.

Me: The attending has been notified and I've paged out for the phlebotomy supervisor. He's a difficult stick and I've tried and clinical support ...

Uro Attending: (cutting me off YET again) So what now?

Uro Resident: Well, honestly, if phlebotomy can't get here then it's the NURSES' job to make sure it's drawn. You know that, right?

... all of this transpiring AT the nurses' station.

Come on, now.

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Specializes in Tele/PCU/ICU/Stepdown/HH Case Management.

LOL, that's definitely a different story! It was only half an hour late? Then he needs to chill. Most of the time you won't get regular draw results back before 30mins anyways.

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Specializes in Med/Surg/ICU/Stepdown.
LOL, that's definitely a different story! It was only half an hour late? Then he needs to chill. Most of the time you won't get regular draw results back before 30mins anyways.

This happens routinely. Phlebotomy is overworked. Our hospital is HUGE. We do have resources such as clinical support RN's and charge RN's, but if the patient is a difficult stick without a PICC line ... then it is what it is. We've had instances where phlebotomy can't get a patient, clinical support can't get a patient, and multiple RN's aren't able to, so we put in a PICC consult or we notify the physician and await further orders. It's just frustrating that MD's can't seem to understand that not all blood draws are created equal and if it's late, there's often a good reason why it's late. I wish they'd start trusting our judgment and our responsibility to our patients. Sheesh.

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Specializes in Pediatrics, Emergency, Trauma.

I was honestly dumbfounded. The conversation literally went like this:

Uro Attending: Can you tell me a bit about Patient X?

Me: Well, he's just returned from [insert procedure here] on [insert fluids/medication here] and his vital signs are stable. The patient has family at the bedside. Presently, he's on [insert number of liters of O2 here] and appears comfortable. We're waiting on his H&H draw right now ..

Uro Attending: (cutting me off) When was it due?

Me: 1400 (it's now 1430) but ...

Uro Attending: (cutting me off again) Well, what's the hold up? It's kind of important we know his H&H at this juncture.

Me: The attending has been notified and I've paged out for the phlebotomy supervisor. He's a difficult stick and I've tried and clinical support ...

Uro Attending: (cutting me off YET again) So what now?

Uro Resident: Well, honestly, if phlebotomy can't get here then it's the NURSES' job to make sure it's drawn. You know that, right?

... all of this transpiring AT the nurses' station.

Come on, now.

...and the comeback would've been "as the NURSE, I have used the proper channels, although I have no issue helping YOU get the blood, or you can contact the primary MD to hash it out." :sarcastic:

Sometimes an intelligent, well informed co back is worth it...to a thick physician, unfortunately, Urologists can be just as annoying as surgeons.

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Specializes in Med/Surg/ICU/Stepdown.
...and the comeback would've been "as the NURSE, I have used the proper channels, although I have no issue helping YOU get the blood, or you can contact the primary MD to hash it out." :sarcastic:

Sometimes an intelligent, well informed co back is worth it...to a thick physician, unfortunately, Urologists can be just as annoying as surgeons.

:dead: I always think of these things after the fact! I really wanted to put an IV kit in her hand and point her in the direction of the patient's room.

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