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.
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.
she clearly stated it was a rant....and when some states there is no on else available, what do yo think it means?
Umm, is this really how you want to represent floor nurses?
I'm not trying to represent floor nurses in any certain light. But, what I will say, is that after I've tried twice and paged the appropriate parties and sought out additional help .. oh, AND notified the physician, I HAVE FIVE OTHER PATIENTS that require nursing care. Period. And that's a reality. Anyone that can't see that is living in a fantasy.
Is there a nurse educator on your staff, OP? How about advocating for ancillary staff to be trained in how to draw labs? By straight sticks as opposed to drawing off lines.
ER techs, paramedics that you may have on staff, other resources to get labs when you are unable to.
Even CNA's have different levels of education. To have those that are into drawing blood be able to advance would not be a bad thing.
Then on the assignment sheet, a CNA/Tech whomever can be assigned for blood draws.
Just a thought on how to make the process smoother to the patient's advantage. The last thing anyone wants is for a post op H&H to be in the toilet on a late draw, and having to react as opposed to being proactive.
Hi, jadelpn .. thanks for the suggestions! :)
It sounds good in theory, but our policy is that ER technicans are the only UAP allowed to perform blood draws. Furthermore, it was half an issue of someone not being available, and half an issue of the patient having poor vascular access. In those cases, we call clinical support, but our hospital is large and has been 97% full the past few weeks, so even clinical support nurses are responding to issues more emergent.
I understand the necessity of these serial H&H draws. Believe me, I do. But it being a half an hour late even after exhausted resources is no reason for a physician to scold a nurse in public. It just isn't. Med/Surg RN's have a heavy load and sometimes, just sometimes, the buck has to get passed after all has been done in the moment.
No, physicians aren't that thick. Some of them, however, don't see things from where you stand and will place impossible standards upon you.
I deal with a hospitalist that frequently storms into our ER, the first thing out of her mouth demanding to know why we haven't done this or that without even having looked at the chart or spoken with the ER doc.
At first, I just thought she was a mean person. But after a while, I realized that she just really cares about her patients and has a very low tolerance for substandard care, which I wouldn't say we deliver, but I would say that in the ER, we are frequently flying by the seat of our pants and things that might seem important to a hospitalist get overlooked because they're not important in the ER. It has certainly prodded me to be a little more thorough with my admitted patients.
Recently, I had an admitted patient that couldn't go to the floor until the lab results were back. Lab tried unsuccessfully. The previous nurse tried unsuccessfully. I tried unsuccessfully and was starting to look at neck veins to do an EJ, when the hospitalist arrived and did the EJ herself. She was a total witch with a "B" the whole time, barking orders while I had five other patients I was caring for (the other nurse was one on one with a patient).
In the end, I said "Thank you, Doctor ______" as she left the department, refusing to allow her behavior to make me react in a less than professional way or to lower myself to behaving in a way that does not fit my with personal sense of integrity.
The next time she showed up, I greeted her like a long lost friend, and she was so much nicer!
I am determined to charm her and win her over.
I think it's great that the hospitalist came to get the labs herself! The plight of the foor nurse is often that an access that would provide blood for a labs is out of our training to perform. I'd never do an EJ to draw labs--I'm not trained. Those that are are sometimes not available in the moment. I honestly welcome a physician to try!
Unfortunately, rather than accepting things as they are and offering to get a lab that's needed, the physicians stand there and bark and rant not realizing that the floor nurse has probably pulled out her hair making 8,000 phone calls to get the serial H&H's drawn.
If the order is put in with phlebotomy as a lab draw, then they should be feeling the heat.
Sadly, the nurse is there on the front lines. If the support staff is not doing their jobs, often the nurse gets blamed.
Precisely. Where is the accountability for the other staff that participate and are responsible for this patient's care? I get a little tired of being the middle man, or the coordinator, and getting slammed when something goes awry.
Precisely. Where is the accountability for the other staff that participate and are responsible for this patient's care? I get a little tired of being the middle man, or the coordinator, and getting slammed when something goes awry.
And guess what, when labs' excuse is that they are understaffed, they are let off the hook, as if that's a reason FOR them to not do their jobs, but god forbid if nursing used it as an excuse!
I'm not trying to represent floor nurses in any certain light.
I was not replying to you comment when I wrote what I wrote....I was replying the person who said they cannot drop everything to tend to his/her patients, when, in fact, sometimes that is a necessity.
Ok, mynursey, you have it. Permission. To rant. Next? If you have any energy left at the end of the day how about a party with a group of like-minded associates at which you might consider what to give a few of your more obstreperous colleagues as a holiday 'token' gift: A kind of do-re-me list/litany of please do and please don't recorded in a fun, sing-song fashion, package it nicly, give it an imaginative title that would be certain to appeal to your audience.. "How Physicians can gain an hour of free time with each visit to the hospital" or 'How to make friends and influence nurses' "Secrets ALL Doctors must know but nurses don't want to tell them!" I'm sure you could pull something together that will cause all of you to scream with laughter before, during and for a long after! Just so you know: Nurses' are Saints, Doctors want to sheppard sheep not discuss the virtues of evidence based medicine i.e. A spinal tap, insisted my primary, is needed. Will the results change my treatment, my condition, my quality of life, asks the not-a-sheep? No. says he. No says I and good bye.
P.S. I added this and only afterwards did I see the string of professional comments that preceded it. Haven't really read every word; apparently there are issues yet to be resolved in any suitable homogenized fashion. My sympathies but never forget: Laughter is the best medicine...
Ok, mynursey, you have it. Permission. To rant. Next? If you have any energy left at the end of the day how about a party with a group of like-minded associates at which you might consider what to give a few of your more obstreperous colleagues as a holiday 'token' gift: A kind of do-re-me list/litany of please do and please don't recorded in a fun, sing-song fashion, package it nicly, give it an imaginative title that would be certain to appeal to your audience.. "How Physicians can gain an hour of free time with each visit to the hospital" or 'How to make friends and influence nurses' "Secrets ALL Doctors must know but nurses don't want to tell them!" I'm sure you could pull something together that will cause all of you to scream with laughter before, during and for a long after! Just so you know: Nurses' are Saints, Doctors want to sheppard sheep not discuss the virtues of evidence based medicine i.e. A spinal tap, insisted my primary, is needed. Will the results change my treatment, my condition, my quality of life, asks the not-a-sheep? No. says he. No says I and good bye.
I think it's great that the hospitalist came to get the labs herself! The plight of the foor nurse is often that an access that would provide blood for a labs is out of our training to perform. I'd never do an EJ to draw labs--I'm not trained. Those that are are sometimes not available in the moment. I honestly welcome a physician to try!
Unfortunately, rather than accepting things as they are and offering to get a lab that's needed, the physicians stand there and bark and rant not realizing that the floor nurse has probably pulled out her hair making 8,000 phone calls to get the serial H&H's drawn.
I get that. I was a floor nurse before I transferred to the ER.
Really, what I would do in your shoes is explain that I have exhausted all of my options and ask them if they would be willing to try a fem stick.
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.
The urologist clearly behaved badly. Maybe it was stress, but she needs to figure out how to control her frustration. I think that, based on the scenario you described in the OP (and the fact that you prefaced it as a vent thread!) was enough information to put together your entire meaning: we work hard. We face challenges. We work as a team. Things often dont work the way they are supposed to. Most situations are only partially under our control. Therefore--we should always be decent to each other.
Understood. I agree and sympathize. :) I'm also sorry that you had to go into so many details to defend your OP in what is such a frustrating and COMMON workplace scenario.
Just a different perspective: one can feel (and actually be) powerless and distressed in the face of such situations... a much more simple and quick way to discharge the negative feelings is to picture the individual naked... if THAT doesn't at least bring on a smile then one may need a little more practice doing so..
morte, LPN, LVN
7,015 Posts
she clearly stated it was a rant....and when some states there is no on else available, what do yo think it means?