Lately, there's been a particular nurse who has been entering orders for every 3 hour vitals and lung sounds, including at night when the patients are sleeping.
She states the orders are entered because these patients "need extra monitoring." Granted, she only enters them on patients who have shown a decline in medical status, but several patients have expressed displeasure about being woken up at 3AM for vitals and lung sound assessment. They stated they can't get any sleep being woken up so often and are then too tired to work with therapy.
It is unclear if these are actual orders from a doctor, but no one can ever find any written orders for every 3 hour vitals and she seems to be the only one who ever receives a "verbal " order for this.
Any thoughts? Does this seem problematic to you or something to let slide?
But the OP has explicitly forbidden staff from deleting orders without her consent….?
Easily sorted, tell this nurse that certainly you will do the vitals BUT... You will then phone them and tell them what they are, regardless of time of day or night. You will soon find out if they are genuine or if she is being a brat. You could also include the doctor in that phone call.
Did this years ago with a junior doctor who wanted neuro obs on a patient 1 hourly but was unwilling to transfer patient to neurosurgery. He was trying to prove that he was the doctor and I was just a lowly nurse who had to do what he wanted. Told him yes I will do that but I will then call you with the results every hour. If you do not reply I will contact your boss and tell him what is going on and if necessary I will contact his boss. That stopped the nonsense.
Lately, there's been a particular nurse who has been entering orders for every 3 hour vitals and lung sounds, including at night when the patients are sleeping.
She states the orders are entered because these patients "need extra monitoring." Granted, she only enters them on patients who have shown a decline in medical status, but several patients have expressed displeasure about being woken up at 3AM for vitals and lung sound assessment. They stated they can't get any sleep being woken up so often and are then too tired to work with therapy.
It is unclear if these are actual orders from a doctor, but no one can ever find any written orders for every 3 hour vitals and she seems to be the only one who ever receives a "verbal " order for this.
Any thoughts? Does this seem problematic to you or something to let slide?
Since when do nurses take medical orders from other nurses? You have no businesses participating in this.
Why not just call the atending for these patient's and ask him/her? Problem solved.
Hppy
I definitely agree that it would be worth checking with the attending... maybe they actually ordered the vitals and assessment, maybe not. If they did, many docs are willing to make some kind of compromise to support patient sleep... and if the patient is really doing so poorly that they won't budge, maybe it would be appropriate for the patient to move to the next level of care?
Also, if we knew what specific conditions were requiring additional monitoring, it might be easier to help provide potential solutions to offer for the whole waking at night issue. For instance - if it were for covid monitoring - you could literally walk in, count the respirations while they slept, stuff a pulse-ox on whatever finger or toe was sticking out and - Viola! - O2 sats, RR, and HR with minimal disturbance (and sometimes no disturbance at all, depending on how hard they sleep). Would be a fair compromise for overnight, as any changes in these vitals would prompt further assessment only when necessary, rather than uncovering patients for a full set of vitals and lung sounds every three hours.
If this nurse said she received a verbal order, she is required to add the order to the chart, documenting which doctor ordered it. Did you tell him/ her this? Consult with YOUR supervisor on this.
Lately, there's been a particular nurse who has been entering orders for every 3 hour vitals and lung sounds,
I don't know how sick these patients are. Q4 I've heard but Q3 is too much. Lots of nurses are obsessed with BP. To wake up a pt q3 seems to create more harm than good. You can always tell when a patient is in distress because when you look at them, you can see they are in distress. Nurses need to learn how to look at patients and see the s/s of distress, and not just look at the numbers or lung sound for that matter.
I don't know how sick these patients are. Q4 I've heard but Q3 is too much. Lots of nurses are obsessed with BP. To wake up a pt q3 seems to create more harm than good. You can always tell when a patient is in distress because when you look at them, you can see they are in distress. Nurses need to learn how to look at patients and see the s/s of distress, and not just look at the numbers or lung sound for that matter.
If said patients need more than q4 vitals they should usually be on a continuous monitor with automatic scheduled bp readings that doesn’t require waking patient up for something so trivial.
Possibly upgrade these patients if it’s that serious (doesn’t sound like it is).
GrumpyRN, NP
1,346 Posts
Easily sorted, tell this nurse that certainly you will do the vitals BUT... You will then phone them and tell them what they are, regardless of time of day or night. You will soon find out if they are genuine or if she is being a brat. You could also include the doctor in that phone call.
Did this years ago with a junior doctor who wanted neuro obs on a patient 1 hourly but was unwilling to transfer patient to neurosurgery. He was trying to prove that he was the doctor and I was just a lowly nurse who had to do what he wanted. Told him yes I will do that but I will then call you with the results every hour. If you do not reply I will contact your boss and tell him what is going on and if necessary I will contact his boss. That stopped the nonsense.