Why do I have to call lab to remind them of timed blood draws being drawn, well, on time?
Why do I have to call dietary to make sure the ordered supplements are on the tray?
Why do I have to call pharmacy to refill the Pyxis?
Why do I have to call supply to tell them that they smooshed two types of IVF together in the supply Pyxis and they need to sort it out?
A STAT imaging call to radiology is our job, but why do I have to follow up 30 minutes later?
Even if I'm busy, I have to check orders every 30 minutes because STAT orders are put in without a courtesy call to the nurse!
I wish, as an orientation exercise, every department of the healthcare team was required to shadow a nurse for a day. I think many eyes would be opened.
The nurse is trained to provide professional oversight for the patient relative to medical orders, nutrition, labs, tests, therapies, etc. If the ordered treatments, meds, tests, etc are not completed it is the responsibility of the RN, who is managing that care during the shift and coordinating it with the other professional staff across the spectrum.
We are the only discipline trained for exactly this responsibility.
My "training" consisted of, "you have to call so-and-so department because they sometimes don't do their jobs." You know as well as I, that it isn't coordinating and prioritizing on the basis of patient need--a situation which would indeed require a nurse as part of the team--it's just giving others a swift kick in the pants, so to speak. However, I do appreciate the ideal, textbook definition.
Also there is a difference between the term "accountable" and "responsible." Unfortunately, I'm not only responsible, but also held accountable (when I'm clearly not supposed to be) and that is where it all becomes ridiculous.
The nurse is trained to provide professional oversight for the patient relative to medical orders, nutrition, labs, tests, therapies, etc. If the ordered treatments, meds, tests, etc are not completed it is the responsibility of the RN, who is managing that care during the shift and coordinating it with the other professional staff across the spectrum.
We are the only discipline trained for exactly this responsibility.
I don't think we should have to chase the other departments to do their jobs though. Also, why are radiology, MRI, CT Dept, phlebotomy, etc. calling me to see if they really have to do the tests or can they wait till tomorrow. I tell them that I was not the one who wrote the order and promptly give them the MDS pager and let them call. Phlebotomy usually doesn't do this but they have on occasion asked if the patient really needs the lab drawn because they are a hard stick. I wish I could pass the buck like these other departments. Half of the time it is because they don't want to stay late. I can not leave until my job is complete and it does not matter that I have not had a dinner break and that I am going to hear about the overtime tomorrow. This is another pet peeve of mine. Why are you asking me about these tests? I am not the Dr.
My "training" consisted of, "you have to call so-and-so department because they sometimes don't do their jobs." You know as well as I, that it isn't coordinating and prioritizing on the basis of patient need--a situation which would indeed require a nurse as part of the team--it's just giving others a swift kick in the pants, so to speak. However, I do appreciate the ideal, textbook definition.
Also there is a difference between the term "accountable" and "responsible." Unfortunately, I'm not only responsible, but also held accountable (when I'm clearly not supposed to be) and that is where it all becomes ridiculous.
Exactly! Why do we have to babysit the other departments? I have way too much to do as it is.
Forgive me, anothergrumpyoldRN. Your post got under my skin, but please know it's not directed to you personally. The situation you describe does happen a lot, however, it does not extend to babysitting the work of other departments. Knowing when PT/OT is coming so that I can properly medicate my patient for pain? That's what you are describing. Knowing that I can delay a routine CXR for an hour or so that has been ordered to monitor the improvement of b/l infiltrates when my patient is not feeling well then medicating to help her? Versus explaining that it is needed when its because of worsening SOB and accompanying her to radiology myself, rather than waiting on transport? That requires training and coordination of care under the definition you gave. What I am talking about is NOT what you are describing. Somehow, I think you know that.
Also, why are radiology, MRI, CT Dept, phlebotomy, etc. calling me to see if they really have to do the tests or can they wait till tomorrow. I tell them that I was not the one who wrote the order and promptly give them the MDS pager and let them call.
That's a pet peeve of mine, too. There are situations when it needs to be delayed or hurried based on the patient situation, but I usually call first in those situations. THAT is coordination of care. If they want to go against MD orders due to their own scheduling issues, CALL THE MD YOURSELF! I am not going to give the ok to go against an MD order just because of your department's scheduling issues, and I DO NOT need to be the middle man because of it. It's a waste of my time; it's a waste of THEIR time!
LOL!!! This thread is hysterical! I am crying I am laughing so hard. All of this is so true.
Real conversation I had with my manager (I guess you could say that I am not mean, per se, but I have zero tolerance for crap)
My Charge: (coming up to me while giving STAT meds in ANOTHER patient's room) "Hey did you call lab and see why that haven't come up for that stat PTT on 243 and where they are and why this wasn't a priority?"
Me: (while feeding (Dr. wouldn't change order to IV!) stat k+ to a 98 year old woman whose K+ was 3.0 in pudding and who I have to make sure doesn't aspirate) "No. Did you?" (Goes back to feeding patient)
Charge Nurse: Blank stare.
This is what I mean. Would it have KILLED her to call them and say "Do this draw ASAP, please". Really? She literally had nothing to say because there WAS nothing to say.
And that, my friends, is 80% of the problem of hospital nursing. I am sure the lab was busy....they always are, but it is not my job to call and threaten their lives on a nightly basis.
LOL!!! This thread is hysterical! I am crying I am laughing so hard. All of this is so true.
Real conversation I had with my manager (I guess you could say that I am not mean, per se, but I have zero tolerance for crap)
My Charge: (coming up to me while giving STAT meds in ANOTHER patient's room) "Hey did you call lab and see why that haven't come up for that stat PTT on 243 and where they are and why this wasn't a priority?"
Me: (while feeding (Dr. wouldn't change order to IV!) stat k+ to a 98 year old woman whose K+ was 3.0 in pudding and who I have to make sure doesn't aspirate) "No. Did you?" (Goes back to feeding patient)
Charge Nurse: Blank stare.
This is what I mean. Would it have KILLED her to call them and say "Do this draw ASAP, please". Really? She literally had nothing to say because there WAS nothing to say.
And that, my friends, is 80% of the problem of hospital nursing. I am sure the lab was busy....they always are, but it is not my job to call and threaten their lives on a nightly basis.
Or how about when you've drawn the labs yourself and sent them stat to the lab and the results still aren't back an hour later... so you call them and say "where are my stat labs?" And on the other end you get "we haven't processed them yet, did you really need them stat?" It's ordered stat and labeled stat, so why do I have to call and tell them a THIRD time that it's stat?
Same thing with pharmacy... MD orders a med "stat", you fill out the online med request form and, again, say "stat", call the pharmacy 45 minutes later wondering why your stat med (which per their own policy is supposed to arrive within 15 minutes) isn't there yet and they haven't even started preparing the med. An hour later a courier comes strolling casually up to the floor with this medication you needed 2 hours ago. And then the doctor and/or your manager want to know why you gave this stat med 2 hours late... Ugh, I so do NOT miss hospital nursing.
If nurses accept responsibility for the actions of others, they have only themselves to blame. It is not the responsibility of the nurse to insure that PT, or lab, or whomever to do their jobs...it is the nurse's job to insure that they are aware of the orders and any time frame or other issues that must be considered.
It is our job to coordinate the care of the patients within the acute care setting, advocating for their return to health.
Or you can just perform medical tasks...it is up to you.
GrumpyRN, I agree. I was always scoffed at on my floor for "backtalk" to the doctors, when all I did was tell them they need to blame the correct people for certain problems. Dr. So and So would be "Why the hell is the amiodarone not up here yet?" And I would say, "Why don't you see in the notes that I have asked pharmacy for it 6 times, gone down there for it twice and then go ask them where it is?". I am sorry, this is not insubordination, this is truth. Only one time has one doctor, a pulmonologist, gone "Oh, look at that, you're right, I am gonna have to talk to that damn pharmacy". The rest looked at me as if I was supposed to make the drug appear out of nowhere.
I take no responsibility for any other person in the hospital but me. I use to document myself up and down and make sure my job was done because I was certain that the first person to be thrown under the bus in a trainwreck of a patient would be the nurse. You can count on it. The housekeeping staff had more advocacy in that hospital than the nurses did.
That's a pet peeve of mine, too. There are situations when it needs to be delayed or hurried based on the patient situation, but I usually call first in those situations. THAT is coordination of care. If they want to go against MD orders due to their own scheduling issues, CALL THE MD YOURSELF! I am not going to give the ok to go against an MD order just because of your department's scheduling issues, and I DO NOT need to be the middle man because of it. It's a waste of my time; it's a waste of THEIR time!
Kelrn- That just happened to me last evening with a stat Cardizem drip. Has also happened with labs. The MDs come and ask us. Ask the pharmacy or the lab themselves. Nurses are always the middle man or woman. CAN NOT WAIT to get away from the bedside. I will definitely miss the hands on care of the patient but the BS you have to put up with is not worth it. Oh wait a minute- how much time do we actually get to spend with our patients any way? All of other "responsibilities" eats into that precious but limited time with our patients.
If nurses accept responsibility for the actions of others, they have only themselves to blame. It is not the responsibility of the nurse to insure that PT, or lab, or whomever to do their jobs...it is the nurse's job to insure that they are aware of the orders and any time frame or other issues that must be considered.
It is our job to coordinate the care of the patients within the acute care setting, advocating for their return to health.
Or you can just perform medical tasks...it is up to you.
I understand what you are saying but the nurses are the ones that are questioned about why these tasks are not done. Some of these stat orders as we all know are critical and need to be done within a certain time frame. As nurses we care about our patients well being so we have to get after the other departments to pull their own weight and to perform their duties. As nurses we are expected to respond to emergencies and stat orders and to drop every thing else. The other departments should be held to the same standards and I don't need to be wasting my time calling them 3 and 4 times when I have very sick patients that need my attention. We can coordinate all we want but the other departments need to step to it in stat situations.
dudette10, MSN, RN
3,530 Posts
My "training" consisted of, "you have to call so-and-so department because they sometimes don't do their jobs." You know as well as I, that it isn't coordinating and prioritizing on the basis of patient need--a situation which would indeed require a nurse as part of the team--it's just giving others a swift kick in the pants, so to speak. However, I do appreciate the ideal, textbook definition.
Also there is a difference between the term "accountable" and "responsible." Unfortunately, I'm not only responsible, but also held accountable (when I'm clearly not supposed to be) and that is where it all becomes ridiculous.