Frustrating night with docs : /

Last nite stunk. One of my patients had a HgB

I had another pt. newly on tube feed that just was not tolerating it well at all (bolus feedings) tube placement was correct, but he was just not digesting it well according to his DR, and he vomitted up a large amt of it. He is on aspiration precautions already : ( So i notifed the PCP, who basically said call GI, who changes his bolus feedings to very low continuous. His lungs are sound clear, sats are good, residuals are low, so middle of the night we start TF as continuous per orders. This morning he had another vomitting episode, nearly of everything we given : ( Luckily I was in the room at the time, he desatted on us/needed suctioned and there was definate fluid in the lungs this time. So i called GI again, who puts the TF on hold. I have to bug her and bug her to order a PCXR for the possible aspiration : / She talks about ordering a ABD xray, but doesnt want to in the end. Call primary who wants to order, the xray, but doesn't want to step on the other doctor's toes. Talk more with primary, who eventually decides to order it. Make up your mind people!! I am wasting precious minutes of my life and time I could be spending on pt. care playing the phone game .

Ahh. I feel better after a vent. Luckily, of my other pts, I only had 1 mental\refusing meds/tx pt acting beligerant who decided to walk into another pts room in the middle of the night to argue with him, lady with a pulled out IV that 'didn't know what happened to it' , another LOL with no IV access that needed scheduled IV meds (thanks days) who of course has no veins (House Sup got it in on her, bless her heart) and multiple PICCS and Ports that I had to do line draws/flushes for all night. All in all it was busy, but I don't feel I did a poor job handling it as a new grad. Or at least I am telling myself that for comfort Makes me appreciate more those that want an ambien and there door shut for the night lol.

Back again tonight for more fun. Thankfully it is my last day for the week.

You're making me miss acute care! That pretty much sounds like a typical evening on my floor (neuro/trauma). I've just started homecare this week. I don't think it will be as stressful, but I hope I don't lose all those skills I learned on the floor. Great job by the way!

It sounds to me like you did a great job!! I had a night last week that I had a LOL who had her Ambien d/c'd because dayshift thought she was acting slightly confused. When I told the pt this at 10pm when she asked for her nightly dose (10mg) of Ambien, she started yelling at me. I told her calmly that I would call the Dr and see what he said. He gave me an order for Benadryl 25mg IV for sleep. Well, she refused that and wanted me to call the Dr who rounded on her that day. I tried to explain that he wasn't on call but she just kept getting more upset. I called the Dr. back and explained the situation and he was disgusted with everything. He asked me if the pt was aware that it was d/c'd becasue of confusion? I said that I told the pt and she yelled at me," Ann, do I look confused to you?" I said, No." He gave me the order for it and she was fine, not confused the next morning at all. The dr wasn't very happy with me either. Oh Well.

Do you know what? When I told the pt that I got the order for the Ambien she told me that I was thinking about what a difficult pt she was and how much she needed the Ambien. I told her that I didn't say she was a difficult pt but she said that she knew what I was thinking! That night I couldn't win!

A few months ago I really was a little fearful of calling Dr's but now I don't think twice about it. It's their job!

You were a good advocate for your patients.

Ann

Girl be proud of yourself you handled that situation trust me there are many more of those days to come. Why dont these doctors realize we dont have time to play with them, its not our job to confirm whos on staff, and whats the big deal with ordering the xray. sometimes they make situations so difficult.