Is everything really the nurses fault?

[jerrylundergard]

I get a new batch of patients yesterday, 6 on a very busy tele/medsurg floor. One of my train wreck total care patients with a trach has sodium of 149. The cardiologist comes in at 0930 and calls me to the nurses desk to get nasty with me about why the patients sodium is 149 and why isnt it being treated by the primary. I tell him I hadnt noticed the lab value yet. I didnt tell him we just got a totally new med system that same day (pyxis with omnicell). We dont always go over labs in report but even if we did it wasnt in critical range (we get calls from lab if its critical and in that case we have to notify corresponding dr). So hes telling me about my incompetence and im thinking to my self, why dont drs take care of labs? Why doesnt this cardiologist just order something to lower the sodium? So anyhow, I make my call to the primary who of course doesnt call back. Im not really too worried about it cause its just 4 points over and several drs came in that day to see the pt. So im thinking all the drs ever do is come in and look at labs and order labs and whatever so I figured it was the way they wanted it. I told the oncoming night nurse of the sodium level and that the cardiologist was ****** at me cause I hadnt noticed it in the morning. Anyhow, today I get a call from the charge nurse cause the cardiologist is really ****** at me cause noone ordered anything. I told the charge nurse everything Im telling you and that was about the end of it. No actions against me that I know of. But my question is, with all these drs seeing the pt is it really my fault they didnt order anything to treat the sodium? Are things like this always are fault? It is annoying!

[MauraRN]

About 98% of our docs barely speak English, most of them I can understand, most of them are nice people. One hung up on me because I asked her to repeat an order, I just can't understand her accent, but lied and said I did not hear her. I was reported for it. I speak English, can get by with some accents, esp Spanish and Russian, but some of the Indian and Asian dialects are beyond me. Must be my fault because I am the Nurse, lol!!!

[RunnerNurse09, BSN, RN]

One thing that one of my nursing instructors from LPN school used to drill in our heads and I will (thankfully) never forget it: CYA= Cover Your A**. Always document. The Dr does sound like a real jerk. A sodium level of 149 is nothing to cry over, but it is abnormal. Some Dr's just like to blame and are ready to blame everyone for everything. Its a learning experience, and remember, CYA!

[firstyearstudent]

Of course it's always the nurse's fault. The joke is if you had called a doctor and notified them of the sodium level and asked if they wanted to give any orders, the doctor probably would have chastised you for calling them and then reported you to the supervisor for calling them unnecessarily.

[RunnerNurse09, BSN, RN]

I love this forum and I learn so much here. I have less than a year experience on a med surge floor and I have always wondered and worried about abnormal lab values. I work the 3 to 11 shift. When I come on duty the hospitalists have until 7 pm to do their rounds with their patients. By the time I get my info and report it is close to 4 pm. By this time most of the patients have been rounded on. If I see an abnormal value I would hope the MD has already reviewed it and taken appropriate action if needed. If it is a low H+H, abnormal Potassium or INR I will usually look in the chart to see if the Dr is aware of values or not. If there isn't anything in the chart I call the MD to make him/her aware of the value. I never have the time to do this but because I know the Docs are human and may miss something I try to make the time.

My question is this. If the MDs do not address the labs when they round and If I am so busy that I cannot double check to make sure said MD seen the lab is it the nurse's fault? Or is it the Doc's ultimate responsibility to look at labs when they round. Of course if there is a critical we let the Md know right away. I ask because some of the nurses I work with have told me they don't look at labs until later in their shifts if at all.

I was told during my preceptorship as a student RN that one of the FIRST things you do is look at labs. I dont understand why one would not look at the labs when some drugs should not be given based on certain lab values(like if the K is low, you arent going to give Lasix, right?) Be careful and cover your bases.

[wooh, BSN, RN]

I was told during my preceptorship as a student RN that one of the FIRST things you do is look at labs. I dont understand why one would not look at the labs when some drugs should not be given based on certain lab values(like if the K is low, you arent going to give Lasix, right?) Be careful and cover your bases.

If you've got 5-10 patients, all of them with labs, only a short time to get report and hit the floor running, you don't always have time to look at all of them. There's what we should do in a perfect world, and there's what we can do in the real world.

[StNeotser, ASN, RN]

See that's the thing though. Do you think the Doctor spends hours documenting things that they notified other people to do just in case some worthless individual comes back to blame them for not doing it?

Furthermore, I know I've spent time documenting things that when it came down to it, were not worth it. Even though I documented patient So and sos behaviors or how many times I had notified an MD of an issue, it was still nursings "fault" The only case where it may have helped were legal cases and even then, reading through some issues on the board here, it seems some prosecutors would indict a ham sandwich.

[Batman25]

You need to document, document, document. If you don't document it the guideline is it didn't happen. Always protect yourself and license.

The cardiologist could have given an order and chose not to do so. The rest of it was just a ******* contest between the doctors. It's immature and uncalled for.

[Ruby Vee, BSN]

i would have been pretty snarky and said something like, "wow, i didn't know your fingers were broken so badly that you couldn't write any orders or dial a phone to call the attending yourself...." really it is his/her issue, and he/she needs to deal with it if it's not acceptable because they are the ones who can write orders, not the nurse......and i probably would have mentioned that to the cardiologist as well......and i would have documented like crazy....i'm not taking responsibility for something i have no control over. i don't care who thinks i should. another reason not to work in the hospital setting.

while you're right, it is the cardiologist's issue and the cardiologist needs to either write the order or leave a note for the attending or whatever, being snarky never helped the situation. now you have a cardiologist who is slightly irritated every time they have to deal with you. humor works better, as does just calmly, straightforwardly explaining your position.

but you're right about the documentation, too.

[erroridiot]

This cardiologist doesn't seem to have any speech deficit and is fully capable of talking to the "primary" about his concerns.

[lovingtheunloved, ASN, RN]

Are things like this always are fault? It is annoying!

Yup. And if the food sucks, the toilet is broken, or the patient is getting a divorce, that's your fault too. :) You'd be amazed the stuff I've gotten yelled at for.

[cherrybreeze, ADN, RN]

See that's the thing though. Do you think the Doctor spends hours documenting things that they notified other people to do just in case some worthless individual comes back to blame them for not doing it?

Furthermore, I know I've spent time documenting things that when it came down to it, were not worth it. Even though I documented patient So and sos behaviors or how many times I had notified an MD of an issue, it was still nursings "fault" The only case where it may have helped were legal cases and even then, reading through some issues on the board here, it seems some prosecutors would indict a ham sandwich.

My take, though, is that I don't give a rip if the docs don't spend hours documenting x,y, or z....my butt is my own to cover, so I'm going to do that! If something ever comes back to them and their lack of documentation, that's their problem, not mine. Their choice not to document it, my choice TO document it.

I've spent plenty of time, too, documenting things that may "not have been worth it" in the long run. Problem is, you don't know it at the time, and if you end up taking on this mentality and being careless, there WILL come a time where you'd give anything to go back and document something you thought at the time "wasn't worth it." Legal cases are the whole POINT, not sure why you're saying that's the "only" case...that's a darn BIG case. Good documentation could VERY well save you someday, just because a prosecutor can indict a ham sandwich doesn't mean he can get a conviction against said sandwich. If you don't document something, it literally becomes a "he said, she said" situation, and chances are, if it's a patient, they're the ones that are going to be believed (a juror is going to be able to relate to being a patient much more than to being a healthcare worker). Your documentation often is the only proof you have of doing (or NOT doing) something...I'll gladly spend time to do it properly.