Just a Little Venting

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Specializes in Oncology, Critical Care.

Hello all!

I just want to vent for a minute. My hospital has a policy that new critical lab values have to be reported within 90 minutes. I work night shift, 7p-7a and have gotten cussed at (by one doctor) and ripped a new one by a few others for following this protocol. 
 

I work in a busy CVICU and always try and wait to see if anyone else needs the critical care doc before paging, but sometimes I just have to bite the bullet and page. The biggest lab value that seems to prompt this is always the critical procalcitonin. The patient is septic and we know that? Of course! They’re on antibiotics? They are! But for some reason the docs keep putting in the FIRST procalcitonin as an EAM lab draw!
 

If I don’t call, I’m in violation. If I do call, I’m on the *** list. There’s no winning.  If I didn’t have to call, I most definitely wouldn’t. 
 

This is an issue within all of the critical care units of my hospital, and if the docs have a problem with it I wish they’d take it up with administration who is writing the policy and not take it out on those of us who have to make the unsavory call in the first place. 
 

The other sore topic is the generic order to call for urine output of less than 30 mL/hr for two consecutive hours. Dayshift will go all day with borderline urines and not address the issues, and it’s understandable because the doctors are right there and not being woken up. Night shift then roles around and my outputs are 30, 25, 15, 10. I always try to fix the issue myself (flush the foley, bladder scan, flow track, check the creatinine and BUN, PRN albumin) but I call and get berated because “this has been happening all day and it couldn’t be addressed earlier?” For CV patients this is something we HAVE to call about. It’s all just so frustrating. I wish I could tell the docs that I don’t want to call them any more than they want to hear from me. 

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Specializes in Mental health, substance abuse, geriatrics, PCU.

I have no sympathy for them, at all. 

When I was a brand new nurse our policy was all critical labs called within 30mins even if the value is expected, I called a critical creatinine on a dialysis patient and got reamed by the patient's doctor. I listened to him call me stupid and moronic for a minute then I explained our policy (which he already knew) and told him that he felt the policy needed to be changed he needed to talk to someone a little higher up on the food chain than a nightshift baylor nurse about his "concerns". He apologized and I never had an issue with him after. However, I have had to have that exact same conversation with physicians several times over the years though I don't tend to be as empathetic and listen to their degrading remarks as I used to.

As far as following parameters that are ORDERED, I always reflect to the provider that if they don't want to be bothered they should discontinue the order and talk with their dayshift counterparts about the problem. 

These divas are being paid to address these issues just like I'm being paid to present them, if they don't want to be called don't go into a specialty that requires it!

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Specializes in ER, Trauma, MICU.

UGH. I was just thinking about this last night. I had to call for something dumb, but ordered and I started with, "Sorry I had to bother you so late".... WHY? Why am I sorry? they placed the order, its their job to respond. Why has it come to this? I completely understand your frustration.... wish I could change it. Good luck with getting someone  in admin to hear you.

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Specializes in New Critical care NP, Critical care, Med-surg, LTC.

I totally understand your frustration! I always hated waking the docs, too, but then I remembered that they get PAID to do their job while I'm doing mine. None of us really want to be awake at 3am, but it's a 24 hour job and that's how it goes. I admit that in my unit we have gotten pretty lax about the critical value notifications, especially if it's something trending down we don't always call.

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Specializes in Med-Surg.

We have the same rule, but if it's something that's expected we don't need to call.  For example if a patient has thrombocytopenia has had platelets of 20 every day then a another 20 doesn't warrant a call, as it's expected.  It would seem in a known and documented septic patient this would apply as well.  

I worked night shift for a while and while it is their job to take call, it also should be worth waking them up for.

 

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I'd opt for following protocol. Then you can't go wrong. The docs know what the protocol is and they expect to be called.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

I like Tweety's answer. If these critical labs are the trend for the patient, there should be leeway.

Sounds like where you are, there is not. So I have had to call Dr's at night and told them I am not calling for my health or entertainment but following policy. If they don't like it, get their more agreeable partners to do it or talk to my manager.

That  usually took care of the problem.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

PS do NOT say your are sorry.

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Specializes in Fall prevention.

I always shut them down by saying “ I understand your are upset and if am I understanding you correctly you are giving me a verbal order to not call you the critical lab value?” To which they very quickly changed their tune or in a few cases I did have a few give an order listing different parameters.  

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Specializes in Oncology, Critical Care.

I’m glad to see we’re not the only hospital that deals with this LOL. We don’t call for things expected, such as a STEMI patient with a high troponin, since they were admitted with the critical values. The issue with the procalcitonin example is since it’s the FIRST time it has appeared as critical, we have to call. Any others after that we can document that the md is aware. 

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Specializes in retired LTC.
1 hour ago, SmilingBluEyes said:

PS do NOT say your are sorry.

I DO feel sorry for them for being on the receiving end of a stoooopid policy - just like I am!

Stoooopid protocols have to be changed from the top down. Find a sympathetic practitioner who'll will take up your cause. It does work.

But it's the only way to get ting changed uniformly.

Only other thing I can think of is to have parameters specifically written whe when to call. But I think that might make for MORE work.

 

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Specializes in Mental health, substance abuse, geriatrics, PCU.
4 hours ago, amoLucia said:

I DO feel sorry for them for being on the receiving end of a stoooopid policy - just like I am!

Stoooopid protocols have to be changed from the top down. Find a sympathetic practitioner who'll will take up your cause. It does work.

But it's the only way to get ting changed uniformly.

Only other thing I can think of is to have parameters specifically written whe when to call. But I think that might make for MORE work.

 

What!? You actually feel bad for them, amo you have more compassion than I do, I thought I was too young to be a COB ?

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