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.
The last time I worked in a hospital, I was cussed at 2am by an ortho. His patient was having major issues. The incision (knee) had ruptured with green pus running everywhere- obviously infected, pt screaming in pain- Tylenol was only pain med order, which had been working. Patient was to have d/c'd home the next afternoon.
I had taken over the patient at MN, and at 2a, this happens. Call the ortho. He starts cussing-I learned how poetically some of these words could be strung together. About 10 seconds into the tirade, "Dr X, while I'm impressed with your use of the English language, patient A has this going on", and began to discuss the issues. Silence. Dead silence for 30 seconds, but since no dial tone, I knew he hadn't hung up...I said "Dr X, are you there..." Dr X: "yes, begin" and gave a full set of orders. Dr X came the next day to round, stopped and made small talk, as well as discuss patients. Was always professional after. All the other nurses were scared of him, he made them cry. Still does from what I understand
I love ya Moon, but I think you are showing a bit of class envy here.
I think of doctors as colleagues. They are fellow widgets. They have families, personal problems, sick dogs.
They deserve just as much respect as a patient, another nurse, or anyone else.
I view them as my colleagues as well and actually do have tremendous respect for their education, knowledge, and role in healthcare. I do not however feel sorry for anyone being called when they are "on call" the hospital does not close down at 5pm and they are not providing call coverage out of the kindness of their hearts, they are being compensated to provide the service.
That being said, if I have multiple issues throughout the night, of course I feel empathy towards them for being called so many times, but that's just how it goes sometimes.
We used to work under the same policy and I told a couple of the hospitalist docs to please call and complain about it if they were tired of the ridiculous calls. The policy was rescinded with the week.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
On 2/9/2021 at 5:54 PM, 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.
When you say you are sorry you set yourself up to be abused.
Be matter of fact. Call the Dr. give name of patient lab value and trend. Ask for any new orders. "Thank you Dr", hang up. No drama, no muss no fuss. I don't feel sorry for them at all. We are ALL at the mercy of stupid policies.
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.
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.
But the MD is not aware of the most current value. And if your policy requires notification of a current value, you could be in trouble for not following policy.
The most sensible way to deal with this stupid mess is to get the docs to c/o to TPTB. Policy will change PDQ.
Hoosier_RN, MSN
3,968 Posts
The last time I worked in a hospital, I was cussed at 2am by an ortho. His patient was having major issues. The incision (knee) had ruptured with green pus running everywhere- obviously infected, pt screaming in pain- Tylenol was only pain med order, which had been working. Patient was to have d/c'd home the next afternoon.
I had taken over the patient at MN, and at 2a, this happens. Call the ortho. He starts cussing-I learned how poetically some of these words could be strung together. About 10 seconds into the tirade, "Dr X, while I'm impressed with your use of the English language, patient A has this going on", and began to discuss the issues. Silence. Dead silence for 30 seconds, but since no dial tone, I knew he hadn't hung up...I said "Dr X, are you there..." Dr X: "yes, begin" and gave a full set of orders. Dr X came the next day to round, stopped and made small talk, as well as discuss patients. Was always professional after. All the other nurses were scared of him, he made them cry. Still does from what I understand