NO, NO, NO!!

[PintheD]

Different day, different crap.

Today I was screamed at by a patient for mentioning one of his admitting dx; syncope, GI bleed, acute renal failure. No one had mentioned the ARF, he assumed I had the wrong patient info. I didn't. Proceeded to explain that ARF is a common result of dehydration, a byproduct of his GI bleed. Said I would review chart for plan of care and clarify ARF dx. Patient (hysterically) not receptive to communication so I offered to contact MD to clarify. Exit.

Paged admitting doc x2 in a half hour - no call back in an hour. Got house MD who graciously came to talk with patient. He claimed patient requested nurses to come in and say "hi" and leave the "medicine speak" to the MD... Prior to the house MD being involved I paged the nursing sup to talk with upset patient, as I couldn't get an MD to call back (I've learned the hard way crap can be kicked up too). After doing so, her sage advice: page the doctor....

This is where it's gets good. Attending shows up late morning and wants to know why the patient, and 5 of his family members at the bedside, are under the impression that the patient has a diagnosis of ARF. Explain exchange with patient, show MD ER note enumerating ARF as part of DX and recite supporting lab values. (BTW he did return the page, as confirmed with his iphone, one hour later. No clerk to answer his call. I was blamed for that too.)

His response: "YOU need to fix THIS"!!!

REALLY? (THIS being the component of DX on record reflecting ARF.)

When will it end? Now the nurse is responsible for the diagnosis too (FWIW admitting lab values did support ARF)? No, No, No!

Never been one to doctor bash as I have the utmost respect for anyone who puts themselves through that process, regardless of the motivation. Now I'm changing my tune.

NO - can't change a diagnosis.

NO- won't support the fact that you, MD, didn't explain adequately to your A&Ox3 patient what was happening to him physiologically.

NO - don't subscribe to the harassment mentality predicated on nurses today.

Learned my lesson. Keep a smile on my face, speak when spoken to, it's a task oriented job, play dumb.

Got it. Take heed new nurses.

[beckster_01, BSN, RN]

That is why I generally refrain from mentioning anything but the PRIMARY diagnosis with the patient, unless they bring it up to me first and/or my care is being directly changed by the diagnosis. I am not responsible to explain a new diagnosis, and I have no idea if the doctors have done so. Your patient was admitted for a GIB, which was probably found during a work-up for syncope. With our electronic charting system a person who is here for a AAA could have 10 "admitting" diagnoses that relate to their disease, but unless it directly affects my care I don't usually talk about it. For example, if I were hanging bicarb on a patient with ARF, then I would probably assess what kind of education they have received and go from there. Not saying that I love having to watch my step like that, but what else am I to do?

[DixieRedHead, ASN, RN]

[quote=PintheD

Learned my lesson. Keep a smile on my face, speak when spoken to, it's a task oriented job, play dumb.

Got it. Take heed new nurses.

Finally got it, huh?

[NurseCard, ADN]

It makes it awfully hard to do patient teaching, when the doctor hasn't discussed diagnoses with the patient, doesn't it?

I mean, for this very reason I've always been careful when directly discussing actual diagnoses with the patient; chances are the doctor hasn't discussed it with them yet! But again, that makes it difficult to do any teaching. I suppose that in this situation, the patient, hopefully at LEAST knowing that they have a GI bleed, could have been instructed on ways to keep hydrated, and taught that the IV fluids that they are receiving are to prevent further complications d/t dehydration.

But, how are you supposed to KNOW when the doctor hasn't told the patient what is going on?

Also, what in the world did the MD expect you to "fix"?

[rntj]

This is why I use acronyms as much as possible during bedside report, and don't mention anything the patient is not aware of (like, ruling out for a certain cancer, or whatever) that the doctor needs to speak to the pt about. Probably using acronyms would not have worked in your case. Sounds like you did the right thing, it's not your fault the dr didn't describe what was going on to the patient. I wonder if the geniuses who came up with bedside report ever considered how freaked out some pt's could be by it, like the one you describe. Just another stupid idea of mgmt, in my opinion.

[tokmom, BSN, RN]

I never assume the pt knows the complete picture until I hear the Doc say otherwise in interdisciplinary rounds. That's my worst fear..to drop the bomb on a pt before the dr does.

Your md sounds like a true ass.

[tokmom, BSN, RN]

This is why I use acronyms as much as possible during bedside report, and don't mention anything the patient is not aware of (like, ruling out for a certain cancer, or whatever) that the doctor needs to speak to the pt about. Probably using acronyms would not have worked in your case. Sounds like you did the right thing, it's not your fault the dr didn't describe what was going on to the patient. I wonder if the geniuses who came up with bedside report ever considered how freaked out some pt's could be by it, like the one you describe. Just another stupid idea of mgmt, in my opinion.

Really? I like beside report. If there is something to be said that a pt is unaware of, we mention it outside the door, and focus on the plan of care at bedside.

Example: We had a pt that was diagnosed with re-occurance of CA. It was something she wasn't quite accepting. That piece of was given out of the room. We then went in and talked about the IV, foley, diet, and activity, etc..

[PintheD]

Yes, Beckster, I agree. However in this specific clinical environment there is no face to face report. I'm dependent on the written word. Now in a perfect world I would have read all the ecare (CERNER) notes and would have a clear picture. Not so here. I learned years ago A&Ox3 people want to see and speak to a nurse at change of shift. I try to get a few minutes of face time right away to negate those feelings. In hindsight, I agree if the admitting dx does not affect plan of care to skip it. Yes, lesson learned. As an ICU nurse that was a given. My current job doesn't permit such initial perspective. It didn't help, in an environment that is already time constricted, that I was called late cover this shift.

Dixieredhead - Took a long time. The less one expects of themselves in a dysfunctional environment the more one can achieve the tasks at hand. Sorry state of affairs but being task oriented is the only way to survive.

Yes, I said it nursing purists, in a med/surg, tele environment the task is king (or queen), not the patient. Let's accept that this is a job and not a calling. That was predicated by religious that historically nursed. Let's all move on. The healthcare systems we work for have and are banking on the fact that we've not figured it out.

[Guttercat, ASN, RN]

After a quick read this sounds like

a.) a fear-based reaction by the patient and,

b.) a not too unusual, doctor-specific case of, "I-don't-want-to-deal-with-this."

It's OK to keep a smile on your face, but please don't "play dumb."

[aboucherrn]

He claimed patient requested nurses to come in and say "hi" and leave the "medicine speak" to the MD....

Ha ha ha, I love it. Just think of how this will revolutionize nursing. No more educating patients, discussing medications and side effects, or doing any patient care. We just have to go in and say "hi". I think I could handle that... might even pick up some overtime shifts.

[PintheD]

Guttercat - I think there is a lot of power in playing dumb. Think about it. You still do your job to the best of your abilities and move on. Unless management wants to blame you for the rain or a snow storm, no harm - no fowl. Thats what I'm looking for.

350 pound diabetic looking for pie? OK. Don't care because if I try and "teach you" you will be offended and I will be screwed. I'm ok with that. Again, task oriented. If I can complete my tasks as dictated by my computer oriented list then I have successfully completed my shift. It's the dumbing down of nursing. I'm good with that but don't make me accountable when the crap hits the fan because it's convenient and you can.

[SuesquatchRN, BSN, RN]

I lasted five weeks as a hospital nurse. I need autonomy, the ability to use my brain without being hamstrung, and fewer than a buttload of crazy families to deal with at one time.