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.
While I agree that the physicians involved in this episode didn't communicate clearly, and the patient appears to have had the tendency to be difficult no matter what the circumstances ... most inpatients have 3-8 "diagnoses" that will likely resolve by treating the primary reason for admission and don't really need to be discussed as a separate course of treatment. It would be a rare scenario where I could see myself rattling off a list of 8 things to a patient or family member. I help them to understand and focus on the most pressing issues to the best of their ability and leave it at that.
See, I find this to be easy, until I'm giving meds to an alert and oriented person and they want to know what every med does. And then: "Why do I need this med?" which always seems to be a med that is being taken to treat something that is secondary to their primary diagnosis. Cue the Big Dumb Smile and "I don't know! Let me call the doctor and have him come in to talk to you" because I have no clue what the patient knows. Makes me look dumb but I'd rather look like a Neanderthal than open up that can of worms.
Along those lines, I took care of a very nice guy who was under a 24 obs/work-up for a suspected TIA. He gets all his tests done. Is expecting to leave that day. I get the call that his chest x-ray had abnormalities in it so they need to re-shoot. The pt had a history of stomach cancer so we're all thinking the worst. But no doc comes by. Pt is like "am I leaving today? What's going on?" Nursing is giving these vague answers as to why he suddenly needs more tests and will probably be staying another night. I'm calling the primary team but getting the run-around. Nobody comes up to explain what is going on. The abnormalities in his chest ended up being calcified something or anothers, at least according to the radiology report. Nobody from medical staff EVER bothered to follow-up with the guy about that stuff. Lack of a willingness to communicate like that just drives me nuts.
See, I find this to be easy, until I'm giving meds to an alert and oriented person and they want to know what every med does. And then: "Why do I need this med?" which always seems to be a med that is being taken to treat something that is secondary to their primary diagnosis. Cue the Big Dumb Smile and "I don't know! Let me call the doctor and have him come in to talk to you" because I have no clue what the patient knows. Makes me look dumb but I'd rather look like a Neanderthal than open up that can of worms.. . . . . . . .
Lack of a willingness to communicate like that just drives me nuts.
Very good points.
This happens all the time with alert and oriented patients (and even confused ones) and my heart just drops when you educate the patient and they are surprised by what the med is for because the doc forgot to mention that.
There are two things that would help. They both are happening to a certain extent.
One is more collaboration between nurses and doctors - starting in nursing school and medical school. Some programs do incorporate this but I don't have a link right now to the one ones I've read about. (I'll look and try to link it later).
The second is public education about what nurses do.
I know the Johnson and Johnson commercials can be controversial.
Should we start a thread about how you all think this issue can be solved?
Or maybe just use this thread? Any ideas?
This is near to my heart because recently I had a non-nurse colleague ask about my hospice patient being started on the "dreaded" morphine. He said it was his impression that when hospice did this, it was like euthanasia. We had a nice chat in the hallway while I did some education. He thanked me.
There are a lot of misconceptions about nursing out there.
Specializes in Leadership, Psych, HomeCare, Amb. Care.
His response: "YOU need to fix THIS"!!!
"Yes Doctor, and exactly what would you like to be done?" Put it back on him.
Renal & Cardiac Failure can be terrifying terms. Even the uneducated know that Heart & kidneys are important body parts & if they are failing, they'll think broken...and about to die
I often let them know that those organs are working, just not as well as they should. Sometimes I use the old car analogy. Not running as efficiently as it did 100,000 miles ago, but still getting the job done.
Many, Many years ago we were not even supposed to tell patients what their B/P was and "Because the doctor ordered it" the common tag line. We moved passed that and began educating our patients to empower themselves to take charge of their healthcare. Sadly, for reasons unbeknownst to me, we are reverting back to the "your doctor said so" baloney is making a come back. I made a joke once that the MD was going to retailiate for makinf them look bad when nurses became empowered, practiced next to the MD, and delivered better care......
Esme this is exactly what came to my mind as I was going back through this thread.
It's a very, very odd phenomenon.
Our hospital not long ago redesigned itself; built its new facility based upon the "decentralized nursing model."
Meaning, no nurse's station. No place where RN's get together with their peers to collaborate; no neutral gathering place where all the various team members filter in and out, share knowledge and bounce ideas off of eachother.
The docs now have their own separate "professional center" next to what is now called the "business center" and one can sense the growing "doctor territorialism" in there.
Now granted if I was a doc, given the fact I prefer a quiet working environment to think and stay on task, I might like this model. But...communication and professional commaraderie is in a freefall.
The idea behind decentralized care as its purported, is to keep the caregiver closer to the bedside. That's all well and good at face value, but with all the new gidgets, widgets, gadgets, cell phones (the staff has to find eachother via phone) and computerized...well, everything...I see the caregivers with their noses buried in the computer, the phone (which alarms non-stop), the med scanners, and otherwise spending most of their day checking off predetermined tasks and fending off assorted beeps and technical difficulties.
This "idea" is proving little more than divide and conquer tactics.
Somewhere in the midst of this controlled chaos, is an actual patient.
My background is ICU where the nurse must have a clear clinical picture of his/her patients in order to do their job safely and effectively. Not so in this environment. Time does not allow and no one expects the nurse to think critically. The expectation begins and ends with completion of tasks - expectation of management, MD's, and based on my experience yesterday, I'm lumping patient's in there too. I have not arrived at this mindset out of apathy. It's survival. Does that make
sense?
Why floor nursing often sucks today for those of us that derive satisfaction from clinical skill and knowledge with a dash of (earned) freedom thrown in.
It's why I specialized.
That said, thank the good lord there are professional RN's out there that thrive very well under task-oriented modalities.
i hate it that this thread may engender fear in new grads. i always remember what the estimable bill belichek, coach of the soon-to-be-once-again super bowl champion new england patriots, said when he was accused of running up the score in a runaway game. if the other team can't play, it went, am i supposed to stop playing?
just because one physician you read about on an, or several, was an ******* and didn't take the time to learn about and understand the professional role and responsibilities of the most important colleagues he has doesn't mean that you have to dial back your game. i predict that this nurse will prevail with the bon supporting her, since she has acted completely within the scope and standards of practice of the american nurses association. if you don't have a copy, get one online. or pm me and i can send you a pdf.
In addition to this I will add; I am a bright, educated human being. I will not be abused by people or systems. Nursing is not rocket science. I am over qualified for this job.
Yup. I think lots of us are and I think that's why there is so much turnover at the 2-5 year mark for nurses. Its a task oriented job. It really is. I work in the ER though and its still "task is king" and "I want a blanket/snack/lunch/vicodin."
Ugh.
And whatever to the idea that critical care means critical thinking. Its just means you hang yourself out there a little further and if the patient is dying and the MD will do nothing, you get to watch. Get some popcorn!!
Good luck to you PintheD. Hopefully you have investigated your options. Getting a break should be on the list. I take all of my vacation time, never get cash out for it and make sure I do something not at all like my job.
Nursing can be a wonderful and beautiful experience.
But sadly in can also be devastatingly stressful and at times unbearable.
I wish you luck in whatever career choice you may. I hope you'll keep your license current. You never know when you might catch the bug again and want to take another stab at nursing.
Specializes in Trauma, ER, ICU, CCU, PACU, GI, Cardiology, OR.
Not to add more fuel to the fire, however, when you tell a pt. at their bedside your doctor ordered your Coumadin which is the blood thinner since you had a heart valve replacement, and the pt., states " I HAD a HEART VALVE REPLACEMENT?" and then you say Mr. So and So, is the same medication you have been taking for the past month. and then they say "Oh the Pink pill, you should have said the little pink one" that's when I smile and say you're absolutely right
He thanked me. 
dirtyhippiegirl, BSN, RN
1,571 Posts
See, I find this to be easy, until I'm giving meds to an alert and oriented person and they want to know what every med does. And then: "Why do I need this med?" which always seems to be a med that is being taken to treat something that is secondary to their primary diagnosis. Cue the Big Dumb Smile and "I don't know! Let me call the doctor and have him come in to talk to you" because I have no clue what the patient knows. Makes me look dumb but I'd rather look like a Neanderthal than open up that can of worms.
Along those lines, I took care of a very nice guy who was under a 24 obs/work-up for a suspected TIA. He gets all his tests done. Is expecting to leave that day. I get the call that his chest x-ray had abnormalities in it so they need to re-shoot. The pt had a history of stomach cancer so we're all thinking the worst. But no doc comes by. Pt is like "am I leaving today? What's going on?" Nursing is giving these vague answers as to why he suddenly needs more tests and will probably be staying another night. I'm calling the primary team but getting the run-around. Nobody comes up to explain what is going on. The abnormalities in his chest ended up being calcified something or anothers, at least according to the radiology report. Nobody from medical staff EVER bothered to follow-up with the guy about that stuff. Lack of a willingness to communicate like that just drives me nuts.