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.

[anotherone, BSN, RN]

Wow, Listening to this really does freak me out. im starting nursing school, but speaking as someone who was diagnosed at 8 with type 1 diabetes it really astounds me how many of you would rather skim by on the job and do the bare minimum to explain to a patient a diagnosis or omit it completely until the MD shows up . Yes, i would also freak out if someone told me i had ARF. that is something serious and i can almost guanrantee in their mind they are thinking the will need a kidney transplant or possibly die even though with most cases of ARF that is not the case. Maybe its me but im someone who has always needed to know everything going on with my body, every 6 months i get my bloodwork and i go over it myself for any abnormalities my primary doesnt want to mention...which has happened before although after doing my own research and talking in great length with my endocrinologist it was nothing bad . that fact that she chose not to mention it really really ****** me off and i hate her now for it because she just passed the buck to my endo. ive been to the hospital only once since my diagnosis when i was 13 for ketoacidosis( my own fault it was Halloween ) and the nurses treated me like garbage, only coming in to change my IV pack and keep me awake for the night . maybe its my exp with other nurses who have treated me with little to no respect or care and with basic indifference to my feelings and questions i feel if you can answer and educate a little to someone who asks you a question about whats going on in their bodies you should if the MD wants to be a ******* and skip out. I know many of you will say i will change my tune when im working the hospitals and i get yelled at but as someone who has been in the hospital bed i can assure you that experience and the experiences with the nurses who treated me will guarantee i will never just go by and basically not tell the patient whats going in with them because its more convenient for me.... If you dislike your jobs that much and want to just get by stress free because you "play dumb" i suggest you go into another line of work because i know there are many other people who would gladly take your place and do a better job because they care and caring about the patient and making them feel as comfortable as possible regardless of how much a Pain in the ass they can be can make all the difference in the world for that patient whether you see it or not....

Treated you like garb age by just changing your iv bags and keepng awake? What did you want ? More education on diabetes and not overindulging even if it is halloween?

[opossum]

I think the scenario the OP poses is even further compounded by the fact that Medicare reimbursement is now based on patient satisfaction scores.

I have an example from a couple of days ago that leaves me wondering if I did the right thing...pt was A&ox3, admitted for intractable N/V/D. On eve shift, she had an ultrasound done. When I come in for NOC shift, I hear in report that results from the US were in, but that [the eve shift RN] did not tell her anything, as "that is the doctor's job". Well, this pt was inquisitive about her care and asked if the US results were in. What was I supposed to say? Should it have gone like this?:

Pt: Are the results of the ultrasound in yet?

Me: Yes.

Pt: What are they? Did they find out why I'm vomiting and have unbearable diarrhea?

Me: I cannot divulge that information. It's 0100 in the morning and the night hospitalist would stab me in the face for calling him to come up here to talk to you about US results that he doesn't know anything about. I'm sorry.

So, in the era of Press-Ganey, what is my role as the RN? I apologize if this is getting off-topic, but I can't help but think about that delicate balance between keeping the pt informed and keeping my license.

[anotherone, BSN, RN]

I think the scenario the OP poses is even further compounded by the fact that Medicare reimbursement is now based on patient satisfaction scores.

I have an example from a couple of days ago that leaves me wondering if I did the right thing...pt was A&ox3, admitted for intractable N/V/D. On eve shift, she had an ultrasound done. When I come in for NOC shift, I hear in report that results from the US were in, but that [the eve shift RN] did not tell her anything, as "that is the doctor's job". Well, this pt was inquisitive about her care and asked if the US results were in. What was I supposed to say? Should it have gone like this?:

Pt: Are the results of the ultrasound in yet?

Me: Yes.

Pt: What are they? Did they find out why I'm vomiting and have unbearable diarrhea?

Me: I cannot divulge that information. It's 0100 in the morning and the night hospitalist would stab me in the face for calling him to come up here to talk to you about US results that he doesn't know anything about. I'm sorry.

So, in the era of Press-Ganey, what is my role as the RN? I apologize if this is getting off-topic, but I can't help but think about that delicate balance between keeping the pt informed and keeping my license.

I say " the doctor/s will go over the results with you in the monring." If they area really up in arms over it I will page the night float who might or might not tell me/the pt the same exact thing I did.

[PintheD]

Wow, Listening to this really does freak me out. im starting nursing school, but speaking as someone who was diagnosed at 8 with type 1 diabetes it really astounds me how many of you would rather skim by on the job and do the bare minimum to explain to a patient a diagnosis or omit it completely until the MD shows up . Yes, i would also freak out if someone told me i had ARF. that is something serious and i can almost guanrantee in their mind they are thinking the will need a kidney transplant or possibly die even though with most cases of ARF that is not the case. Maybe its me but im someone who has always needed to know everything going on with my body, every 6 months i get my bloodwork and i go over it myself for any abnormalities my primary doesnt want to mention...which has happened before although after doing my own research and talking in great length with my endocrinologist it was nothing bad . that fact that she chose not to mention it really really ****** me off and i hate her now for it because she just passed the buck to my endo. ive been to the hospital only once since my diagnosis when i was 13 for ketoacidosis( my own fault it was Halloween ) and the nurses treated me like garbage, only coming in to change my IV pack and keep me awake for the night . maybe its my exp with other nurses who have treated me with little to no respect or care and with basic indifference to my feelings and questions i feel if you can answer and educate a little to someone who asks you a question about whats going on in their bodies you should if the MD wants to be a ******* and skip out. I know many of you will say i will change my tune when im working the hospitals and i get yelled at but as someone who has been in the hospital bed i can assure you that experience and the experiences with the nurses who treated me will guarantee i will never just go by and basically not tell the patient whats going in with them because its more convenient for me.... If you dislike your jobs that much and want to just get by stress free because you "play dumb" i suggest you go into another line of work because i know there are many other people who would gladly take your place and do a better job because they care and caring about the patient and making them feel as comfortable as possible regardless of how much a Pain in the ass they can be can make all the difference in the world for that patient whether you see it or not....

A lot of patients suffer from "comprehension" issues. Could be the stress of illness or could be a general inability to process information.

The trouble (clearly stated in my post) stemmed from me sharing with a patient what the MD should have explained. Hence, the physician is the one who "skim(med) by on the job". This patient was not receptive to any explanation, and was quite hostile toward me in his demeanor.

As nurses we are faced with, on a daily basis, the intellectually challenged, those who are just plain angry, and those with no self control. Often it is all of the above.

Good luck to you in your pursuit of a nursing career.

[GM2RN]

yadi87 - Wait until you've walked a few miles in the shoes of an experienced nurse. Right now you don't know what you don't know.

[MinnieMomRN]

Some of the nurses I see who routinely leave defeated and are at the edge of burn out are the ones who try to do teaching and put in more effort, going above and beyond, looking though the chart, lab values, alerting drs to possible issues that they might have missed etc... some times that is greatly appreciated other times it is not at all, or leads to situations like the op was in. The nurses who just try to do tasks or don't even care are some of the ones who have the better shifts and seem less stressed out.

I find this incredibly sad, but true.

I found that I just couldn't do this, and so I left hospital nursing. My feeling is that the OP has come to the same conclusion.

[beckster_01, BSN, RN]

I find that interesting because I tend to feel better about my job when(if) I am able to look through their chart and get a better 'snapshot' of the patient. I tend to be a better advocate when I am more aware of the patient's background. Consequently, I feel better about myself for A) Not looking like a fool when the doctor asks a question, and B) I occasionally catch something that might make a difference in that patient's plan of care, make me feel well-equipped to answer a question, or even simply learn something new. Those are the things that I like about my job.

When I try to evaluate the things that I dislike about my job it ALWAYS comes down to whether or not I have time to put in the extra effort and, on an unrelated note, what the people I work with are like. I am relatively new into my career, so only time will tell how it affects my burn-out potential.

*Disclaimer* I am pretty exhausted right now so I apologize for my run-on sentences, over-use of punctuation, and occasional poor choice of wording I tried to fix it but it really isn't happening right now. Time for bed.

[MinnieMomRN]

I find that interesting because I tend to feel better about my job when(if) I am able to look through their chart and get a better 'snapshot' of the patient. I tend to be a better advocate when I am more aware of the patient's background. Consequently, I feel better about myself for A) Not looking like a fool when the doctor asks a question, and B) I occasionally catch something that might make a difference in that patient's plan of care, make me feel well-equipped to answer a question, or even simply learn something new. Those are the things that I like about my job.

I agree. If you are in a supportive environment that allows for this, you are in a very good place. The frustration/disconnect comes from wanting to work this way, but being continually placed in a situation which does not allow it.