No orders?

[Tracy38000]

I am a new RN, fresh out of school. I recieved an admit straight from the doctors office, no problem, but she had chest pain. I look at the physicians admission orders and all there was to give was protonix. I was floored. Is this normal? I had to call the doctor to get orders for nitro, 02, etc...dr was kinda pissy with me. I do not understand this.....shouldnt there have been cardiac orders?

clueless!

[Penelope_Pitstop, BSN, RN]

gosh - even a consult to an appropriate service for diagnostic work-up. sounds to me as if the doctor was going to be "pissy" no mater what - but i wasn't there. could you have conveyed a feeling of mistrust in his admitting diagnosis by asking about cardiac work up?- you were right in your concern, but this conversation needs to be handled with kid gloves. the last thing an attending doc wants to hear is some nurse that just met his patient deciding he dosen't know an mi from heart burn and sounding like they are busting his chopps about it. is there an admitting resident service that is supposed to handle routine admitting orders? did the patient follow instructions? i've had patients show up in admitting when the doctors instructions were "go to the er- you need to be checked out right away" i've had the opposite- patients that were told " if this keeps up we may have to admit you to get to the bottom of it" who show up in er with the story " my doctor told me to come" . there are lots of angles to this picture we don't have. he still should have been polite and professional- he would expect no less from you.

did we read the same post? i think not! when the op asked if the patient should have come with cardiac orders, i did not get the impression that she was slighting the doctor's ability to determine who needs to be admitted; rather, she wanted a full set of admitting orders. no "chop busting" involved. also, i believe you are assuming a great deal in how the conversation with the physician went. and, i hate to be flippant, but when it comes to patient safety and doing my job, i know for a fact that i do not give a flying cupcake about what the "last thing" an attending wants.

and about the patient following instructions, it sounds to me that the er was not involved, and that the patient was right in coming directly from the office (considering there was an order...physicians don't tend to write inpatient orders on patients who are not going to be admitted!)

correct me if i am wrong, but i believe the issue is lack of admitting orders. therefore, "angles" to the story aren't really needed.

~jess

[Dolce, RN]

I I look at the physicians admission orders and all there was to give was protonix.

I would have asked him if his diploma was written with a crayon.

Seriously? How do these guys graduate from med school?