Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
Cheyenne RN,BSHS said:
Nurses not being able to chart or say anything that could be seen as a medical diagnoses. So you used words like "seems" or "appears" as in "pt seems to have ceased respiration..." meaning death, but since only doctors could declare a demise you had to wait for him or her to make that determination first.
DoGoodThenGo, your entry reminds me of a conversation I had with a doctor in one of my early years of nursing. I had to call a rather difficult doctor who had little regard for nurses and didn't respect women in general I don't think. The patient had died and I called to let him know so he could come pronounce the patient and speak with the family.
He popped off at me asking Will are you sure they're dead? I don't want to drive all the way over there and then find them just taking a nap. He hit me in a rare blunt mouthed mood and I said Well they have no pulse, no blood pressure, and they aren't breathing and that looks pretty dead to me unless you know something I don't. He slammed the phone down hanging up on me which is how he usually ended any phone calls we nurses made.
I love this thread and with so much grump in the news it is a breath of fresh air.
Years ago in the MICU, I had a patient on a balloon pump, which was brand new. She was in multi-system organ failure and had finally been made a DNAR the day before the interns rotated. The new intern was, of course, fascinated with a patient that had this new piece of machinery. He ordered blood gases drawn every hour. Then the radial arterial line fell out, and we were going to have to do an arterial stick hourly to get gases because we weren't allowed to draw anything from the aortic line (and wouldn't have known how to anyway. Brand new technology.) I called him and explained this, but he wanted me to go ahead and stick this poor little old lady anyway. I asked him if he was going to treat the blood gas results, and he screamed at me that "I ordered what I wanted, and you just damned well better do what I say!"
So I stuck the lady for ABGs and called him the results.
An hour later, I stuck her again. This time, when I called him he screamed at me not to bother him with the freaking results, he'd look at them when he was good and ready. So I asked if we could stop drawing them, given as how we weren't treating them, he wasn't looking at them and sticking the poor lady caused her to squirm and grimace indicating pain.
"Just give her more morphine and draw the gases."
Then, for good measure, he came by the unit and wrote in ginormous letters covering an entire page of doctor's orders "Draw ABGs q 1 h JUST LIKE I ORDERED."
At about 2 in the morning, we we weren't able to get ABGs from radials, and weren't allowed to draw from any other artery per policy. I asked my best friend, who was an excellent stick to try, and even she couldn't get gases. Then the heart rate on the monitor slowed . . . and stopped . . . and we needed to call an MD to pronounce death.
I called our friendly intern and and began with "We're not able to get blood gases on Mrs. DNAR -- we've used both of her radials so often that there's no place to poke her. Would you like us to D/C the q1h blood gases."
"No, &*(^*)! Continue the q1h ABGs. How many times to I have to tell you morons this?"
"OK, then since we aren't allowed to draw from any other site, you're going to have to come up here and draw from a femoral artery." (Lucky he didn't understand the balloon pump enough to know that there was a monitoring line in her aorta!)
I heard the unmistakable sound of a phone being smashed against a wall or floor or something, and about 10 minutes later the intern stomped onto the floor, snatched the ABG kit (I'd made one up as we didn't have remade kits then) and disappeared into the room with the now deceased patient. He was in there for half an hour or so when he came storming out, threw the glass ABG syringe against the wall and said "You've won. You can D/C the q1h blood gases now."
"Thank you, doctor," I said sweetly. "Now could you do us a favor and pronounce her?"
I don't think he ever lived down spending half an hour trying to draw blood gases from a corpse, and I still haven't lived down waking a physician to come to the unit to TRY to draw blood gases from a corpse.
Specializes in ER, ICU/CCU, Open Heart OR Recovery, Etc.
Years ago in the MICU, I had a patient on a balloon pump, which was brand new. She was in multi-system organ failure and had finally been made a DNAR the day before the interns rotated. The new intern was, of course, fascinated with a patient that had this new piece of machinery. He ordered blood gases drawn every hour. Then the radial arterial line fell out, and we were going to have to do an arterial stick hourly to get gases because we weren't allowed to draw anything from the aortic line (and wouldn't have known how to anyway. Brand new technology.) I called him and explained this, but he wanted me to go ahead and stick this poor little old lady anyway. I asked him if he was going to treat the blood gas results, and he screamed at me that "I ordered what I wanted, and you just damned well better do what I say!"
So I stuck the lady for ABGs and called him the results.
An hour later, I stuck her again. This time, when I called him he screamed at me not to bother him with the freaking results, he'd look at them when he was good and ready. So I asked if we could stop drawing them, given as how we weren't treating them, he wasn't looking at them and sticking the poor lady caused her to squirm and grimace indicating pain.
"Just give her more morphine and draw the gases."
Then, for good measure, he came by the unit and wrote in ginormous letters covering an entire page of doctor's orders "Draw ABGs q 1 h JUST LIKE I ORDERED."
At about 2 in the morning, we we weren't able to get ABGs from radials, and weren't allowed to draw from any other artery per policy. I asked my best friend, who was an excellent stick to try, and even she couldn't get gases. Then the heart rate on the monitor slowed . . . and stopped . . . and we needed to call an MD to pronounce death.
I called our friendly intern and and began with "We're not able to get blood gases on Mrs. DNAR -- we've used both of her radials so often that there's no place to poke her. Would you like us to D/C the q1h blood gases."
"No, &*(^*)! Continue the q1h ABGs. How many times to I have to tell you morons this?"
"OK, then since we aren't allowed to draw from any other site, you're going to have to come up here and draw from a femoral artery." (Lucky he didn't understand the balloon pump enough to know that there was a monitoring line in her aorta!)
I heard the unmistakable sound of a phone being smashed against a wall or floor or something, and about 10 minutes later the intern stomped onto the floor, snatched the ABG kit (I'd made one up as we didn't have remade kits then) and disappeared into the room with the now deceased patient. He was in there for half an hour or so when he came storming out, threw the glass ABG syringe against the wall and said "You've won. You can D/C the q1h blood gases now."
"Thank you, doctor," I said sweetly. "Now could you do us a favor and pronounce her?"
I don't think he ever lived down spending half an hour trying to draw blood gases from a corpse, and I still haven't lived down waking a physician to come to the unit to TRY to draw blood gases from a corpse.
Washing and starching my cap, slappingit onthe side of the refridgerator to dry, then peeling it off, reattaching the ribbon and refolding to a wearable cap! 100% cotton undergarments in surgery to prevent sparks, and plugged surgical shoes!
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
Great story!
However feel so bad that the poor woman should have spent her last hours on this earth that way.
Am not blaming you or anyone else, just makes me sad.
It made me sad, too. That's why I tried so hard to get the blood gases D/C'd. I even refused to draw them, but my NM told me that unless I could get someone to D/C the order, I had to continue to draw them. I tried going up the chain, but it was a weekend and I couldn't get anyone to overrule the resident because they didn't want to come in for a "non-emergency."
RNatheart4eva
3 Posts
I remember when a doc ordered red wine (i think to stimulate a patient 's appetite) every shift had to mark the bottle and document it