Radiology tech: "this patient has q0600 portable chest X-rays part of his old ICU order set. They normally DC these but they didn't DC his. Do I really need to do this?"
#2:
Me, to a different radiology tech: "we just discovered he might have foot fractures and I'm putting in orders right this exact second. Do you mind grabbing images of his feet while you're here?"
Rad tech: "the order wasn't already in so your, have to get that later."
Me: "the order is in right now."
Rad tech: "no."
Two seconds later, does the images anyway, because she realized it meant she'd have to come all the way upstairs again.
#3:
Respiratory: "Earlier MD asked for a different patient to have ABGs done at 0800" (after RT's shift would be over) "so we can just do this patient's in a few hours, too, right?"
#4:
Lab, after walking the whole unit to find me: "that patient has a PICC, why can't you draw her?"
Me: "I don't have orders saying I can."
Lab: "I saw her get drawn off that line last week, you need to draw her."
Me: "her line isn't being used for labs. I don't have an order saying it can be. I CAN'T use it. You need to draw her."
If it weren't the same people trying to get out of their orders every time, I'd figure they were just confirming things, but I am absolutely convinced they're trying to get out of doing their job, and they're trying to get the RN's "okay" so they can pass the buck to us, I am so done with this! If they want to questions orders, they should call the people writing them. :\
OMG lab and PICCs. I now have a manager that insists we draw labs without an order on every patient with a PICC. The first time I got told "you missed these labs" I said we don't draw labs on a PICC without an order. Got told yes we did and we've always done so. LIES.
Before that, we used to fight with the lab all the time over the PICCs. One time the phlebotomist stood and argued with us for 5 minutes that she didn't want to draw the labs, then when we went to assist another patient, she just wrote on the req "unable to draw after numerous attempts. RN to draw from PICC" LIES.
I also love when the unit clerk or housekeeping berate nurses because we "forgot" something that is their job. "You forgot to clean the shower. I'll let it go this time but don't let it happen again".
For the record - I'm an ED nurse. My past background includes Ortho/Med-surg and Neuro step-down.
I can't tell you the number of times I've had nurses call me (in the ED) after I've admitted patients to the respective unit:
"Uhh, Dr. SoSo didn't order repeat troponins. It needs to be ordered."
"Ummm, why did Dr. NoNo not order the patients Gabapentin? Pt is requesting it now as it's time for her usual dose."
"Uhhhh, Dr. YesYes ordered D5NS @ 200 ml/hr for this patient. Does she know patient has CHF? That order needs to be changed."
"Hey just want to let you know, patient has been placed on NPO per Dr. NoFeedUm's orders, for a procedure due tomorrow. It's 4 in the afternoon. Can't you get the order changed? He's really hungry...."
And on and on and on....
Never mind the nonsense from Pharmacy - "Hey, the Doc ordered XX drug @ YY dose. That sounds odd. Can we clarify..."
Or this gem from Lab:
I had a patient brought into the ED. Obtunded. Shaky vital signs (hypotensive). Known history of IDDM. STAT glucometer said "HI". Suspect DKA etc. By a miracle I managed to obtain IV access, drew labs and gave it to a tech to send 'em off to lab, while I stayed behind to stabilize the pt. 30 minutes later, I was finally able to stabilize the patient enough to be able to leave bedside and scurry over to my desk to begin charting. As I was charting, a note popped up in the comments section: "Redraw BMP, contaminated specimen." As I was in the middle of charting right that moment, I waited to finish my charting and refreshed the screen. Now it not only said "Redraw BMP, Contaminated specimen", it also said "Redraw CBC, Contaminated speicmen"!!!
What the Devil?!
I called lab:
Roy: Hey! This is Roy in the ED. I'm trying to figure out what is the problem with the blood work on patient XYZ? I'm being told that the specimens are contaminated?
Lab tech: Which tests?
Roy: The CBC and the BMP. Also I noticed that the Ketone was cancelled and never run.
Lab tech: Oh! You need to talk to Micro and Chemistry!
Roy: Oookay. Guess I'll talk to Chem first ('cuz I really need to know what the patient's glucose and ketone levels were)
After waiting forever, 'cuz they're busy too I'm sure (ED's busy, Lab's busy. Simple);
Chemistry: Chemistry, how can I help you?
Roy: Hey! This is Roy in the ED. I'm trying to figure out what is the problem with the blood work on patient XYZ? I'm being told that the specimens are contaminated?
Chemistry: Oh yeah! That patient's glucose was sky-high. So I figured it was contaminated and discarded the specimen and cancelled the tests. I informed Micro as well to not run it as the specimen was contaminated."
Roy: *stares at telephone receiver for a good 5 seconds... tries to regain composure* "Why didn't you call and ASK for clarification??!! The patient may be in DKA!!"
Chemistry: "Well, I thought it was contaminated. If you want it run again, you'll have to re-order and resend specimens."
Roy: "Thanks!" (not really!)
Aaaand: Don't EVEN get me started on the OB/ED turf war! ;-)
However, sometimes when things are cancelled, it's because we can see that one doc just ordered troponin x3 q6 and another doctor ordered the same and you may not have your results just yet or be able to check those orders just yet. That means the patient is getting drawn constantly for no reason when each just wanted a trop level q6. Or when a doc orders something within another test...like a potassium at 1430 that is w/in the CMP due at 1445...so a lot of times our "laziness" IS trying to spare our self extra work but also trying to save the patient unnecessary sticks. Same with the PICC, we'll hunt you down because usually someone with a PICC means their veins are crap.
I honestly don't think any competent nurse would disagree with you over this.
I DO think that what most nurses are complaining about is the fact that other departments seem to see nursing as the "GO TO person to solve MY problem" - when clearly, nurses aren't the ones who write/order patient care.
Take PICC lines for instance - Now, I consider myself pretty good when it comes to venipuncture and IVs (my baptism of fire was working an ED which saw a lot of IV drug users and dialysis patients). But there have been times when I've missed. I talk to someone else on shift whose been at it longer than I. They miss.
I think it is appropriate at this point to consult the vascular team for peripheral access ... but every single time I've had to put in the order, I've heard nothing but grief and angst. Like it was OUR fault that we couldn't get access on the patient! "Can't you ask the ER Doc?" You don't think I have? Where do you think the order for the VAD Team consult COMES FROM??!!
Once I had a doc order for a patient to have a thoracentesis on the left side. Patient is sent down for the procedure and the radiologist calls ME and says that there is more fluid on the right side and wanted to know if the ordering doc meant for the right side to be tapped. I told the radiologist that he needed to clarify this with the ordering physician and not the lowly nurse
Understand, Ixchel. Been there, done that and know all about skeleton crews! I am from the oldest of schools, where I would draw from the line without the almighty order and .. nobody died.
Obviously, you are not able to stick your neck out like that. Again, it's patient advocacy, I didn't need an order to cover my tookas. I used my common sense.
jeez, just leave it be til morning, some things CAN wait, dismount from your high horse please.
Can top all of this. Our nurse manager has decided that if we have any or even no empty beds, but have staff we will do all the after hours recoveries. And all the while paying PACU nurses on call pay.
Specializes in OR, Nursing Professional Development.
Can top all of this. Our nurse manager has decided that if we have any or even no empty beds, but have staff we will do all the after hours recoveries. And all the while paying PACU nurses on call pay.
On call pay is likely only a few dollars an hour. If those nurses get called in, they are likely getting paid time and a half for those hours spent working. It's cheaper for the facility to pay flat pay to nurses already working and $2/hour to those on call than to pay those working flat pay and time and a half to the PACU nurses who are called in. If there are open beds and the appropriate ratios are utilized and adequate orientation to recovering patients has been given, it certainly makes financial sense. If there aren't open beds, appropriate orientation hasn't been given, and ratios aren't appropriate, then yes, there are issues. But this isn't trying to get out of work, which is what this thread is about. It's about a management decision that may need revisited.
It always amazes me that ancillary departments can just refuse to do their job for no reason so their job automatically no questions asked becomes the nurses' responsibility. Somebody in dietary called in so the nurses will have to deliver the breakfast and lunch trays. You need a late tray for your patient, dietary folks are all "on break" so you'll have to come get it yourself. Need a new med immediately which requires a call to pharmacy? The first words out of their mouths is always "Have you already looked for it?" Well, no, of course not, I just thought I'd call your first because you are always such a joy to talk to! I'm pretty sure I've posted this one before but we had a transporter who didn't think she got an immediate enough response to her request for assistance to put the patient back to bed. Patient could have basically get out of the WC by herself. The transporter pushed the code button! I'm happy to report she doesn't work here anymore.
Understand, Ixchel. Been there, done that and know all about skeleton crews! I am from the oldest of schools, where I would draw from the line without the almighty order and .. nobody died.
Obviously, you are not able to stick your neck out like that. Again, it's patient advocacy, I didn't need an order to cover my tookas. I used my common sense.
And a couple of needle blood draws never killed anyone either. Good god, super nurse. Take it back a bit.
And a couple of needle blood draws never killed anyone either. Good god, super nurse. Take it back a bit.
Hi, devils advocate here. I have actually taken care of patients that could die from those blood draws. High-strung children with severe pulmonary hypertension who would scream themselves to death over a blood draw. We would have to drug them with PO or intranasal benzos first.
Of course I know thats not what you were going for, or what the prior poster was talking about
lemur00, BSN, RN
134 Posts
OMG lab and PICCs. I now have a manager that insists we draw labs without an order on every patient with a PICC. The first time I got told "you missed these labs" I said we don't draw labs on a PICC without an order. Got told yes we did and we've always done so. LIES.
Before that, we used to fight with the lab all the time over the PICCs. One time the phlebotomist stood and argued with us for 5 minutes that she didn't want to draw the labs, then when we went to assist another patient, she just wrote on the req "unable to draw after numerous attempts. RN to draw from PICC" LIES.
Pheh.