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. :\
Oh gosh, reading these posts makes me anxious! As a CNA I certainly hope I do not come off as some of the people that are being complained about here. I am a new(ish) CNA as well as a BSN student and there are times when I have to ask questions at my job and I feel that the verbal responses I get from certain nurses is accompanied with A LOT of attitude that makes me feel like A) they think I am stupid, B) they think I should have known the answer (aka should have been able to read their minds) C) they don't want to help me (help them!) D) they are just generally put out or unhappy in general which (surprise!) just plain sucks to be around. I often see on AN that it is recommended for nursing students, new RN's, CNA's to "ask questions," but honestly, being met with responses like those listed above makes one less likely to want to do so unless it's a dire situation, hence the pass the buck or it's not my job response.
Also, I don't doubt at all that a big reason many people don't take initiative or act on certain assumptions( do "their job" ) is that they probably did (said task) at one point and then got an earful about it from somebody in the chain of command about how "it should've been done or handled THIS WAY," and were told so, with that negative kind of attitude mentioned above.
I try to stay constantly vigilant against ever becoming complacent or succumbing to this apathetic way of operating but honestly, many people in the health care field make it incredibly hard NOT to go down that dark road. I guess I am writing this to ask those who initially posted here, "what would have been the ideal turn of events in these situations?" is it a matter of solely changing attitudes or is it more than that? And whose would you say should lead the charge in changing these attitudes? As a future RN I'd love to know more about this aspect of the nursing culture.
I am also asked these questions in similar formats from other staff. Generally the Xray guys won't cause me much trouble other than asking for help positioning a patient.
In regards to your XRay example (the ankle) - their system may not update immediately with new orders, and they may not be able to do scans unless their system has a current order - Kind of like how a doc will be saying they're putting in XYZ med and it won't pop up on my MAR / Pyxis immediately.
In my experience, the lab will inquire about nurse collect if they see the patient with a picc. Their logic - Why should I stick this patient and cause them pain if they have a picc? I have only had one lab tech in 9 months seem like she was ''lazy'' and didnt want to draw. I think she is just more brunt than other lab techs.
On days, you get many calls about lab A being put in at one time and lab B is 2 hrs later - can we do both together? These are steps for the lab to be more efficient- sometimes we cannot do that though - IE troponins.
At my last job, housekeeping would not clean up body fluids if they were abundant. I don't know if it was policy though.
RT: tells me that patients breathing tx from the ED are expiring this shift, can I message the doctor now? She won't see the patient again until I do. And does the patient REALLY need them every four hours? Can I clarify that for her? RT never wants to call themselves!
Also, patient just came from PACU with oxygen on. No orders for oxygen protocol. Patient is confused, nauseated, and in severe pain. I am dealing with that when a furious RT tells me I have to take the oxygen off because there is no order. Really?? I'm prioritizing and that's not on my radar right now.
Lab: can I draw the patients q8hr h/h now with their vanc trough? It's 19:00, h/h is due at 23:00.... I say no and they do it anyway. Uh...
Lab freaks out anytime they have to draw someone with a CL. They don't understand if I tell them it's clotted and I have ordered tpa. They will ask if the labs can wait. When I say no, they act mortally offended and seem to think I am intentionally causing them to stick the patient.
Seen that, done that. The suggestions to turf to doc are spot on.
Wondering if you are equally as culpable.. Why would you NOT get an order to draw from the PICC? The patient has been in critical care for days.... central line access for blood draws is standard care.
The MD who placed the PICC didn't/won't give an order to draw off it. Not sure why, but without the order, we can't touch it to draw labs. He only gave an order to use it for giving meds.
Our phlebotomists get overwhelmed and start canceling labs without telling anyone.
I hope they get written up Every. Single. Time.
I have no problem telling Consulting Dr. that no, I won't be calling Primary Dr. for them. I'm the patient's nurse, not the dr's secretary.
But this business of d/c'ing medical orders is practicing w/o a license and disrupts the pt's treatment. Someone could die as a consequence of missed results.
Oh gosh, reading these posts makes me anxious! As a CNA I certainly hope I do not come off as some of the people that are being complained about here. I am a new(ish) CNA as well as a BSN student and there are times when I have to ask questions at my job and I feel that the verbal responses I get from certain nurses is accompanied with A LOT of attitude that makes me feel like A) they think I am stupid, B) they think I should have known the answer (aka should have been able to read their minds) C) they don't want to help me (help them!) D) they are just generally put out or unhappy in general which (surprise!) just plain sucks to be around. I often see on AN that it is recommended for nursing students, new RN's, CNA's to "ask questions," but honestly, being met with responses like those listed above makes one less likely to want to do so unless it's a dire situation, hence the pass the buck or it's not my job response.
Also, I don't doubt at all that a big reason many people don't take initiative or act on certain assumptions( do "their job" ) is that they probably did (said task) at one point and then got an earful about it from somebody in the chain of command about how "it should've been done or handled THIS WAY," and were told so, with that negative kind of attitude mentioned above.
I try to stay constantly vigilant against ever becoming complacent or succumbing to this apathetic way of operating but honestly, many people in the health care field make it incredibly hard NOT to go down that dark road. I guess I am writing this to ask those who initially posted here, "what would have been the ideal turn of events in these situations?" is it a matter of solely changing attitudes or is it more than that? And whose would you say should lead the charge in changing these attitudes? As a future RN I'd love to know more about this aspect of the nursing culture.
What you are describing is very different from what we're responding to in this thread. Ancillary departments like radiology, lab and respiratory therapy approach the nurse trying to get out of doing things that are ordered by the MD. Rather than call the doctor, they ask the nurse with the hopes the nurse will tell them they don't have to follow the doctors' orders. If the nurse lets them off the hook for whatever the order was, they'll make a note saying the nurse said it was okay to completely ignore the MD's orders. They will gladly toss the nurse under the bus to excuse them for not doing what was ordered.
What we are saying here is if they want to refuse doctors' orders or cancel doctors' orders, they need to call the doctor, not us. This is very different than a new hire having questions and asking for help. us.
RT: tells me that patients breathing tx from the ED are expiring this shift, can I message the doctor now? She won't see the patient again until I do. And does the patient REALLY need them every four hours? Can I clarify that for her? RT never wants to call themselves
(One of my big mean scary and less than diplomatic colleagues has the perfect response for these people: do you want me to wipe your XXX too?)
This is another sneaky way of dumping the RT work on a nurse. It's blackmail. Do my work or I will let your patient suffer or die.
"Are you trying to blackmail me into doing your work? I don't ask you to renew IV pain meds, don't ask me to renew your bronchodilator orders." Yes I actually said that to the worlds' laziest RT. He did shape up and never asked me again.
I also do not order their ABGs, I offer to teach them. They all know how to do it but they think of it as something to delegate to a nurse and that's not happening either.
I am not bashing all RTs. Just the lazy ones who clearly don't care and do stuff like this or hand me a lab slip with critical ABG values and say "this needs to be called." Again, I don't ask you to call my labs, don't ask me to call yours.
There is always going to be that one employee who tests the nurse saying:
"Why can't you draw these labs from the line?" ---Because if I stop the IV meds it might kill him.
and my alltime favorite:
"Can this CT of the head wait until dayshift?" --------- It's a stat so no it can't wait.
I do not waste my time and energy discussing the rationale in depth with people who clearly don't care and want to get out of doing their jobs.
Definitely agree with the above line draw one! Luckily our phlebotomists are usually ok with whatever the RN says...they draw extra tubes when I ask too. Wish I could get them to put back the BP cuff though!
As to the routine AM CT head at 05...my response was "NO, because I am the day shift and I came in at 03 and the neuro surgeon wants it done before he comes in at 07!" (Lazy tech tried to turf it!)
I do feel just a bit bad for portable CXR tech as they come up many many times a day on multiple patients...sorry, we just intubated, placed a line, and now an ngt...sorry but yes you do have to do 3 CXR because the doctors can't combine stuff! Unfortunately they do take out my pillows but will usually put them back if I ask them to.
What you are describing is very different from what we're responding to in this thread. Ancillary departments like radiology, lab and respiratory therapy approach the nurse trying to get out of doing things that are ordered by the MD. Rather than call the doctor, they ask the nurse with the hopes the nurse will tell them they don't have to follow the doctors' orders. If the nurse lets them off the hook for whatever the order was, they'll make a note saying the nurse said it was okay to completely ignore the MD's orders. They will gladly toss the nurse under the bus to excuse them for not doing what was ordered.
What we are saying here is if they want to refuse doctors' orders or cancel doctors' orders, they need to call the doctor, not us. This is very different than a new hire having questions and asking for help. us.
Oh, cool, thanks for clearing it up. Obviously I'm totally unaware of what was actually going on here. I misunderstood.
The lab tech the other day came in and seriously went to every room and was like "I'm the lab tech are you sure you really want to have your labs drawn now? No? Okay someone will come back later." Of course this was at 4 am and 90% of the patients were confused. I was like seriously, go back in there and draw the labs.
I must be lucky because I have rarely experienced things like this! I mean, I have experienced lab techs and radiology techs asking if their blood draws or xrays can be combined with later ones, or if they really need that second xray or if it was entered as a mistake...but I never get the impression that they are trying to get out of work. They always seem to be trying to do the best, most efficient job they can for the patient. Sometimes this results in a patient being saved a blood draw or an extra xray exposure.
The only department that has really ever given me grief really is housekeeping, I am sad to say. I adore some of the housekeeping people that I have worked with...but some seem to resent having to do things like empty the trash or mop a sticky floor even if I have already cleaned up the bulk of whatever bodily fluid was spilled there. And woe to the nurse that doesn't strip the bed or remove the patient's old food tray from the room before housekeeping comes to clean after discharge. Frustrating
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
Housekeeping: "Yes, I cleaned that room."
Me: "Then why is there blood all over the siderails, the bedside table, the toilet and the floor? I have a patient coming out of OR in 15 minutes."
Housekeeping: "I can't clean it by myself! You'll have to help me."
Me, to RT who is busy watching a football game on the TV in an empty room: "I have to get Mr. B some pain meds and his stat antibiotic. Would you please see why Mr. A's ventilator is alarming?"
RT: "Do it yourself."
X-Ray Tech to me, the day I came back from FMLA after a back surgery: "I have a bad back. You'll have to lift him up so I can put this board underneath him."
Me: "And then you'll help me ambulate him, right?"
X-Ray, offended: "You're really a (bad word meaning female dog), aren't you."
BertG77
134 Posts
Oh gosh, reading these posts makes me anxious! As a CNA I certainly hope I do not come off as some of the people that are being complained about here. I am a new(ish) CNA as well as a BSN student and there are times when I have to ask questions at my job and I feel that the verbal responses I get from certain nurses is accompanied with A LOT of attitude that makes me feel like A) they think I am stupid, B) they think I should have known the answer (aka should have been able to read their minds) C) they don't want to help me (help them!) D) they are just generally put out or unhappy in general which (surprise!) just plain sucks to be around. I often see on AN that it is recommended for nursing students, new RN's, CNA's to "ask questions," but honestly, being met with responses like those listed above makes one less likely to want to do so unless it's a dire situation, hence the pass the buck or it's not my job response.
Also, I don't doubt at all that a big reason many people don't take initiative or act on certain assumptions( do "their job" ) is that they probably did (said task) at one point and then got an earful about it from somebody in the chain of command about how "it should've been done or handled THIS WAY," and were told so, with that negative kind of attitude mentioned above.
I try to stay constantly vigilant against ever becoming complacent or succumbing to this apathetic way of operating but honestly, many people in the health care field make it incredibly hard NOT to go down that dark road. I guess I am writing this to ask those who initially posted here, "what would have been the ideal turn of events in these situations?" is it a matter of solely changing attitudes or is it more than that? And whose would you say should lead the charge in changing these attitudes? As a future RN I'd love to know more about this aspect of the nursing culture.