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. :\
Specializes in Psych, Corrections, Med-Surg, Ambulatory.
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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.
In the cases I mentioned, the pharmacists are supposed to call the doctor if they need clarification. That way there can be a two-way conversation between the people who need to communicate with each other. Forcing the nurse to act as go-between is cumbersome and fosters poor communication.
Where the transporter is concerned, it is their job to help move the patient from gurney to bed. Not insist the patient can move him or herself; not their place to assess that. In one instance, a transporter brought a woman who'd just had a bilateral mastectomy and he tried to tell me she could scoot herself over. Unbelievable.
These occurrences need to be reported to the respective department heads. I've at times had my charge nurse or manager voice a complaint with another department. Sometimes you get cooperation; sometimes you don't. But the individual nurse always has to be assertive for the patient's benefit.
Slightly off topic but since several other posters have mentioned it... Does anyone know why housekeeping won't/can't clean body fluids when they turn over a room? Or bags on IV poles? Our environmental services staff won't touch this stuff. What's the difference from taking out an NGT canister (oh no!) and having to mop up a pool of diarrhea off the floor (which they can do).
I just don't get it. I feel they should be trained on dealing with any body fluid or waste that they encounter in the hospital. Instead they basically 75% clean a room and leave the yucky stuff to us (if we have time before he ED sends that new patient up!).
I can sort of get it with the IV bags... They aren't trained to know what can and cannot be harmful medications. But they should be trained on all body fluids.
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.
"Not sure why" doesn't cut it. Your patient is lying helpless in an ICU bed, repeatedly being stuck with needles. You need to speak with the doc (that does not give a rat's pattooty that their patient is receiving multiple invasive and painful procedures) and get their rationale as to how this benefits the patient. Unless the PICC is used for TPN, there is NO reason it cannot be used for blood draws.
PLEASE advocate for your patient.
Because the doctor said so.... is never a reason to carry out any order.
"Not sure why" doesn't cut it. Your patient is lying helpless in an ICU bed, repeatedly being stuck with needles. You need to speak with the doc (that does not give a rat's pattooty that their patient is receiving multiple invasive and painful procedures) and get their rationale as to how this benefits the patient. Unless the PICC is used for TPN, there is NO reason it cannot be used for blood draws.
PLEASE advocate for your patient.
Because the doctor said so.... is never a reason to carry out any order.
It was 4:30 in the morning, we were short staffed (5:1 on a stepdown unit) so I didn't look at her labs ahead of time, and the MD who placed the PICC is an outpatient doc without hospital privileges. I included the issue in report that morning. I don't just blindly follow orders or like excessive, unnecessary sticks. It was not something I could change for the purposes of that lab draw.
It was 4:30 in the morning, we were short staffed (5:1 on a stepdown unit) so I didn't look at her labs ahead of time, and the MD who placed the PICC is an outpatient doc without hospital privileges. I included the issue in report that morning. I don't just blindly follow orders or like excessive, unnecessary sticks. It was not something I could change for the purposes of that lab draw.
The patient does not care what time it is, or that you are short staffed. All they know is they are being stuck with a needle (needlessly).
What I hear you saying is .. the order for the PICC was placed by a doctor without hospital privileges? Knowing that, requires that YOU obtain an order from the attending physician for management of the line. Again.. it's all about advocating for your patient.
The patient does not care what time it is, or that you are short staffed. All they know is they are being stuck with a needle (needlessly).
What I hear you saying is .. the order for the PICC was placed by a doctor without hospital privileges? Then, who is responsible for the the management of the of the line? That is now YOUR responsibility to clarify. Again.. it's all about advocating for your patient.
But, in this specific scenario, it really wasn't feasible to obtain an order for PICC draws right at that moment, in time for that blood draw that needed to be drawn at that time.
I think adressing it in the morning, to be taken care of that day, is fine and being an advocate and a prudent nurse and all that.
If this had been passed on from shift to shift with no one owning it, and the patient getting poked over and over, that'd be another story.
But, in this specific scenario, it really wasn't feasible to obtain an order for PICC draws right at that moment, in time for that blood draw that needed to be drawn at that time.
I think adressing it in the morning, to be taken care of that day, is fine and being an advocate and a prudent nurse and all that.
If this had been passed on from shift to shift with no one owning it, and the patient getting poked over and over, that'd be another story.
This is the STORY ...it has NOT been addressed shift after shift. OP knew who ordered the line, was not credentialed no less.. and felt "passing it on on report" was a sufficient nursing action.
But, in this specific scenario, it really wasn't feasible to obtain an order for PICC draws right at that moment, in time for that blood draw that needed to be drawn at that time.
I think adressing it in the morning, to be taken care of that day, is fine and being an advocate and a prudent nurse and all that.
If this had been passed on from shift to shift with no one owning it, and the patient getting poked over and over, that'd be another story.
Thank you, Brandon. And yes, that's what I'm saying. This patient facility hops and has a ton going on with her. The PICC was placed a hospital 30 miles south of where I work before she was discharged to a short term place. When she was admitted to my hospital, my understanding is the admitting hospitalist received from the MD who placed and is managing the PICC that we are allowed to run meds through it ONLY. I don't know why, nor was I given the opportunity to ask. Based on the way that shift went, the thought didn't even cross my mind until lab was there, telling me I needed to draw the labs. The order and note specifically said the PICC was for meds only. At 4:30 in the morning, no, I was not going to contact the hospital's ONE night time hospitalist (who specifically is only there for symptom management, not plan of care issues, unless the patient is unstable or newly admitted - neither applied to her) to tell him he needed to call a doctor who consults for a neighboring hospital to change the order.
Yes, I understand advocating for patients. A million and one percent, I understand advocating for patients. I also have a realistic understanding of what is possible. We are not a large hospital with residents in abundance. I work for a small rural community hospital without access to everything we might want right then and there. It's a skeleton crew on night shift. Unfortunately it does mean that there will be times when we have to give things to day shift. I didn't get her back, so I don't know if the order changed. Genuinely, I do hope it did.
I had a doctor (hospitalist) ask me to call a cardiologist, get an order, and then call her back so that I could get a verbal order from her and then enter the order in the computer.
.....what????
Same doc told me to call an oncologist to find out a patients prognosis, then relay that message to the family. Again, what???
This is the STORY ...it has NOT been addressed shift after shift. OP knew who ordered the line, was not credentialed no less.. and felt "passing it on on report" was a sufficient nursing action.
No, it was not addressed shift after shift. I didn't say they weren't credentialed. I said they don't have privileges at my facility. And unfortunately, giving it to day shift had to be a sufficient nursing action.
TriciaJ, RN
4,328 Posts
In the cases I mentioned, the pharmacists are supposed to call the doctor if they need clarification. That way there can be a two-way conversation between the people who need to communicate with each other. Forcing the nurse to act as go-between is cumbersome and fosters poor communication.
Where the transporter is concerned, it is their job to help move the patient from gurney to bed. Not insist the patient can move him or herself; not their place to assess that. In one instance, a transporter brought a woman who'd just had a bilateral mastectomy and he tried to tell me she could scoot herself over. Unbelievable.
These occurrences need to be reported to the respective department heads. I've at times had my charge nurse or manager voice a complaint with another department. Sometimes you get cooperation; sometimes you don't. But the individual nurse always has to be assertive for the patient's benefit.