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. :\
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.
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.
Wow did I write this!? Sounds sooo familiar! Isn't it amazing how we all work in all four corners of the US and the same mess goes on everywhere! I thought it was just me that has noticed this. So true.
Case Management: "Patient A's insurance will not pay for him to be in the hospital anymore. You need to call the doctor and get a discharge order"
Me: "The doctor's at the other end of the hallway. How about you check on that discharge order"...case management asked for orders all the time from the doctors....as for discharge orders on a patient that was obviously going to get us a "Heck no!(only a different set of words that is inappropriate for this site)" response they always tried to pass on to the staff nurse...I'm not getting my butt chewed out again. I learned my lesson the first time I relayed a message from case management. This time they're on their own. They're the one's in contact with the insurance company, they can have that conversation with the attending.
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 why I go back to school to become an NP.
Patient's RR is 36? Do we have critical care on board? If no, get a consult, call me back with what they think.... hey, doc, I was going to tell you that hb is down 2 grams within last 12 hours, HR... SOB... will you listen to me?
BP is 80/50 after I bumped up lisinopril? Get cardiology stat!
Is he fighting the vent like crazy again? Get psych people!
They do not want dialysis for their mom? She'll be dead without it within 24 hours, do they know? Go tell them, let me know when to put her on schedule for Quinton.
Dear Mr. Hospitalist, I know that you guys have your own politicos and do your damnedest to scuttle patients often enough between each other, hence providing each other's reimbursement. But please remember that these are your patients, and if you are too lazy to do your job, I will be more than happy to step into your shoes in just a couple of years.
Specializes in Peds Urology,primary care, hem/onc.
I started going to one of our satellite offices with one of our attendings to help her see the large volume of patients she was seeing there. There was just too many patients and she needed another provider with her to help with the flow. My first day there, I go up to the Medical Assistant who was working with us. She was sitting in the break room eating a snack (we had only been there an hour so it was not a scheduled break time for her). I asked her nicely if she could please do a dipstick on the urine specimen that I had placed in the lab while I went in and saw a patient. She looked at me and said, "ummm isn't that YOUR job??? Isn't that why you are here to do those things???". I looked at her (dumbfounded)and said "No, it is YOUR job, especially when we have several rooms of patients to see you are sitting here in the break room!". She did, reluctantly, go and do it for me. Now, I have NO problem doing my own dipsticks, labs etc if the MA's are very busy and I have time. I do it all the time. I have not forgotten where I cam from (I used to work back office in a pediatrician's office before I went to grad school) and it is not below me to get vitals or do labs on a patient if everyone is really swamped. I instantly saw why my attending would come back the following day from being at that satellite clinic always angry b/c this MA refused to do anything!!! The next time I was there, the office manager pulled me aside (I instantly thought I was in trouble) and asked me to relay to her my previous conversation with that MA which I did. They fired her within a couple of days.
I work in a surgical specialty and we have a whole pre-op department (staffed with APN's) that are supposed to work up the patients prior to surgery. They are SUPPOSED to order the pre-op labs. They dump it on us ALL the time. Had one call me last week, stating this patient "was really hard to get a hold of" so "you can order her labs and arrange for her to get them right???". They also call us if one of our patients is having surgery with another specialist and ask us to order the labs...and it is not for OUR surgery. really???
I typically end up just doing it b/c I want to make sure our patient gets what they need but it is so annoying. We (and the surgeons I work with) have talked with management ad nauseum but they will not do anything about it. I always thought the purpose of hiring APN's was so they could order labs/testing etc prior to surgery. If they are not going to order/manage the patient, they could save money and just hire nurses!!!
I've had radiology call to see if a MRI can be postponed until morning. Usually radiology will call within a few minutes of the order being enter and the doctor is in house so I can check with him/her. We don't need an order to draw from a invasive line, so that isn't an issue. Respiratory is usually pretty good about arriving quickly when paged and giving scheduled treatment on time.
I have seen lab and nurses allow patients that are AAOx1 (person) refuse lab draws. Coincidentally, I often manage to draw these patients blood myself without any assistance. There have also been a few times that I perceived a DNR patient to be receiving inadequate care as opposed to a Full Code patient.
The pharmacy gives me the most problems. They never send the ordered eye drops, nasal spray, topical creams, etc. You can call them at 2030 about your Vancomycin scheduled for 2100 and they say "well it's not 2100 yet, so give us a little bit", the Vanc then shows up at 2145. We have 1 hour before and after to pass scheduled meds, so a 2100 med could be given between 2000-2200.
I once had lab mark a troponin "consistent with previous" when it went from 0.060 to around 5.000 on the second set. They didn't call me the result since they were "consistent". I was lucky that I happened to see them relatively soon.
Specializes in Psych, Corrections, Med-Surg, Ambulatory.
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.
Sorry, venting here :/
I agree. How can you have a job as a hospital housekeeper and not expect to have to deal with certain things?
Specializes in Psych, Corrections, Med-Surg, Ambulatory.
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???
Yeah, because you get paid about the same as they do, right?
Nursing is stretched too thin in terms of ratios and their patient acuity. Certain departments sleep all night while we play catch up and never get a lunch break. It might be because they have manipulated us into doing all of their scut work.
( ya think?)
We need to stop babying the doctors and ancillary staff who play dumb and/or are too lazy send a text or log on to a computer. We have been suckers for far too long.
I have enough to do without being the secretary and receptionist for RT pharmacy Radiologists Neurologists Case management etc.
We have the tools to be efficient but half of these people think it's 1985 and that the nurse is responsible for everyone's "orders."
It is 2015. We have to re-train them to actually use the technology, one at a time, to access the on call schedule, use the text paging, and do their own order entry.
If the rad tech wants to question the XR order, or the RT wants to postpone an ABG, like in the original post, nip that in the bud and give him a number to call. These people have no qualms about wasting my time; I have no qualms about telling them who to call and to let me know what he says.
Nursing is stretched too thin in terms of ratios and their patient acuity.
We need to stop babying the doctors and ancillary staff who play dumb and/or are too lazy to log on to a computer. We have been suckers for far too long.
I have enough to do without being the secretary and receptionist for RT pharmacy Radiologists Neurologists Case management etc.
We have the tools to be efficient but half of these people think it's 1985 and that the nurse is responsible for everyone's "orders."
It is 2015. We have to re-train them to actually use the technology, one at a time, to access the on call schedule, use the text paging, and do their own order entry.
If the rad tech wants to question the XR order, or the RT wants to postpone an ABG, like in the original post, nip that in the bud and give him a number to call. These people have no qualms about wasting my time; I have no qualms about telling them who to call and to let me know what he says.
Like times 100!!! Maggie you and I must have think-alike brains!
dirtyhippiegirl, BSN, RN
1,571 Posts
I feel like this is my response to a lot of threads on here.