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. :\
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 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.
(Certain departments sleep all night while we play catch up and never get a lunch break. It might because they have manipulated us into doing all of their scut work. ya think?)
AMEN maggie!!!!!!!
It is ASTOUNDING to me that with amount of technology and more rules, regs, policies, procedures, laws and watchdog groups than any other industry, how inefficiently and many times unsafe the general practice of healthcare is due to issues like these.
How did it get to be this way??? I am a new RN and worked as a CNA for three years while in school where these things happened and are still happening where I now work even more. I wish things could be different for all our sakes.
Yeah, because you get paid about the same as they do, right?
Oh yeah, just about the same!😜
I don't know how many times I've been put in the situation of telling a family their loved one is dying because a doctor has been beating around the bush, or because he/she used the words "hopeful" and "optimistic".
Morbidly obese woman with end stage CHF, cololady partsl fistula, acute CVA, DM and stage IV on coccyx (as well as other comorbidities). Why on earth was I the first person to tell them why she was no longer producing urine? Her body was shutting down. But the docs were "hopeful".
Specializes in Acute Care - Adult, Med Surg, Neuro.
AMEN to this post!
This happens at least several times a week.
Me: (Puts in 1900 labs)
1900 comes, and the phlebotomist is blowing up my phone. Phlebotomist: Do you need those labs done on room 8 at 1900?
Me: Yes. (in my head: OMG, why did you have to ask, I didn't enter those for farts and giggles).
My patient will have an x-ray ordered and the x-ray tech will call and ask me all sorts of questions that I would have no idea of knowing unless I was the MD's mind reader. I.e. "Do the doctor want it in this view or this view, what kind of contrast, blah blah blah. Do we really need in STAT?"
I grind my teeth and have to page the doctor, but I know they can check with the doctor themselves. One time I asked why they didn't just page the MD themselves, and the guy was stammering on the phone "Well ... uh ... it's just easier if you do it."
My patient will have an x-ray ordered and the x-ray tech will call and ask me all sorts of questions that I would have no idea of knowing unless I was the MD's mind reader. I.e. "Do the doctor want it in this view or this view, what kind of contrast, blah blah blah. Do we really need in STAT?"
I grind my teeth and have to page the doctor, but I know they can check with the doctor themselves. One time I asked why they didn't just page the MD themselves, and the guy was
stammering on the phone "Well ... uh ... it's just easier if you do it."
That Xray is his responsibility not yours.
At 2 am radiology guy is going to be sleeping or playing words with friends with other departments while you get no break at all.This is a perfect example of wasting the nurse's time with their scutwork.
At that point I would say "It's says stat and Dr Hodad is on call. You're a smart guy I'm sure you'll figure it out" and hang up. Next time he'll call the MD not me. I am not his nanny or his Mother.
People like this need to get over their fear get some confidence and learn how to interact with doctors.
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.
Not anymore. Peripheral sticks and pedi tubes are preferred by many intensivists
to minimize iatrogenic blood loss in patients with anemia of chronic disease.
Here is another example of lazy people trying to skip on doing their work.
A patient with aspiration pneumonia has a swallowing evaluation by Speech Therapy. The ST puts a sign above the bed with dysphagia instructions, bills for the service, but neglects to enter the diet order or any instructions.
The night nurses do put it in the computer so that the patient receives the correct diet and so that the CDA (or complete discharge assessment) is correct.
No one holds the ancillary staff responsible for ordering the interventions that they prescribe in the computer system or for their negligence when they don't.
As an elder care nurse assistant -- I work with others that almost always refuse to do more than the minimal for the pt/client. This is causing an unequal distribution in tasks, but it is a poor sign of character. Ultimately, it is not about me or them, but the pt and their quality of life! I feel that eldercare in particular does not require any education -- yet, it is very skilled nursing -- I see that some are natural born caregivers and some are just in the field for manipulative reasons.
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 would wake up a hospitalist (who no doubt is making a gazillion bucks managing this patient) in a heart beat... if I identified an issue that my patient needs to be addressed.
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?
.....
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.
I agree! If its too hazardous then I shouldnt be allowed to clean it up either right? Its not like I had super special training for cleaning up bodily fluids....pretty much just wear PPE and know where to dispose of it. Surely housekeeping is capable. Why don't they?
Graduatenurse14
630 Posts
AMEN maggie!!!!!!!
It is ASTOUNDING to me that with amount of technology and more rules, regs, policies, procedures, laws and watchdog groups than any other industry, how inefficiently and many times unsafe the general practice of healthcare is due to issues like these.
How did it get to be this way??? I am a new RN and worked as a CNA for three years while in school where these things happened and are still happening where I now work even more. I wish things could be different for all our sakes.