"I'm a Nurse Practitioner!"

[Anna Flaxis, BSN, RN]

Patient comes in by ambulance for Unspecified. On the way in, EMS throws in an 18g and draws blood for labs. Patient looks good, is completely with it, condition seems pretty benign, but need to check a few things. Order CBC, Comp, EKG, do orthostatics, send blood to lab, hang 2nd liter of NS. New ED Doc That I've Never Worked With Before picks up the chart. Orders something that makes sense (but I couldn't order it myself), and something else that seems unnecessary. But whatever. I don't have "M.D." after my name, so I don't question, I just do, and order the test that seems unnecessary.

A while later, Family Member comes out of room, interrupting report I'm giving to Esteemed Colleague so I can go to my federally mandated meal break 6 hours into my 8 hour shift (and I'm starving).

Family Member: "Um, yeah, I was wondering if anyone is ever going to come in and take some blood?"

Me: "They took blood in the ambulance on the way in. It's already in the lab."

Family Member: "Oh, okay, well I was just wondering because the doctor said he was going to order XYZ test, and I'm a Nurse Practitioner, and nobody ever came in and got blood."

Me: "Yeah, they got it in the ambulance. It's in the lab. XYZ test is being done right now."

Family Member: "Okay, well I just thought I'd check, because I'm a Nurse Practitioner...."

Me: Blank stare.

Family Member: Goes back into room.

I finish report and go for a latte since nothing's open at this hour, and I didn't bring a meal.

While I'm on my federally mandated meal break drinking my Latte Dinner, New ED Doc That I've Never Worked With Before apparently tells patient and Family Member that he's going to keep the patient for overnight observation, and Family Member goes home. NEDDTINWWB then asks me to do orthostatics and order another unnecessary test.

Me: "I did orthostatics already (pointing at the chart where I had clearly documented orthostatics on arrival, which were negative), his pressure was rock solid, but I guess I can do them again if you want..."

NEDDTINWWB: (Seeing my documented orthostatics for the first time and barely glancing at them) "Yeah, I think we should repeat them, and get ABC test."

Me: "Okay, but he's not on any blah blah blah medication for his blahbitty blah blah, because yadda yadda, so are you sure we really need this test?"

NEDDTINWWB: (Looking irritated) "Yes, the admitting doctor wants it."

Me, to myself: "Yeah, but if the admitting doctor knew what I just told you, he would think this test was just as unnecessary as I do."

Me, in reality: "Sure, no problem."

Sigh. So, I repeat orthostatics and order ABC test, a bit surprised that this A&O, reasonably healthy, middle aged, walkie talkie patient is going to be admitted for observation of his Benign Condition. This should be a slam dunk treat and street. There is nothing to observe.

Admitting Doctor Genius (really, no sarcasm here; he is brilliant and I'd let him take care of me and mine any day) comes and sees the patient, and says the patient does not need to be admitted (surprise). He does a great job of explaining the Benign Condition to the patient, and the patient is satisfied with the explanation and his disposition.

Next thing I know, my phone is ringing.

Me: "Hi, this is Stargazer."

Voice on Phone: "Yeah, this is the Family Member for Patient X. I want to know what's going on, because I thought he was going to be admitted and he just called me to say he's being discharged, and I'm a Nurse Practitioner, so..."

Me: "I'm sorry, but I can't give out personal medical information over the phone. I can tell you that we've run some tests, everything looks fine, and he's being discharged."

Voice: "Well, I'm not satisfied with that. Did they do Test X? I'm a Nurse Practitioner, so I know they should do Test X."

Me: "I'm sorry, I can't give out specific medical information over the phone. All I can tell you is that we ran some tests and everything looks fine, and he's being discharged."

Voice: "That's not good enough. Did they do Test X or didn't they? I'm a Nurse Practitioner and..."

Me: "Ma'am, I can't give out confidential medical information over the phone. I can let you talk to your family member if you like."

Voice: "I already talked to him. I want to know why he's not going to be admitted. I'm a Nurse Practitioner and I know he's "At Risk", plus I just had surgery."

Me: "Two Medical Doctors have examined him and have determined that it's not medically necessary to admit him. All of his test results are normal. He is being discharged. That's all I can tell you."

Voice: "Blahbitty blah blah Nurse Practioner yakkity schmakkity blah blah blip blip."

Me, to myself: "I don't care if you're the Queen of England, I'm not divulging PHI. You can go jump in a lake."

Me, in reality: "Well, maybe when you come pick him up, the doctor will still be here and you can ask him your questions."

I then very efficiently discharged the patient to the lobby.

[Orange Tree]

Ugh. I am annoyed on your behalf.

[jadelpn, LPN, EMT-B]

You mean you CAN'T admit someone with a diagnosis of "One who does everything for Family Member (who, BTW, is an NP) just had surgery, needs some rest and Family Member is a PIA"????? Wow, that is just AWFUL....

[DizzyLizzyNurse]

Just wanted to say you have a great sense of humor and I like your writing.:lol2:

[Amanda.RN]

How annoying! ...I hate it when people do that. This was a well worded & funny read. Thanks for sharing! :)

[casi, ASN, RN]

Here's the million dollar question: What she actually a NP?

[Katie5]

Here's the million dollar question: What she actually a NP?

Who cares? Plus we might never know. Besides even if she was, it still wasn't her turf. Madame Nurse practitioner, LOL::)

[NurseLoveJoy88, ASN, RN]

This reminds me of a patients daughter who was a BSN student. I found it very hard to believe she was a BSN student because she called the tube feeding line an IV, refused to help do care for her mom( ie. helping to turn, and etc.), she thought trach ties had to be changed q2h and the list go on.

When ever a family feels free to tell me who they are , I don't even blink... who they are have NOTHING to do with me and how I take care of my patients. Whether they are an MD or cashier at mcdonalds, my patients will get the same care.

[EmergencyNrse]

I just LOVE the docs that do the million-dollar workup one test at a time taking 6 + hours and still can't make a decision... Turf it off to the hospitalist.

You know what you call the person that graduates last in med school?

Doctor.

[Orange Tree]

I've had a family member claim to be a physician, then ask me what penicillin was for.

Some people are just weirdos.

[classicdame, MSN, EdD]

I took care of a baby once. BOTH parents were MD's. They told me to treat them like every other parent and I did, explaining plans and procedures in lay terms. Because they were so concerned about their child it did more good than harm to "talk down" to them and we all got along fine. Wish all family members could be that way.

[Katie5]

I took care of a baby once. BOTH parents were MD's. They told me to treat them like every other parent and I did, explaining plans and procedures in lay terms. Because they were so concerned about their child it did more good than harm to "talk down" to them and we all got along fine. Wish all family members could be that way.

You know what's funny and amazing. Even with all the learning and being a doctor or a nurse, when it comes down to family, all of that vanishes- the objective thinking, critical thinking... out the window.

Panic or anxiety sets in first before you get to the calm mode again.