R U annoyed by some ancillary staff too?

KarynicaRN · Aug 12, 2009

Situation: I am finishing working an eight hour night shift. It is 0715, I am done in 15 minutes. I usually don't care about getting out on time, but my facility is asking people to "please finish your duties on time and do not accrue OT". I have a pt. in one room who Occupational Therapy is going in to see, but there is only one of them and she is a max assist of three. I am imagining him dropping her on the floor. In another room, a pt. who is trying to finish her second dose of barium has begun to vomiting despite having received zofran. Also, a CNA has just informed me that another pt's saturation is "lower than usual".
How I thought I'd handle it: Poke my head in the door of the room with the OT staff who is about to make a huge mistake and inform him he needs more help, thus averting a "fall" occurring on my watch and even more importantly, avoid an injury to him or the pt. Then get to the desaturating pt., check their oxygen level. Once that is solved, go to the pt. with N/V due to barium, inform them they don't have to finish the second dose and inform CT.
What actually happened: Cant find a pulse ox to check the saturation of the pt. I am most worried about. Run around like a mad man trying to find it. All the while, the nurse replacing me is taking her time going through report (she has not even started yet). Said nurse then informs me the CNA who just left (yeah, same one who told me "That pt's saturation is lower than usual, but I dont remember the number exactly"), didnt do her daily weights and they need done, the doctor who is known for flipping out about this is just down the hall. I see Respiratory Therapy approaching, figure I will use their pulse ox and proceed to poke my head in the door to warn him the pt. he is working with is too much for one person, he should call for help. His response "I need help with this pt. then, you need to get the bedpan for her and help me move her." I tell him I have issues in other rooms and cant spare any time at the moment. The response "So what, I don't care, get in here and help like U R supposed to." At this point I try to tell him not to squabble in front of the pt. and that I have pressing matters I need to attend to. His solution, instead of contacting his dept. to get help, was to throw a hiss fit, cursing and swearing in the hall "Unbelievable, never in my life, anyone around who can help this guy, ALL HIS PT'S ARE DYING AND HE NEEDS HELP, SOUND THE CODE ALARM." So I ignored him and continued with my plan. Checked the guy, and yeah, he was 88%, fixed that with Resp. Therapy. Then checked the vomiting pt. She was alright, CT was contacted and not worried about it. Then as I am updating the nurse who is coming on (she just decided to listen to report about the time the OT guy was throwing his temper tantrum). As I am updating her, the OT guy is storming the halls screaming about lack of teamwork.
Now what gets me here is, how ancillary dept's always end up thinking they are the only one's with duties/responsibilities to manage. Whats even best is, nurses don't have the luxury of approaching one pt at a time. We have a team of 6 patients, and must attend to them all at once, round the clock. Can't just hide in one room and pretend the world begins and ends at the door. But other dept's (PT/OT, security, housekeeping, radiology.....all of them) throw temper tantrums when we cant drop everything and attend to something they want done.
I didnt write him up, I wanted to sleep on it, but I will be when I return tomorrow. As much as I am against writing people up, this guy needs to go.

yes, ancillary staff and physicians who show up late at night unannounced make me crazy. They think we are supposed to stop everything and run to help them. I was in the middle of a med pass, which has to be done on time btw, and a person I had never seen before walks up and asks me where she can find a certain resident. I didn't want to come across harsh, but I asked her who she was. She says "oh I am Dr. So and So and I am the Podiatrist here cutting toenails"... at 8pm at night. Why on this green earth she didn't come to me and state that she was in the building is beyond me. I know how you feel about staff that thinks we are supposed to drop everything and run to help them because we have nothing else to do. HMPPHHHH! :banghead:

NurseKatie08, MSN · Aug 12, 2009

The therapists on our TCU seem to think they are God's gift to the Earth at times & that no one else could possibly be busy.

Most of them take to grabbing seats at the nurse's station right at change of shift when we are trying to get report. You should have heard them talking under their breath the day our NM came out and told them all to clear out as it was change of shift and the nurse's needed seats to have their report.

Also, my particular favorite (since I do evening shift, which is when my floor gets 90% of our new admissions) is when the therapists try grabbing the new admission charts and start writing plan of care orders before the nurse has even had the chance to review the referral, talk to the MD or NP and write the admission telephone order. Some of them even have the nerve to huff and puff when we ask them to wait a second while we write the order, because imagine that, you can't always drop everything and get right to admission paper work when you have anywhere between 6 & 8 other patients besides the admission that you're taking care of at once.

Bit of a long night tonight...gotta love when your 3-11 shift ends with you clocking out at 12:45am.

cjcsoon2bnp, MSN, RN, NP · Aug 12, 2009

In my opinion the OT was being completely unprofessional and you should take the necessary steps to have them written up for what they did. I can say if I was that CNA I would not have left until I was sure that I saw you come in the room to deal with the destating patient, I would have also redone the pulse ox to give you a solid number not just some guess. True enough that its all about teamwork (especially in a multidisciplinary setting like a hospital) but we all need to play fairly and work together and it sounds like none of the people you encountered were doing their part to work as a team.

!Chris :specs:

locolorenzo22, BSN, RN · Aug 12, 2009

I would say to write him up....it suprises me how when docs and other departments are around, I'm expected to stop what I'm doing and do everything right then....or (this is classic)....

a doctor came in to see a patient(the patient has been there 2 days, stable, nothing urgent going on), grabbed the chart, asked "who has the patient in room 432432?" Now, I'm off seeing my patient who has had chest pain for the last 3 hours, didn't say anything to the day nurse, and I'm running trying to situate her, and see my other patients while labs are drawn and EKG done.

The other nurses didn't hear him right away and he says "does this patient even HAVE a nurse?" they say "oh, lorenzo has him, let us go find him, give us a minute." I'm hopping room to room at the end of the back hall(farthest from the station)...took them 5 minutes to find me...after 2, he's down there saying "find the charge, this patient DOESN'T HAVE a NURSE!"....

I get down there, no idea this has been happening(found out 5 hours later), let him know we needed some sort of dvt medication, he ordered Coumadin, I told him she'll go to a nursing home tomorrow due to transportation issues(it's 9PM), and he says ok....

just cracks me up...gotta love it.

StNeotser, ASN, RN · Aug 12, 2009

Wow, I think I've had some of the same experiences. Unfortunately the rudest dept is therapy. In my last job they would grab a new admit chart and start leafing through it because I' went to do something and then I would spend ten minutes looking for it. They also bag all the chairs and it doesn't matter in who's room you're in they will find you to tell you that a patient needs more pain medicine prior to starting therapy and why didn't you give it. Ugh, maybe because who knows when you guys will show up and to which patient?

They don't work Sundays which is great.

This OT was a jerk and you probably do need to say something.

netglow, ASN, RN · Aug 12, 2009

Yup, noticed this as a student. Everybody is a "cardio/thoracic surgeon inbetween open-hearts" aren't they. At one clinical site, the RT's had just a bit of an undeserved swagger, and ability to become scarce on a lark ("I'm with a patient" meant I'm in the coffee shop too much- you actually hear, "skim, no whip") seems that at that site, they were a little too much the independent contractor.

eriksoln, BSN, RN · Aug 13, 2009

I didnt have to write up an incident report. Manager called me in the office, said she wanted me to have a phone meeting PT/OT.

Seems the pt. reported the OT guy already. They are investigating possible pt. abuse by him concerning this and another incident at the same time.

StNeotser, ASN, RN · Aug 13, 2009

Good I'm glad. It was totally unprofessional and abusive behaviour towards you.

Virgo_RN, BSN, RN · Aug 13, 2009

RT forgot to put end stage COPD patient back on his O2 after a neb tx. I was in the room preparing PO and IV meds, and noticed when the patient started to convulse and gasp like a fish out of water. I had just started IV abx, so at first I thought that was it, but when I went to check the O2 flow, saw that it was not even on.

Immediately turned NC (because our simple masks are not even in the room, and I wanted to get him on Os *immediately*, and the NC was right there) up to 6LPM, attached pulse ox. He was at 78%, and immediately started to gain. Our orders were to keep him at 88% or better (CO2 retainer). Since his sats were coming right up with the NC, I saw no need to go grab a simple mask.

About the time he was up to 84-85% and his distress was visibly decreased, RT came back into room, saying she had remembered that she had not put him on Os. She then asked me how much O2 I had him on, I told her 6, and she began to lecture me about how NCs don't provide adequate O2 flow past 5LPM, and we should put him on a simple mask. I ignored her and continued to reassure the patient, with my hand on his shoulder, as we watched his sat climb steadily back up to 88%.

He was back up to 90% when the RT brings the simple mask in and proceeds to place the patient on simple mask. I informed her that he was already recovered, and our orders were 88%. She ignored me and switched him over to simple mask at 10LPM for a couple of minutes, while I bit my tongue because I really wanted to tell her to get away from my patient and get out of my room.

Later, she had the gall to confront me about an inhaler I had charted on. It was a once daily inhaler, which he had been given prior to admission that day, and should not even have been on the MAR. So I charted it "not needed" and in the comments, wrote that he had already had it that day. Perfectly acceptable for the admitting RN to do. She accused me of having charted it "given", which only RTs are allowed to give inhalers unless the patient has an MD order that they may self admin.

I didn't write an incident report, because IRs are not supposed to be punitive, and I was majorly ticked off, and writing it up would have been out of anger.

But now I am thinking I might write it up anyway, because this is not the first time I've had to deal with RTs coming in and doing things that interfere with my patient care. There have been many instances where I have a cupfull of PO meds that I am preparing, and the RT will swoop in and start a routine neb tx, causing me to have to wait at least ten minutes before I can give the pt. their meds, or when I call for a PRN for a patient who's having some difficulty, they'll tell me they won't be able to come for a couple of hours because they're busy.

nerdtonurse?, BSN, RN · Aug 13, 2009

Pitching a fit and swearing in front of the patient?

NO, no, got to go.

eriksoln, BSN, RN · Aug 13, 2009

He was also very rough with her when he put her back to bed once he realized I was not there to be his assistant. Thats the issue his and my manager had with him. Apparently, he's had a number of complaints that when he is in a rush or it is the end of the day, he is very rough. This was the last straw I guess.