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So disappointed in hospital RNs and MDs

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Not sure what happened...continued from above post...

I also do find the occasional enthusiastic student who does all the things I used to as a student. Those are the ones I find enjoyable to teach! The others go through the motions but will get minimal input from me.

I primarily precept on my unit so I do enjoy teaching. I find you only get what you put into it! Just because you want to do OB or peds doesn't mean your ICU rotation can't be awesome too! We want you to learn & experience stuff that only our unit has to offer, seize the opportunity with both hands!

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VANurse2010 has 6 years experience.

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This is one of the worst rationalizations for poor care that I have seen. Regardless of whether an individual doctor does this, it's still the nurse's responsibility to do a proper assessment, and to document this. This documentation is evidence of the nursing care that the patient has received, and of the patient's condition at the time of documentation. How does a nurse advocate for their patient if they don't do a decent initial assessment and chart this? Don't you compare your initial assessment with what was reported to you from the previous shift, and to the patient's baseline, and observe for changes during the hospitalization? What do you base the rest of your care on? Don't you monitor your patients conditions for changes and document accordingly? Don't you need that documentation when you have to advocate for your patient's needs with the physician? How can you properly advocate for your patients without proper documentation in place? And yes, physicians do review the nurses assessments/notes when they make decisions about their patients.

And please, don't sink to the level of personal insults when you reply to me.

As nurses, don't we want to demonstrate our value to our patients? No wonder, with such attitudes, why nurses are being looked on by some as superfluous to patient care. If a nurse doesn't even recognize the value of his/her assessments and documentation, and behave with the knowledge that these are valuable to the patient and to the delivery of patient care, why should anyone else?

I really don't appreciate your projecting my comment as a "rationalization of poor care." You are way out of line. I am simply stating what I have found to be true. Get off your high horse and stop being so dishonest.

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calivianya is a BSN, RN and specializes in ICU.

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It's uncommon to rare that a doctor bases orders off a nursing assessment. It depends on the facility and the culture there-in, but as a blanket statement that's flat out untrue.

I call physicians every single night usually, sometimes multiple times a night (sometimes more than once an hour, depending), to tell them what I see and hear and I get new orders based on my assessments all of the time. This is a really floor-dependent statement. This is why I like ICU - the physicians seem to actually act on nursing assessments. It's a good collaboration.

I saw totally different things when I did my clinicals on the floor. I feel like floor nurses often have less interaction with physicians, so the physicians don't develop a trusting relationship with most nurses, and then they dismiss the nurses' concerns... which is a whole different can of worms. Either way, the physicians are definitely writing orders based on my verbal recitation of my assessment findings. I have yet to see anyone write orders based on my have to be q4h on the dot, whether I'm in the room or not, charting.

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calivianya is a BSN, RN and specializes in ICU.

2,418 Posts; 35,807 Profile Views

Back to the main topic of the thread, the team leader pulled me aside the other day to tell me I'd missed charting a turn from the shift before and to go back and fix it. There was no, "Hey, did you turn this patient at 1 AM?" and even if there had been, does anybody think I'd actually remember what precise time I did it? No verification of whether care had happened or not... just a request to go put in some charting. So much for charting being based on things you actually do. My facility does not work like that.

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dudette10 has 9 years experience as a MSN, RN and specializes in Med/Surg, Academics.

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It's uncommon to rare that a doctor bases orders off a nursing assessment. It depends on the facility and the culture there-in, but as a blanket statement that's flat out untrue.

I took this to mean that it's uncommon for a doctor to look at a nurse's charted assessment and make orders based on that. Where I work, they can't even see our assessment without a number of clicks on links with titles that don't even relate to nursing assessment. I had to show an attending where he could see the part of our flowsheet related to wound care because he had never done it (an attending that has been there umpteen years!).

A lot of people took this post differently than I did. Oh well.

However, docs do indeed base orders on our assessments...pain management being the most obvious one. They just don't look at the charted head-to-toe assessment.

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68 Posts; 1,952 Profile Views

In my experience, in practice, complaints are not welcome, and are not received well.

Amen! I reported a physician who chose to scold me in front of coworkers for performing an EKG on a pt who had just arrived via EMS because now he had "to handle it." Apparently an EKG wasn't indicated given that EMS initially indicated that pt only had a seizure. While assessing the pt and getting report from EMS, it was revealed that family members called 911 when the pt "had a seizure or something" and they performed CPR.... The pt was lethargic, extremely distended abdomen, diaphoretic, and pale so I did an EKG. Needless to say that the rhythm was irregular, what you'd expect postresucitation.

After getting lectured by MD for doing an EKG for a seizure (before MD even laid eyes in pt), MD ordered Zofran for pt's nausea. As I'm drawing up Zofran, pt starts puking. As a coworker and I attempt to maintain pt's airway due to vomit pouring out of pt's mouth and nose, I yell for someone to get MD because pt wasn't protecting airway and needed to be intubated. MD literally stood in doorway as I and other nurse were suctioning pt and attempting to place an NPA while pt is vomiting everywhere just to scold me again for calling for help because I didn't "need a doctor to give Zofran." Five minutes at least of being "schooled" by this jerk rather than just listening to me. I let MD say his piece but reiterated my concern that something was really wrong with the pt and pt needed to be intubated. "Then ******* give Reglan"....

I can't describe how embarrassed and furious I was. Needless to say, less than 10 minutes later, I called a code when pt, brady'd down, became unresponsive and arrested. Turns out pt had a bowel resection a week earlier and developed an obstruction. Pt was vomiting fecal matter and aspirated. We ran the code for 20 minutes, MD finally intubated pt, but we ended up calling the code.

I reported the MD to my NM. I was assured that the complaint would be communicated to medical director and handled. I don't know if pt would've survived even if this doctor hadn't blown me off, but this MD's behavior was nothing short of negligent. I never heard about how this was handled or if MD was ever disciplined, but this MD still works in the same ED....

That day changed me as a nurse; it jaded me. I got a crash course in how incompetence can cause pt harm. I'm definitely more assertive, almost to the point of annoying when warranted. I gained confidence in my assessment skills, but also learned that not everyone shares my confidence. Some people suck, and at the end of the day sometimes it comes down to CYA. I've learned to use my photographic memory to document, document, document.

Edited by Esme12
TOS/profanity

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SRDAVIS has 10 years experience and specializes in Tele, Stepdown, Med/Surg, education.

140 Posts; 6,781 Profile Views

I can't believe this conversation. I am a float pool nurse and I do a full assessment including VS ( Bp and pulse) at the beginning of every shift. I do this before I give medications. I'm not sure what everyone is talking about but it takes 5 mins to do a full assessment. If they have a lot of lines, drips and drains a little longer but at that point you have fewer patients. I also reassess my patient by doing a focused assessment. Now I have to be honest I almost always leave 45mins to an hour after my shift. But I do drive home knowing that I gave the best care that I could and IF I missed something it was not due to my negligence. I'm saddened and a little embarrassed by this thread.

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SRDAVIS has 10 years experience and specializes in Tele, Stepdown, Med/Surg, education.

140 Posts; 6,781 Profile Views

Or leave the bedside. People are depending on us.

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sofla98 has 14 years experience and specializes in Peds, PICU, NICU, CICU, ICU, M/S, OHS....

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It's unrealistic with the current trend of high patient loads to a single RN in addition to the customer service focus most facilities are pushing for a complete assessment to be done in the beginning of the shift on each and every patient. Quick, focused assessment based on admitting diagnosis and the remainder in bits and pieces throughout the shift (skin when turning, etc) seems to be the more common method according to nurses I know who work/have worked on the floors (I've never worked on a floor). However, to never assess lung or bowel sounds does sound unusual.

Speak for yourself! I do a FULL head to toe assessment Q 4 Hours, every time I work on EVERY patient. And I work on a very busy unit with alarms blaring, vents going off every 5 seconds, someone needing something, etc. Skipping out on BASIC nursing skills is ridiculous and there is NO excuse for it.

Sounds like the OP's friend received extremely poor care and if it was me or mine? I would complain to the board of health and the Joint, whom ever would listen to my concerns...JMHO.

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sofla98 has 14 years experience and specializes in Peds, PICU, NICU, CICU, ICU, M/S, OHS....

64 Posts; 2,558 Profile Views

I can't believe this conversation. I am a float pool nurse and I do a full assessment including VS ( Bp and pulse) at the beginning of every shift. I do this before I give medications. I'm not sure what everyone is talking about but it takes 5 mins to do a full assessment. If they have a lot of lines, drips and drains a little longer but at that point you have fewer patients. I also reassess my patient by doing a focused assessment. Now I have to be honest I almost always leave 45mins to an hour after my shift. But I do drive home knowing that I gave the best care that I could and IF I missed something it was not due to my negligence. I'm saddened and a little embarrassed by this thread.

You're not alone! I cannot fathom ANY situation when it is NOT OK to do a full assessment, regardless of how busy you are, patient load, etc. People need to learn to multitask and manage their time better. I can do 2 or 3 things and knock it off my list when I need to.

Not assessing patients but charting you did?? That is fraud and dangerous practice. It's not even bad practice, it is just BAD!!!

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138 Posts; 2,311 Profile Views

I just finished my 1st semester of nursing school and during clinicals I never saw anRN do any kind of assessment. I seriously could not believe it. And I was there during shift changes every single time.

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51 Posts; 3,898 Profile Views

I ALWAYS ALWAYS ALWAYS Assess my patients! It may not happen in the first hour, but it ALWAYS happens. Focused assessments may happen first, but my Head to toe always happens prior to actually CHARTING my head to toe. Basic nursing skills.

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