Vent: MD visitors who are NOT intensivists

[Rabid Response]

This has happened to me so many times, but today I nearly lost it. I absolutely hate it when an ICU patient has a visitor who is a doctor but not an intensivist and who grills me on the patient's condition, makes stupid comments, and expects me to carry out ridiculous and often dangerous interventions at their behest. Often these MD visitors are so old that they probably can't remember their ICU rotations (if they even had them). I am sorry, but being an opthamologist for 40 years in a private office does not give you much if any insight into how to care for vented patients, titrate vaso-active drips, run CRRT, etc...

Today I had a pretty good shift until one of these idiots interrupted my report to the oncoming nurse (24 hour visitation at its finest) to tell me that my patient needed to be NT suctioned. The patient was extubated yesterday and has a history of being reintubated within a week of each extubation. I know he sounded awful (like he was gargling phlegm), and I had been suctioning him with the Yankauer pretty much every hour all day with little result. Really I think he needs a trach, but the family cannot accept that he is not improving. Normally I would have no problem NT suctioning someone like that, BUT in my facility you need an order to NT suction AND the guy was on a heparin drip so one nick to his mucuous membrane, and I'd have a throat full of blood as well as phlegm.

I told the visitor that I could not NT suction the patient for the reasons I just mentioned. He basically accused me of letting him choke on his secretions. I told him that the sats were 100% all day on 2 L NC, he was coughing up and swallowing most of his secretions, and that I had been suctioning every 15 minutes (could not leave the room; thank god he was CRRT/drips 1:1!) for the past hour (after wife gave him "sip" of water!), and that I could not do more. Then he started grilling me about the most recent lab results with questions like, "Is he still anemic?" Well, DUH. The patient has had a hemoglobin of 8 for the past MONTH, and this visitor was here yesterday, so I hardly think he has miraculously bounced up into the normal range overnight! Gah. The questions went on and on, each dumber than the last. At least he did not TASTE the patient's oral secretions (that's right folks) like the last annoying MD visitor I had issues with.

Ugh. You had to be there to see how annoying this guy was and how he was totally showing off for the family members who were there. Usually he insists on talking to one of the attendings when he visits (they are equally annoyed by him), but today I clocked out before he escalated to that.

Sorry, just had to vent. This has happened to me at least four times in the last month. Sometimes they merely phone the unit, and I have to spend 15 precious minutes explaining IABP to an oncologist from Iran or something equally ridiculous. Bah!!!!!

[guest239592]

I work in a large high risk CVICU. I haven't had this issue before with MD visitors, but have definitely had this issue MANY times with family members/friends of family who are nurses, physical therapists etc. etc. Like your situation, these family members work in clinics, nursing home, rehab etc. etc ie: Basically have no clue what's going on. What makes me laugh the most is when they'll just stare at the monitor when the pt has a Swan Ganz Catheter (basically every pt of ours initially) It makes me chuckle because you can look at the dang thing all you want, your still not going to have a clue what it means. They'll say things like, "Oh his blood pressure is high/low" or "oh his heart rate is kinda fast" It's like, uh ya, he just had his chest ripped and sawed open, those numbers are going to be a little off for a bit from what "our normal" is. I just wish these people would say, "I'm a nurse, but not an ICU nurse so I really don't know what's going on, is he/she doing ok?" I guess for these people thinking they know something/suggesting something maybe gives them back some sense of control they may feel they have lost with their loved one being in this situation.

These are some of the reasons I switched to straight nights a few months ago (not that we don't have annoying family at all hours of the night, we have a 24/7 visitation policy, argh...)

Rapid Response, I feel your frustration.

[General E. Speaking, RN, RN]

Rabid Response: I have to say I feel your pain and love your screen name.

[guest239592]

Thanks, your screen name is pretty clever too!

[sicushells, RN]

I wish there was a "Shut Up" button- like an "Easy" button, y'know? And when the 75 year old physician tells me my chronically critically ill patient can't possibly be adrenally insufficient I could hit the button and finish working, and then teach him about critical care. *Sigh* a girl can dream I guess.

[llltapp]

I'm sitting here laughing so hard at the OP and others. I WAS that ED nurse in the ICU with my 17 year old son who was literally on the edge of death for a week. The first time I went to the unit, I told the nurse (who recognized me as a nurse), yes, I am a nurse, I work ED, but I don't know CRAP about ICU, and I know LESS THAN CRAP when my son is involved so please talk to me like a 2 year old :).

Of course I knew more than I thought I did, but, the nurses were great. Wonder what they said behind my back LOL

[getoverit, BSN, RN, EMT-P]

Great post! I feel your pain too!

we had a similar experience a couple years ago but the visiting doctor (and I use the term loosely) asked to see the chart. I said "no", she got indignant. then she ordered a medication, she didn't have privileges at my hospital (and I'm not sure she has any privileges anywhere). I not only said "no" again but also advised her that our conversation was drawing to a close. It ended up with her leaving before she was escorted out.

We don't have open/24 visitation and I'm so glad. I truly feel for you guys.

and godfatherRN, a lot of times the people that present themselves as "nurses" turn out to have been CNAs about 15 years ago in nursing homes, etc. Not that there's anything wrong with that, but if that's your healthcare experience then you are out of your league in the ICU with vents, drips, etc.

[RN1980]

or how about med or pre med students that becuase they scored exceptionally high that they can impress you and their friends with fancy questions. in the begining i use to give them slam dunk answers that left them puzzled, or answered thier questions with another question. now i've grown bored with them and have found for better time management to give simple direct answers.

[Darkfield]

We don't have a 24/7 visitor policy, but a lot of people slip around the visiting hours. Had an especially sassy nursing student visiting her dad-started playing with the iv pumps, taking off his restraints, took off his bi-pap.

We had a woman with rheumatoid arthritis who went into ARDS after an abdominal surgery and was on the oscillator forever, and when she finally graduated back to the regular vent, we changed her settings at least every eight hours because her ABGs were so screwed up. After about a month of this, her family doc came in and talked to the attending. It was morbidly hilarious to hear the conversation; like talking to a brand-new doc. He just kept asking, have you cultured her? And nothing on the results? But have you cultured her?

[BittyBabyGrower, MSN, RN]

We get docs babies in our unit and thankfully they aren't supposed to be in there without the parents, but the occas one slips by because their name badge gives them access to the unit.

We just say to that doc, "Now, you know I can't discuss his/her condition with you, that violates the privacy law. You can talk to their family members about XYZ." Then we report them to our manager who puts the cabash on their ID badge lol

[edogs334]

In my unit, we have restricted visiting hours from 7am-9am and 7pm-9pm specifically so the nurses can give uninterrupted reports and complete uninterrupted assessments (without family member interference). The only exception to this rule is if the patient is actively dying or if our nurse manager makes an exception for a specific patient/family. If this guy were in my unit interrupting my report, I would say to him that that patient's sats are 100%, that they aren't in any distress or having SOB, and that I would get to it in a few minutes after giving report. If he still complained, I would explain our visiting hours policy and that he would need to leave during these hours- no exceptions. Don't get me wrong, family visitation and involvement is important to the patient- especially in the acute phase of their critical illness. But some family members think they can practically get away with anything in terms of the demands they put on the nursing staff. Especially when a nurse has two vented, busy patients- some family members need to get it through their heads that we can't pay attention 100% of the time to their loved one- unless they are acutely decompensating (or are about to do so).

I once had a non-ICU nurse ask me what a particular antibiotic was for. I stated what it was for and that the infusion had since finished. She said something like "well, it looks like it hasn't because it's still dripping." What she was really seeing was the small remainder of the fluid in the secondary bag dripping because the secondary roller clamp was still open and the primary bag was still lower than the secondary- even though the pump had switched back to the primary basic infusion a long time ago. Hence the pump was still pulling fluid from the secondary due the the effect of gravity in relation to the position of the primary bag.

[mskate]

I came out of my 1 patients room and into the other to find a young woman flipping through the chart that she brought into the room. She started trying to quiz me on things and before I answered anything (and after i grabbed the items from her hand), I asked her relationship the patient and her medical background... "Oh, I'm his neighbor and I'm a pre-pharmacy student." *SMACK*