When doctors and directors attack!

[ThePsychWhisperer, BSN, MSN, APRN, NP]

Okay, so this is more of a rant session than anything. I'm not really looking for constructive feedback or commentary, but they're welcome if offered. So, within the last seven days, I've been pulled into the "Principal's Office" twice for different offenses (well, technically three, but one visit turned into a two-fer), and even though I'm still a relatively new nurse, I am already beginning to hate the politics of nursing. My visits for the week follow:

1.) Had a COPD patient arrive in my ED for uncontrolled nose bleed on 4L per NC. My patient was beginning to mouth breathe due to all the bloody discharge from his schnozz, so imagine when the NC wasn't doing much good for oxygen support. I ask the physician if I can place a nasal clamp on patient along with a Venturi mask with settings appropriate to attempt to maintain an appropriate O2 flow since he was already mouth breathing. Physician says no, didn't want to hyperoxygenate pt, and to keep him on the cannula. Physician later comes to me and asks if the patient's O2% was really 83% on arrival. Ummm, yes. You were in the room sticking a rocket up his nose; the O2 monitor never left his finger. You were aware of his decreased O2%. You stated you would rather him have not enough oxygen as opposed to too much temporarily. Long story short, physician emails nursing director of ER, tells her I knew the patient was hypoxic and did nothing... I'm sorry?!

2.) On the same visit, I am chastised about not documenting my home medications in, wait for it...a progress note, not findable by many, hated by all. The problem I have with this "standard of care" (as is touted by the director and the nurse manager) is this: we are not required to have the dosages or how many times a day this medication is taken in the progress note. We are not allowed to touch the med rec feature (you know, the thing doctors can easily find to write orders for patients...the thing that will bounce off of med orders that may create problems with the home meds the patient is already on). The progress note is also the responsibility of the nurse whose care the patient is dispositioned from (home, admitted, *cough* deceased). So if I walk into a crap storm left for me by the last nurse, I now not only have to play catch up for however long, but now I have to check the charting of the person before me? This is exactly why I choose not to precept, and now I am responsible for the charting of two or more nurses that are not new to the unit and should already have their heads on straight? Really? And finally...

3.) Now, I'll take responsibility for this one, as it was completely my fault. Had a patient with a STAT order of 1mg of Ativan for possible conversion disorder/seizure symptoms/didn't-really-know-what-was-wrong-with-him syndrome. I draw the med up, scan it, and attach syringe with med in it to patient's IV piggytail. Ordering physician walks in says "Let's start with 0.5mg." I administer said 0.5mg. Physician states "We may want to hold onto that other 0.5mg for a few minutes, just in case we need it." Since the last time I held onto something for "just a minute or two," I ended up with Demerol and Phenergan squirted into my scrub shirt pocket, I taped the needleless syringe to the back of the sharps container, completely out of sight with every intent of coming back and wasting the remainder after the patient was admitted. Needless to say, it was so out of sight that I forgot it was there, and it was found in the morning by the peeps that change out the sharps containers. I know this was a boo-boo, not only for leaving a drug like this in the patient's room, but also for not wasting a controlled substance. I'll take my lumps for this one, because I did what I did, really against my better judgment. But the other two? I'm calling complete shenanigery.

Rant over. Thanks for listening/reading (possibly judging). *Breathe in, breathe out*

[applesxoranges, BSN, RN]

That's why I have started to document stuff in communications. Informed physician of blood sugar of 420. Informed physician of x, y, z and received verbal order for a,b,c. Physician informed of patient wanting more pain meds. Physician informed patient is trying to bite RN. Whatever. Most ER physicians are not petty thank god.

I will waste my meds immediately. I don't hold onto narcotics. I don't care why. Unless it is a vented patient I am having trouble managing and it's fentanyl or some other medication to help calm them down. I really hope the other day I hit all my fentanyls.

[Nonyvole, BSN, RN]

Boo. Feel you, completely and totally, on having to catch up on other people's charting.

And something that I'll do when I've a partially-used dose, or don't want to worry about a syringe in my pocket? Scribble some identifier on it, ie "0.5 ativ rm 23 1330" and then tape it to my thigh. I then know what's in it and who it belongs to, and don't have to worry about it accidentally being squirted out in my pocket. (Two pieces of tape - one over the barrel, and one over the plunger that is pulled back enough to have a decent amount of air in the syringe.) (yes, people laugh, but it works.)

Oh - and sure, it says nasal cannula, but I'll put that sucker in somebody's mouth if I gotta. It works, although I may have to bump the O2 up by 1 LPM or so in order to maintain the patient's sats.

[ScrappytheCoco]

Every time there is something like scenario #1, you need to chart "Dr. Liar made aware of blah blah blah, no orders received."

Every. Single. Time.