I have a two nursing degrees, going for a third and have a whole lotta common sense. When I see stupid or hear stupid orders I may or may not carry them out..here are my all time favorites:
1) Male patient with active lower GI bleed...HGB of 5...Hypotensive and tachycardic..has 2 large bore IVs running with NS wide open as fast as it will go...blood bank working as fast as possible to get me my units of PRBCs ASAP...BP barely 90 systolic.
Order from resident: "We need orthostatic vitals on this patient"
I work in pedi and the moonlighters are generally ICU residents/fellows from one of the larger area childrens hospitals. Some are NICU residents. We have a couple of excellent ones, but for the most part theyre just ok. I had a little guy who was very easily dehydrated and his feeding tube was leaking badly. It had gone on for almost 12 hours at this point and the doctor initially wrote to turn the rate down to half of what it was so it wouldnt leak as much. Well, his heart rate was around 200, RR up, very pale at this point, crying and agitated intermittently from pain and all his meds just leaked out the tube so I couldnt even get him comfortable. I said ok, so what about an IV? He said, Im a NICU doctor and I couldnt get an IV in him because he has too many rolls. Ok, what about sending him out to the ER so he can get a line? He said no, he didnt want the child getting stuck by an overnight staff who didnt know what they were doing, hed rather wait for day shift to come in because dayshifters are the experts! OK?? Not only did that comment not make any sense, but it still didnt solve the problem of how to hydrate him. He wrote to turn off the feed and insisted that the patient wouldnt get dehydrated. I argued with him saying Id had him before with this problem and he got so behind he needed IV fluids for hours to catch up. Hes a very medically fragile and complex child. He said to me, okay again, hes not going to dehydrate in the time it takes to send him out in the morning. Oh okay, but what about the other 12 hours hes had minimal hydration?? He then asks me what I want to do and I said I wouldve sent him as soon as this became a problem instead of waiting til the middle of the night. He insisted he would be sent out right at 7 for a replacement even though he hadnt talked to anyone from IR or the receiving hospital. That poor baby sat with an elevated HR all night without a wink of sleep and naturally didnt get shipped at 7. He was thirsty and kept going for the wet facecloth to suck on. The medical director ended up being able to get a line in him thankfully, because he didnt leave for a replacement until the afternoon. I absolutely love my job but sometimes the moonlighters scare me.
Specializes in Quality Nurse Specialist, Health Coach.
ED doc ordered d/c instructions for post-cath patient: "Do not drive for 2 days." What's so funny about this is the patient is an inmate in a prison...Don't drive what? His wheelchair? We all got a kick out of that one!
Patient in SVT, connected to cardiac monitor, EKG machine and the crash cart. Doctor orders Adenosine 6 mg slow IV push over 2 minutes. Needless to say, it didn't work. I wasn't the patient's nurse, but my colleague told me about this when I came in to bring her a patient from triage.
I work hospice, and in order for a patient to qualify for services, they have to have an illness or combination of illnesses that will limit their lives to 6 months to a year. So a doc wants a patient on hospice. "What diagnosis do you have?" I ask. Doc says "Why do you need a diagnosis? She's 98 years old! She is going to die soon." I said "Well, yes, she is very elderly, but I need a concrete diagnosis and I need you to write it up on an order sheet." So the brainiac writes "Evaluate and admit to hospice services. Diagnosis: Old". URGH!
How about the pregnancy test insisted by an attending ( yes, that's right, attending!) on a 68 yr old nun? P.S. that MD no longer works for my hospital.
Scooty Puff Jr
117 Posts
Order from my NICU days,
On a vented term infant with no sedation ordered. "calm the baby PRN."
Freakin' genius I tell you!!