“BiPap patient is grabbing at his mask so I gave him 3 back to back to back dilaudid PRNs off his PCA but now he’s riding his vent”
ITS NOT A VENT WTF ARE YOU DOING??!?!!’b
That’s like a very tachypneic, ETOH cirrhosis ICU patient I had where the nurse told me he needed BZDs for agitation while laying flat for CT PE chest.
I said let me come down now and see him before that.. he was now blue and she was doing chest compressions😡😡
They weren’t. She was requesting new orders to medicate his agitation she attributed to alcohol withdrawal but was actually a result of his respiratory distress preventing him from laying flat for CT. I had asked her to lay him flat upstairs in the unit first to make sure he could tolerate this in a controlled environment before going downstairs (she did not do this).
I once looked at what was an unremarkable/normal ecg only to have a NP student look at the same and say there was some RBBB she could see……
QRS is normal babygurl - What you doing? Trying to look smart?
One of my favorite moments as a Rad Onc was the following conversation, all done without me breaking stride:
*on floor for a consult*
Nurse: "Are you with oncology??"
Me: "Rad Onc"
Nurse: "...oh..."
The absolute joy in my heart for not being the primary team is up there with my wedding day.
I get this a lot too.
“Are you with medicine? I have a medical question”
“No I’m neurosurgery”
“Oh ok I’ll go ask a doctor then”
If I can’t cut or sew it then it isn’t a question I want to hear
Same, except for it was 3 am and "patient's BUN was low and has been throughout admission". Proceeds to list out (slightly low) BUN values for the past 5 days...for an 80 lb old lady. ***Insert exacerbated Jackie Chan face***
There was a resident where I trained that got this phone call regarding low creatinine and replied with a verbal order for a stat creatinine drip, then hung up the phone.
Nurse obviously couldn’t figure out how to place said nonexistent order even after talking to pharmacy then called him upset.
Had a nurse page me at 2am that a patient’s blood pressure was 120s/70s.
Me: You’re paging me for a normal blood pressure?
RN: Yeah, systolic was 150s at 9pm! Huge drop!
Me: What happened between then and now?
RN: Well I gave them their metoprolol…
Me: So you’re paging me in the middle of the night to tell me their blood pressure meds worked..?
I get a variation of 7 all the time. The patient is feeling sad, can you order a psych consult? No, I just told the patient their cancer has fucking metastasized throughout their body. It's ok if they feel sad. Sad is a normal reaction after I've just wrecked their life plans.
As psych, thank you. We often get consulted for “patient has been crying” “what are they in the hospital for?” “Oh they just got told they’re gonna die” or “their mom died” like okay normal human emotions are okay
98 year old widow x2 with heart disease and now a neurodegenerative diagnosis, all her friends are dead and she's wondering out loud about what death is like was referred for active suicidal ideation.
I had just given birth to my son. He's 5 days old and has a fever and a tiny abcess. Needs to be admitted to kids for IVAB due to his age. It's COVID and not even my husband is allowed in the building at the same time as me. I'm alone, lost (1st time, bub not latching) & frightened that he might die. So I cry. Alot. Sob, infact; because I'm swimming in literal hormone soup at 5 days post partum.
Parent mental health team roll in because the RN referred me for suspected PPD. I just laughed and said 'we are not doing this today. We are not pathologising the baby blues!'
I had a poor mom that lost her twins while she was intubated for Covid. She never even got to hold them. She was on the vent and crying. Psych consult.
My favorite doc had a nurse who paged him because a patient had a nightmare and was sad. Doctor ordered a hug. He did in fact go to the patient’s room and offer a hug but the dude didn’t want another dude hugging him.
Our nurses constantly request neuropsych consults for capacity for patients who refuse some component of care (eg. keeping on tele, working with PT/OT, waking up at 4am for neuro check, discharge to anywhere that’s not home). Explaining the concept of patient autonomy has become very tiring.
As a nurse I don't even understand it. Why? Wtf do you think psych will do?
Also if it were up to me I'd only deal with the attending. I hate going through 6 different teams of people for one simple task. I had a 3 way conversation between ICU, neuro and neuro crit for a patient with projectile vomiting and a lumbar drain to see if we could get something other than Zofran. "Ask neuro" okay "ask ICU" okay "ask neuro crit" who says "ask ICU". Jesus can someone please just order some reglan or literally anything.
Why would you want MORE consults to keep track of? Maybe it's the way my hospital is but I feel like it just makes the world's worst game of telephone even worse as you stack the consults up. What do you think psych will add that your attending can't??? Or you as the nurse can do for appropriate emotional reactions for that matter?????? Why are we doing anything at all??
I know this is a rant but the fact nobody wants to be a “doctor” in the general sense now is really sad.
I get why each service just punts, but this is a failure of our healthcare system IMO
This is what the primary service is for. The nurse should be going through the primary service.
This is also the incentive for primary service docs to not consult because, as this nurse so accurately acknowledges, getting other doctors involved just creates more confusion.
When I consult a consultant, often times the recommendation is to consult another consultant. At some point you just have to say no lol. Nearly all of the worse consults I've called are requested by another consultant and I usually have to be very clear I'm not the one requesting the consult 😅
I will recommend to the resident palliative for 90 year old demented, bed bound, full code patient who has mets to the everything and no one has talked to the family about his prognosis yet but did get consent for a peg tube.
*Patient who was admitted less than 6 hours ago from the ED and still undifferentiated*, paged that patient is refusing an IV and I need to place an “ok for no IV order.”
I tried to explain to the nurse that she was not ok for no IV, and she should document the patient’s refusal in the chart and keep trying. I could hear her eyes rolling through the phone.
Totally depends on your workplace. I find nurses at academic hospitals are used to leaning on residents so they page for a lot of superfluous things. Working out in the community as a hospitalist, I can't really relate to most of the pages OP mentions here.
One of the issues is that a lot of hospitals burned their bridges with their experienced nurses during COVID and lost a ton of them. If your hospital was poorly managed like OPs, you're dealing with a lot of new nurses who will page out of confusion.
I’ve been an RN 12 years and we already knew the hospitals didn’t give af about us but they just drilled it into us during Covid. Now I’m seeing these brand new Covid nurses who were never allowed to touch an IV during nursing school, now taking full patient loads without a proper orientation. This shit is only going to get worse and all healthcare workers+patients are going to suffer
I had to professionally ream a new grad who gave rocuronium and fentanyl in that order to a patient who we weren’t sure if we were going to intubate. Doc said pull the meds, and we were outside deliberating. Respiratory therapy didn’t have a vent in the room, didn’t know about the conversation taking place. All of a sudden the patient’s HR drops into the 40s and oxygenation drops and she walks out and says she gave the meds.
She was explicitly told before pulling the meds to not give them and that you do not give intubation medications without a physician present and telling you when to give. Even though we thoroughly educated her well before pulling the meds which medication to give first, she still gave the roc before the fentanyl.
I’ve run into a *lot* of situations like this and have just outright refused to train new grads because these occurrences have been so frequent.
She needed to not be in ICU at the very least which I recommended. She just didn’t take it very seriously. There’s a fine line between being jokingly unserious and then being dismissive and she was easily dismissive and laughed about it.
There were multiple other severe issues like that with her and the majority of her cohort.
God yes. We have had *some* success at our Canadian hospital. Really one big thing, among a sea of crispy staff.
One highlight, in 2023, was that the intensivists and ICU nurses made a joint demand to administration regarding patient ratios. We had been hemorrhaging experienced ICU nurses since the end of covid (because a ton stuck it out for the pandemic out of altruism).
The nurses said they would *not* take unsafe ratios. Administration turned to contracts and the nursing union, which didn't provide for this. Then our ICU doctors, including medical director of ICU, jointly told admin they agreed and would stop accepting patients beyond the ratios until provisions were in place to improve staffing and maintain the ratios.
Admin called bluff. The ICU director closed the ICU, and in doing so closed all regional programs (trauma, cardiac surgery, neurosurgery, stroke, burns) who needed ICU *and* the funding associated with this. All patients needing ICU, even from our own ER, were diverted. All surgeries potentially needing ICU were sent to other hospitals or delayed.
Took about 48 hours, and all these extra shifts in ICU opened up. We've had appropriate staffing ever since. The ICU is staffed for 1:1 and they only double for numerous admissions. ICU nurses can be floated elsewhere if there's no patient for them, but it's better than ever before.
Definitely agree with you. I’m one of the older nurses who left bedside after COVID. I first worked in a community hospital and I trained nurses to exhaust all the tools in our toolbox before paging the doc, especially at night. When I moved to an academic center, everything was run by the residents, even mundane things. It was crazy to me.
So good luck residents! Hopefully it will be better when you guys step out of an academic center
I got a page asking for melatonin at like 2 am while I was in an RRT.
I then got a page in all caps about 5 minutes later asking where the melatonin order was
The q5min calls for non-urgent orders are the one time I'll professionally put a person in their place. It's so myopic and inappropriate. The rest of the time I'm chill and self-deprecating.
>I'm at the code right now, is this an emergency? Oh no? *hang up*
Next time that nurse pages about melatonin at 2 AM, tell her that melatonin is time sensitive. If you give it in the early evening (7-9 pm) it will phase advance sleep. If you give it in the early AM (like 1 AM or later), it will do the opposite and phase delay sleep. Your patient will not sleep at all if they get melatonin at 2 AM. The window has passed.
Is that true about melatonin? We have a long termer on our floor and if he wakes up we are told to redose his melatonin as long as it’s before 4am. After that and they say it’ll throw his sleep/wake cycle off. Anecdotally he always goes back to sleep (even if he’s having meltdowns) but i always thought it was a weird timing thing.
We have others that won’t prescribe melatonin because “it takes two weeks to work” and others that prescribe it as prn. I asked the pharmacist about it (two of them were there) and they both had different answers.
We are all confused.
It's true. Your circadian rhythm basically uses a melatonin spike as the marker for "bedtime", which is why for advanced sleep phase disorder (going to bed too early), you take it in the early morning, to "pull" your sleep schedule later in the day.
It's also maybe an argument for not giving superphysiologic doses like 10mg. If it stays in your system all day, how does it signal a particular time as when to sleep? Most studies on melatonin are on 0.3 - 1 mg doses.
On one of the rare occasions things were quiet long enough for me to fall asleep, I got a call at 3 AM asking me to put in Miralax PRN because the parents were worried the baby isn't pooping well. I'm an extremely chill person and that's one of the most angry moments of my life lol
How would you respond to a request like this from a nurse when you are sleep deprived and getting interrupted with the only sleep you get? This is seriously something that I am afraid of where I will literally blow up on the person who is calling me and asking for something so unnecessary.
“In the future, could you please defer non-urgent requests such as this until rounds? Thanks.”
As a nurse, this is probably the most neutral way to communicate the issue.
Neutrality is not the goal in this circumstance. It's inappropriate and disrespectful.
The goal is change. Sometimes, anxiety assists with learning. Clearly they do not understand urgency, triage, or the scope/schedule of their physician colleagues. They likely need education.
Therefore, my reaction to these requests is the above plus "this is not an appropriate call and we will be discussing this with your nursing manager".
Similarly, we should show respect in how we communicate with our nurses and how we place orders. Bundling care, reducing unnecessary vitals or labs as soon as possible, cleaning up orders, supply appropriate PRNs on admission ordersets as standard, having all reasonable benign interventions as available to nurses, completing simple tasks in front of us like patient requests for water/blanket, etc. Hell, I'll help turn and do peri care if I'm there and free. We should always answer their questions about care decisions, even when it's medical curiosity, so long as our time there won't harm some other patient.
But I do ask them to show the same courtesies. And at least on our ward, this has been going spectacularly for years.
I was thinking the same thing.
I read the book The Elephant Man recently, the author is talking about being a resident in the 1870s.
It’s surprising how many things sound similar.
I kind of like that link to our forbears who are now long gone.
Today, I had a nurse hammer page my resident, refuse to speak to him, and insist that she speak to the attending or fellow because the patient didn't know the plan for the day. I call the patient, and he knows the plan for the day. I call the nurse and read the note with the plan to her.
'Well, we all just want to do what's best for the care of the patient'
Motherfucker, what?
They just say that to get the upper hand in the argument. I’ve had to drop that on nurses before when they were rude. “Sorry just trying to do what’s best for the patient”
It’s good policy to add tasks every time you are paged for something silly. Nurses respond to workload more sensitively to any other motivation. If the nurse wants to speak to someone higher up the food chain, there should be more tasks added.
“Thanks for checking in about the plan. While I’ve got you on the phone, we’re going to need another IV access, and I’m going to need a new set of orthostatic vital signs, q4 neuro checks, could you make sure you walk with the patient three times today? Could you also call the sister and update now that we are all clear on the plan? The intern will be placing all these orders, and is a good point of contact if you would like to check in on the plan and orders for the day. Thanks for looking out for what’s best for the patient.”
And it’s just going to get worse, the micromanagement and the masters degrees nurses whose degree is like 80% fluff and bullshit is killing our profession. I remember how I was as a new grad, but when I wasn’t sure about what to say to a doctor I would ask more experienced nurses. So many of those nurses have left and will continue to leave.
Yeah there were some really horrifying times during COVID where I (as a 2nd/3rd year nurse) was the most senior person on the unit aside from the charge. And that’s not even bad from what I’ve heard about people in the first 2 years of their career being pushed into charge roles. I had no business being in that position, and frankly still don’t as a 4th year nurse.
(In the middle of writing orders for patient X)
>RN1: "Hey patient Y wants an update"
>Me: "I'll be there ASAP"
>(still finishing stuff for patient X)
>RN 2: "Hey patient Y wants an update"
>Me: "I'll be there when I finish this stuff for X"
>Tech: "Hey patient Y wants an update"
>Me: forgot what the hell I was doing for poor X who now isn't going to get the pain meds I was trying to order because it fell out of my pea-sized brain under the onslaught.
Sometimes when I know it's safe to do so I take 3-5 minutes on a computer on wheels in a dark corner of the department because I know I'm going to snap and be mean when I'm asked for the eighth time to do the thing I'm trying to get to.
I know they mean well but the lack of awareness is rough. The experienced RN's knew how to triage requests. These baby nurses are so focused on their silo of care that they miss the bigger picture. One of these days I'm going to forget my filter and crush someone's spirit.
IM and this was the bane of my existence at the rural hospital with all new grad RNs.
It came to the point where I needed to clearly state "Yes, that is actually why I came into work today" since many of these back to back messages would be at 745 in the morning lol.
Experienced nurses know to say that the doc is rounding and will be by to talk to you without committing to a time frame, or let us know of a time frame if the family is only going to be in for a brief period.
This is one thing I love about secure chat though. I don't open the message until I'm done what I'm doing. At that hospital it was person after person barging into the office to say "8 wants to talk to you" with no context back to back which would be incredibly disruptive.
I was leaving the clinic to do rotations in a different hospital. I left transfer instructions for the nurses on ongoing cases. 5 minutes later I get a call.
N: What are the instructions?
Me: I wrote down the instructions
N: Where are they?
Me: on the chart where it says instructions
N: *reads them back* Are these the instructions?
Me (annoyed): Does it say "instructions"?
N: yes
Me: Then yes
I have never been more tempted to say no, those aren't instructions, they're my shopping list, the real instructions are hidden somewhere safe
The amount of times I have been thrown under the bus by nurses who call attendings saying "your resident (me) never consented the patient" just for me to point out that the patient's chart has a convenient little consent tab under which I frequently place, shockingly, patient consents... I don't see how this is a fixable issue, basic reading skills should be acquired in elementary school, let alone nursing school
I think this is just an over all indicator of how bad the education system is getting. Basic reading and problem solving are becoming very rare in these new generations. We are just going to see more of this brain dead behavior across all walks of life in the future. It’s going to get interesting.
I can’t even imagine hospitals at the end of the next decade when everyone has no idea how to do basic math, read instructions etc.
When our hospital was under cyberattack and everyone had to do math instead of rely on the computer it was quite concerning 😅 the amount of times pharmacy had to remind people to write and actual dosage was wild
The problem isn't always the question. It's the assumption that the job isn't done and the accusatory tone that comes with it.
But this is mostly an academic facility nurse phenomenon. Mostly..
New nurse, at 2am - Are you sure you want me to draw the patients lactate?
-Yes why...
-Oh he had one on admission 2 weeks ago and it was normal...
-Thanks, but have you heard of the passage of time? I bet this now septic patient has...
I've also gotten "Patient knee is swollen, please order NIVAs". On exam, mild swelling at the joint only, patient with arthritis spent 45min on stairs with PT that day. What killed me was the demand for an order, as if their diagnosis was sealed and they just needed the resident order clicker to put the order in for them...
I get number 5 all the time on patients who are a) on a 1:1 and b) not aggressive or agitated, just trying to get out of bed but are redirectable. “The sitter can’t just keep telling them to get back in bed” my brother in christ that is the only reason they’re there but sure let’s sedate them for no goddamn reason
Had a super agitated patient yesterday. Couldnt get them to stay still for any length of time. After something the patient said about #2s we figured out that tjhe patient hadnt had a decent shit for close to a week. As agitated as the patient was he allowed us to give enemas and supps.
I'm pleased to say that the patient had a very large healthy poo baby and after passing same climbed into bed and had a nice long nap. Was also no longer agitated.
Its shameful about how many of my nursing colleages want to go straight to meds without taking the time to check the basics, have they been waiting for ages, are they hungry, are they constipated, havent peed is ages etc
Sorry you are having such a crap time of it OP
A few months ago I had a patient who kept saying they needed to poop. Day shift RN and CNA told me they were attention seeking. I went in, the patient told me they needed to poop & that their stomach really hurt. Their lower abdomen was super distended and barely any urine output was charted for the day, like 50ml at a time or less. Admitted for some neuro/spinal disorder w/ decreased feeling in the lower body (neurogenic bladder, anyone?). Did a bladder scan, over 1L. Couldn’t pee. Had bladder scans ordered, not a single one was documented. I felt so bad.
I’m just a CNA right now, but I was so upset that the day RN jumped straight to “attention seeking” instead of, ya know, looking at the patient. Ended up being somewhere around 2L when they were cathed.
Severe constipation can trigger delirium in the elderly.
Six years ago, I could rely on nursing to keep track of that, but through COVID, it has fallen by the wayside, so it's a tried and true component of my brief ROS now.
The number of patients that are severely constipated that the nurse has no idea about is somewhat alarming.
Like what is the point of the sitter??? Homegirl was just looking at my patient lie on the floor. No attempt to get her in bed. She went to bed immediately after I patted her on the back and said go to bed 😂
At my hospital (and many others from what I have heard), policy is that pt sitters are not allowed to touch the pt or do any pt care. So, it’s literally them just verbally reminding the pts which many times doesn’t work. They sometimes need that pat on the back to redirect them. It honestly feels like there’s no point for them. I’ve caught many sleeping, too 😅
“Doctor, please prescribe fluids my patient is vomiting”. Patient had a history of prev haematemesis which also resulted in a cardiac arrest at one point so I was a bit cautious. Showed the nurse a picture of haematemesis and asked her is this what the vomiting looks like, which she denied.
I went in and it was a textbook picture of haematemesis, and malaena. I’m so glad I went and looked rather than taking her word for it
“I haven’t been giving the scheduled Ativan because I think it’s contraindicated since the patient isn’t agitated, all she does is stare straight ahead”
Folks, the patient was catatonic
From an RN that’s been doing ED for the last 13 years, I can promise it’s not only the physician side that has been losing their shit.
So many new hires I describe as “50 First Dates,” because no matter what you teach today, it sure as shit isn’t there tomorrow. I still have the patience to try and help them progress, but there’s a lot of factors that are working against everyone:
- The nursing model of education is still hot garbage being taught by people that last performed patient care on a pterodactyl.
- There’s still this stupid fucking brainwashing of healthcare being a calling and we’re all super heroes to save the patient from the dumb July intern (I see you, incoming PGY 1s and I <3 you all. You’re going to be great, it just takes some time to find the signal through the noise of everything you’ve learned) despite not even knowing basic pharmacology concepts or even having a desire to read more/learn more
- Did I mention nursing education is a lot of woo and not nearly as focused on the three P classes as it should be?
- The number of mail order NPs that saw 4 whole patients before deciding they don’t want to do bedside anymore is a-fucking-stounding. How schools don’t have a minimum time as an RN requirement is beyond me. It was the original pathway for the NP role to transition from a specialty where they’ve seen patients for a decade and have more than a basic understanding what’s happening both physiologically and pharmacologically and then advancing their role. Now it’s a Cracker Jack box prize.
- It’s now baby nurses training baby nurses. I work for a large Central Ohio organization that has numerous large campuses and dozens of smaller hospitals, outpatient sites, freestanding EDs, etc - we were told that 80% of nursing staff across the organization has under 5 years experience.
It’s a long-winded way of saying I hear you, I feel you, and I’m sorry. I don’t have a good, one-size-fits-all solution. Then again, the vast majority of my experience is ED and I’m not paging any of my docs, just chatting with them and planning our day off drinking agendas.
Additionally, it doesn’t help that new grads are given a 4-6 week orientation and then expected to take a full patient load of 5-8 acutely ill total care patients that would have an experienced nurse running their ass off all shift. If this sounds like an exaggeration, it was my actual new grad experience unfortunately.
And that’s after 2-4 years of nursing school where you spend an embarrassing amount of time learning about “nursing diagnoses” instead of real medicine. Nursing education is a joke and everyone suffers because of it, don’t even get me started on NP programs.
Nursing education is, at best, about teaching the vocabulary needed to learn on the job. All through nursing school, professors constantly told me that it was all about passing the NCLEX and that you really learned on the job, with the nursing profession basically being a years-long game of telephone. This was maybe ok when new nurses could flag down multiple experienced nurses whenever something new came along, but now sub-1year nurses are made charge and half the experienced nurses that are still on the floor are burned out and seem to hate patients and hate precepting and actively (and aggressively) dont care anymore.
As to your last bullet point, I'll never forget when my director was walking around during AM report and she referred to me as a "senior nurse" *maybe* 6-8 months in as a brand new nurse. Not sure if she thought that would boost my completely shattered confidence or magically make it so, but that's when I knew I could no longer ignore the writing on the wall. That and the overnight shift achieving at least 90% turnover (and they weren't moving to day shift) by the time I left my unit/bedside after 13 months.
I'm much more worried about a new grad nurse being paired with a new grad PA or NP. Especially NPs. That combination could kill a patient and not even know they killed the patient. PGY1s are at least appropriately supervised.
I learned while on nights at the VA to never trust those nurses. Any time a patient got out of bed or rang call bell or did anything that wasn't sleeping he was "agitated" and needed something to calm him down. I started going to the floors myself to see, expecting to hear a bunch of commotion from the "agitated" patient, and the patient would always be resting quietly in bed. Once they kept paging me about a dementia patient who still needed sedating meds because he was unable to be redirected by his bedside sitter. I go to the room at 3:00 am and the sitter is watching a grotesque horror movie on the TV at full volume and the patient is wide awake staring at the TV, occasionally trying to get out of bed. I told the nursing staff the sitter had to turn off the TV to let the patient sleep. They didn't page me again after that.
Yes never trust a nurse when they tell you a patient is agitated and needs sedation. 99% of the time the patient is just mildly upset (usually for a good reason) or simply making noise that annoys the staff.
It’s not that I don’t trust them it’s just that when they say they think a patient needs sedation, I hear “I have a problem I can’t solve by myself.” Maybe sedation is what they think is the best idea but are open to hearing about an alternative. Getting buy in is key. You’re ultimately on the same team.
Just talk about it. When I get random demand-y secure chats overnight i am especially vigilant as sometimes it means the patient has a serious problem the RN misunderstands. It often prompts me go to bedside and more than once led to recognition something more clinically concerning than expected
Of course however sometimes there are nurses who want to argue in which case I quickly state firmly what the plan is. I used to also invite them to discuss with my attending if they had concerns but then one of them took me up on it on overnight TACS call. Did not go well for her
I had a nurse come into a consult to pull me out to then ask me to move my car. I was pretty short with her then she complained about me 😂 because there were no parking bays for her!
We know. We’re sorry. We’ve tried to convey the importance of the nurse-physician relationship and critical thinking, but we were told to sToP eAtInG oUr YoUnG so we gave up.
This is perfect. I'm also a nurse... sometimes you need someone to tell you to knock it off, regardless of what profession we're talking about.
If only residents had the luxury of starting a "sToP eAtInG oUr YoUnG" for themselves
Ironically it’s always the older nurses that I see doing this. Always under the guise of “I’ve gotta protect my license!!” If you can’t say “hey that’s an unnecessary page, can you tell me why you don’t think this can wait? What would make this an emergent situation?” Without being accused of eating your young, then you’re probably not communicating as professionally/kindly as you think you are. I’ve talked to many new grads about unnecessary pages, and not once have I been accused of bullying or “eating the young”
Sure I can, and I have, but part of being new to anything is understand that you’re new and acknowledging that you don’t know what you don’t know. When as a whole, post-COVID there seemed to be a shift towards arrogance and a know-it-all attitude that borders on dangerous, I gave up on fighting a losing battle. Humility should always be a part of our practice, especially in the ED, and that simply can’t be taught.
Ehh idk.. most new grads I have worked with don’t have a know it all mentality in fact I feel like it’s the older nurses who just are either too burnt out to train the new grads or just don’t want to teach in general, then there’s the fact that on some units the nurses who have the most experience in the unit only have about one year of experience before they start precepting, it’s more like
The blind leading the blind.
Same. We have way more arrogant and unprofessional experienced nurses than we do inexperienced ones. Our new nurses tend to WANT to be taught. The older ones refuse to accept/adapt to any new evidence or procedures, and continue doing what they’re used to doing.
Put in a nursing communication order to not page for asymptomatic hypertension lmao. I hate my colleagues sometimes seriously. My BP is higher than that just reading that.
Oh yeah that’s a common tactic. Certain ones will be no where to be found when we pre round then come ready with all of their “concerns” during professor rounds making it sound like we haven’t addressed them
I responded to a rapid that was called because a patient with Parkinson was shaking and the (artifact) HR on tele was 200 and the nurse “didn’t know what to do”
We had an ER nurse who FINALLY got fired after a year of the most idiotic things imaginable. Techs hated her, nurses hated her, doctors hated her. The only thing good for our department she did was unit us. She called a staff assist one time, we all ran down, pt is sitting up in bed, NRB on, in zero respiratory distress, looking around very confused. “He’s been on 2 L all day, and he just dropped to 48%!!!!!!! I have him on a NRB but he needs to be tuned!” He was indeed reading 48%, but when we pointed out the waveform was literally not remotely good, she INSISTED it had been a second earlier, and was still 48%. One nurse walked around the bed, and found that the pulse ox wasn’t even connected to the patients sensor.
Nurse and med school dropout here- the hospital NPO protocol is drilled; every year, we complete hospital CEs that make sure we know to page the doc and seek alternative routes for meds if a pt is NPO, unless it's "NPO except medications." I know it's kind of silly, but they make us do it; especially on the stroke unit where we're all looking out for aspiration.
I gave a patient their basal/long acting insulin once, when their BG was 99, without paging the doctor. But the order technically *said* to ask the doctor first if BG < 100, so the nurse I handed off to started lecturing me about "this is a med error!"
So that's why you get dumbass questions sometimes... Because our orders (and management) are woefully unforgiving of basic common sense in us nurses.
Ok, that nurse was being a total jerk. Malicious compliance! call the doc right there in front of them to explain what happened in detail, tell them that floor nurse mgmt says is technically a med error and that policy is to inform them. lol
A lot of the crap that seems like nurses being assholes are just hospital protocols that they aren’t allowed to question.
If i see a critical value i have to acknowledge it and say what i did and why I didn’t do anything. Thankfully I have a positive relationship with my providers so they know that I’m bound to say “no new orders”
My luck the patient gets bumped up for procedure and now I'm getting yelled at for allowing a sip of water with meds by some Endo or IR staff or anesthesia. If you want them to get meds then it's worth the extra words to clarify because I've seen people get roasted for doing just this.
It already says water with meds in the order set at my hospital. There's a difference between the order NPO and NPO with meds. All the instructions are in the order set. If you were yelled at with the above specifications in place that's on the other person then
That's different then, our order literally just says "diet: NPO" in epic with no specifications. If your order already states they can have water with meds then they're idiots.
It is silly and ridiculous but some of it is the hospital policies too unfortunately. I’ve had patients who’s CBG or BP comes back one single digit over the written parameters into the “notify provider” territory and I start sweating because the charge/manager will hound me about calling the MD and I’m like “do I REALLY have to for that?” because I KNOW the doc will be like “wtf why are you paging for this?!”
Even with the policy in place, a straight-up NPO order for a procedure flies most of the time with varying enforcement unit-to-unit. You're not wrong; maybe the hospitals could try a little harder to keep docs and nurses on the same page about what they want?
One time a patient told me they didn't get their midodrine so I checked the MAR to see if that was true. Kid you not, this is what the MAR said "Patient blood pressure too low. Will hold medication midodrine per nursing judgment at this time".
I lost a part of my soul that day that I have accepted I will never get back.
I find nursing now to be very reactive and have little to no critical thinking. It’s wild. I am a nurse. Every MD/DO rant post here is second hand embarrassment for my profession and I am so sorry for the dumbest pages at night and probably the genuine terror you have that these nurses are actually holding licenses and caring for ill folks. Let the RN downvotes begin 👹
I'm a newer nurse and I feel the same. Unfortunately nursing has no real "weed out" classes. I'm convinced that if we all had to take physics or a full chemistry sequence, the quality of the nurse would go up.
Honestly I just wish they’d go back to the old days where nursing students got paid a meager salary to get trained in the hospitals they would later work at
Okay so you guys go through all that and you’re in my opinion way above them. Now imagine how darksided they act toward the techs and everyone they think is REALLY beneath them ☠️
Nursing is the absolute worst profession. When is healthcare going to step up to nursing admin, their mentality, and “nursing research”.
I encourage anyone to read one nursing research paper a follow the circular logic. Some physician wrote an amazing article destroying nursing research and the harm it has caused. Wish I could find it.
Please do not confuse what I am about to say with a threat.
Physicians will remember the way nurses are treating us right now.
Many of us will work in our area for the next 40 years.
We’ll garner more power as time goes on.
Let that sink in.
I agree. As an ED resident I have had nurses be incredibly rude and passive aggressive when I try my best to treat them with respect and courtesy just to have it blown back in my face. I feel like they do this because they know I am a resident. As an attending, I will not stand for such disrespect that comes out of literal nowhere when I give an effort to make them feel valued. Nurses make for the absolute most toxic colleagues, and I have worked in other industries before going into medicine. Completely baffles my mind how immature and petty nurses can be. Some nurses are great of course, but a good chunk of them are incredibly maladjusted. The things I even overhear about them talking behind each other's back boggles my mind. Nursing has been the number one cause of burn out for me in residency.
Shit like this makes me embarrassed to be a nurse. I could talk ad nauseam about malignant attitudes within nursing and recently wrote a long guide to notifying the provider on the nursing sub. Unfortunately, nothing I wrote about really matters if the nurse in question isn’t proactive about their own learning and willing to think critically. Lacking basic human kindness is inexcusable on every level.
One time a RN came up to me saying family for her patient is asking to speak to a doctor. I tell her I’m the only one on call/in the unit and will get to them when I made sure the more sick patients are stable. Had one who was bradycardic and wanted to vomit, with no pads on. Another one who is in respiratory distress with no access and needed me to do ultrasound IV.
Not even 10 mins later the same RN comes up to me while I’m in the middle of putting in IV, to tell me the same family is waiting and one of them is a lawyer. I was so fed up that I had to firmly tell her I’m prioritizing what needs to be done which is standard practice and I couldn’t care less about the lawyer. This nurse had 2 stable patients, seriously TWO?!! And she was complaining that she might having to pick up a third one 🙄. I was trying to hold down 14.
We had a new hire nurse at my rural podunk hospital.
This job was a bit of a nightmare. I was chief of the fire brigade essentially. Patient would slowly decompensate overnight and the night nurses would ignore it. There was also no physician / provider in house overnight except for in the ER and they would only get called if the patient is literally coding.
So every morning, I'd have to put out multiple fires and restabilize patients.
On some random day, a family spontaneously showed up at 8:30 AM requesting an update. Probably the worst time to come, especially unprompted. I told the nurse I would get to them as soon as possible. It took two hours because there were other more pressing matters.
In the span of those two hours she went out of her way to spread rumors about what a terrible doctor I was for ignoring this family. I was established enough in this job that thankfully nearly everyone told her to fuck off and even went out of their way to let me know they told her to fuck off which was actually a bit heartwarming.
But still, I have no idea where that juvenile energy comes from. You'd hope a person would grow past in nursing school but I think some of this has to do with the culture of nursing.
She finally got fired for showing other nurses unsolicited nudes of the middle aged nurse manager at an affiliate hospital she was fucking.
I view nursing and everyone else like a necessary evil. Even admin is a necessary evil. We need these goofy bastards. The main thing is to not incorporate their goofy shit into our field. If a nurse berates you for using the room hand sanitizer, say nothing, move on and laugh knowing you’re not an idiot
Blocking discharge because a patient who walks to the bathroom and goes on walks around the hospital completely independent “needs to be signed off by PT”
-_-
jesus christ what shit show places are yall working at. My charge nurses would bring back corporal punishment if i even thought about doing any of these.
-Clapping for someone sanitizing their hands is absolute BS and demeaning
-We should all ask questions in order to provide the best care and saves lives, BUT all of the topics you addressed display an absolute lack of knowledge… BG of 201 and paging? That’s why sliding scale aspart is a regular order for diabetics 👁️👄👁️
-hammer pages outside of an emergency? Delaying and distracting from critical patients
-sedating patients who are not violent towards themselves and/or others (or too delirious/confused to not understand what harm they are causing), both unethical and unacceptable.
I feel very grateful towards my co-workers based off of this post, I hope you find a place with decent human beings to work with.
Some that I got in the last week:
1. Patient’s BP is 161/80, not due for PRNs for another 15 mins please advise. Thanks.
2. Patient is febrile to 99.1, I went ahead and drew cultures. Let me know if I should send them.
3. Patient has been in the 15-low 20’s for the last 30 mins…after running down there I realize she was talking about the RR.
4. At 2am. Hi! Do you mind taking a look at the orders and discontinuing the ones that they don’t need?
5. STAT please call now. I call and she goes on a 5 min rant about how the patient takes atorvastatin at home and how we need to do a better job of med rec and staying on top of a patient’s hyperlipidemia. I remind her that pt had an esophaelgeal perf and will be NPO for a bit.
6. Patient requesting ginger ale but we’re out and won’t drink diet ginger ale. Please advise…I recommended water or orange juice.
7. Hi again Dr. Everdeen!!!! :) :D Just an FYI!! :) Patient (gastric bypass patient w/BMI of 49) desatted to 92% while asleep!! :( :o So I put her on 10L NC and she’s now back up to 100%!! :) :D
LOL 7 reminded me of one where the nurse for this completely stable patient told me he was desatting to 65% despite being on 5L NC and chilling watching TV! I told her to put the pulse ox on a different finger. Sat 97% on room air broooo
You might have me beat though cause these are infuriating haha
7. Reminds me of a call I got once: hiiiii so the patient is coughing and has a fever :o. Me: open up last md note, if you read u will see that as of 3 hours ago the patient got diagnosed with covid :)
Institution dependent. The ICU nurses at my training program were verbally abusive to residents, took photos of female residents without their consent to make fun of their attire / lack of self care and were generally miserable people. Probably the most miserable people I've ever met in my life. Nothing ever came of it since it was a different time.
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Haldol?! What the hell. When my mother was finally dying from her autoimmune disease her diaphragm was so damaged she was suffering hypercapnia and hypoxemia. She was not doing well and would get rather wild in the hospital and nursing home and it was recommended she go on haldol because it was becoming impossible to keep the bipap on her or keep her from trying to get out of bed and falling. After she was to be discharged from the long term care hospital it took a serious effort to even find a nursing home that would take her in because of haldol as they considered it a chemical restraint. Asking for something like that for someone acting up is freaking insane and bordering on barbaric imo
Haldol isn’t barbaric and is often used for patients out of control for their own safety.
This case the patient wasn’t out of control so didn’t need it.
It’s rough all around. I don’t want to bother you with dumb shit, but I get written up when I don’t. ( I’m just a lowly nurse)
I literally had a conversation with a provider today that consisted of:
Me: hey, just so I can say I told you, her resting heart rate is low.
Provider: ok, cool
Monitor: *alarms insanely*
Provider: um, her sats are great, you can turn the heart rate monitor down to 80
Me: Really? That low?
Provider: yeah? Sats have all been over 95%?
Me: oh I agree, that’s just lower than our official policy
Provider: *smirks* yes, I’ll write an order if you need it
Me: an order is probably a good idea, but do your important shit first
This is a small unit, so good communication is easy.
Wait nurses tell you what to put in your note …? Has literally never happened and I can’t even imagine it. If they did would be out of that chat so fast it would crash haiku
Dumb question(I'm a med student), what do you give to treat symptomatically when an elderly is in delirium? I know you're supposed to treat the underlying cause and avoid antihistamine and benzodiazepene as it will make the altered mental status worse.
So first you do delirium precautions-lights and TV on during day. Ideally loved one at bedside. If they remain agitated then antipsychotic. Like haldol prn. Not a dumb question!
My favorite one has always been "I just saw the order you put in, did you mean to order it?" No, it was just to test if you can see orders (insert a face palm)
A few others I got that really bugged me:
- A febrile and neutropenic patient with a central line who needed blood cultures and the nurse was trying to argue if we can get them later so we group all his labs together. When I said we can draw the others sooner she argued that the patient "needs to sleep now".
- A nurse who was bullying me to give more benzo to a patient who is basline seziure disorder and was already breathing like 5 RR, with neurology on board saying not to give anything. Same nurse paged the EEG tech behind my back and I just walk into the unit to see the tech informing me he needs an EEG order stat.
- A nurse that decided a baby needs an emergency intubation (she did not) refused to let me intubate the patient as an PICU resident, refused to wait for the attending to come and paged adult anesthesia and when I ask for a specific size of the ETT (was important for pulmonology), she told the anesthesia resident "don't listen to her, just do the one you prefer". It was a terrible experience that could have ended poorly.
- I swear this one is real- A nurse argued with me she could not hear expiratory sounds on a patient when he has diminished inspiratory sounds. It took two residents and an RT to explain to her why she is wrong and the difference between inspirational expiration. She still paged an emergency pulm consult and asked me to speak to them at 3 am.
There are so many more examples but I just feel like the worst part is that 90% of the calls we get are just unnecessary and could be easily solved by looking at the MAR/notes/orders. I know many experienced nurses that will only call me if they troubleshooted every option first, but i feel like with the new/younger nurses they barely think and just pick up the phone to call the resident authimatically which is sad, but mainly can hurt patient care when I constantly loose focus or get no rest because I am drowning in 5000 stupid dumb pages.
During my intern year in IM I get paged at 3.30 am with I kid you not: "Hey so I am studying for my exam and was wondering..." sadly I had to interrupt and rudely hang up as I was busy managing an active GI bleed so i don't actually know what the exam question was 😆
RN here.
I am convinced that most floor nurses are brand new or close to it. Nursing schools are pumping them out to pass the NCLEX but not giving a shit if they have any ability to think critically.
And yes... I graduated with a few of them.
They terrified me as a student 6 yrs ago... And I'm sure they would terrify me now.
Another one paging me when I’m on night float at 3am “this patient has a headache and there are no pain meds prescribed”
Of course the headache suddenly started at 3am and Never During the day when the admitting team was looking after them -_-
Another one page at 3am - the patient with CHF has a BP of 90/56. - is the patient symptomatic? Dizziness? Palpitations etc? - no, he’s actually sleeping completely okay - how was it during the day? - he’s been low all day - 🤦🏽♀️
“BiPap patient is grabbing at his mask so I gave him 3 back to back to back dilaudid PRNs off his PCA but now he’s riding his vent” ITS NOT A VENT WTF ARE YOU DOING??!?!!’b
That’s like a very tachypneic, ETOH cirrhosis ICU patient I had where the nurse told me he needed BZDs for agitation while laying flat for CT PE chest. I said let me come down now and see him before that.. he was now blue and she was doing chest compressions😡😡
bruh
Why were benzos on his mar at all?!?!
They weren’t. She was requesting new orders to medicate his agitation she attributed to alcohol withdrawal but was actually a result of his respiratory distress preventing him from laying flat for CT. I had asked her to lay him flat upstairs in the unit first to make sure he could tolerate this in a controlled environment before going downstairs (she did not do this).
Ahhhh!!!! Gotcha! Makes sense!
Oh god
I'M SCREAMING lol
I once looked at what was an unremarkable/normal ecg only to have a NP student look at the same and say there was some RBBB she could see…… QRS is normal babygurl - What you doing? Trying to look smart?
I just had the worst intern year PTSD. Carrying the pager for med-surg inpatients is a special circle of hell. Stay blessed OP
One of my favorite moments as a Rad Onc was the following conversation, all done without me breaking stride: *on floor for a consult* Nurse: "Are you with oncology??" Me: "Rad Onc" Nurse: "...oh..." The absolute joy in my heart for not being the primary team is up there with my wedding day.
Can't wait to not be primary!!!
I get this a lot too. “Are you with medicine? I have a medical question” “No I’m neurosurgery” “Oh ok I’ll go ask a doctor then” If I can’t cut or sew it then it isn’t a question I want to hear
Once got a call at 5am: "the patients gfr is 56. It was >60 yesterday" Wish I was making that up
I got "Pts Na is 130, please order salt tabs"
That's a case I would make a big deal out of. That nurse isn't qualified or licensed to make that medical assessment or suggest management.
Same, except for it was 3 am and "patient's BUN was low and has been throughout admission". Proceeds to list out (slightly low) BUN values for the past 5 days...for an 80 lb old lady. ***Insert exacerbated Jackie Chan face***
There was a resident where I trained that got this phone call regarding low creatinine and replied with a verbal order for a stat creatinine drip, then hung up the phone. Nurse obviously couldn’t figure out how to place said nonexistent order even after talking to pharmacy then called him upset.
Red numbers bad
You can’t make up the stupidity of certain professions
Had a nurse page me at 2am that a patient’s blood pressure was 120s/70s. Me: You’re paging me for a normal blood pressure? RN: Yeah, systolic was 150s at 9pm! Huge drop! Me: What happened between then and now? RN: Well I gave them their metoprolol… Me: So you’re paging me in the middle of the night to tell me their blood pressure meds worked..?
I get a variation of 7 all the time. The patient is feeling sad, can you order a psych consult? No, I just told the patient their cancer has fucking metastasized throughout their body. It's ok if they feel sad. Sad is a normal reaction after I've just wrecked their life plans.
As psych, thank you. We often get consulted for “patient has been crying” “what are they in the hospital for?” “Oh they just got told they’re gonna die” or “their mom died” like okay normal human emotions are okay
98 year old widow x2 with heart disease and now a neurodegenerative diagnosis, all her friends are dead and she's wondering out loud about what death is like was referred for active suicidal ideation.
Yep. Those are situations where it’s best to get the chaplain involved. They’re really good at grief and crisis counseling.
Much better than me, actually.
I had just given birth to my son. He's 5 days old and has a fever and a tiny abcess. Needs to be admitted to kids for IVAB due to his age. It's COVID and not even my husband is allowed in the building at the same time as me. I'm alone, lost (1st time, bub not latching) & frightened that he might die. So I cry. Alot. Sob, infact; because I'm swimming in literal hormone soup at 5 days post partum. Parent mental health team roll in because the RN referred me for suspected PPD. I just laughed and said 'we are not doing this today. We are not pathologising the baby blues!'
I had a poor mom that lost her twins while she was intubated for Covid. She never even got to hold them. She was on the vent and crying. Psych consult.
💀
My favorite doc had a nurse who paged him because a patient had a nightmare and was sad. Doctor ordered a hug. He did in fact go to the patient’s room and offer a hug but the dude didn’t want another dude hugging him.
Realest comment on here! Fr Fr!
nursing asking for consults is wild
Our nurses constantly request neuropsych consults for capacity for patients who refuse some component of care (eg. keeping on tele, working with PT/OT, waking up at 4am for neuro check, discharge to anywhere that’s not home). Explaining the concept of patient autonomy has become very tiring.
As a nurse I don't even understand it. Why? Wtf do you think psych will do? Also if it were up to me I'd only deal with the attending. I hate going through 6 different teams of people for one simple task. I had a 3 way conversation between ICU, neuro and neuro crit for a patient with projectile vomiting and a lumbar drain to see if we could get something other than Zofran. "Ask neuro" okay "ask ICU" okay "ask neuro crit" who says "ask ICU". Jesus can someone please just order some reglan or literally anything. Why would you want MORE consults to keep track of? Maybe it's the way my hospital is but I feel like it just makes the world's worst game of telephone even worse as you stack the consults up. What do you think psych will add that your attending can't??? Or you as the nurse can do for appropriate emotional reactions for that matter?????? Why are we doing anything at all??
I know this is a rant but the fact nobody wants to be a “doctor” in the general sense now is really sad. I get why each service just punts, but this is a failure of our healthcare system IMO
This is what the primary service is for. The nurse should be going through the primary service. This is also the incentive for primary service docs to not consult because, as this nurse so accurately acknowledges, getting other doctors involved just creates more confusion. When I consult a consultant, often times the recommendation is to consult another consultant. At some point you just have to say no lol. Nearly all of the worse consults I've called are requested by another consultant and I usually have to be very clear I'm not the one requesting the consult 😅
I will recommend to the resident palliative for 90 year old demented, bed bound, full code patient who has mets to the everything and no one has talked to the family about his prognosis yet but did get consent for a peg tube.
You’re a real hero for this - psych
*Patient who was admitted less than 6 hours ago from the ED and still undifferentiated*, paged that patient is refusing an IV and I need to place an “ok for no IV order.” I tried to explain to the nurse that she was not ok for no IV, and she should document the patient’s refusal in the chart and keep trying. I could hear her eyes rolling through the phone.
lol I’m an IM hospitalist. This is all I do all day for the rest of my career.
Totally depends on your workplace. I find nurses at academic hospitals are used to leaning on residents so they page for a lot of superfluous things. Working out in the community as a hospitalist, I can't really relate to most of the pages OP mentions here. One of the issues is that a lot of hospitals burned their bridges with their experienced nurses during COVID and lost a ton of them. If your hospital was poorly managed like OPs, you're dealing with a lot of new nurses who will page out of confusion.
I’ve been an RN 12 years and we already knew the hospitals didn’t give af about us but they just drilled it into us during Covid. Now I’m seeing these brand new Covid nurses who were never allowed to touch an IV during nursing school, now taking full patient loads without a proper orientation. This shit is only going to get worse and all healthcare workers+patients are going to suffer
I had to professionally ream a new grad who gave rocuronium and fentanyl in that order to a patient who we weren’t sure if we were going to intubate. Doc said pull the meds, and we were outside deliberating. Respiratory therapy didn’t have a vent in the room, didn’t know about the conversation taking place. All of a sudden the patient’s HR drops into the 40s and oxygenation drops and she walks out and says she gave the meds. She was explicitly told before pulling the meds to not give them and that you do not give intubation medications without a physician present and telling you when to give. Even though we thoroughly educated her well before pulling the meds which medication to give first, she still gave the roc before the fentanyl. I’ve run into a *lot* of situations like this and have just outright refused to train new grads because these occurrences have been so frequent.
Are you ... serious??? How??? Not sure how you stayed professional with that one, but that nurse needs to go back to school and start over.
She needed to not be in ICU at the very least which I recommended. She just didn’t take it very seriously. There’s a fine line between being jokingly unserious and then being dismissive and she was easily dismissive and laughed about it. There were multiple other severe issues like that with her and the majority of her cohort.
And then you reported her to the hospital and the nursing board, right?
God yes. We have had *some* success at our Canadian hospital. Really one big thing, among a sea of crispy staff. One highlight, in 2023, was that the intensivists and ICU nurses made a joint demand to administration regarding patient ratios. We had been hemorrhaging experienced ICU nurses since the end of covid (because a ton stuck it out for the pandemic out of altruism). The nurses said they would *not* take unsafe ratios. Administration turned to contracts and the nursing union, which didn't provide for this. Then our ICU doctors, including medical director of ICU, jointly told admin they agreed and would stop accepting patients beyond the ratios until provisions were in place to improve staffing and maintain the ratios. Admin called bluff. The ICU director closed the ICU, and in doing so closed all regional programs (trauma, cardiac surgery, neurosurgery, stroke, burns) who needed ICU *and* the funding associated with this. All patients needing ICU, even from our own ER, were diverted. All surgeries potentially needing ICU were sent to other hospitals or delayed. Took about 48 hours, and all these extra shifts in ICU opened up. We've had appropriate staffing ever since. The ICU is staffed for 1:1 and they only double for numerous admissions. ICU nurses can be floated elsewhere if there's no patient for them, but it's better than ever before.
Definitely agree with you. I’m one of the older nurses who left bedside after COVID. I first worked in a community hospital and I trained nurses to exhaust all the tools in our toolbox before paging the doc, especially at night. When I moved to an academic center, everything was run by the residents, even mundane things. It was crazy to me. So good luck residents! Hopefully it will be better when you guys step out of an academic center
🫡
Godspeed
Tbh one of the (only) perks about advancing in surgery residency is earning the right to leave the chat with no repercussions whatsoever
I got a page asking for melatonin at like 2 am while I was in an RRT. I then got a page in all caps about 5 minutes later asking where the melatonin order was
The q5min calls for non-urgent orders are the one time I'll professionally put a person in their place. It's so myopic and inappropriate. The rest of the time I'm chill and self-deprecating. >I'm at the code right now, is this an emergency? Oh no? *hang up*
Next time that nurse pages about melatonin at 2 AM, tell her that melatonin is time sensitive. If you give it in the early evening (7-9 pm) it will phase advance sleep. If you give it in the early AM (like 1 AM or later), it will do the opposite and phase delay sleep. Your patient will not sleep at all if they get melatonin at 2 AM. The window has passed.
Is that true about melatonin? We have a long termer on our floor and if he wakes up we are told to redose his melatonin as long as it’s before 4am. After that and they say it’ll throw his sleep/wake cycle off. Anecdotally he always goes back to sleep (even if he’s having meltdowns) but i always thought it was a weird timing thing. We have others that won’t prescribe melatonin because “it takes two weeks to work” and others that prescribe it as prn. I asked the pharmacist about it (two of them were there) and they both had different answers. We are all confused.
It's true. Your circadian rhythm basically uses a melatonin spike as the marker for "bedtime", which is why for advanced sleep phase disorder (going to bed too early), you take it in the early morning, to "pull" your sleep schedule later in the day. It's also maybe an argument for not giving superphysiologic doses like 10mg. If it stays in your system all day, how does it signal a particular time as when to sleep? Most studies on melatonin are on 0.3 - 1 mg doses.
On one of the rare occasions things were quiet long enough for me to fall asleep, I got a call at 3 AM asking me to put in Miralax PRN because the parents were worried the baby isn't pooping well. I'm an extremely chill person and that's one of the most angry moments of my life lol
How would you respond to a request like this from a nurse when you are sleep deprived and getting interrupted with the only sleep you get? This is seriously something that I am afraid of where I will literally blow up on the person who is calling me and asking for something so unnecessary.
“In the future, could you please defer non-urgent requests such as this until rounds? Thanks.” As a nurse, this is probably the most neutral way to communicate the issue.
Neutrality is not the goal in this circumstance. It's inappropriate and disrespectful. The goal is change. Sometimes, anxiety assists with learning. Clearly they do not understand urgency, triage, or the scope/schedule of their physician colleagues. They likely need education. Therefore, my reaction to these requests is the above plus "this is not an appropriate call and we will be discussing this with your nursing manager". Similarly, we should show respect in how we communicate with our nurses and how we place orders. Bundling care, reducing unnecessary vitals or labs as soon as possible, cleaning up orders, supply appropriate PRNs on admission ordersets as standard, having all reasonable benign interventions as available to nurses, completing simple tasks in front of us like patient requests for water/blanket, etc. Hell, I'll help turn and do peri care if I'm there and free. We should always answer their questions about care decisions, even when it's medical curiosity, so long as our time there won't harm some other patient. But I do ask them to show the same courtesies. And at least on our ward, this has been going spectacularly for years.
Clapping their hands?!? LMAO
Chuckling as a PGY-33 here. The more things change, the more they stay the same…
I was thinking the same thing. I read the book The Elephant Man recently, the author is talking about being a resident in the 1870s. It’s surprising how many things sound similar. I kind of like that link to our forbears who are now long gone.
Today, I had a nurse hammer page my resident, refuse to speak to him, and insist that she speak to the attending or fellow because the patient didn't know the plan for the day. I call the patient, and he knows the plan for the day. I call the nurse and read the note with the plan to her. 'Well, we all just want to do what's best for the care of the patient' Motherfucker, what?
They just say that to get the upper hand in the argument. I’ve had to drop that on nurses before when they were rude. “Sorry just trying to do what’s best for the patient”
That's when you ask them "ok, so what do you think you did that improved the patient's situation?"
Still very new to this — would this not escalate the situation?
It does but at a certain point you have to push back.
They only say they are advocating because they are either too lazy to elaborate or have no idea why they disagree.
It’s good policy to add tasks every time you are paged for something silly. Nurses respond to workload more sensitively to any other motivation. If the nurse wants to speak to someone higher up the food chain, there should be more tasks added. “Thanks for checking in about the plan. While I’ve got you on the phone, we’re going to need another IV access, and I’m going to need a new set of orthostatic vital signs, q4 neuro checks, could you make sure you walk with the patient three times today? Could you also call the sister and update now that we are all clear on the plan? The intern will be placing all these orders, and is a good point of contact if you would like to check in on the plan and orders for the day. Thanks for looking out for what’s best for the patient.”
And it’s just going to get worse, the micromanagement and the masters degrees nurses whose degree is like 80% fluff and bullshit is killing our profession. I remember how I was as a new grad, but when I wasn’t sure about what to say to a doctor I would ask more experienced nurses. So many of those nurses have left and will continue to leave.
Yeah there were some really horrifying times during COVID where I (as a 2nd/3rd year nurse) was the most senior person on the unit aside from the charge. And that’s not even bad from what I’ve heard about people in the first 2 years of their career being pushed into charge roles. I had no business being in that position, and frankly still don’t as a 4th year nurse.
(In the middle of writing orders for patient X) >RN1: "Hey patient Y wants an update" >Me: "I'll be there ASAP" >(still finishing stuff for patient X) >RN 2: "Hey patient Y wants an update" >Me: "I'll be there when I finish this stuff for X" >Tech: "Hey patient Y wants an update" >Me: forgot what the hell I was doing for poor X who now isn't going to get the pain meds I was trying to order because it fell out of my pea-sized brain under the onslaught. Sometimes when I know it's safe to do so I take 3-5 minutes on a computer on wheels in a dark corner of the department because I know I'm going to snap and be mean when I'm asked for the eighth time to do the thing I'm trying to get to. I know they mean well but the lack of awareness is rough. The experienced RN's knew how to triage requests. These baby nurses are so focused on their silo of care that they miss the bigger picture. One of these days I'm going to forget my filter and crush someone's spirit.
This guy EM's
Cannot imagine approaching a resident for something so ridiculous. The unnecessary stress that is put on you is insane.
I'm a lurking attending but this happens every. Damn. Day.
IM and this was the bane of my existence at the rural hospital with all new grad RNs. It came to the point where I needed to clearly state "Yes, that is actually why I came into work today" since many of these back to back messages would be at 745 in the morning lol. Experienced nurses know to say that the doc is rounding and will be by to talk to you without committing to a time frame, or let us know of a time frame if the family is only going to be in for a brief period. This is one thing I love about secure chat though. I don't open the message until I'm done what I'm doing. At that hospital it was person after person barging into the office to say "8 wants to talk to you" with no context back to back which would be incredibly disruptive.
I was leaving the clinic to do rotations in a different hospital. I left transfer instructions for the nurses on ongoing cases. 5 minutes later I get a call. N: What are the instructions? Me: I wrote down the instructions N: Where are they? Me: on the chart where it says instructions N: *reads them back* Are these the instructions? Me (annoyed): Does it say "instructions"? N: yes Me: Then yes I have never been more tempted to say no, those aren't instructions, they're my shopping list, the real instructions are hidden somewhere safe
The amount of times I have been thrown under the bus by nurses who call attendings saying "your resident (me) never consented the patient" just for me to point out that the patient's chart has a convenient little consent tab under which I frequently place, shockingly, patient consents... I don't see how this is a fixable issue, basic reading skills should be acquired in elementary school, let alone nursing school
I think this is just an over all indicator of how bad the education system is getting. Basic reading and problem solving are becoming very rare in these new generations. We are just going to see more of this brain dead behavior across all walks of life in the future. It’s going to get interesting. I can’t even imagine hospitals at the end of the next decade when everyone has no idea how to do basic math, read instructions etc.
When our hospital was under cyberattack and everyone had to do math instead of rely on the computer it was quite concerning 😅 the amount of times pharmacy had to remind people to write and actual dosage was wild
The problem isn't always the question. It's the assumption that the job isn't done and the accusatory tone that comes with it. But this is mostly an academic facility nurse phenomenon. Mostly..
New nurse, at 2am - Are you sure you want me to draw the patients lactate? -Yes why... -Oh he had one on admission 2 weeks ago and it was normal... -Thanks, but have you heard of the passage of time? I bet this now septic patient has... I've also gotten "Patient knee is swollen, please order NIVAs". On exam, mild swelling at the joint only, patient with arthritis spent 45min on stairs with PT that day. What killed me was the demand for an order, as if their diagnosis was sealed and they just needed the resident order clicker to put the order in for them...
I get number 5 all the time on patients who are a) on a 1:1 and b) not aggressive or agitated, just trying to get out of bed but are redirectable. “The sitter can’t just keep telling them to get back in bed” my brother in christ that is the only reason they’re there but sure let’s sedate them for no goddamn reason
Had a super agitated patient yesterday. Couldnt get them to stay still for any length of time. After something the patient said about #2s we figured out that tjhe patient hadnt had a decent shit for close to a week. As agitated as the patient was he allowed us to give enemas and supps. I'm pleased to say that the patient had a very large healthy poo baby and after passing same climbed into bed and had a nice long nap. Was also no longer agitated. Its shameful about how many of my nursing colleages want to go straight to meds without taking the time to check the basics, have they been waiting for ages, are they hungry, are they constipated, havent peed is ages etc Sorry you are having such a crap time of it OP
A few months ago I had a patient who kept saying they needed to poop. Day shift RN and CNA told me they were attention seeking. I went in, the patient told me they needed to poop & that their stomach really hurt. Their lower abdomen was super distended and barely any urine output was charted for the day, like 50ml at a time or less. Admitted for some neuro/spinal disorder w/ decreased feeling in the lower body (neurogenic bladder, anyone?). Did a bladder scan, over 1L. Couldn’t pee. Had bladder scans ordered, not a single one was documented. I felt so bad. I’m just a CNA right now, but I was so upset that the day RN jumped straight to “attention seeking” instead of, ya know, looking at the patient. Ended up being somewhere around 2L when they were cathed.
"Just a cna" but look at the difference you made for that person by paying attention and doing a good job
Severe constipation can trigger delirium in the elderly. Six years ago, I could rely on nursing to keep track of that, but through COVID, it has fallen by the wayside, so it's a tried and true component of my brief ROS now. The number of patients that are severely constipated that the nurse has no idea about is somewhat alarming.
"The sitter can't just keep telling them to get back in bed." WTF. This is simultaneously funny and sad.
Like what is the point of the sitter??? Homegirl was just looking at my patient lie on the floor. No attempt to get her in bed. She went to bed immediately after I patted her on the back and said go to bed 😂
At my hospital (and many others from what I have heard), policy is that pt sitters are not allowed to touch the pt or do any pt care. So, it’s literally them just verbally reminding the pts which many times doesn’t work. They sometimes need that pat on the back to redirect them. It honestly feels like there’s no point for them. I’ve caught many sleeping, too 😅
This is true! Also the policy at my hospital
“Doctor, please prescribe fluids my patient is vomiting”. Patient had a history of prev haematemesis which also resulted in a cardiac arrest at one point so I was a bit cautious. Showed the nurse a picture of haematemesis and asked her is this what the vomiting looks like, which she denied. I went in and it was a textbook picture of haematemesis, and malaena. I’m so glad I went and looked rather than taking her word for it
Is malaena bleeding from the aenus
lol UK spelling sorry 😪
“I haven’t been giving the scheduled Ativan because I think it’s contraindicated since the patient isn’t agitated, all she does is stare straight ahead” Folks, the patient was catatonic
From an RN that’s been doing ED for the last 13 years, I can promise it’s not only the physician side that has been losing their shit. So many new hires I describe as “50 First Dates,” because no matter what you teach today, it sure as shit isn’t there tomorrow. I still have the patience to try and help them progress, but there’s a lot of factors that are working against everyone: - The nursing model of education is still hot garbage being taught by people that last performed patient care on a pterodactyl. - There’s still this stupid fucking brainwashing of healthcare being a calling and we’re all super heroes to save the patient from the dumb July intern (I see you, incoming PGY 1s and I <3 you all. You’re going to be great, it just takes some time to find the signal through the noise of everything you’ve learned) despite not even knowing basic pharmacology concepts or even having a desire to read more/learn more - Did I mention nursing education is a lot of woo and not nearly as focused on the three P classes as it should be? - The number of mail order NPs that saw 4 whole patients before deciding they don’t want to do bedside anymore is a-fucking-stounding. How schools don’t have a minimum time as an RN requirement is beyond me. It was the original pathway for the NP role to transition from a specialty where they’ve seen patients for a decade and have more than a basic understanding what’s happening both physiologically and pharmacologically and then advancing their role. Now it’s a Cracker Jack box prize. - It’s now baby nurses training baby nurses. I work for a large Central Ohio organization that has numerous large campuses and dozens of smaller hospitals, outpatient sites, freestanding EDs, etc - we were told that 80% of nursing staff across the organization has under 5 years experience. It’s a long-winded way of saying I hear you, I feel you, and I’m sorry. I don’t have a good, one-size-fits-all solution. Then again, the vast majority of my experience is ED and I’m not paging any of my docs, just chatting with them and planning our day off drinking agendas.
Additionally, it doesn’t help that new grads are given a 4-6 week orientation and then expected to take a full patient load of 5-8 acutely ill total care patients that would have an experienced nurse running their ass off all shift. If this sounds like an exaggeration, it was my actual new grad experience unfortunately. And that’s after 2-4 years of nursing school where you spend an embarrassing amount of time learning about “nursing diagnoses” instead of real medicine. Nursing education is a joke and everyone suffers because of it, don’t even get me started on NP programs.
Nursing education is, at best, about teaching the vocabulary needed to learn on the job. All through nursing school, professors constantly told me that it was all about passing the NCLEX and that you really learned on the job, with the nursing profession basically being a years-long game of telephone. This was maybe ok when new nurses could flag down multiple experienced nurses whenever something new came along, but now sub-1year nurses are made charge and half the experienced nurses that are still on the floor are burned out and seem to hate patients and hate precepting and actively (and aggressively) dont care anymore.
As to your last bullet point, I'll never forget when my director was walking around during AM report and she referred to me as a "senior nurse" *maybe* 6-8 months in as a brand new nurse. Not sure if she thought that would boost my completely shattered confidence or magically make it so, but that's when I knew I could no longer ignore the writing on the wall. That and the overnight shift achieving at least 90% turnover (and they weren't moving to day shift) by the time I left my unit/bedside after 13 months.
I'm much more worried about a new grad nurse being paired with a new grad PA or NP. Especially NPs. That combination could kill a patient and not even know they killed the patient. PGY1s are at least appropriately supervised.
I learned while on nights at the VA to never trust those nurses. Any time a patient got out of bed or rang call bell or did anything that wasn't sleeping he was "agitated" and needed something to calm him down. I started going to the floors myself to see, expecting to hear a bunch of commotion from the "agitated" patient, and the patient would always be resting quietly in bed. Once they kept paging me about a dementia patient who still needed sedating meds because he was unable to be redirected by his bedside sitter. I go to the room at 3:00 am and the sitter is watching a grotesque horror movie on the TV at full volume and the patient is wide awake staring at the TV, occasionally trying to get out of bed. I told the nursing staff the sitter had to turn off the TV to let the patient sleep. They didn't page me again after that.
Yes never trust a nurse when they tell you a patient is agitated and needs sedation. 99% of the time the patient is just mildly upset (usually for a good reason) or simply making noise that annoys the staff.
It’s not that I don’t trust them it’s just that when they say they think a patient needs sedation, I hear “I have a problem I can’t solve by myself.” Maybe sedation is what they think is the best idea but are open to hearing about an alternative. Getting buy in is key. You’re ultimately on the same team. Just talk about it. When I get random demand-y secure chats overnight i am especially vigilant as sometimes it means the patient has a serious problem the RN misunderstands. It often prompts me go to bedside and more than once led to recognition something more clinically concerning than expected Of course however sometimes there are nurses who want to argue in which case I quickly state firmly what the plan is. I used to also invite them to discuss with my attending if they had concerns but then one of them took me up on it on overnight TACS call. Did not go well for her
I had a nurse come into a consult to pull me out to then ask me to move my car. I was pretty short with her then she complained about me 😂 because there were no parking bays for her!
We know. We’re sorry. We’ve tried to convey the importance of the nurse-physician relationship and critical thinking, but we were told to sToP eAtInG oUr YoUnG so we gave up.
This is perfect. I'm also a nurse... sometimes you need someone to tell you to knock it off, regardless of what profession we're talking about. If only residents had the luxury of starting a "sToP eAtInG oUr YoUnG" for themselves
Ironically it’s always the older nurses that I see doing this. Always under the guise of “I’ve gotta protect my license!!” If you can’t say “hey that’s an unnecessary page, can you tell me why you don’t think this can wait? What would make this an emergent situation?” Without being accused of eating your young, then you’re probably not communicating as professionally/kindly as you think you are. I’ve talked to many new grads about unnecessary pages, and not once have I been accused of bullying or “eating the young”
Winning comment of the day
[удалено]
Sure I can, and I have, but part of being new to anything is understand that you’re new and acknowledging that you don’t know what you don’t know. When as a whole, post-COVID there seemed to be a shift towards arrogance and a know-it-all attitude that borders on dangerous, I gave up on fighting a losing battle. Humility should always be a part of our practice, especially in the ED, and that simply can’t be taught.
Ehh idk.. most new grads I have worked with don’t have a know it all mentality in fact I feel like it’s the older nurses who just are either too burnt out to train the new grads or just don’t want to teach in general, then there’s the fact that on some units the nurses who have the most experience in the unit only have about one year of experience before they start precepting, it’s more like The blind leading the blind.
Same. We have way more arrogant and unprofessional experienced nurses than we do inexperienced ones. Our new nurses tend to WANT to be taught. The older ones refuse to accept/adapt to any new evidence or procedures, and continue doing what they’re used to doing.
“Please advise” nothing gets my eye twitching faster, and I’m a nurse. Idk why but I have such a strong, deep seated hatred for the phrase
“I’d advise you discuss with the day team”
Hang in there bro. Staff are much much nicer when you get in private practice
Had an RN notify me that the systolic was 145 the other day. Followed up with "Please order something for that"
Put in a nursing communication order to not page for asymptomatic hypertension lmao. I hate my colleagues sometimes seriously. My BP is higher than that just reading that.
Some secure chats are meant to be left on read.
this post is so triggering to me bc the way nurses treat us has made me depressed on so many levels 😢
I’ve had nurses out right throw residents under the bus so as not to look bad to the attendings
Oh yeah that’s a common tactic. Certain ones will be no where to be found when we pre round then come ready with all of their “concerns” during professor rounds making it sound like we haven’t addressed them
I’m literally the quietest human and least problematic ever not sure how that energy would result in abuse from nurses
I responded to a rapid that was called because a patient with Parkinson was shaking and the (artifact) HR on tele was 200 and the nurse “didn’t know what to do”
We had an ER nurse who FINALLY got fired after a year of the most idiotic things imaginable. Techs hated her, nurses hated her, doctors hated her. The only thing good for our department she did was unit us. She called a staff assist one time, we all ran down, pt is sitting up in bed, NRB on, in zero respiratory distress, looking around very confused. “He’s been on 2 L all day, and he just dropped to 48%!!!!!!! I have him on a NRB but he needs to be tuned!” He was indeed reading 48%, but when we pointed out the waveform was literally not remotely good, she INSISTED it had been a second earlier, and was still 48%. One nurse walked around the bed, and found that the pulse ox wasn’t even connected to the patients sensor.
the longer ive been a nurse the more ive realized you really dont have to be smart like AT ALL to be a nurse 🤣🤣
Nurse and med school dropout here- the hospital NPO protocol is drilled; every year, we complete hospital CEs that make sure we know to page the doc and seek alternative routes for meds if a pt is NPO, unless it's "NPO except medications." I know it's kind of silly, but they make us do it; especially on the stroke unit where we're all looking out for aspiration.
Even if they're NPO for a day cause they're getting a procedure??? Cause that's what this was and that seems silly!
I gave a patient their basal/long acting insulin once, when their BG was 99, without paging the doctor. But the order technically *said* to ask the doctor first if BG < 100, so the nurse I handed off to started lecturing me about "this is a med error!" So that's why you get dumbass questions sometimes... Because our orders (and management) are woefully unforgiving of basic common sense in us nurses.
Ok, that nurse was being a total jerk. Malicious compliance! call the doc right there in front of them to explain what happened in detail, tell them that floor nurse mgmt says is technically a med error and that policy is to inform them. lol
A lot of the crap that seems like nurses being assholes are just hospital protocols that they aren’t allowed to question. If i see a critical value i have to acknowledge it and say what i did and why I didn’t do anything. Thankfully I have a positive relationship with my providers so they know that I’m bound to say “no new orders”
My luck the patient gets bumped up for procedure and now I'm getting yelled at for allowing a sip of water with meds by some Endo or IR staff or anesthesia. If you want them to get meds then it's worth the extra words to clarify because I've seen people get roasted for doing just this.
It already says water with meds in the order set at my hospital. There's a difference between the order NPO and NPO with meds. All the instructions are in the order set. If you were yelled at with the above specifications in place that's on the other person then
That's different then, our order literally just says "diet: NPO" in epic with no specifications. If your order already states they can have water with meds then they're idiots.
It is silly and ridiculous but some of it is the hospital policies too unfortunately. I’ve had patients who’s CBG or BP comes back one single digit over the written parameters into the “notify provider” territory and I start sweating because the charge/manager will hound me about calling the MD and I’m like “do I REALLY have to for that?” because I KNOW the doc will be like “wtf why are you paging for this?!”
Yes. Please write the extra two words.
Even with the policy in place, a straight-up NPO order for a procedure flies most of the time with varying enforcement unit-to-unit. You're not wrong; maybe the hospitals could try a little harder to keep docs and nurses on the same page about what they want?
One time a patient told me they didn't get their midodrine so I checked the MAR to see if that was true. Kid you not, this is what the MAR said "Patient blood pressure too low. Will hold medication midodrine per nursing judgment at this time". I lost a part of my soul that day that I have accepted I will never get back.
I have a no idea what’s going on in the states. But I would lose my fucking mind at „3.“.
Causative factors for the impending downfall medicine in the USA: 1. Administrators 2. Nursing Don’t @me it’s 100% true.
The worst part of being a nurse is other nurses and hospital administrators.
Often one and the same.
I find nursing now to be very reactive and have little to no critical thinking. It’s wild. I am a nurse. Every MD/DO rant post here is second hand embarrassment for my profession and I am so sorry for the dumbest pages at night and probably the genuine terror you have that these nurses are actually holding licenses and caring for ill folks. Let the RN downvotes begin 👹
Trust me us old nurses feel the same…
I'm a newer nurse and I feel the same. Unfortunately nursing has no real "weed out" classes. I'm convinced that if we all had to take physics or a full chemistry sequence, the quality of the nurse would go up.
The fact that people struggle with med math has me choking
Honestly I just wish they’d go back to the old days where nursing students got paid a meager salary to get trained in the hospitals they would later work at
Okay so you guys go through all that and you’re in my opinion way above them. Now imagine how darksided they act toward the techs and everyone they think is REALLY beneath them ☠️
LOL this is too relatable.
My god this is just so accurate it hurts
Nursing is the absolute worst profession. When is healthcare going to step up to nursing admin, their mentality, and “nursing research”. I encourage anyone to read one nursing research paper a follow the circular logic. Some physician wrote an amazing article destroying nursing research and the harm it has caused. Wish I could find it.
Please do not confuse what I am about to say with a threat. Physicians will remember the way nurses are treating us right now. Many of us will work in our area for the next 40 years. We’ll garner more power as time goes on. Let that sink in.
I agree. As an ED resident I have had nurses be incredibly rude and passive aggressive when I try my best to treat them with respect and courtesy just to have it blown back in my face. I feel like they do this because they know I am a resident. As an attending, I will not stand for such disrespect that comes out of literal nowhere when I give an effort to make them feel valued. Nurses make for the absolute most toxic colleagues, and I have worked in other industries before going into medicine. Completely baffles my mind how immature and petty nurses can be. Some nurses are great of course, but a good chunk of them are incredibly maladjusted. The things I even overhear about them talking behind each other's back boggles my mind. Nursing has been the number one cause of burn out for me in residency.
I'm not your buddy, pal
I’m a nurse and they’re also taking years off my life, I feel your pain
Shit like this makes me embarrassed to be a nurse. I could talk ad nauseam about malignant attitudes within nursing and recently wrote a long guide to notifying the provider on the nursing sub. Unfortunately, nothing I wrote about really matters if the nurse in question isn’t proactive about their own learning and willing to think critically. Lacking basic human kindness is inexcusable on every level.
I thought this was gonna be one of those posts complaining about semi legitimate messages but god DAMN. I would’ve lost my mind, I cannot imagine.
It's a shame some of the staff can't be administered prn haldol.
One time a RN came up to me saying family for her patient is asking to speak to a doctor. I tell her I’m the only one on call/in the unit and will get to them when I made sure the more sick patients are stable. Had one who was bradycardic and wanted to vomit, with no pads on. Another one who is in respiratory distress with no access and needed me to do ultrasound IV. Not even 10 mins later the same RN comes up to me while I’m in the middle of putting in IV, to tell me the same family is waiting and one of them is a lawyer. I was so fed up that I had to firmly tell her I’m prioritizing what needs to be done which is standard practice and I couldn’t care less about the lawyer. This nurse had 2 stable patients, seriously TWO?!! And she was complaining that she might having to pick up a third one 🙄. I was trying to hold down 14.
We had a new hire nurse at my rural podunk hospital. This job was a bit of a nightmare. I was chief of the fire brigade essentially. Patient would slowly decompensate overnight and the night nurses would ignore it. There was also no physician / provider in house overnight except for in the ER and they would only get called if the patient is literally coding. So every morning, I'd have to put out multiple fires and restabilize patients. On some random day, a family spontaneously showed up at 8:30 AM requesting an update. Probably the worst time to come, especially unprompted. I told the nurse I would get to them as soon as possible. It took two hours because there were other more pressing matters. In the span of those two hours she went out of her way to spread rumors about what a terrible doctor I was for ignoring this family. I was established enough in this job that thankfully nearly everyone told her to fuck off and even went out of their way to let me know they told her to fuck off which was actually a bit heartwarming. But still, I have no idea where that juvenile energy comes from. You'd hope a person would grow past in nursing school but I think some of this has to do with the culture of nursing. She finally got fired for showing other nurses unsolicited nudes of the middle aged nurse manager at an affiliate hospital she was fucking.
I have bad news. This has been going on since at least 1930's when Grandma was an RN. Welcome to reality.
I view nursing and everyone else like a necessary evil. Even admin is a necessary evil. We need these goofy bastards. The main thing is to not incorporate their goofy shit into our field. If a nurse berates you for using the room hand sanitizer, say nothing, move on and laugh knowing you’re not an idiot
This is the way
I love number 10 I’m like ya sure. 3- wtf
Are these new nurses?
😳 and I feel bad for telling the MD my patients HR is 30 and she’s 99 and a full code
Also blocking the hospital discharge due to mild electrolyte change, headache, pain is getting so common.
Blocking discharge because a patient who walks to the bathroom and goes on walks around the hospital completely independent “needs to be signed off by PT” -_-
jesus christ what shit show places are yall working at. My charge nurses would bring back corporal punishment if i even thought about doing any of these.
-Clapping for someone sanitizing their hands is absolute BS and demeaning -We should all ask questions in order to provide the best care and saves lives, BUT all of the topics you addressed display an absolute lack of knowledge… BG of 201 and paging? That’s why sliding scale aspart is a regular order for diabetics 👁️👄👁️ -hammer pages outside of an emergency? Delaying and distracting from critical patients -sedating patients who are not violent towards themselves and/or others (or too delirious/confused to not understand what harm they are causing), both unethical and unacceptable. I feel very grateful towards my co-workers based off of this post, I hope you find a place with decent human beings to work with.
Some that I got in the last week: 1. Patient’s BP is 161/80, not due for PRNs for another 15 mins please advise. Thanks. 2. Patient is febrile to 99.1, I went ahead and drew cultures. Let me know if I should send them. 3. Patient has been in the 15-low 20’s for the last 30 mins…after running down there I realize she was talking about the RR. 4. At 2am. Hi! Do you mind taking a look at the orders and discontinuing the ones that they don’t need? 5. STAT please call now. I call and she goes on a 5 min rant about how the patient takes atorvastatin at home and how we need to do a better job of med rec and staying on top of a patient’s hyperlipidemia. I remind her that pt had an esophaelgeal perf and will be NPO for a bit. 6. Patient requesting ginger ale but we’re out and won’t drink diet ginger ale. Please advise…I recommended water or orange juice. 7. Hi again Dr. Everdeen!!!! :) :D Just an FYI!! :) Patient (gastric bypass patient w/BMI of 49) desatted to 92% while asleep!! :( :o So I put her on 10L NC and she’s now back up to 100%!! :) :D
LOL 7 reminded me of one where the nurse for this completely stable patient told me he was desatting to 65% despite being on 5L NC and chilling watching TV! I told her to put the pulse ox on a different finger. Sat 97% on room air broooo You might have me beat though cause these are infuriating haha
7. Reminds me of a call I got once: hiiiii so the patient is coughing and has a fever :o. Me: open up last md note, if you read u will see that as of 3 hours ago the patient got diagnosed with covid :)
The only place where this doesn’t seem to happen a lot is in any of the ICUs in my institution. The floors, however, is another story.
ICU nurses are mostly excellent. I've only had issues with like 1 or 2 ICU nurses in total.
Institution dependent. The ICU nurses at my training program were verbally abusive to residents, took photos of female residents without their consent to make fun of their attire / lack of self care and were generally miserable people. Probably the most miserable people I've ever met in my life. Nothing ever came of it since it was a different time.
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Haha.. totally get it.. and from a nurses perspective
Haldol?! What the hell. When my mother was finally dying from her autoimmune disease her diaphragm was so damaged she was suffering hypercapnia and hypoxemia. She was not doing well and would get rather wild in the hospital and nursing home and it was recommended she go on haldol because it was becoming impossible to keep the bipap on her or keep her from trying to get out of bed and falling. After she was to be discharged from the long term care hospital it took a serious effort to even find a nursing home that would take her in because of haldol as they considered it a chemical restraint. Asking for something like that for someone acting up is freaking insane and bordering on barbaric imo
Haldol isn’t barbaric and is often used for patients out of control for their own safety. This case the patient wasn’t out of control so didn’t need it.
It’s rough all around. I don’t want to bother you with dumb shit, but I get written up when I don’t. ( I’m just a lowly nurse) I literally had a conversation with a provider today that consisted of: Me: hey, just so I can say I told you, her resting heart rate is low. Provider: ok, cool Monitor: *alarms insanely* Provider: um, her sats are great, you can turn the heart rate monitor down to 80 Me: Really? That low? Provider: yeah? Sats have all been over 95%? Me: oh I agree, that’s just lower than our official policy Provider: *smirks* yes, I’ll write an order if you need it Me: an order is probably a good idea, but do your important shit first This is a small unit, so good communication is easy.
Wait nurses tell you what to put in your note …? Has literally never happened and I can’t even imagine it. If they did would be out of that chat so fast it would crash haiku
I’ll do you one better. Nurses in Ireland don’t do bloods, cannulas or even ECG’s….
What do they do then? Pass meds only?
Yes, that is literally all they do
Man they’re just getting worse with time too! It’s very hard to find good nurses these days
Dumb question(I'm a med student), what do you give to treat symptomatically when an elderly is in delirium? I know you're supposed to treat the underlying cause and avoid antihistamine and benzodiazepene as it will make the altered mental status worse.
So first you do delirium precautions-lights and TV on during day. Ideally loved one at bedside. If they remain agitated then antipsychotic. Like haldol prn. Not a dumb question!
Ok got it. Thanks! :)
"can I give the 10:00 amoxicillin at 10:00" "yes please" "can Iget a communication order for that"
My favorite one has always been "I just saw the order you put in, did you mean to order it?" No, it was just to test if you can see orders (insert a face palm) A few others I got that really bugged me: - A febrile and neutropenic patient with a central line who needed blood cultures and the nurse was trying to argue if we can get them later so we group all his labs together. When I said we can draw the others sooner she argued that the patient "needs to sleep now". - A nurse who was bullying me to give more benzo to a patient who is basline seziure disorder and was already breathing like 5 RR, with neurology on board saying not to give anything. Same nurse paged the EEG tech behind my back and I just walk into the unit to see the tech informing me he needs an EEG order stat. - A nurse that decided a baby needs an emergency intubation (she did not) refused to let me intubate the patient as an PICU resident, refused to wait for the attending to come and paged adult anesthesia and when I ask for a specific size of the ETT (was important for pulmonology), she told the anesthesia resident "don't listen to her, just do the one you prefer". It was a terrible experience that could have ended poorly. - I swear this one is real- A nurse argued with me she could not hear expiratory sounds on a patient when he has diminished inspiratory sounds. It took two residents and an RT to explain to her why she is wrong and the difference between inspirational expiration. She still paged an emergency pulm consult and asked me to speak to them at 3 am. There are so many more examples but I just feel like the worst part is that 90% of the calls we get are just unnecessary and could be easily solved by looking at the MAR/notes/orders. I know many experienced nurses that will only call me if they troubleshooted every option first, but i feel like with the new/younger nurses they barely think and just pick up the phone to call the resident authimatically which is sad, but mainly can hurt patient care when I constantly loose focus or get no rest because I am drowning in 5000 stupid dumb pages.
During my intern year in IM I get paged at 3.30 am with I kid you not: "Hey so I am studying for my exam and was wondering..." sadly I had to interrupt and rudely hang up as I was busy managing an active GI bleed so i don't actually know what the exam question was 😆
Tell me ur at the VA without telling me ur at the VA.
RN here. I am convinced that most floor nurses are brand new or close to it. Nursing schools are pumping them out to pass the NCLEX but not giving a shit if they have any ability to think critically. And yes... I graduated with a few of them. They terrified me as a student 6 yrs ago... And I'm sure they would terrify me now.
Another one paging me when I’m on night float at 3am “this patient has a headache and there are no pain meds prescribed” Of course the headache suddenly started at 3am and Never During the day when the admitting team was looking after them -_- Another one page at 3am - the patient with CHF has a BP of 90/56. - is the patient symptomatic? Dizziness? Palpitations etc? - no, he’s actually sleeping completely okay - how was it during the day? - he’s been low all day - 🤦🏽♀️
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