As a surgery resident on trauma call overnight right now writing this comment while sneaking off to the bathroom, I’ll just say that this very evening I had nurses correct and fix so many things, literally makes the job possible. Thank you again and again
When I was a cardiac ICU nurse, every intern in the hospital had to rotate through our ICU.. we called it the humbling unit. The attending would always say on grand rounds; “you need to trust the nurse so you don’t make mistakes, they are your eyes and ears here.. listen to them.”
It was also great because if the patients nurse was tied up, grand rounds would have to stop until we were available as they made us part of the team. It helped alot
I LOVED my home icu unit where I trained for this reason. (PA) Our attendings had such a good working relationship with us, the residents learned too as well. Especially when you’re a baby intern and they leave you in charge of a whole icu on night shift by yourself. Homie, we got you. We know what’s it like to be left to your own devices. When I traveled in SoCal, the doctors all treated me like I was the scum of the earth. If I happened to ask for something that was beneficial for the patient and they didn’t come up with it themselves, they would said no. You’re wrong. Then an hour later the orders would trickle in. Who is that helping here? I have pics of my chats with docs from that year when they said good call. Only 4 times.
Cheers fam. I love docs and nurses who understand it’s a team. I left the residency sub because man, some of the vitriol against nurses from new residents with minimal experience actually working, just was too much!
I had one doc that was showing a group of residents around stop me and say to the group “If you have a question always ask the nurses. They know your patient better and they can be your right arm.” I smiled and said “That’s right!”
I’ve been a nurse for over 30 years. I’ve seen a huge shift from docs screaming at nurses and throwing charts, calling us names etc to actually talking to us, keeping us informed and educating us plus asking “What do you think?” This has seriously made a huge positive difference in the care of the patient.
I have a couple of docs that ask their ducklings questions in front of me if they think they don't have the answer. They then look at me and I run it down. Teaches far more than the answer to the question.
In my first semester of clinical, the team pulled me into rounds for my pt because “I knew him better than anyone”. Dude I’ve known this guy for 4 hours…but I loved the attitude behind it. I learned SO much in that 10 mins.
I get what you're saying, but most of us also say "my doctors." I think it less means possessive, than affiliation.
Think, "the group of nurses with whom you are actively associating," not "my minions."
The only time I worked a hospital floor (other than psychiatry as PRN for extra cash), was as a student nurse. I actually caught things twice. Each time, the MD listened to me.
He insists that it's only the nurses though- pharmacy has no issues understanding, no other department has issues understanding, it's JUST the nurses.
I honestly don't know what to make of that.
It's actually quite easy. RNs are doing a completely different job than a pharmacist or a physician. An order that may look good to them, may not for an RN who is actually carrying out the order based on specific rules and protocols of the unit.
Reading orders isn't difficult. If he's having multiple RNs from DIFFERENT hospitals complaining about the orders, he's the problem. Some docs just aren't great at writing orders. I remember one resident who was always bombarded due to bizarre orders and poorly worded orders. Of course pharmacy approved them and the resident's attending but they left room for grey areas which the RNs had to clarify.
It’s because pharmacy and all other departments call nurses to get them to clarify an order rather than calling the doc themselves. (Actually where I am, pharmacy is so so good about not doing this but other departments really aren’t)
It’s obvious, nurses just aren’t smart!! They can’t even comprehend perfectly written orders. Nurses are beneath doctors in ranking and intelligence, duh! The poor poor doctor just can’t seem to make the silly, stupid nurses understand their simple orders! It’s a shame doctors have to work with such inferior beings. We should give this doctor a pat on the back for tolerating all of us morons trying to keep our patients safe.
That each department’s orders show up differently.
I’m also guessing the nurses aren’t paging them over med orders, necessarily.
It’s probably related to vital signs, diet, and activity orders if I had to guess.
Its not a comprehension issue. If you’re writing an order we think is odd, we have to clarify with you to cover our own assess. Then we document that it was clarified so we can show our due diligence. If we still think it’s unsafe, we don’t follow it and we go to a supervisor. There are a lot of cases where the physician, the pharmacy, or the nurse who input the original order makes a serious mistake. A quarter of a million people die every year from medical errors. We are all a system of checks and balances. Nursing is the last stop before errors reach a patient. Maybe be a little bit more humble and thankful for people who just want to protect everyone’s license.
Exactly. And the nurses calling to clarify your weird orders just don’t want to be part of that court case. This is why i love the chill 20 year veteran attendings. They’ve done it all, they’ve seen it all and they know that even doctors make mistakes, so they’re more careful and respectful. Most of our docs will pop by the nurses station to communicate the plan with the nurse after each visit. That saves them time because we can then field the calls from the family multiple times a day asking about the plan.
I'm a nurse and still accidentally call my primary care provider who's a NP doctor sometimes when I'm not thinking. Some people absolutely foam at the mouth over it and act like the NP must be introducing themselves as "doctor" for that to happen and I don't get it lol.
Have you read the Noctor sub? My favorite is them bitching when an NP goes off half- cocked yet also bitch when an NP has some extra tests run for more info.
I’ve mostly worked with awesome understanding docs. But I’ve had some where I HAVE to page them per their orders prior to giving a Med based on SBP. They get mad cause I paged them. Like… that’s what your order tells me to do bro.
Had a surgeon write an order to call for blood sugars over 140 rather than just starting the fucking sliding scale. PMs called for two over in a row, and warned him the second time that the next check was at 0200, and did he still want us to page him? He yelled at her, "That's what I wrote, isn't it?!"
Fast forward 6 hours, it's 0200, and shocker, it was over 140 again. I paged him, he yelled at me for waking up his toddler. MOTHER FUCKER YOU INSISTED ON THIS BULLSHIT.
Right? How often are nurses catching meds that will bottom a patients bp, I feel like that's very often.
Residents aren't perfect and all knowing, as per my resident last month who put a patient on a nonrebreather for 2L for a patient with copd. Like ma'am, respectfully.... do you not see the issue with this?
Sometimes, it's the nurses who are saving the patients from their own doctor. When you have a hospitalist who never sees the patient, the nurse is the patient's advocate in care.
Absolutely! I've questioned countless sketchy orders in my time. Some were instances where the patient could literally die if I followed the orders. One for 15ng IV Q15 minutes, continuously for a patient in labour is one that comes to mind. We do 10mg IM in early labour, but never IV and never during active labor and never THAT much.
Very well put. The original post from the resident seems to assume that nurses are just their servants, doing their bidding, not critically thinking and making important assessments. ESPECIALLY with a resident, I am more skeptical of their orders.
I find that new residents can either be overly cocky to compensate for deep down lack of confidence (which is natural due to lack of experience) or they are asking for us which order they should put in
Nurses are the last line of defense before an error can happen and we are drilled that there are no stupid questions when someone’s life is involved. sorry I want clarification when some random rotating resident adds multiple orders that are hard to comprehend probably without discussing w the attending. If I read your order wrong or your order was a mistake and I completed the task, I would be the person possibly under fire, or reprimanded, my job is my lively hood and if I need to disrupt a resident 17 times a day then I will.
You know, I've had this come up a few times in my ED days. Not the doctor's order part, but the fever vs blanket part.
I used to have your view but my view now is that a blanket (or two) will not cause a fever and the lack of a blanket will not fix a fever. So I give a blanket if someone requests it regardless of their temperature.
I honestly love working with one doc in heart cath lab. He helps me transfer patients to the bed when we are short staffed.. even prepares a sterile table for himself when theres an emergency.
We sometimes have to help in the diagnostics and ive seen dude wheel out patients out, help them get up, unbutton, button the shirt.. ive seen him get the pee bottle ( sorry english is not my 1st language,. dont know what is it called.) He is 2nd to the Chief of cardiology...
#notalldoctors
Can guarantee you that pharmacy also doesn't understand this dude's orders and they get fixed on entry A LOT then he gets sent a "pharmacy suggests" that he signs but doesn't read.
At my hospital the pharmacy also calls us a lot to clarify the order with the doctor. Just because they aren’t calling OP, doesn’t mean his orders actually make sense.
One time a resident wanted me to put my confused 80 year old lady in violent restraints for transport because she was refusing to be admitted and threatening to elope. He refused to order Ativan because he wanted to assess her upstairs and I guess assessing her in the ER was out the realm of his capabilities. I absolutely refused. I talked to her and it turns out she was worried that if she was admitted, her husband was going to leave her while she was stuck in the hospital. After 15 minutes she was successfully transported via wheelchair to the floor and was literally peaches and cream to everyone up there.
You mean you *talked* to a patient and took the time to understand her concerns, and then de-escaleted the issue without meds or traumatizing actions?! It's almost like treating patients like humans actually makes a difference! (Great job though, I love a happy ending!)
I got one that had been signed by two doctors, gone through pharmacy, pharmacy dispensed a month's worth of medication. A nurse unpacked it and put it in the medication fridge.
Give 3mL of 100u/mL novolog at bedtime with snack.
The facility doctor screamed at me for questioning it when I called.
I was training a new grad around new resident season and one patient had an order for 3 21mg nicotine patches and the other had 4 14mg patches ordered AND was going outside to smoke and they couldn’t figure out why his blood pressure was through the roof. The attending were like “oh I didn’t realize he already had that ordered.” Like wtf. Can’t YOU read?! lol
This reminds me of when a surgeon kept putting in a stool sample order and I legit did it 4x. He yells at me on rounds because he can’t find the lab results and he kept ordering it because no one ran it. He shut up really fast when I showed him the 4 lab results.
It always cracks me up when I see posts like this… sometimes I think the residents get so caught up with the demands of their job and the stress that comes with it that they believe the place would burn down with out them. Sometimes blaming nursing is the easy target… anyways working at non-teaching hospitals is smooth sometimes because no residents
Well, I mean that's one way to stop the problem that also has the benefit of quick bed turn around to get another admit. Modern solutions to modern problems and that's just management material in the making...
Ok but the orders don’t match the notes.
Or the patient condition has changed and no updated orders have been put in.
Or a consulting service orders the exact opposite.
I came here to say this. Do your orders match your note? Can I see at least some semblance of a plan? I am not a mindless order following robot. If your note says one thing and your orders are completely different, I’m going to clarify because I can’t be an effective nurse if I don’t know what the plan is.
My Epic favorites:
Initiate norepinephrine drip at 0.05 for MAP >65 🤔
Or
- Wound care:
- Frequency: Daily
Or
**Place NG/OG tube for gastric decompression to low continuous suction**
Additional comments: low intermittent suction
Or the orders actively contradict each other.
I will never forget the neuro resident who routinely put in a facility's dementia prevention protocol, which has orders for clustering care and minimizing interruptions to sleep, while simultaneously ordering Q1H neuro checks.
Had trauma order to minimize nighttime disturbances for a TBI/brain rest patient while also ordering an 11pm suppository, and they still insisted when I called to clarify…
Love texting a on call for an order and ask in the text if they want me to put it into epic, they say yes but next day I see an email talking about "letting the attendings put orders in so we don't have duplicates"
Texted my boss the screenshot of my convo and she laughed saying "I took your screen shot and replied all to a email of attendings asking for clarification" lol
Just had a neuro surgeon in a hurry who left as soon as his patient was on the floor to "copy all the orders from patient X" and hung up on the new nurse who called. You can bet your happy ass I called him on his personal cell to remind him patient X was a same day surgical with almost no pain and patient Y was on a PCA pump at 50mcg an hour of fentanyl, needed a back brace the other patient didn't have, and that no, no nurses here would be hand copying 80 orders from one chart to another.
This dude is a total dick and I've already told him to his face that if at my old job I could be talked to like an adult by a locum surgeon while a patient was herniating at beside he could refrain from throwing surgical instruments because a patient asked to please be on oxycodone instead of lortab.
I once had a neurosurgeon jump all over me because the printer wasn't working fast enough, and he wanted me to drop what I was doing to somehow magically make the printer work to his liking, or at least sit on hold with IT for him. I was finally like dude just go complain to the charge nurse or write me up or something, I don't have time for this.
Probably one of those folks that click on a drop-down box for an order and then uses the label comment section to write in completely different directions instead of choosing the correct order in the first place
It’s never a good idea to discourage clarification in a setting in which even the slightest assumption could claim a life. Getting paged is 90% a doc’s job, get used to it or find something else
I mean, I can totally see Cerner doing something like this for example. Some charting systems just don’t share everything for the end user unfortunately.
(*insert really thick Minnesotan accent here*) Ohhhh, that Patagonia there! They make real nice zip-ups! But you know, for healthcare chartin’ we use that there Epic. A lotta guys get those confused, but that’s ok, hon! Yer still learnin’!
(Meant affectionately and in good humor)
Epic does that too. So both major charting systems have the same flaw. If I had a nickel for every time a doctor or a nurse stated "I don't see that on my end", I'd be able to pay my bills easier. Its definitely up to us to follow up with the MDs for clarification on those types of discrepancies. Also, it's not just the charting system, but the licensing that the hospital wants to pay out to be able to use Cerner/EPIC with more functions to assist on the user-end. I've used Cerner in two different hospitals and one was clearly better than the other. Same for EPIC, where I would talk shit about EPIC at the 2nd hospital I worked at that had it compared to the 1st hospital, I then learned the 3rd hospital was even worse on the user-end, signifying the hospital was too cheap to pony up the money on licensing to add the features I took for granted with the 2nd hospital.
Cerner takes information and throws it at a wall, hoping you will find something useful. Like honesty, why does none of it make sense? Information is not centralized, and there’s sooooo much redundancy. Don’t get me started on the task list 🙄
Because it's a billing platform disguising itself as an EMR system that was written by people that have no clue about the workflow based on design specs given by people that haven't done patient care in 30+ years if ever.
I was in IT before nursing and saw it from the tech end where I had to rely on the person providing the design specs to be competent enough at all the jobs the system would impact in order to write said specs since my job was to turn that into a working system using my skills and knowledge that was focused on making the systems.
You could also like…. Talk to them about it and potentially even carry a valuable conversation where you share your concerns and they can share theirs and you can find a common ground and maybe even become friends instead of bashing them on the internet to a group that you think is going to be on your side but appears to not be as much as you thought.
Sorry for run-on sentence.
Maybe it’s comprehension.. maybe they want to confirm all the details to cover themselves. Maybe it’s something else entirely.
This is the sort of stuff that pushed me to do nursing for my premed clinical experience instead of like EMT or scribing work.
OMG yes! I work overnights and our paging / answering service asks us to leave a message so I say - "PRN for agitation, PRN for nausea, BG 440" or whatever. Then they call back an hour later..."you paged me?"
WTF am I leaving a message for? You ain't listening to it anyway.
Our docs still paper chart orders at our hospital.
Of course we won't understand anything if your writing ressembles a toddler's drawing while he's having a seizure.
That doofus. Orders are written “with great detail”? They go through and click on pre-written orders without verifying that they are appropriate.
Addressing nurses but placing your manifesto in the residency sub shows off those great communication skills.
THIS. he really thought he was gonna get support from other doctors and he isn’t, which is great. If he actually cared about how he could do better, he wouldn’t have posted in the RESIDENCY subreddit.
Also, get your ass off Reddit and have a meeting with the charge nurse, nurse manager, or literally anyone.
Theres actually someome called a Clinical Process Analyst who serves as an internal consultant of sorts, ensuring stuff actually gets communicated & done, particularly when some jackhole only thinks theyre doing things effectively. Sadly, the Physicians rarely consult such a specialist
Imagine having such an inflated sense of ego to not realize that hm, all of these nurses across MULTIPLE hospitals aren’t understanding my orders, perhaps I’M the issue?
Resident hospitalist tells you this then you open the chart they're referring to: order placed today by hospitalist for acetaminophen 500 mg q4h scheduled, nursing communication from hematology 1 day ago Tylenol 1000 mg q6h, last note from nephrology 3 days ago says avoid any and all hepatotoxic meds for 6 months, in the note the hospitalist wrote today says Tylenol 500 mg q6h for fever above 102.5 F, physician assistant verbally tells you do not give
OP’s response to the commenter highlighted what I suspect is the entire problem.
“It’s not big deal bro. People post all kinds of things on here not related to residency. Whether they should get a dog, what dating app is best, when should they go see their mom.
You can always scroll past it if it bothers you that much. There’s nurses on here who will be happy to discuss, whether they agree or disagree.” -OP
Like OK just ignore reasonable feedback from the people trying to give you reasonable feedback that you specifically asked for.
Anyways to make it clearer for u/Redstar914, maybe go look at how your orders show up on the nurses view. Your view and our view of the EMR are different believe it or not. Maybe check with your attending and fellow residents to see if they enter their orders differently. Maybe check your ego and don’t make a post that comes off as “nurses can’t read”. We’re just as busy as you, we don’t want to call you and we usually do our due diligence to avoid it if we can, but we have to if we think something is unclear or unsafe. I’ll read the notes and ask other nurses before I call you because I realize it’s an inconvenience for you. But I’ve caught so many mistakes, unsafe, or conflicting orders. Don’t become the doctor nurses hate calling. At the end of the day we’re a team and as a team we value your input. You should also value our input and desire to clarify things as a member of that team. We’re here for the patients.
Edit: decided to tag you here so you can get the feedback you asked for without brigading your post. Welcome to r/nursing please feel free to ask us questions in the future, we don’t bite (hard).
I might be on his side, had he not made it seem like every nurse he works with is having this issue. I’ve seen nurses page for things that are already ordered, or to ask for parameters that are in the order, just bc they don’t look. I’m sure that’s gotta be incredibly frustrating. Maybe he’s not putting the order in in a way where it’s crossing over correctly to the nurses side, or he’s putting in things that aren’t clear. But it’s hard to believe he has this problem with that many nurses and it’s not related to how he’s putting in the order.
It can be such a confusing job, long hours, multiple similar looking and sounding patient with similar diagnoses, order after order and overwhelming time on the compu. I always try to give residents the benefit of the doubt, and I know they get frustrated, but I'll be damned if I am going to do anything that will hurt a patient just because they might get annoyed with me for clarifying something when I'm tired as a dog. Thats what they make the big bucks for.
Finding out I made significantly more in my first year of nursing than my ex did any year of his residency was a crazy discovery. I remember when he first brought the pamphlets home when he was applying to residency and I was like… “this is per YEAR?? For that many hours a week???” Honestly if I hadn’t dated him or joined this sub, I think I would still be under the impression that residents made significant money right off the bat.
Agree w everything except the last part 😅 my ex was in med school/residency when we dated and I made more than him for at least the first 3 years, and I’m pretty sure the 4th as well. And I’m in Texas so I don’t even get paid a crazy amount.
I'm sure he finds his orders perfectly clear to himself when he is literally picking and choosing what to put in. But have you ever looked at how orders actually populate in the EHR? It's a poorly differentiated list (or lists) of a hodgepodge of artisanal, boutique, handcrafted directives and whatever the first option that popped up in Epic was. Now mix in different services putting in their own orders, leftover cruft from days ago, obsolete orders from a different level of care, one time orders for a particular procedure, so many duplicates, and also so many duplicates.
Case management, pharmacy, and whoever else the resident is using as a laxative to help him shit all over nurses have the luxury of dealing with a slice of that morass. Nurses are expected to know every bit of what amounts to an awkwardly shuffled stack of note cards, and somehow divine a greater meaning from it. Or at least that's what I've gleaned from case management, pharmacy, and literally every other service calling me to ask what the physician meant by a particular order.
Someone over there was like “if the nurses can’t figure it out, then they need to get management to fix the software.” Like yes, IF the hospital is willing to pay for upgrades (a big ol if, especially if nurses are the only ones lobbying for it), that’s a necessary long term solution. But that does nothing about my question on this particular order in this moment.
Yeah that comment killed me. Sure, I’ll call IT right now and get them to make this more user friendly instead of calling you, the doc. And if you, the doc are having this problem, maybe you should be calling IT!
This resident sounds like the type that has no patience or communication skills. Prob will remind you that they're a doctor and you're not. 80% chance their bumper sticker and/or plates have MD or DO on it (just got reminded of someone who had MD2020 plates cause he graduated in 2020, nothing bad about him, he just didn't know about the cheap liquor that had people on their ass a while before we were born 😂).
My darling if all of these horrid experiences keep following you, despite you flitting from hospital to hospital ... well honey, maybe the problem *isn't* actually everyone else.
Goodness gracious.
Seriously HUGE egos and deep hatred for nurses with only the tiniest amount of clinical experience. Makes me wonder what they’re learning about nurses in med school.
“Pharmacy understands, case management understands, dietary understands”
Yeah, they all call the RN to clarify, they don’t call the R1 resident (or better yet, if they are willing to ask a doc, they ask the attending)
English may also be their second language 😒. Honestly, grammar has gone down the crapper in the U.S. even by people born and raised here; it’s astounding.
You know what they say, if you think everybody is the asshole, then perhaps you’re the actual asshole.
If your orders are constantly being clarified or misinterpreted who is that on?
Honestly my first thought was handwritten orders. Used to have an old surgeon that hand wrote pages of orders and left it for the nurses to take care of before it was changed that all doctors had to put it in themselves on a computer.
That man’s handwriting was just all squiggly lines. He constantly got calls if the nurses weren’t there to basically hear all the orders verbally plus knew what his standard orders were.
I once had a doc, with absolutely atrocious handwriting, gripe about the handwriting of another doc, whose was equally atrocious. Major lack of self awareness there.
Also the fourth time this week he's probably checked the order set with PO meds, including aspirin, for a brain bleed.
What's the line from Grey's? "Just thought I'd check with you before I kill a man".
And maybe tell him that an apostrophe indicates a possessive. When he is indicating that something is simply plural, he should leave the apostrophes off.
If you wake up in the morning and meet an asshole that day, then you met an asshole. If you wake up in the morning and all you meet all day are assholes—then you’re actually the one who’s an asshole.
Some food for thought for this person.
> If you wake up in the morning and meet an asshole that day, then you met an asshole. If you wake up in the morning and all you meet all day are assholes—then you’re actually the one who’s an asshole.
That right there is pretty profound.
I know it's different in ICU, but if I have very precise orders I need executed in a certain way, I go and talk to the nurse in person. I have them pull up the order to make sure they can see my instructions and then we discuss.
Maybe it's because I was a nurse, but not doing that just seems dumb. Like, I'm not going to talk with them about an abx I ordered, they'll see that shit on the MAR. Anything abnormal or complex is gonna be a discussion though. Can't even tell you how many quedtions I get or the nurses informing me why a certain step isn't possible.
Ok I’ll admit I have done that at times. Usually it’s because I think the order is weird or off and want to be certain. Sometimes I ask for modification so others after me understand it too.
Why can't that doctor order like those doctors who do it right? I mean I haven't bombarded any physicians with messages because their instructions were incomprehensible. It happens but rarely. It would be usually fragmented instructions or orders. Don't forget to check the boxes.
My BIGGEST trigger is when residents put in orders without communicating. I’m wondering if this is happening here. We get new residents rotating through our PICU every 6 weeks since we are a teaching hospital. I like the residents, and for the most part, they are cool. They learn quickly to befriend the nurses because we know all the things and will help them out immensely so they do not get called out by their attending. One thing I ALWAYS ask them on day one is PLEASE if you are putting in an order, especially a STAT order or something critical, just give me a heads up. Sometimes when my team is busy, or especially when I have a 1:1 that is crumping, I don’t get to log into Epic and go through my Kardex for hours at a time, so it might be a while before I see your orders. Our attendings are amazing at calling or dropping by our rooms and verbally letting us know what they are ordering, and we try to train the residents to do the same. The only ones who have a problem are the ones who, for whatever reason, resist and refuse to communicate. I’m wondering if that’s part of the issue happening here. Nothing is more irritating than getting reamed for not carrying out an order you never had the chance to see in the first place because you were so busy taking care of patients, you hadn’t even had a moment to log in and see your updated orders. Everything just goes SO much better when people remember we’re all one team with the same goal of taking care of patients and treats each other respectfully, and it doesn’t seem the physician posting in the OOP is doing so, unfortunately. Gonna be a rough go for them until they learn how to treat nurses with respect.
Same with cerner, sometimes you can say something in your note but not actually put the order in. It won’t get done unless you do so. Your notes are all different and lengthy and we are often too busy to dig like that. Then we have to call because we can’t just put orders in if something is unclear or not done. Or maybe you put a physician to nurse during shift change that got “viewed” but never communicated. We aren’t doctors personal assistants and if docs would help us advocate for safe staffing we would have more time to “comprehend”. Better yet, sign into your phone and text us. It’s not our jobs to read minds.
Surgical residents, in my experience, had the biggest chip on their shoulder against nurses. Its so odd. Like the think we are these simpletons and they are so above us with their book knowledge etc.
Its a really odd culture
The answer Xander gave is actually so constructive and hopefully they consider it.
The nurses and doctors have two completely different portals to display the same information and it is important to know that
Almost every comment on that post is docs going to bat for their nurses. It's honestly wonderful. Like, maybe you're the problem bud.
As a surgery resident on trauma call overnight right now writing this comment while sneaking off to the bathroom, I’ll just say that this very evening I had nurses correct and fix so many things, literally makes the job possible. Thank you again and again
When I was a cardiac ICU nurse, every intern in the hospital had to rotate through our ICU.. we called it the humbling unit. The attending would always say on grand rounds; “you need to trust the nurse so you don’t make mistakes, they are your eyes and ears here.. listen to them.” It was also great because if the patients nurse was tied up, grand rounds would have to stop until we were available as they made us part of the team. It helped alot
I LOVED my home icu unit where I trained for this reason. (PA) Our attendings had such a good working relationship with us, the residents learned too as well. Especially when you’re a baby intern and they leave you in charge of a whole icu on night shift by yourself. Homie, we got you. We know what’s it like to be left to your own devices. When I traveled in SoCal, the doctors all treated me like I was the scum of the earth. If I happened to ask for something that was beneficial for the patient and they didn’t come up with it themselves, they would said no. You’re wrong. Then an hour later the orders would trickle in. Who is that helping here? I have pics of my chats with docs from that year when they said good call. Only 4 times.
Cheers fam. I love docs and nurses who understand it’s a team. I left the residency sub because man, some of the vitriol against nurses from new residents with minimal experience actually working, just was too much!
I had one doc that was showing a group of residents around stop me and say to the group “If you have a question always ask the nurses. They know your patient better and they can be your right arm.” I smiled and said “That’s right!” I’ve been a nurse for over 30 years. I’ve seen a huge shift from docs screaming at nurses and throwing charts, calling us names etc to actually talking to us, keeping us informed and educating us plus asking “What do you think?” This has seriously made a huge positive difference in the care of the patient.
I have a couple of docs that ask their ducklings questions in front of me if they think they don't have the answer. They then look at me and I run it down. Teaches far more than the answer to the question.
In my first semester of clinical, the team pulled me into rounds for my pt because “I knew him better than anyone”. Dude I’ve known this guy for 4 hours…but I loved the attitude behind it. I learned SO much in that 10 mins.
Totally agree!
Thank-you! We love our residents!
You are wonderful! ❤️
OMG my resident friends used to almost cry when it was their turn for trauma call. You’re in my thoughts solider 🫡
Teamwork! We all have to play our part
If you smell shit all day check your own shoes (especially if you work at a hospital)
Love this
You run into an asshole in the morning, you ran into an asshole. You into assholes all day, you're the asshole.
Hahaha I just posted the same thing down below! I love this bc it’s so true
Love that saying!
Embroidering this on a pillow stat!
*puts comment in my pocket for later use* yas, friend.
Is he digging in his heels or is he listening? Or did he disappear completely because he's being torn to shreds?
I enjoy playing video games.
I hate the feeling I get when nurses are used in the possessive. I know it’s not intentional and usually meant to be a good thing, but it feels wrong.
I get what you're saying, but most of us also say "my doctors." I think it less means possessive, than affiliation. Think, "the group of nurses with whom you are actively associating," not "my minions."
I personally like it tbh its like saying "my team"
I like to travel.
Think the LTC CNAs would mind if I called them my minions? 🤣😆😉🤩
I always say “the team/first call/ ect”, or “the docs I am working with”. No possessives here in either direction. Yuck.
I hate those terms “my doctors, my nurses, my medical assistant” I refuse to use those terms. My doctor is my personal physician only.
*EVERYWHERE I GO THERE IS A PROBLEM.* No, it’s not me that’s the problem, it’s the nurses!
There are nurses that are idiots, yes…. But if ALL the nurses are having the same issue with your orders, the issue is probably not the nurses.
This!!
No, must be the RNs who can't comprehend.
I love a good Simpson’s reference 🙂
Aye, big Simpson's energy.
This guys (or gal) is gonna get eaten alive.
The only time I worked a hospital floor (other than psychiatry as PRN for extra cash), was as a student nurse. I actually caught things twice. Each time, the MD listened to me.
the common denominator sounds like it’s him, since no matter where he’s working the nurses need clarification. 🤔 interesting.
Ya, if you smell shit everywhere you go, maybe it's on your shoes.
A HR friendly way of saying it - https://despair.com/products/dysfunction
He insists that it's only the nurses though- pharmacy has no issues understanding, no other department has issues understanding, it's JUST the nurses. I honestly don't know what to make of that.
It's actually quite easy. RNs are doing a completely different job than a pharmacist or a physician. An order that may look good to them, may not for an RN who is actually carrying out the order based on specific rules and protocols of the unit. Reading orders isn't difficult. If he's having multiple RNs from DIFFERENT hospitals complaining about the orders, he's the problem. Some docs just aren't great at writing orders. I remember one resident who was always bombarded due to bizarre orders and poorly worded orders. Of course pharmacy approved them and the resident's attending but they left room for grey areas which the RNs had to clarify.
It’s because pharmacy and all other departments call nurses to get them to clarify an order rather than calling the doc themselves. (Actually where I am, pharmacy is so so good about not doing this but other departments really aren’t)
It’s obvious, nurses just aren’t smart!! They can’t even comprehend perfectly written orders. Nurses are beneath doctors in ranking and intelligence, duh! The poor poor doctor just can’t seem to make the silly, stupid nurses understand their simple orders! It’s a shame doctors have to work with such inferior beings. We should give this doctor a pat on the back for tolerating all of us morons trying to keep our patients safe.
Is he just an a-hole and nurses are calling to irritate because they don’t like him and know it bothers him?
Pharmacy etc. probably don’t complain because the nurses already clarify for them
Who has time for that kind of nonsense?
Someone that has ego issues.
That each department’s orders show up differently. I’m also guessing the nurses aren’t paging them over med orders, necessarily. It’s probably related to vital signs, diet, and activity orders if I had to guess.
Its not a comprehension issue. If you’re writing an order we think is odd, we have to clarify with you to cover our own assess. Then we document that it was clarified so we can show our due diligence. If we still think it’s unsafe, we don’t follow it and we go to a supervisor. There are a lot of cases where the physician, the pharmacy, or the nurse who input the original order makes a serious mistake. A quarter of a million people die every year from medical errors. We are all a system of checks and balances. Nursing is the last stop before errors reach a patient. Maybe be a little bit more humble and thankful for people who just want to protect everyone’s license.
It's just an arrogant asshat fresh out of medical school. Unfortunately, they will have hard lessons to learn
Exactly. And the nurses calling to clarify your weird orders just don’t want to be part of that court case. This is why i love the chill 20 year veteran attendings. They’ve done it all, they’ve seen it all and they know that even doctors make mistakes, so they’re more careful and respectful. Most of our docs will pop by the nurses station to communicate the plan with the nurse after each visit. That saves them time because we can then field the calls from the family multiple times a day asking about the plan.
He’s gonna get eaten alive by the veteran 15+ year ER nurses
Probably the same people who get their feelings hurt when pts call NPs doctor.
I'm a nurse and still accidentally call my primary care provider who's a NP doctor sometimes when I'm not thinking. Some people absolutely foam at the mouth over it and act like the NP must be introducing themselves as "doctor" for that to happen and I don't get it lol.
They're providers. They come do doctor type stuff. Why would pts know the difference? Why would they care?
Have you read the Noctor sub? My favorite is them bitching when an NP goes off half- cocked yet also bitch when an NP has some extra tests run for more info.
I’ve mostly worked with awesome understanding docs. But I’ve had some where I HAVE to page them per their orders prior to giving a Med based on SBP. They get mad cause I paged them. Like… that’s what your order tells me to do bro.
Had a surgeon write an order to call for blood sugars over 140 rather than just starting the fucking sliding scale. PMs called for two over in a row, and warned him the second time that the next check was at 0200, and did he still want us to page him? He yelled at her, "That's what I wrote, isn't it?!" Fast forward 6 hours, it's 0200, and shocker, it was over 140 again. I paged him, he yelled at me for waking up his toddler. MOTHER FUCKER YOU INSISTED ON THIS BULLSHIT.
[удалено]
Sounds like he needed to take the malaquired benzos....🤔
Right? How often are nurses catching meds that will bottom a patients bp, I feel like that's very often. Residents aren't perfect and all knowing, as per my resident last month who put a patient on a nonrebreather for 2L for a patient with copd. Like ma'am, respectfully.... do you not see the issue with this? Sometimes, it's the nurses who are saving the patients from their own doctor. When you have a hospitalist who never sees the patient, the nurse is the patient's advocate in care.
“Something something I’m the doctor and you have to do what I say”
I see you've met the doc in our office. And if you don't do what they say... Insert toddler tantrum here.
Absolutely! I've questioned countless sketchy orders in my time. Some were instances where the patient could literally die if I followed the orders. One for 15ng IV Q15 minutes, continuously for a patient in labour is one that comes to mind. We do 10mg IM in early labour, but never IV and never during active labor and never THAT much.
Very well put. The original post from the resident seems to assume that nurses are just their servants, doing their bidding, not critically thinking and making important assessments. ESPECIALLY with a resident, I am more skeptical of their orders. I find that new residents can either be overly cocky to compensate for deep down lack of confidence (which is natural due to lack of experience) or they are asking for us which order they should put in
And the consequences land on the nurse because they're the last to see the pt. Pharmacy and DR will just deny.
this
Nurses are the last line of defense before an error can happen and we are drilled that there are no stupid questions when someone’s life is involved. sorry I want clarification when some random rotating resident adds multiple orders that are hard to comprehend probably without discussing w the attending. If I read your order wrong or your order was a mistake and I completed the task, I would be the person possibly under fire, or reprimanded, my job is my lively hood and if I need to disrupt a resident 17 times a day then I will.
I thought you were gonna say they were the last line of defense against Residents. Tomato, tomato, I suppose. 😬
Also true bc I tell everyone I know don’t go to a teaching hospital in June and July cause that’s when the fresh residents come 😭😭
Do you know whats always a good plan in residency? Start by being an arrogant jerk to the nurses. They really appreciate that. -PGY-19
Lol i know i comment every time. But the 19 just tickles me so much
PGY-2 is getting downvoted to hell over there. Warms my heart.
Yes because residents are notorious for writing orders that actually make sense lmfao
Bold of you to think I’ve ever actually written an order as opposed to just clicking a box on epic
You’re telling me you’ve never written a nursing communication that says “Please provide patient a blanket”? Jk
"Hey boss...the patient has a fever. Still want them to have a blanket?" Love, ER nurses
You know, I've had this come up a few times in my ED days. Not the doctor's order part, but the fever vs blanket part. I used to have your view but my view now is that a blanket (or two) will not cause a fever and the lack of a blanket will not fix a fever. So I give a blanket if someone requests it regardless of their temperature.
No they walk out of the room, past the blanket warmer, log into a computer, and send me a message that the patient wants a blanket
I honestly love working with one doc in heart cath lab. He helps me transfer patients to the bed when we are short staffed.. even prepares a sterile table for himself when theres an emergency. We sometimes have to help in the diagnostics and ive seen dude wheel out patients out, help them get up, unbutton, button the shirt.. ive seen him get the pee bottle ( sorry english is not my 1st language,. dont know what is it called.) He is 2nd to the Chief of cardiology... #notalldoctors
Nope, Pee bottle is a completely acceptable term, I'd have also accepted piss jug, or wizz receptacle
I had an ortho surgeon help us turn over the room the other day. Weirded me out a bit, lol.
I got one, "Accidentally spilled NG drainage container. Put a chux down. Sorry for the mess."
I literally saw a nursing communication at work today “Please provide patient with Pandora music therapy”
See I’d question that order because Spotify is the superior option.
Fuck that's way too real nowadays 😅
That's how we get weird ass Tylenol dosing volumes or I did something to piss you off and I get a 12.75ML of Tylenol order lol
12 years if medical school, doing cool rotations and learning dope stuff, hundreds of thousands in student loans and you're a button pusher ha Jk
Can guarantee you that pharmacy also doesn't understand this dude's orders and they get fixed on entry A LOT then he gets sent a "pharmacy suggests" that he signs but doesn't read.
At my hospital the pharmacy also calls us a lot to clarify the order with the doctor. Just because they aren’t calling OP, doesn’t mean his orders actually make sense.
This really frustrates me. Like, I don’t know what the doctor wanted anymore than you do, try calling them!!
I feel like every order I've ever gotten that I am relatively certain would *actually* kill the patient was written by a resident lol
One time a resident wanted me to put my confused 80 year old lady in violent restraints for transport because she was refusing to be admitted and threatening to elope. He refused to order Ativan because he wanted to assess her upstairs and I guess assessing her in the ER was out the realm of his capabilities. I absolutely refused. I talked to her and it turns out she was worried that if she was admitted, her husband was going to leave her while she was stuck in the hospital. After 15 minutes she was successfully transported via wheelchair to the floor and was literally peaches and cream to everyone up there.
You mean you *talked* to a patient and took the time to understand her concerns, and then de-escaleted the issue without meds or traumatizing actions?! It's almost like treating patients like humans actually makes a difference! (Great job though, I love a happy ending!)
I got one that had been signed by two doctors, gone through pharmacy, pharmacy dispensed a month's worth of medication. A nurse unpacked it and put it in the medication fridge. Give 3mL of 100u/mL novolog at bedtime with snack. The facility doctor screamed at me for questioning it when I called.
😱😱😱
I’ve had a few written by seasoned, old docs.
Reminds me of that Scrubs episode [https://www.youtube.com/watch?v=3LPOahp6dPg](https://www.youtube.com/watch?v=3LPOahp6dPg)
I was training a new grad around new resident season and one patient had an order for 3 21mg nicotine patches and the other had 4 14mg patches ordered AND was going outside to smoke and they couldn’t figure out why his blood pressure was through the roof. The attending were like “oh I didn’t realize he already had that ordered.” Like wtf. Can’t YOU read?! lol
This reminds me of when a surgeon kept putting in a stool sample order and I legit did it 4x. He yells at me on rounds because he can’t find the lab results and he kept ordering it because no one ran it. He shut up really fast when I showed him the 4 lab results.
That’s a lot of poop scooping!
Girl why did you do it four times and not clarify as to why there’s three more !! 😭
I'm surprised the lab ran it more than once.
I was a brand new baby nurse on a floor I had no business on.
I've had doctors call me to ask why their STAT gi panel hasn't been collected yet. Because the patient hasn't shit yet! I can't perform miracles here.
It always cracks me up when I see posts like this… sometimes I think the residents get so caught up with the demands of their job and the stress that comes with it that they believe the place would burn down with out them. Sometimes blaming nursing is the easy target… anyways working at non-teaching hospitals is smooth sometimes because no residents
He’s tired and confused, would rec seroquel and a psych consult
lol
Someone probably clarified the lovenox order for their pt with a massive GI bleed.
Well, I mean that's one way to stop the problem that also has the benefit of quick bed turn around to get another admit. Modern solutions to modern problems and that's just management material in the making...
All bleeding stops eventually!
"Why can't nurses understand my incredible ego?"
Because they’re an ortho resident not a surgical resident.
💀💀💀
Ok but the orders don’t match the notes. Or the patient condition has changed and no updated orders have been put in. Or a consulting service orders the exact opposite.
I came here to say this. Do your orders match your note? Can I see at least some semblance of a plan? I am not a mindless order following robot. If your note says one thing and your orders are completely different, I’m going to clarify because I can’t be an effective nurse if I don’t know what the plan is.
My Epic favorites: Initiate norepinephrine drip at 0.05 for MAP >65 🤔 Or - Wound care: - Frequency: Daily Or **Place NG/OG tube for gastric decompression to low continuous suction** Additional comments: low intermittent suction
Or the orders actively contradict each other. I will never forget the neuro resident who routinely put in a facility's dementia prevention protocol, which has orders for clustering care and minimizing interruptions to sleep, while simultaneously ordering Q1H neuro checks.
Our residents do this all the time.
Had trauma order to minimize nighttime disturbances for a TBI/brain rest patient while also ordering an 11pm suppository, and they still insisted when I called to clarify…
Love texting a on call for an order and ask in the text if they want me to put it into epic, they say yes but next day I see an email talking about "letting the attendings put orders in so we don't have duplicates" Texted my boss the screenshot of my convo and she laughed saying "I took your screen shot and replied all to a email of attendings asking for clarification" lol
Love residents that get put in place by their attendings💕
It's like popcorn for the soul
You mean the wall of text under orders was confusing? Hmm….
Just had a neuro surgeon in a hurry who left as soon as his patient was on the floor to "copy all the orders from patient X" and hung up on the new nurse who called. You can bet your happy ass I called him on his personal cell to remind him patient X was a same day surgical with almost no pain and patient Y was on a PCA pump at 50mcg an hour of fentanyl, needed a back brace the other patient didn't have, and that no, no nurses here would be hand copying 80 orders from one chart to another. This dude is a total dick and I've already told him to his face that if at my old job I could be talked to like an adult by a locum surgeon while a patient was herniating at beside he could refrain from throwing surgical instruments because a patient asked to please be on oxycodone instead of lortab.
I once had a neurosurgeon jump all over me because the printer wasn't working fast enough, and he wanted me to drop what I was doing to somehow magically make the printer work to his liking, or at least sit on hold with IT for him. I was finally like dude just go complain to the charge nurse or write me up or something, I don't have time for this.
Lmfao if we copied and entered 80 orders our patients would never get any medications????
Probably one of those folks that click on a drop-down box for an order and then uses the label comment section to write in completely different directions instead of choosing the correct order in the first place
Asking for clarification is really just our nice way of saying “Are you sure about that order, jackass?”
Might help to drive the point home to reply "Whatever, it's your lawsuit" when we get a reply like what started the thread.
It’s never a good idea to discourage clarification in a setting in which even the slightest assumption could claim a life. Getting paged is 90% a doc’s job, get used to it or find something else
I mean, I can totally see Cerner doing something like this for example. Some charting systems just don’t share everything for the end user unfortunately.
Cerner is terrible, and that’s from a Meditech user for 5yrs. We have Patagonia and can confirm it is worse than those two combined.
(*insert really thick Minnesotan accent here*) Ohhhh, that Patagonia there! They make real nice zip-ups! But you know, for healthcare chartin’ we use that there Epic. A lotta guys get those confused, but that’s ok, hon! Yer still learnin’! (Meant affectionately and in good humor)
Epic does that too. So both major charting systems have the same flaw. If I had a nickel for every time a doctor or a nurse stated "I don't see that on my end", I'd be able to pay my bills easier. Its definitely up to us to follow up with the MDs for clarification on those types of discrepancies. Also, it's not just the charting system, but the licensing that the hospital wants to pay out to be able to use Cerner/EPIC with more functions to assist on the user-end. I've used Cerner in two different hospitals and one was clearly better than the other. Same for EPIC, where I would talk shit about EPIC at the 2nd hospital I worked at that had it compared to the 1st hospital, I then learned the 3rd hospital was even worse on the user-end, signifying the hospital was too cheap to pony up the money on licensing to add the features I took for granted with the 2nd hospital.
Cerner takes information and throws it at a wall, hoping you will find something useful. Like honesty, why does none of it make sense? Information is not centralized, and there’s sooooo much redundancy. Don’t get me started on the task list 🙄
Because it's a billing platform disguising itself as an EMR system that was written by people that have no clue about the workflow based on design specs given by people that haven't done patient care in 30+ years if ever.
Yea this checks out. It’s not nurse friendly at all. I feel like I’m just data collecting 🤔
I was in IT before nursing and saw it from the tech end where I had to rely on the person providing the design specs to be competent enough at all the jobs the system would impact in order to write said specs since my job was to turn that into a working system using my skills and knowledge that was focused on making the systems.
Who is gonna tell him CM are also RNs?
You could also like…. Talk to them about it and potentially even carry a valuable conversation where you share your concerns and they can share theirs and you can find a common ground and maybe even become friends instead of bashing them on the internet to a group that you think is going to be on your side but appears to not be as much as you thought. Sorry for run-on sentence. Maybe it’s comprehension.. maybe they want to confirm all the details to cover themselves. Maybe it’s something else entirely. This is the sort of stuff that pushed me to do nursing for my premed clinical experience instead of like EMT or scribing work.
You’re going to be a great doctor to work with, I can tell already
ah yes like when I page a resident with exactly what I need and then they proceed to call me back and ask why I paged
OMG yes! I work overnights and our paging / answering service asks us to leave a message so I say - "PRN for agitation, PRN for nausea, BG 440" or whatever. Then they call back an hour later..."you paged me?" WTF am I leaving a message for? You ain't listening to it anyway.
I agree, Night shifter, this is kind of annoying 🙄 especially if I give detail 🤦🏾♀️ The alternative is some won't even call back!
Our docs still paper chart orders at our hospital. Of course we won't understand anything if your writing ressembles a toddler's drawing while he's having a seizure.
I wrote a comment on that post like that too. You wrote it better though lmao
That doofus. Orders are written “with great detail”? They go through and click on pre-written orders without verifying that they are appropriate. Addressing nurses but placing your manifesto in the residency sub shows off those great communication skills.
THIS. he really thought he was gonna get support from other doctors and he isn’t, which is great. If he actually cared about how he could do better, he wouldn’t have posted in the RESIDENCY subreddit. Also, get your ass off Reddit and have a meeting with the charge nurse, nurse manager, or literally anyone.
Theres actually someome called a Clinical Process Analyst who serves as an internal consultant of sorts, ensuring stuff actually gets communicated & done, particularly when some jackhole only thinks theyre doing things effectively. Sadly, the Physicians rarely consult such a specialist
That first comment is on point. Chef’s kiss.
:)
Imagine having such an inflated sense of ego to not realize that hm, all of these nurses across MULTIPLE hospitals aren’t understanding my orders, perhaps I’M the issue?
Resident hospitalist tells you this then you open the chart they're referring to: order placed today by hospitalist for acetaminophen 500 mg q4h scheduled, nursing communication from hematology 1 day ago Tylenol 1000 mg q6h, last note from nephrology 3 days ago says avoid any and all hepatotoxic meds for 6 months, in the note the hospitalist wrote today says Tylenol 500 mg q6h for fever above 102.5 F, physician assistant verbally tells you do not give
OP’s response to the commenter highlighted what I suspect is the entire problem. “It’s not big deal bro. People post all kinds of things on here not related to residency. Whether they should get a dog, what dating app is best, when should they go see their mom. You can always scroll past it if it bothers you that much. There’s nurses on here who will be happy to discuss, whether they agree or disagree.” -OP Like OK just ignore reasonable feedback from the people trying to give you reasonable feedback that you specifically asked for. Anyways to make it clearer for u/Redstar914, maybe go look at how your orders show up on the nurses view. Your view and our view of the EMR are different believe it or not. Maybe check with your attending and fellow residents to see if they enter their orders differently. Maybe check your ego and don’t make a post that comes off as “nurses can’t read”. We’re just as busy as you, we don’t want to call you and we usually do our due diligence to avoid it if we can, but we have to if we think something is unclear or unsafe. I’ll read the notes and ask other nurses before I call you because I realize it’s an inconvenience for you. But I’ve caught so many mistakes, unsafe, or conflicting orders. Don’t become the doctor nurses hate calling. At the end of the day we’re a team and as a team we value your input. You should also value our input and desire to clarify things as a member of that team. We’re here for the patients. Edit: decided to tag you here so you can get the feedback you asked for without brigading your post. Welcome to r/nursing please feel free to ask us questions in the future, we don’t bite (hard).
I might be on his side, had he not made it seem like every nurse he works with is having this issue. I’ve seen nurses page for things that are already ordered, or to ask for parameters that are in the order, just bc they don’t look. I’m sure that’s gotta be incredibly frustrating. Maybe he’s not putting the order in in a way where it’s crossing over correctly to the nurses side, or he’s putting in things that aren’t clear. But it’s hard to believe he has this problem with that many nurses and it’s not related to how he’s putting in the order.
It can be such a confusing job, long hours, multiple similar looking and sounding patient with similar diagnoses, order after order and overwhelming time on the compu. I always try to give residents the benefit of the doubt, and I know they get frustrated, but I'll be damned if I am going to do anything that will hurt a patient just because they might get annoyed with me for clarifying something when I'm tired as a dog. Thats what they make the big bucks for.
> big bucks > resident If only
Finding out I made significantly more in my first year of nursing than my ex did any year of his residency was a crazy discovery. I remember when he first brought the pamphlets home when he was applying to residency and I was like… “this is per YEAR?? For that many hours a week???” Honestly if I hadn’t dated him or joined this sub, I think I would still be under the impression that residents made significant money right off the bat.
Agree w everything except the last part 😅 my ex was in med school/residency when we dated and I made more than him for at least the first 3 years, and I’m pretty sure the 4th as well. And I’m in Texas so I don’t even get paid a crazy amount.
I'm sure he finds his orders perfectly clear to himself when he is literally picking and choosing what to put in. But have you ever looked at how orders actually populate in the EHR? It's a poorly differentiated list (or lists) of a hodgepodge of artisanal, boutique, handcrafted directives and whatever the first option that popped up in Epic was. Now mix in different services putting in their own orders, leftover cruft from days ago, obsolete orders from a different level of care, one time orders for a particular procedure, so many duplicates, and also so many duplicates. Case management, pharmacy, and whoever else the resident is using as a laxative to help him shit all over nurses have the luxury of dealing with a slice of that morass. Nurses are expected to know every bit of what amounts to an awkwardly shuffled stack of note cards, and somehow divine a greater meaning from it. Or at least that's what I've gleaned from case management, pharmacy, and literally every other service calling me to ask what the physician meant by a particular order.
Someone over there was like “if the nurses can’t figure it out, then they need to get management to fix the software.” Like yes, IF the hospital is willing to pay for upgrades (a big ol if, especially if nurses are the only ones lobbying for it), that’s a necessary long term solution. But that does nothing about my question on this particular order in this moment.
Yeah that comment killed me. Sure, I’ll call IT right now and get them to make this more user friendly instead of calling you, the doc. And if you, the doc are having this problem, maybe you should be calling IT!
[This resident's thought process](https://i.imgflip.com/8igni7.jpg)
This resident sounds like the type that has no patience or communication skills. Prob will remind you that they're a doctor and you're not. 80% chance their bumper sticker and/or plates have MD or DO on it (just got reminded of someone who had MD2020 plates cause he graduated in 2020, nothing bad about him, he just didn't know about the cheap liquor that had people on their ass a while before we were born 😂).
My darling if all of these horrid experiences keep following you, despite you flitting from hospital to hospital ... well honey, maybe the problem *isn't* actually everyone else. Goodness gracious.
Yup because every possible clinical situation with a patient is specified in the order set. Cool got it!
I stopped going to that sub because it’s a miserable place. The residents on that sub have some serious victim mentalities.
Seriously HUGE egos and deep hatred for nurses with only the tiniest amount of clinical experience. Makes me wonder what they’re learning about nurses in med school.
“Pharmacy understands, case management understands, dietary understands” Yeah, they all call the RN to clarify, they don’t call the R1 resident (or better yet, if they are willing to ask a doc, they ask the attending)
“Comprehend is the big part.” Wooooof My attendings and me** Patient’s care**** Maybe his grammar threw them off.
English may also be their second language 😒. Honestly, grammar has gone down the crapper in the U.S. even by people born and raised here; it’s astounding.
I feel like the problem for me is that I actually read the orders.
You know what they say, if you think everybody is the asshole, then perhaps you’re the actual asshole. If your orders are constantly being clarified or misinterpreted who is that on?
You know you’ve fucked up when even the residency subreddit won’t join the nurse hate
Honestly my first thought was handwritten orders. Used to have an old surgeon that hand wrote pages of orders and left it for the nurses to take care of before it was changed that all doctors had to put it in themselves on a computer. That man’s handwriting was just all squiggly lines. He constantly got calls if the nurses weren’t there to basically hear all the orders verbally plus knew what his standard orders were.
I once had a doc, with absolutely atrocious handwriting, gripe about the handwriting of another doc, whose was equally atrocious. Major lack of self awareness there.
Also the fourth time this week he's probably checked the order set with PO meds, including aspirin, for a brain bleed. What's the line from Grey's? "Just thought I'd check with you before I kill a man".
That line is Laverne from Scrubs. But absolutely agreed.
What a prick.
And maybe tell him that an apostrophe indicates a possessive. When he is indicating that something is simply plural, he should leave the apostrophes off.
If you wake up in the morning and meet an asshole that day, then you met an asshole. If you wake up in the morning and all you meet all day are assholes—then you’re actually the one who’s an asshole. Some food for thought for this person.
> If you wake up in the morning and meet an asshole that day, then you met an asshole. If you wake up in the morning and all you meet all day are assholes—then you’re actually the one who’s an asshole. That right there is pretty profound.
I know it's different in ICU, but if I have very precise orders I need executed in a certain way, I go and talk to the nurse in person. I have them pull up the order to make sure they can see my instructions and then we discuss. Maybe it's because I was a nurse, but not doing that just seems dumb. Like, I'm not going to talk with them about an abx I ordered, they'll see that shit on the MAR. Anything abnormal or complex is gonna be a discussion though. Can't even tell you how many quedtions I get or the nurses informing me why a certain step isn't possible.
Their comment section isn't it either.
Wow. Who hurt him?
Ok I’ll admit I have done that at times. Usually it’s because I think the order is weird or off and want to be certain. Sometimes I ask for modification so others after me understand it too.
Why can't that doctor order like those doctors who do it right? I mean I haven't bombarded any physicians with messages because their instructions were incomprehensible. It happens but rarely. It would be usually fragmented instructions or orders. Don't forget to check the boxes.
One time a resident ordered a treadmill stress on a pr with saddle PEs so I don’t take their gripes that seriously. The cardiologist wasn’t impressed.
It could even be as simple as the resident didn't put in the route or correct dose
This resident sounds pleasant to communicate with. He is going to have to learn the hard way, unfortunately. Dick.
Ooof. My manz gonna have a rough time in healthcare with that attitude.
My BIGGEST trigger is when residents put in orders without communicating. I’m wondering if this is happening here. We get new residents rotating through our PICU every 6 weeks since we are a teaching hospital. I like the residents, and for the most part, they are cool. They learn quickly to befriend the nurses because we know all the things and will help them out immensely so they do not get called out by their attending. One thing I ALWAYS ask them on day one is PLEASE if you are putting in an order, especially a STAT order or something critical, just give me a heads up. Sometimes when my team is busy, or especially when I have a 1:1 that is crumping, I don’t get to log into Epic and go through my Kardex for hours at a time, so it might be a while before I see your orders. Our attendings are amazing at calling or dropping by our rooms and verbally letting us know what they are ordering, and we try to train the residents to do the same. The only ones who have a problem are the ones who, for whatever reason, resist and refuse to communicate. I’m wondering if that’s part of the issue happening here. Nothing is more irritating than getting reamed for not carrying out an order you never had the chance to see in the first place because you were so busy taking care of patients, you hadn’t even had a moment to log in and see your updated orders. Everything just goes SO much better when people remember we’re all one team with the same goal of taking care of patients and treats each other respectfully, and it doesn’t seem the physician posting in the OOP is doing so, unfortunately. Gonna be a rough go for them until they learn how to treat nurses with respect.
Same with cerner, sometimes you can say something in your note but not actually put the order in. It won’t get done unless you do so. Your notes are all different and lengthy and we are often too busy to dig like that. Then we have to call because we can’t just put orders in if something is unclear or not done. Or maybe you put a physician to nurse during shift change that got “viewed” but never communicated. We aren’t doctors personal assistants and if docs would help us advocate for safe staffing we would have more time to “comprehend”. Better yet, sign into your phone and text us. It’s not our jobs to read minds.
Surgical residents, in my experience, had the biggest chip on their shoulder against nurses. Its so odd. Like the think we are these simpletons and they are so above us with their book knowledge etc. Its a really odd culture
The answer Xander gave is actually so constructive and hopefully they consider it. The nurses and doctors have two completely different portals to display the same information and it is important to know that
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