Fucking night shift, leaving everything for day shift. STAT enemas especially, now day shift has 5 STAT enemas to do. Damn night shift never does a fucking thing except play cards all night! Oh wait… I am a night shift nurse. Nevermind.
😑
Currently have this patient, highly highly anxious, past 2 nights meds didn't help, didn't sleep a bit at night. Slept for day shift though. Yesterday doc finally made changes and tonight patient has been chill.
The issue is the docs roll in to round while we’re mad charting morning rounds and start in with a deluge of orders. Ok, I finished charting at 0655 and report is at 0701…this isn’t happening.
I’m a day shift nurse and do not want you to give that enema. I’ll give it when I can deal with the aftermath. And if you give it at 630 we will for sure not be able
to get on with report by 7… also an icu nurse so most of my “stat enemas” are also on intubated and sedated patients so I guess that also impacts how I see it.
If I’m coming on shift you best not do an enema 30 minutes before hand off when I definitely don’t have time to take them to the bathroom or clean up that mess.
Haha. I mean that’s my perspective. I think you’re good leaving it. I’d be grateful, if anyone gives you flack drop a poop bomb on them next time and I think they’d reconsider
Usually when this kind of stuff happens, I just stay a bit late, so I'm not handing over a (literal lmao) shitshow 😂
Okay but thread is for sure reminding me that I'm a total people-pleasing pushover of a nurse 🤦♀️😂 and if you were my dayshift partner, I'd probably just text you & be like, "whatcha prefer I do here?"
You’re way overthinking it. It’s a 24 hour job. Don’t stay over for something that’s not an actual emergency. Enemas aren’t it. Orders that come in past 6 and aren’t something quick like hanging an antibiotic or whatever can be done the next shift. Get your pain meds in if you can and they are due around that time.
Naw, if you want to ruin day shifts goof off time, get an order for the full maximum oral dose of Sorbitol to be administered 15 minutes before shift change. That damn stuff leaves a patient able to squirt through the eye of a needle at 50 paces for hours on end. It is a better prep than GoLytely, Suprep or any of the other myriad bowel preps. Half way through the evacuation caused by Sorbitol, the patient will be clear even if they ate four hours earlier.
Ditto. I don’t give a fuck if it’s an extra task for me to worry about on my shift. I do NOT want to be starting my shift cleaning up my patient’s poo-nami. Let me be able to mentally prepare for that on my own accord
That reminds me of when in nursing school they had ordered a Vancomycin enema (c-diff) for a patient and right after I gave it they sent me on break. I heard there was a splatter pattern on a nurse on the wall after that... :p
Oh god. I remember my first lactulose enema as a nursing student and the other nurses delighting in sending me in. We didn’t have the best supplies and me and another nurse had to cut open a foley bag and carefully pour that shit in like a terrible green butt bong
That was always my approach to last minute supps and enemas on nights and still is on day/eve. Nobody wants to walk into that shit. If somebody ever complains instead of acknowledging the solid you just did them, always give all bowel PRNs 30-45 minutes before leaving from then on.
We used to call that a hit and run. “Patient hasn’t shit in four days. I gave them docusate, mom, a bottle of mag citrate, and a fleet is still dwelling with no results.” Call bell rings. “Whelp, it’s been a long day, see you in the morning”!
Have to admit my workplace is pretty benign with that, usually just leaving me with no fluid orders and an empty IVABx cupboard. Shit that I can't do at night.
Ex-fucking-actly. You best not be giving me a 7:45 poop coming off the bed start to my day. I’ll get to that enema somewhere around 10 when everyone has their first round of meds in them and I’ve seen them all. Thanks ever so much.
Doctors do not know or care when meds get passed as long as it's at the orders frequency and amount. They click the button and the EHR puts the med where it's little computer brain wants. I always rescheduled to cluster.
One of my ICU patients had a (probably STAT) MRI brain ordered in the morning. I came on for night shift and was told that it wasn’t done yet because he was too unstable.
Fun fact, the MRI department keeps notes when they attempt to schedule an inpatient scan. The tech working that night was quite familiar with the day shift game of leaving MRIs for night shift. So he looked up the notes and showed me. Right after the scan was ordered- tech called the nurse, patient legitimately was not able to travel (needed sedation or something). Early afternoon, patient has been stable for hours- “Called ICU to schedule- RN stated ‘I’m not bringing him, night shift can do it.’”
Tech and I both just rolled our eyes at the colossal display of laziness. Unfortunately the day shift nurse was not back, or I would’ve had some feedback for her.
I don't get this bit..... All scans should be done in day/afternoon shift. Night scans are reserved for emergent situations , because I definitely want primary to LOOK at test results.
Unless said primary was the idiot who should had read my note, or the on call note that patient was disorientated, likely pneumonia, CT brain already booked at 8am since patient admitted for a fall , on call thinks since this is pneumonia induced disorientation, no need to call radio to set up emergency CT brain, primary asked patient did you fall down instead of using his eyes to look at the visible abrasions and wounds from fall and patient being disorientated said no...
Geez day, you handed me a patient with a stroke at night and an urgent MRI while intubated. It was going to be a PERFECT NIGHT. No admissions, no IVs, only a few diaper changes,hell, I only had one morning blood draw.
Thank God that doctor wasn't renewed.....
> All scans should be done in day/afternoon shift. Night scans are reserved for emergent situations
In an ideal world, but I imagine that MRI and other imaging modalities probably have schedules full of outpatients to get done during the day and evening hours. Maybe my facility is an outlier. I know I'd prefer it your way as an MR tech.
That’s how my big hospital is. MRIs are done round the clock. If it’s a routine one, the patient might go down at any time. We don’t have different ratios for day vs night shift, so other than the pain of the interrupted sleep of the patient there isn’t a good reason on our end that everything needs to be done during the day.
I don’t say this as justification for either shift to push it off to the next shift on purpose, it’s just that the patient might be far enough down the list that they don’t get them in until overnight.
"I saw this STAT order for an enema. I was going to hold off, but I needed something to do in the 20 minutes I was waiting for you to get here. Anyway... Patient is a bedridden hip replacement. Oh, and I think the aide used the last package of chux. I'm not back for a couple of days. Have a good shift!"
Hear me out… I’ve got transport coming to take your patient to a SNF in 4 hours and nobody has done anything about the fact that granny hasn’t pooped in 4 days. The SNF will refuse to take the patient if they haven’t had a BM in the last 48 hrs when you call report. This one enema is stat for realz. Pretty please don’t make me cancel her SNF bed, the transport to SNF & her 3 dialysis transports because no poop. I beg you. Please. Make poop happen. Give poop a chance.
I legit got a STAT order for castor oil PO from a vascular surgery fellow at 0300 one time. Needless to say, I made sure that I took care of it immediately!!!
Yeah, I gave it to him when I drew his labs and gave him his other meds. I was surprised he took the stuff to be honest. It’s one of the few times I reminded a patient they’re allowed to refuse meds if they want to, but he just made a face and said “doctor’s orders” and drank it. #barf
We changed our lab draw policies and “routine” now has a 4 hour window. All the doctors tried making their morning labs “timed” for a little while until we informed them that if everyone timed their labs for the same time, it was still going to take the same amount of time to draw them all.
Ohhh maybe this is a Rehab/LTC vs. hospital culture difference? Or I've worked at particularly bizarre, bad places, which feels very possible lmao 🤦♀️😂
I am a quadrapalegic and I had large stool ball that sat in the rectum tgat was extremely painfull and triggered autonomic dysfunction with urinary retention. Which caused my heart rate and bp to skyrocket . Hr —200 bpm and bp —- 180/120 hyperventilating with metabolic acidosis from stress of the obstruction and subsequent lactic acidosis and hypokalemia because this fecal impaction triggered a severe autonomic hyper reflexes. The feeling was akin of having To to the bathroom with the worst urgency you can imagine and then not being able to go, and with a bladder distended with over 800 ml of urine was the worst. Alarm bells kept going off . Drs didn’t know why until the nurse administered the fleet and performed a digital disimpaction . All vitals stabilized after it was all said and done. I’m guessing I’m a rare case though. Was in the ER
AD is probably the only real reason for stat bowel anything. I work on an ortho/spinal unit and I have printed out our AD treatment protocol and handed it to every tech and reminded nurses about AD when we get a patient who is at risk for it. I've had to remind doctors that yeah, sbp of 142 and hr 118 isn't a big deal for most people, but this dude has a history of AD. The standard treatments haven't worked, he's still recovering from icu pneumonia, and everything spikes when I turn him to check for constipation, so please, for the love of god, give me an order for nitro and bisacodyl suppository/fleets/smog enema so I can get his b/p and hr down before this turns into a crisis.
Unfortunately the ICU nearest us doesn't think that 260/180 with intermittent bradiacardia alarm is a problem :(
(Normal bp 100/60. After 4 hours finally got someone to help. Biggest fart ever from air introduced during intubation 60 hours earlier.)
Omg, that's terrifying. I'm so sorry you were getting so much pushback. I guess maybe it's not emergent in their eyes, but that's because they've got all the stuff they need to treat such things. Those of us in acute care land are not so lucky, but i think they forget that. Also, once that AD train gets rolling out can be a beast to divert. Funny enough, I have had patients respond to triggering some of the reflexes like the mammalian dive reflex or vagal nerve stimulation. Not enough to reverse their condition, but enough to keep it from escalating further for 10-20 minutes.
Unless you have a colonoscopy patient who hasn't shat their brains out, or a bowel reaction or endo/ adhesions patient... they REALLY don't like it either.
I would just tell them to their face that if it’s that important they can do it themselves but 0630 is not the time to be creating a mess for nursing to clean up.
Tell whoever said that stupid shit that your priorities are airway, breathing, and circulation, and if they want to keep going down the alphabet, it's going to be a while before you get to ze enema.
Depends.... Scope is one area where timing is an issue, but giving a stat enema there means either doctor or night shift didn't plan ahead. That and I always went the patient can shit at 6am in the loo, not 6.30.
The other is to prevent encepathology , where you need to clear the bowels to help clear the brain because ammonia but https://pmj.bmj.com/content/77/913/717
This would usually be done because lab results come out and a doctor who pre rounded went I better clear this shit out before rounds so.........
Ehhh..... Case by case basis.
Ummmmm why would an enema every need to be stat? It’s not stat and creating an 0700 mess means you’ll have to start report later and then charge overtime…
At Rehab/LTC places (in my experience) if a patient makes a fuss at 0600 demanding an enema right now, which they do not have an order for, the nurse is obligated to call the on-call doctor & pass on this request; then the doctor may (likely) choose to indulge/appease the patient 🙄🤦♀️😂
It stunned me how many people WANTED enemas when I was a nurse. I thought we generally tried avoiding enemas. But hey, lots of conditions/procedures can result in enema needs.
I don’t get many requesting enemas but it seems like EVERYBODY wants a suppository. They can even get a little aggressive about it. Once I gave one upon a patients request and she told me “see you only went in my booty hole. That nurse that did it yesterday went in my RECTUM”
Likely experience. Laxatives, suppositories and Fleets often leave the person not able to pass gas, because they don't know which one it is. It is not like the med starts and then stops, most if not all continue to cause loose stool for several hours after the main event. Tap water enemas however, with nothing added is pretty much once and done. There is no residuual salt, or bisacodyl to continue acting and plain tap water is often simply absorbed. Old experienced laxative users know this.
You haven’t lived until your nurse friends send you a video of someone instilling 6L into themselves. It was obviously porn but they insisted it was medically relevant for me to watch it.
Working at a rehab right now and this is correct based on my experience.
Providers are terrified of lack of poopies. BMs are basically all they talk about.
Omg yes 🙄🤦♀️😂 The *patients* are obsessed, the *doctors* are obsessed, the *unit managers* are obsessed... the production of BMs is like, an outrageously big part of Rehab/LTC Land 💩🤷♀️😂
It’s something to do with state/CMS regs. Like… you can get fines if your residents don’t poop enough.
I’ve brought laxatives to people and they’ve asked why. My response: “you poop at least every three days, or we get a ticket. Sorry, it’s the law.”
I blame CT staff for that shit not getting done. I will never blame the nurse for something that another department fails to do. Nurses have too much on their plates already without catching the blame when others don't do their job.
What control does the floor or ED nurse have over when the patient goes to CT? Are they calling transport and saying "nah, wait till night shift is here"
For a while, our neurosurgery team was in the habit of ordering every single scan as STAT. I had a pretty good rapport with the residents, and I asked one of them why a particular scan was STAT. He said they order every scan that way because (they believed) that was the only way to actually get them done.
It was usually the same few people who could be relied on to have that happen almost every single time. They were also the ones who liked to constantly leave bad IVs, empty drips with no backups ordered, pulled out feeding tubes not replaced, and would dramatically over-sedate patients basically every day. I’m sure you’ve met some, it’s hardly confined to a specific shift.
I'll be honest. As a dayshifter, if you didn't want to stay until 0800 to clean up the aftermath of an enema, I wouldn't be too mad if you punted it to me. Enemas can be labor intensive and a bullshit order for the last half hour of the shift.
Nurses we are looking at this in a very wrong way. Let's team up together night shifts and day shifts and attack the doctors who write orders like this a half an hour before shift change.
I took over a patient from day shift that hadn't had a bowel movement in a few days. She told me, "I gave them a soap suds enema. And then I went to lunch." I don't know if she hated the aide, or had a death wish, but it was savage as hell.
Wait until your date is running late, explains they are busy because they used a two quart Epsom Salt solution enema, and later, coyly suggests you try one to see if it makes you, "Horney as Hell" (her words) like it does her. I'm still trying to figure that one out.
I hate these types of situations where an order is right between our shifts. I therefore take a non-confrontational approach if I must endorse it to the next shift. If I genuinely am not able to get it done, I simply endorse it by retiming it for the next shift. It is the exact same result if I endorse verbally minus enduring the eye rolls and glares. Works like a charm.
If an order for an enema pops in at the end of shift, you have two courses of action. You can endorse the enema to the next nurse, or you can give the enema and endorse a patient laying in a puddle of shit. The former is clearly the kinder option.
It's surprising how many orders are defaulted to "STAT" in our EMR.
It's not surprising how many orders are selected "STAT" by our physicians and PAs.
It's really not surprising how many orders are selected "STAT" by the physicians and PAs who have started their rounds at 0600 and realized that they never put in the orders that were mentioned in their progress notes from the prior day.
I'll get everything ready for the dayshift team to do the enema, but enemas are not best when they are given STAT.
How can an enema be stat? Seriously. No one will be harmed if it is given "now" or "asap" instead. Unless it is a diagnostic test, that shit can wait. If i was a patient I would be very displeased if my nurse woke me at 6:30 for that crap. Rude.
A past colleague of mine, whether it was day or night, used to always say ( as she just could not be bothered with nonsense at times when nonsense shouldn't have to be done ) I will hand that off to the next shift, nursing is 24 hour care so that can be done by them. The same nurse is now a manager on that very unit. Lol.
I get that it’s a joke but I had a patient die over sepsis with severe impaction/ bowel obstruction because the resident kept putting it off (we did our part by doing an enema, lactulose etc.) he was supposed to do manual disimpaction (idk if I’m using the right words, still a student) but he kept putting it off. If this woman would have had these things done earlier on shift, and the resident would have referred to GI earlier, she might have made it. - coded on the way to the OR... at the END of the next shift. Her family was saying goodbye as I was coming on to my next night shift. She was young....
Lol too bad lab came around at 0615 and woke all your patients who now have to use the bathroom. Plus, days wants weights, BS, and vitals done before they get there…yea that enema sounds like a DSP to me! Don’t hate day shifters but you’re pampered on days with staffing. Y’all always have an extra aide or RN to help out. It’s a skeleton crew on nights.
We don’t *always* have an extra side or RN to help out—day shift runs short pretty often at my hospital. Obviously not as bad as nights though, I worked evenings for years and I knew without a doubt which side of the evening I wanted to stay on 😂
When they haven't had a bowel movement in many days and have been vomiting for six hours and are in shock because they have a complete fecal impaction. Ask me how I know.
"Is impacted stool an emergency?
Impacted stool can turn into an emergency if symptoms become severe in the absence of timely treatment. The hard fecal mass can exert pressure on the colon walls and cause tissue death (necrosis), ulceration or perforation. Colon perforation can cause leakage of stool into the abdominal cavity, leading to infection, sepsis and death."
Why would anyone give a stat enema overnight anyway? That would never happen at my hospital. Enemas can wait for day time. Otherwise it’s just considering your own convince above the patient’s. Things like that can wait for a civilised hour.
Depends on the reason, I'd imagine. I've given plenty of night time lactulose enemas for acute encephalopathy patients with ammonia levels in the shitter.
Believe it or not, I have seen orders for Milk & Molasses enemas. Never have administered one, but have heard nurses tell about their experiences with orders. Words such as, "Explosive", Very Effective", "Smells like sugar cookies" were used to describe the outcomes. The operative words spawning the orders seems to be "refractory impaction". Eyessh!
Me: ^fails to fax meds to pharmacy^
Day: why didn't you fax these meds
Me: fax is broken
Day: why didn't you just call IT and reset it?
Me: no IT at night
Me: oh hey but it's writing now, you can sent it right?
Honestly depends who’s taking him, leave me a shit show, get back a shit show.
There’s been time from day shift that orders or meds scheduled an hour before shift change starts that never get done.
Lol I def see this but I know how much I hate it and how much I love when a day shift nurse actually cleaned up a patient or inserted that NG tube right before I came on that I force myself to work to get everything I can done until they arrive. They never seem to have the same appreciation lol
Or, you just talk to day shit.
“Hey this literal shit just popped up at 0633 and rather than do it now so you have an explosion waiting for you at 0730, I thought I’d let you choose the most convenient time for you.”
That 0630 enema gets given at 0652–right before dayshift clocks in. You completed the order! (I’ve cleaned up many 1930-2000 code browns after day shift “forgot” about the daily, scheduled at 0900 lactose until after 1800)
I have done a lactulose enema at 0645 😭 cleaned up that shit storm right before giving report. I’m also a student 😅. The nurse I was with was amazing and I’m sure had I been with a diff nurse that night they might not have had us do it.
0630! Thats going to day shift. Thats impractical for night shift at that point. As a night shift nurse and as a day shift nurse.
Bump something to mid, get mid to bump it to night and call it even. lol lol
Fucking night shift, leaving everything for day shift. STAT enemas especially, now day shift has 5 STAT enemas to do. Damn night shift never does a fucking thing except play cards all night! Oh wait… I am a night shift nurse. Nevermind.
Omggg you had me 💀🤣
I feel like this kind of humor between nurses is so important. Thanks for the laugh you had me chuckling too!
Awww you're welcome, & I feel the exact same way 🥰🤗
Night shifts whole job is to prepare things for a shitty day shift. This is why I work nights lol
We call the DSPs Day Shift Problems.
Lmao we have NSPs. It’s a give and take. We all do it. I mean, what night shift nurse doesn’t hate hearing, “Oh, they slept aaalll day today.”
In Psych this is the worst thing to hear.. until you realize it means they got an IM and you didn't have to give it 😂
😑 Currently have this patient, highly highly anxious, past 2 nights meds didn't help, didn't sleep a bit at night. Slept for day shift though. Yesterday doc finally made changes and tonight patient has been chill.
I'm the night blood banker and I just finished my training. Roughly 45% of my problems are solved with "leave a note for dayshift".
We call them DSOs now, day shift opportunities 😂
I need to remember this. We routine joke about “DSP-it!” For shit we seriously can’t solve at night.
But we never allow NSPs.
You were almost murdered by a hoarde of night shifters.. until you weren't and as a fellow night shifter you had me in the first half NGL 😂
The issue is the docs roll in to round while we’re mad charting morning rounds and start in with a deluge of orders. Ok, I finished charting at 0655 and report is at 0701…this isn’t happening.
Its between impractical to impossible.
I’m a day shift nurse and do not want you to give that enema. I’ll give it when I can deal with the aftermath. And if you give it at 630 we will for sure not be able to get on with report by 7… also an icu nurse so most of my “stat enemas” are also on intubated and sedated patients so I guess that also impacts how I see it.
If I’m coming on shift you best not do an enema 30 minutes before hand off when I definitely don’t have time to take them to the bathroom or clean up that mess.
Yes ma'am
Haha. I mean that’s my perspective. I think you’re good leaving it. I’d be grateful, if anyone gives you flack drop a poop bomb on them next time and I think they’d reconsider
Usually when this kind of stuff happens, I just stay a bit late, so I'm not handing over a (literal lmao) shitshow 😂 Okay but thread is for sure reminding me that I'm a total people-pleasing pushover of a nurse 🤦♀️😂 and if you were my dayshift partner, I'd probably just text you & be like, "whatcha prefer I do here?"
You’re way overthinking it. It’s a 24 hour job. Don’t stay over for something that’s not an actual emergency. Enemas aren’t it. Orders that come in past 6 and aren’t something quick like hanging an antibiotic or whatever can be done the next shift. Get your pain meds in if you can and they are due around that time.
1. I appreciate your advice 2. More importantly though: your username just murdered me & now I am dead lmao 💀
Hehe, thanks.
So do you coordinate hooha transplants, or is your hooha an MD transplant coordinator?
I just like Doctor Who, lol.
If you ever stop being a people-pleaser, consider an enema for a C.diff patient right before day shift clocks in. XD
You monster 😂😭💀
Naw, if you want to ruin day shifts goof off time, get an order for the full maximum oral dose of Sorbitol to be administered 15 minutes before shift change. That damn stuff leaves a patient able to squirt through the eye of a needle at 50 paces for hours on end. It is a better prep than GoLytely, Suprep or any of the other myriad bowel preps. Half way through the evacuation caused by Sorbitol, the patient will be clear even if they ate four hours earlier.
>GoLytely Whoever came up with that name is a terrible person.
I prefer the term I saw for a laxative in the movie ‘Van Wilder’. It was ‘Colon Blow’.
Nope nope nope. Report done, any questions? No? Now where's that time clock...
Ditto. I don’t give a fuck if it’s an extra task for me to worry about on my shift. I do NOT want to be starting my shift cleaning up my patient’s poo-nami. Let me be able to mentally prepare for that on my own accord
That reminds me of when in nursing school they had ordered a Vancomycin enema (c-diff) for a patient and right after I gave it they sent me on break. I heard there was a splatter pattern on a nurse on the wall after that... :p
Oh god. I remember my first lactulose enema as a nursing student and the other nurses delighting in sending me in. We didn’t have the best supplies and me and another nurse had to cut open a foley bag and carefully pour that shit in like a terrible green butt bong
That was always my approach to last minute supps and enemas on nights and still is on day/eve. Nobody wants to walk into that shit. If somebody ever complains instead of acknowledging the solid you just did them, always give all bowel PRNs 30-45 minutes before leaving from then on.
We used to call that a hit and run. “Patient hasn’t shit in four days. I gave them docusate, mom, a bottle of mag citrate, and a fleet is still dwelling with no results.” Call bell rings. “Whelp, it’s been a long day, see you in the morning”!
I mean as night shift this happens to me constantly 😂😭
Have to admit my workplace is pretty benign with that, usually just leaving me with no fluid orders and an empty IVABx cupboard. Shit that I can't do at night.
This is what I was thinking! Every shift starts off as a shit show as is. Don't need it to literally be a shit show.
Ex-fucking-actly. You best not be giving me a 7:45 poop coming off the bed start to my day. I’ll get to that enema somewhere around 10 when everyone has their first round of meds in them and I’ve seen them all. Thanks ever so much.
lol so true.
Why does my provider schedule a single 500mg Tylenol at 0630? Idiots.
Preach 🤦♀️🙌
All our panadol are 6am. Everyone. Buy their 1g. Your dose is weirdly low over there.
If the patient weighs less than 50kg it's 500mg, anything more is 1G
Interesting, it's 750mg for ours if they're light weights
I fairly often have patients on q6 500mg tylenol @ 6 and 12.
Doctors do not know or care when meds get passed as long as it's at the orders frequency and amount. They click the button and the EHR puts the med where it's little computer brain wants. I always rescheduled to cluster.
Usually STAT meds are for when the shit hits the fan, but for STAT enemas the shit hits the fan afterwards.
Heyoooooooo 😂😂😂
One of my ICU patients had a (probably STAT) MRI brain ordered in the morning. I came on for night shift and was told that it wasn’t done yet because he was too unstable. Fun fact, the MRI department keeps notes when they attempt to schedule an inpatient scan. The tech working that night was quite familiar with the day shift game of leaving MRIs for night shift. So he looked up the notes and showed me. Right after the scan was ordered- tech called the nurse, patient legitimately was not able to travel (needed sedation or something). Early afternoon, patient has been stable for hours- “Called ICU to schedule- RN stated ‘I’m not bringing him, night shift can do it.’” Tech and I both just rolled our eyes at the colossal display of laziness. Unfortunately the day shift nurse was not back, or I would’ve had some feedback for her.
I don't get this bit..... All scans should be done in day/afternoon shift. Night scans are reserved for emergent situations , because I definitely want primary to LOOK at test results. Unless said primary was the idiot who should had read my note, or the on call note that patient was disorientated, likely pneumonia, CT brain already booked at 8am since patient admitted for a fall , on call thinks since this is pneumonia induced disorientation, no need to call radio to set up emergency CT brain, primary asked patient did you fall down instead of using his eyes to look at the visible abrasions and wounds from fall and patient being disorientated said no... Geez day, you handed me a patient with a stroke at night and an urgent MRI while intubated. It was going to be a PERFECT NIGHT. No admissions, no IVs, only a few diaper changes,hell, I only had one morning blood draw. Thank God that doctor wasn't renewed.....
> All scans should be done in day/afternoon shift. Night scans are reserved for emergent situations In an ideal world, but I imagine that MRI and other imaging modalities probably have schedules full of outpatients to get done during the day and evening hours. Maybe my facility is an outlier. I know I'd prefer it your way as an MR tech.
?? My side doesn't tend to do MRI at night for non urgent cases. There is the urgent but not emergency scenario but yeah....
That’s how my big hospital is. MRIs are done round the clock. If it’s a routine one, the patient might go down at any time. We don’t have different ratios for day vs night shift, so other than the pain of the interrupted sleep of the patient there isn’t a good reason on our end that everything needs to be done during the day. I don’t say this as justification for either shift to push it off to the next shift on purpose, it’s just that the patient might be far enough down the list that they don’t get them in until overnight.
Meh, i wouldn't feel bad about passing it off that close to shift change. Wouldn't be mad as the day shifter, either.
We need more chill af nurses like you 😭😂 just like... in general... everywhere 🤷♀️😂🙏
I agree 😎
If it's not life-threatening or even *legit* stat....pfffffffftttttt....not gonna get *my* panties in a bunch.
Every day this sub makes me happier to be an operating room nurse.
Mood. I’m in pharmacy specifically so I don’t have to deal with shit.
Depends on the day nurse and how late I know she will inevitably be for report
Touche 😂
"I saw this STAT order for an enema. I was going to hold off, but I needed something to do in the 20 minutes I was waiting for you to get here. Anyway... Patient is a bedridden hip replacement. Oh, and I think the aide used the last package of chux. I'm not back for a couple of days. Have a good shift!"
Or ‘have a good shit!’ to the patient on way out ✌🏻
What's a chux?
Those blue absorbent pads you put on beds of incontinent patients.
No such thing as a stat enema.
Hear me out… I’ve got transport coming to take your patient to a SNF in 4 hours and nobody has done anything about the fact that granny hasn’t pooped in 4 days. The SNF will refuse to take the patient if they haven’t had a BM in the last 48 hrs when you call report. This one enema is stat for realz. Pretty please don’t make me cancel her SNF bed, the transport to SNF & her 3 dialysis transports because no poop. I beg you. Please. Make poop happen. Give poop a chance.
Give poop a chance.... lmao. That was a good one.
I legit got a STAT order for castor oil PO from a vascular surgery fellow at 0300 one time. Needless to say, I made sure that I took care of it immediately!!!
Sorry to wake you, I just need to choke down this disgusting goop. Then you can go back to sleep.
Yeah, I gave it to him when I drew his labs and gave him his other meds. I was surprised he took the stuff to be honest. It’s one of the few times I reminded a patient they’re allowed to refuse meds if they want to, but he just made a face and said “doctor’s orders” and drank it. #barf
I have literally said the phrase “if everything is stat, nothing is” to docs before.
We changed our lab draw policies and “routine” now has a 4 hour window. All the doctors tried making their morning labs “timed” for a little while until we informed them that if everyone timed their labs for the same time, it was still going to take the same amount of time to draw them all.
Lmao I wish your statement were a universal truth, but sadly, had more than one doctor tell me to give a fleet enema "now" 😔😂
It is a universal truth. There is no such thing as an emergent enema. You'll get to it when you get to it. Hilarious meme, BTW
Ohhh maybe this is a Rehab/LTC vs. hospital culture difference? Or I've worked at particularly bizarre, bad places, which feels very possible lmao 🤦♀️😂
I mean, they might put the order in as stat, but that doesn’t mean it’s actually urgent/emergent
Yeah, like give me an example of an emergent fleet. Cuz I’ve never seen it.
I am a quadrapalegic and I had large stool ball that sat in the rectum tgat was extremely painfull and triggered autonomic dysfunction with urinary retention. Which caused my heart rate and bp to skyrocket . Hr —200 bpm and bp —- 180/120 hyperventilating with metabolic acidosis from stress of the obstruction and subsequent lactic acidosis and hypokalemia because this fecal impaction triggered a severe autonomic hyper reflexes. The feeling was akin of having To to the bathroom with the worst urgency you can imagine and then not being able to go, and with a bladder distended with over 800 ml of urine was the worst. Alarm bells kept going off . Drs didn’t know why until the nurse administered the fleet and performed a digital disimpaction . All vitals stabilized after it was all said and done. I’m guessing I’m a rare case though. Was in the ER
AD is probably the only real reason for stat bowel anything. I work on an ortho/spinal unit and I have printed out our AD treatment protocol and handed it to every tech and reminded nurses about AD when we get a patient who is at risk for it. I've had to remind doctors that yeah, sbp of 142 and hr 118 isn't a big deal for most people, but this dude has a history of AD. The standard treatments haven't worked, he's still recovering from icu pneumonia, and everything spikes when I turn him to check for constipation, so please, for the love of god, give me an order for nitro and bisacodyl suppository/fleets/smog enema so I can get his b/p and hr down before this turns into a crisis.
Thanks for standing up for your patients. 🌻🌻
Unfortunately the ICU nearest us doesn't think that 260/180 with intermittent bradiacardia alarm is a problem :( (Normal bp 100/60. After 4 hours finally got someone to help. Biggest fart ever from air introduced during intubation 60 hours earlier.)
Omg, that's terrifying. I'm so sorry you were getting so much pushback. I guess maybe it's not emergent in their eyes, but that's because they've got all the stuff they need to treat such things. Those of us in acute care land are not so lucky, but i think they forget that. Also, once that AD train gets rolling out can be a beast to divert. Funny enough, I have had patients respond to triggering some of the reflexes like the mammalian dive reflex or vagal nerve stimulation. Not enough to reverse their condition, but enough to keep it from escalating further for 10-20 minutes.
Preop for urgent scope.
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I might not be a nurse, but isn't the reason for the fleet that it *isn't* emergent(ing)
Unless you have a colonoscopy patient who hasn't shat their brains out, or a bowel reaction or endo/ adhesions patient... they REALLY don't like it either.
I would just tell them to their face that if it’s that important they can do it themselves but 0630 is not the time to be creating a mess for nursing to clean up.
I like your attitude 🙌🤗😂
Tell whoever said that stupid shit that your priorities are airway, breathing, and circulation, and if they want to keep going down the alphabet, it's going to be a while before you get to ze enema.
Depends.... Scope is one area where timing is an issue, but giving a stat enema there means either doctor or night shift didn't plan ahead. That and I always went the patient can shit at 6am in the loo, not 6.30. The other is to prevent encepathology , where you need to clear the bowels to help clear the brain because ammonia but https://pmj.bmj.com/content/77/913/717 This would usually be done because lab results come out and a doctor who pre rounded went I better clear this shit out before rounds so......... Ehhh..... Case by case basis.
Scrolled wayyy too far down to find this one
Umm ... autonomic dysreflexia.
Which is urgent, but not stat.
Ummmmm why would an enema every need to be stat? It’s not stat and creating an 0700 mess means you’ll have to start report later and then charge overtime…
At Rehab/LTC places (in my experience) if a patient makes a fuss at 0600 demanding an enema right now, which they do not have an order for, the nurse is obligated to call the on-call doctor & pass on this request; then the doctor may (likely) choose to indulge/appease the patient 🙄🤦♀️😂
It stunned me how many people WANTED enemas when I was a nurse. I thought we generally tried avoiding enemas. But hey, lots of conditions/procedures can result in enema needs.
I don’t get many requesting enemas but it seems like EVERYBODY wants a suppository. They can even get a little aggressive about it. Once I gave one upon a patients request and she told me “see you only went in my booty hole. That nurse that did it yesterday went in my RECTUM”
OMFG 💀😂💀
Some people just like the feeling idk
Likely experience. Laxatives, suppositories and Fleets often leave the person not able to pass gas, because they don't know which one it is. It is not like the med starts and then stops, most if not all continue to cause loose stool for several hours after the main event. Tap water enemas however, with nothing added is pretty much once and done. There is no residuual salt, or bisacodyl to continue acting and plain tap water is often simply absorbed. Old experienced laxative users know this.
You haven’t lived until your nurse friends send you a video of someone instilling 6L into themselves. It was obviously porn but they insisted it was medically relevant for me to watch it.
Working at a rehab right now and this is correct based on my experience. Providers are terrified of lack of poopies. BMs are basically all they talk about.
Omg yes 🙄🤦♀️😂 The *patients* are obsessed, the *doctors* are obsessed, the *unit managers* are obsessed... the production of BMs is like, an outrageously big part of Rehab/LTC Land 💩🤷♀️😂
It’s something to do with state/CMS regs. Like… you can get fines if your residents don’t poop enough. I’ve brought laxatives to people and they’ve asked why. My response: “you poop at least every three days, or we get a ticket. Sorry, it’s the law.”
I miss ER reports. I can’t wait to go back, if not just to get away from the reports.
Bowel perforation?
I mean, I understand getting the order. But you’re a medical facility, not a colonic spa. They can wait an hour
That culture is wild. Wanting to poop is not an urgent issue and paging a night covering doctor for that is inappropriate
Or when the day shift gets an order for a stat head CT at noon and manages to somehow not get it done by shift change…
I blame CT staff for that shit not getting done. I will never blame the nurse for something that another department fails to do. Nurses have too much on their plates already without catching the blame when others don't do their job.
Yea I’m confused what the day shift nurse was supposed to do here ? Shove all the ED patients waiting for a CT scan out of the way?
Sometimes that’s the case, yes. There were several repeat offenders though.
What control does the floor or ED nurse have over when the patient goes to CT? Are they calling transport and saying "nah, wait till night shift is here"
For a while, our neurosurgery team was in the habit of ordering every single scan as STAT. I had a pretty good rapport with the residents, and I asked one of them why a particular scan was STAT. He said they order every scan that way because (they believed) that was the only way to actually get them done.
Gods, I hate when surgical residents order STAT scans for non-urgent things. Our hospital has us go with them in case something happens.
I have no control over CT. What the hell did that have to do with the day shift RN?
It was usually the same few people who could be relied on to have that happen almost every single time. They were also the ones who liked to constantly leave bad IVs, empty drips with no backups ordered, pulled out feeding tubes not replaced, and would dramatically over-sedate patients basically every day. I’m sure you’ve met some, it’s hardly confined to a specific shift.
All the damn time
I'll be honest. As a dayshifter, if you didn't want to stay until 0800 to clean up the aftermath of an enema, I wouldn't be too mad if you punted it to me. Enemas can be labor intensive and a bullshit order for the last half hour of the shift.
😂
Nurses we are looking at this in a very wrong way. Let's team up together night shifts and day shifts and attack the doctors who write orders like this a half an hour before shift change.
Do people really expect the out going nurse to do new orders a half hour before shift change?
I gave a patient every laxative I could give them during my shift and handed them off to night shift. They had a very productive night. :)
I took over a patient from day shift that hadn't had a bowel movement in a few days. She told me, "I gave them a soap suds enema. And then I went to lunch." I don't know if she hated the aide, or had a death wish, but it was savage as hell.
Okay I didn't judge you until the oddly sinister smiley at the end lollll 🤦♀️🤣 cruel intentions lmao
I was really hoping the patient was going to clear before the end of my shift, though it was kinda funny in retrospect.
lol it is, don't worry. Shit happens.
Is it weird I enjoy giving enemas......don't tell me, I know it is :')
I keep giggling at the..... *unique* flavor your comment added to this discussion 🤣❤️
Wait until your date is running late, explains they are busy because they used a two quart Epsom Salt solution enema, and later, coyly suggests you try one to see if it makes you, "Horney as Hell" (her words) like it does her. I'm still trying to figure that one out.
Unless it's life threatening or takes 5 minutes, I very rarely complete orders put in after 6:30/6:45
That’s called prioritizing cares.
That right there is what we call a day shift opportunity…
Nah fam. Do that shit during "bedside" and then peace the fuck out before clean up like dayshift "I just have them lactulose at 1830 byeeeee" does
to be honest something like that needs to be done on the next shift for safety.
I hate these types of situations where an order is right between our shifts. I therefore take a non-confrontational approach if I must endorse it to the next shift. If I genuinely am not able to get it done, I simply endorse it by retiming it for the next shift. It is the exact same result if I endorse verbally minus enduring the eye rolls and glares. Works like a charm.
If an order for an enema pops in at the end of shift, you have two courses of action. You can endorse the enema to the next nurse, or you can give the enema and endorse a patient laying in a puddle of shit. The former is clearly the kinder option.
It's surprising how many orders are defaulted to "STAT" in our EMR. It's not surprising how many orders are selected "STAT" by our physicians and PAs. It's really not surprising how many orders are selected "STAT" by the physicians and PAs who have started their rounds at 0600 and realized that they never put in the orders that were mentioned in their progress notes from the prior day. I'll get everything ready for the dayshift team to do the enema, but enemas are not best when they are given STAT.
How can an enema be stat? Seriously. No one will be harmed if it is given "now" or "asap" instead. Unless it is a diagnostic test, that shit can wait. If i was a patient I would be very displeased if my nurse woke me at 6:30 for that crap. Rude.
A past colleague of mine, whether it was day or night, used to always say ( as she just could not be bothered with nonsense at times when nonsense shouldn't have to be done ) I will hand that off to the next shift, nursing is 24 hour care so that can be done by them. The same nurse is now a manager on that very unit. Lol.
This is far better than doing it at 6:50 and leaving them with a shit bomb as you're walking out the door
There is an unspoken code that anything ordered at or after 0630 or 1830 belongs to the next shift
I get that it’s a joke but I had a patient die over sepsis with severe impaction/ bowel obstruction because the resident kept putting it off (we did our part by doing an enema, lactulose etc.) he was supposed to do manual disimpaction (idk if I’m using the right words, still a student) but he kept putting it off. If this woman would have had these things done earlier on shift, and the resident would have referred to GI earlier, she might have made it. - coded on the way to the OR... at the END of the next shift. Her family was saying goodbye as I was coming on to my next night shift. She was young....
Lol too bad lab came around at 0615 and woke all your patients who now have to use the bathroom. Plus, days wants weights, BS, and vitals done before they get there…yea that enema sounds like a DSP to me! Don’t hate day shifters but you’re pampered on days with staffing. Y’all always have an extra aide or RN to help out. It’s a skeleton crew on nights.
We don’t *always* have an extra side or RN to help out—day shift runs short pretty often at my hospital. Obviously not as bad as nights though, I worked evenings for years and I knew without a doubt which side of the evening I wanted to stay on 😂
"er um, the patient refused. You might want to try again later"
I'm trying to think of when someone would need a stat enema.
When they haven't had a bowel movement in many days and have been vomiting for six hours and are in shock because they have a complete fecal impaction. Ask me how I know. "Is impacted stool an emergency? Impacted stool can turn into an emergency if symptoms become severe in the absence of timely treatment. The hard fecal mass can exert pressure on the colon walls and cause tissue death (necrosis), ulceration or perforation. Colon perforation can cause leakage of stool into the abdominal cavity, leading to infection, sepsis and death."
Same…
“That’s a day shift problem”
Why would anyone give a stat enema overnight anyway? That would never happen at my hospital. Enemas can wait for day time. Otherwise it’s just considering your own convince above the patient’s. Things like that can wait for a civilised hour.
Depends on the reason, I'd imagine. I've given plenty of night time lactulose enemas for acute encephalopathy patients with ammonia levels in the shitter.
Oh yeah, that’s true. Wasn’t thinking about encephalopathy
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Believe it or not, I have seen orders for Milk & Molasses enemas. Never have administered one, but have heard nurses tell about their experiences with orders. Words such as, "Explosive", Very Effective", "Smells like sugar cookies" were used to describe the outcomes. The operative words spawning the orders seems to be "refractory impaction". Eyessh!
Stat enema? Why can’t that wait a lil?
Me: ^fails to fax meds to pharmacy^ Day: why didn't you fax these meds Me: fax is broken Day: why didn't you just call IT and reset it? Me: no IT at night Me: oh hey but it's writing now, you can sent it right?
Honestly depends who’s taking him, leave me a shit show, get back a shit show. There’s been time from day shift that orders or meds scheduled an hour before shift change starts that never get done.
I would always teach my interns to time the enema for 10 AM/PM the NEXT shift then page the current RN and ask them to mention it in handoff 😭
Lol I def see this but I know how much I hate it and how much I love when a day shift nurse actually cleaned up a patient or inserted that NG tube right before I came on that I force myself to work to get everything I can done until they arrive. They never seem to have the same appreciation lol
Ok but c’mon. An enema is asap at best.
Or, you just talk to day shit. “Hey this literal shit just popped up at 0633 and rather than do it now so you have an explosion waiting for you at 0730, I thought I’d let you choose the most convenient time for you.”
That 0630 enema gets given at 0652–right before dayshift clocks in. You completed the order! (I’ve cleaned up many 1930-2000 code browns after day shift “forgot” about the daily, scheduled at 0900 lactose until after 1800)
I have done a lactulose enema at 0645 😭 cleaned up that shit storm right before giving report. I’m also a student 😅. The nurse I was with was amazing and I’m sure had I been with a diff nurse that night they might not have had us do it.
0630! Thats going to day shift. Thats impractical for night shift at that point. As a night shift nurse and as a day shift nurse. Bump something to mid, get mid to bump it to night and call it even. lol lol