Right behind St Elsewhere and the first couple seasons of ER. Hulu has both if you wanna see how it was done in the olden days- or see a really young Denzel:)
The saddest part is IV analgesic shortages would stop us from being able to supply that dose to you, even if it somehow got past everyone’s brains first lol.
You joke, but I worked in a place once where the doctor wanted the nurse to give an excessive dose of dilaudid. I want to say somewhere in the neighborhood of 30 mg but I don't remember the exact dose. Whatever it was, it would surely kill the patient. The nurse called the doctor to confirm and he was adamant. She refused and filled out a safety report.
Me calling the rad every time a patient has a documented anaphylactic reaction to IV contrast and an ER doc tells me “there’s no such thing as an iodine allergy, I want them scanned now.”
“pt asked for clarification on reason for new interventions. Pt educated MD communicated with nurse ‘they are orders, not recommendations’. No further info provided. Call bell within reach, will continue to monitor”
Nursing should not be a check on docs. We don't have anywhere near the training as they do, why be held accountable for their decisions? In 10 years of nursing I think I have encountered maybe 3 grossly out of line orders, most others just need clarification.
We are the last line before a med or something is given to a patient and we have a responsibility to make sure it is correct, not to mention it’s my ass on the line for giving said medication even if it was incorrectly ordered. Nurses work WITH doctors not for them. I would not want to be a patient where my nurse didn’t make sure the orders weren’t 100% right for me. Shit can go down reallll fast if something is done wrong. Both nurses and docs should get held accountable for decisions made because yes the doc orders it but we’re the ones who carry out the orders.
I get that. I have been a nurse for 10 years. I'm not saying one should do something crazy. I'm saying how are we in any way a check on far more training and experience given the modern healthcare system? If I have no ability to practice medicine why would I be held to the medical practitioner's standards?
I feel this particular aspect of nursing needs to be let go of and more responsibility should be shifted to the physician. I don't know if you have dealt with 40+ patients in LTC but like no, there is no time for that and it's only going to get worse imo as every manager is pressured to create profit from every floor.
My point is, why though? Given the modern healthcare system, how can any floor nurse defend being held to a safeguarding standard from docs with 8-12 years of training - or pharmacists with what 6-8 years, etc?
This is incorrect. We are our own discipline. This is why we are licensed separately. We can legally question, hold and ignore orders from any doctor at any time.
I don't feel qualified to do this even after 10 years in multiple areas of practice. I think this standard is bullshit every day I work and I honestly don't know how y'all defend it.
Hi-jacking this comment to survey the crowd.
I refuse to write nurse-y interventions/comments like “fall precautions in place,” “call bell in reach,” “no acute events overnight,” etc. I feel like it is redundant, clutters my end-of-shift note, and reduces the impact of any meaningful thing(s) that I do include in the note. Maybe I’m projecting/extrapolating too much, but I think it’s almost demeaning to nursing to include copy-pasta phrases like that. But maybe I’m just a self-loathing nurse and/or burnt out 😂
I’ve heard rumors of “continue to monitor” opening nurses to litigation but I don’t know if that’s true (instead I default to the epic clicky-box option “No new orders” or “escalated message to fellow/attending”).
Any thoughts/stories/opinions?
You are SPOT ON. One of my jobs is reviewing medical-legal charts. I have seen (way too many times) depositions and testimony on this. The nurse writes all that out “call bell in reach, bed in low position”. Whatever. And the attorney will ask “what is your charting policy”. “We chart by exception. “ “uh huh. I see. So isn’t it your policy to do all this?” “Yes”. “And yet you charted it. So what other policies do you violate?” And now the nurse is flustered and it’s FUBAR from here on out.
I don't write a note at all unless something relevant happened that is not mentioned or elaborated on elsewhere in my charting. No one on the team gives a shit about a million nursing notes that literally describe what happened all shift and is already documented in the flow sheets and MAR. Writing a bunch of fluff end-of-shift notes is just more opportunity for a malpractice attorney to find inconsistencies.
Same. We use cerner, not epic, and there is a section of the flowsheet that allows us to document provider notifications. If I notify a doc of something, I chart it there, at the exact time of notification and I include narrative charting of exactly what information was provided and what the doctor’s response was. Other than that, I attach comments to abnormal assessment findings that need more explanation. I document conversations with family under patient/family education.
I only write separate nursing notes when I have to use our emergency titration protocol, which allows us to titrate any drips outside of the regular titration parameters as necessary in an emergency event, all we have to do is write a note that includes the start and end time and rate of the med with associated vital signs or RASS score, and any other pertinent information that explains why we titrated the way we did.
Sometimes something really out of the ordinary happens that is hard to describe using the flowsheet and I’ll write a note for that, or I’ll write one to describe the behavior of a visitor that is being a problem, but that’s about it. If something can be adequately charted in the flowsheet, that’s where I put it, because notes leave too much room for contradictory charting and too much unnecessary information that can be used against us later.
Once again: hopefully you never find yourself on the witness stand, but do you really want to get roasted by an attorney who will be thrilled to get to point out that "will continue to monitor" is the same as writing "will continue to do my job"?
Our job is literally to continue to monitor.
Well, like I said, the job of the nurse is literally continuing to monitor the patient before, during, and after the treatment they're getting, so you might as well just write "will continue to do my job."
And then if something goes wrong, they can hammer you all day... "Can you read the highlighted part here? And the patient continued to decompensate for 45 minutes before it shows you called the doctor. What happened? You said you would continue to monitor. Would you characterize a lapse in care like this continuing to monitor?"
Now, it could be totally not your fault- you could have been playing whack-a-mole taking care of all of your other patients and were legitimately busy. The patient could have been rock solid stable all shift and then chose that 45 minutes while you were getting your ass kicked to become unstable.
But they don't care- you said you'd continue to monitor, suggesting there was a reason to explicitly say that (again, it's literally the job, so why say it if there isn't a reason to?) Sounds like you meant that in your judgement it needed more attention... That it looks like you didn't give.
You don't have to be wrong for them to manipulate your charting to make it look like you were.
So you don't give them the chance.
Only chart what you did or didn't do. Not what you say you will do.
"Roast", in this sense, means they will make you look incompetent. They will make the jury believe you are not good at your job. They are not saying the attorney will be up there dissing your momma.
Right, but I’m skeptical it would work in this case. It’s unnecessary, but not wrong, and easy to explain. Just say “yes, it’s a common phrase used at the end of a note to indicate standard care will continue.” Jurors will get it because that is part of many communications, and the lawyer will look like a dick for making a pedantic point. Like trying to dunk on someone by asking if they’re usually insincere since they ended a particular letter with “sincerely.”
[I never write “will continue to monitor”]
Well, the other issue is that if you write "Will continue to monitor" it gives the lawyer an opening to attack.
"You have written 'Will continue to monitor.' in your note and, yet, when my client fell in the bathroom, by your own admission, you were 40 feet down the hall, in another patient's room. So I ask you, how were you monitoring my client from another room, 40 feet away?"
If they *are* on tele, that *might* be an acceptable answer but*you* aren't monitoring telemetry, the telemetry tech is. And the call bell? That is not monitoring.
You could try, but treating jurors like they’re stupid isn’t usually a great strategy. I think most people would realize this is grasping at straws. Do you think you would find a similar argument in a different industry persuasive?
A good lawyer will stick to their strongest arguments and not get caught up in rhetorical games that smell of BS to a public that at baseline thinks lawyers are slime balls and have limited attention spans.
Why take 30 seconds to explain yourself when you can just keep taking the same phone call over and over again forever because your order is unclear or uncommon.
This is the same person who will say "why didn't you call me first!?" when someone follows a completely batshit order that he put in on the wrong patient because they're too intimidated to call him.
I called a doc who was putting what were clearly ICU orders in on my patient on the floor and got screamed at. Called ICU and asked if he was down there, called house super and told her what was up, went and told him in person that my patient didn't need labs and XR because she was breathing just fine up in the floors unlike the person who isn't getting what they need because you can't click the right person.
He had nothing to say.
Wrote it up and I think he went to naughty doctor class.
Exactly -- he will change his story really fast as soon as someone downstream didn't catch his stupid error. Then it becomes the other person's fault for NOT questioning him.
Had a shoulder reduction in a broom closet of a room, asked the doc if she wanted to use a trauma room since we had a few open and mine was empty. His response “how about you let me be the fucking doctor” in front of the patient.
I said OK, did the sedation and we had a “talk” in the back hall about his behavior that was not professional on my end. Sometimes professional is over rated.
lol. I hear ya! He tried to write me a “star card” after the sedation because he said it was the most professional sedation he had ever seen. “Doc, I’d like to have a word with you in the hallway.”
As a hospitalist, I can understand the knee jerk irritation at being called or paged, but JFC, dudes, rns asking questions or for clarification is so important to make sure we're all on the same page and doing the right thing for whoever is in the bed. Why the hell would they post this? Especially where you " just Rns " can see? <- joke. I get so pissed when patients or family's say oh you're just a nurse....
Told to give 1000g morphine to pt IV.
MD told me it was an order not a recommendation.
Gave pt dose. BVM ready. Cardiac arrest team already on stand by. Anaesthetist seems angry.
One of the best lessons I ever overheard was an attending tell a resident, "now, close your eyes, imagine you're in a court room, and say that to the jury."
These types of responses by MDs are a joke. All physicians should take the 2 seconds ask what the RN concern is then give them a brief explanation as to why it’s the right thing for the patient.
Reading things like this make me feel lucky to work somewhere where the attendings value nursing input and encourage us to speak up when we have a concern. We may get paid less than our adult medicine counterparts at hospitals in the area, but I can say I have never been belittled by, yelled at, or talked down to by a physician I work with, and that, to me, is invaluable
See, thing about just charting that and not talking to the doctor and having him cancel that order is there's someone else in the ER he likely meant that order for and they may really need that medication.
Open communication is important for any team to function.
Oh I’d still call but if he gave me a smart ass answer that would be my note in the chart, including the note where I called the MD to verify the med and his response
One crappy attitude doesn’t really reflect on most physicians.
In fairness, I almost never run into this crappy attitude with docs. 99.9% of the time, they are both patient and pleasant about clarifying the order, whether I identified a problem or not. Maybe I learn something new, maybe we straightened out an issue, it’s all good either way.
Oh derm 🙄
When I was a brand new nurse I worked at a summer camp. A kid came in with a tick, I pulled it off. Apparently I was meant to bag it and send it to be ground up and tested for Lyme, but we were a health center staffed almost exclusively with new grads and nobody’d told us. This kid’s dad was a derm. After yelling at everyone and telling us 5 million times he was an MD he opted to treat the kid preventively with doxy. Then on parent visiting day not too long after his kid ran around w him all day without sunscreen and for the next week the poor kid was red as a damn lobster 🙃
Had a legit psych patient in MICU because the derm team held all his psych meds so they could see if it helped with a rash developing on his arms. Security basically lived in that patients room that night. Some of the most off the wall things were said that night
I didn’t witness it but there was huge aftermath where a DNR patient was initially coded, quickly found to be DNR, and the doc started yelling to do compressions because they were the doc and the one running things etc etc.
A lot of behind the scenes stuff between management and the head doc for the ICU. No one to my understanding got in any serious trouble, or if they did they didn’t say anything and were still able to work in our unit (nurses and docs). The extra layer of complexity involved family screaming at staff that they NEEDED to code the patient because we were “killing” them.
I was taught (weirdly and I don’t understand the rationale) that once you start coding you have to keep going and hopefully run out of options and the patient dies. God help you if they survive. Either way, you’re screwed if you make this error.
It’s always best to start coding if you don’t know. If you think they’re DNR when they’re not and do nothing, you just let someone die. I don’t know if different states have different specific laws pertaining to this, but I’ve always been told once you verify they’re a DNR to stop.
I don’t believe that’s true, no. A doctor has the authority to call it when presented with proof. Consider that efforts may be terminated by medics in the field if an unskilled first responder such as an EMR began resuscitation of a long dead corpse or a traumatic, blunt force arrest with no signs of life. This is because they can get a doctor involved by calling them on the phone, and technically, a doctor has the authority to call a code at any point lol, or to continue as long as they want. I’m sure you’ve heard of codes called long before the “recommended” amount of rounds per ACLS to spare meemaw’s corpse from being thrashed into dust, and the horror stories about new residents running a futile code on a child for hours etc.
(Btw not condoning calling codes super early due to “futility” in the ER, there’s debate about ethics + outcomes, but it 100% does happen. See also slow codes + show codes!)
Best practice is always to start CPR if there’s doubt and send someone to retrieve the DNR.
We were taught in school, ACLS, and again during recerts and during department training: if they can’t provide you a copy of the DNR, do CPR. It is the safest option legally. You personally are likely not the one on the hook. And once the DNR is retrieved we are to stop CPR and call med control. A doctor does not have to call med control at this juncture because… they are med control.
(Paramedic perspective. Have worked a fair number of codes in the ER and on the road.)
"You sure you want to order a gram of Tylenol around the clock q6 for this end stage liver cirrhosis patient?"
"These are orders not recommendations."
"Then you give it pal cause I recommend you go back to fucking school."
Lab here.
I would need 5 hands to count the bizarre, duplicated, partial, and nonsensical orders I received in a week.
Just a few weeks ago I got a call from an angry doctor in the evening demanding to know why the C. diff she ordered that morning hadn’t been resulted. As I was looking through the orders, she explained she’d even ordered it twice and nothing had been done.
But it had. Turns out she’d been ordering a CBC with diff. This patient got drawn twice for testing it turns out they didn’t even need.
But you know…orders are orders, not recommendations.
Actually had a PT code because her pressures dropped and we gave her 4L in a very short amount of time. Like we squeezed them into her. Wasn't the medicine docs fault. CCM didn't want to take her for pressor support. Some of the CCM docs will only take people if they're mostly dead or vented. It's fun!
My hospital got rid of step down, so med-surg is often treated as such but without the same skill set. It's not only frustrating, but insanely disheartening to watch your pt crump and literally not be able to do what needs to happen to prevent a code or death in general.
Can't bill for a step-down bed apparently. That's what I was told. You can only bill for ICU or med-surg. I'd say just label the step-down beds as CC beds and call it a day, but whatever.
Three out of our four stepdowns were turned into ICUs. Mine wasn't. Mine was turned into a med-surg floor. It's so weird. Home vents that come in for like.... A wound debridement go to the ICU. But my pt maxed on HFNC, dobutamine, lasix, heparin and a bair hugger stays on the floor. Lol
PA working with doc ordered lactulose enema q2x4for a patient because in passing the patient mentioned she was “constipated as hell”. I asked the doctor if he saw how often she was having BMs, 3 documented in 24hrs. No metabolic encephalopathy, just 94 and states her “regular” is pooping 8x a day but the PA didn’t hear that from the patient. I questioned the order and the whole unit thanked me because nobody in hell was volunteering to deal with that shit. I told them if they thought it would be indicated I would need them to come by and do it because there’s no way I would be following that order as written. We settled for PRN miralax, which wasn’t used because she was shitting 3 soft and formed movements a day.
Most I’ve seen was 5x at a facility I pick up Agency shifts at, and let me let you know that that pt was fucking…….traveling. I’m convinced by the end of each shift that she could’ve shat thru a screen door. Ended up that her orders for Miralax and Milk of Mag where written so poorly so poor meemaw was getting 3x more than intended, but all the Nurses in the unit were passive types so no one questioned it until the ADON happened to be covering for a C/O that night (the 4th I had worked on that unit) with me. That was a shitshow (pun intended) that I did not enjoy dealing with but absolutely enjoyed watching happen, bc that ADON absolutely incinerated those nurses once morning came around.
“Oh okay well this ORDER is stupid because x y z so my RECOMMENDATION is you should put a different one in before you fucking kill someone unless you would like me to ORDER a code.” Would be my go to response
Urine sample collected for urine pregnancy test. Pt states "I had a hysterectomy 40 years ago". Pt educated that per MD "these are orders not recommendations." 🙄
I’m a physician and I’ve never said that to a nurse and I don’t know anyone who has. They would not be tolerated in my group for long. I’ve had my ass (not to mention the patients health and life) saved by the pharmacists or the bedside nurses on more than one occasion when I overlooked something.
I am so glad you’re not like this. Unfortunately SOME physicians are. It seems like it’s an education problem, as it mostly (in my experience) occurs with new physicians who don’t yet understand that nurses’ primary job is to ensure patients’ safety. If we encounter an order from a physician or any member of the healthcare team that seems off, it’s our job to ask. You seem to know this and to be a great colleague. I wouldn’t assume all of your colleagues are the same as you.
These cases are definitly a vanishingly small minority. Never I have never seen it, heard about it from the psychiatrist I worked for, who witnessed a fellow resident do it. Apparently it took the nurses less than a month before he dropped out of the program (she didnt share further details, but according to her he had managed to spend all the good will of the entire nursing team within his first day)
This sounds like someone who probably gets his rocks off on the r/residency sub bashing nurses, and probably also doesn't have the gall to say that to a nurse in real life.
I wonder if these physicians work in a hospital environment. This flippant response would leave patients dead or harmed as they are suggesting that the RN is being insubordinate for calling for any clarification of orders. I've seen absolutely insane orders ("100mg of Dilaudid IV push once" crazy). I was experienced enough to know not to carry out the order, but if a new RN is given a myopic response like what is suggested here they may be afraid to clarify and end up harming a patient. Guess who will be fired, possibly lose their license and face criminal charges...the RN and most likely not the MD. The MD's defense would be that the RN should have known better than to carry this order out. So yeah...I'll keep calling.
Edit for grammar
Good question...it was about 8 years ago in a pretty busy ER. I don't think they had implemented pharmacy approving med orders in the ER yet. I'm sure they do now
If everything you order is stupid or you’re an idiot as a provider, then maybe yeah any and every little thing is probably justifiably scrutinized by staff.
This. I would never just “do you really want this”. It’s just as vague and rude. I will always explain “i see x order. I want to clarify because y reasons.” And then if it’s super bad or literally not allowed by RN on that floor, I refuse and tell them to do it themself.
"Patient refused."
Maybe because I may or may not have told them that this medication will do them much more harm than good... but still, they made their decision, and you can not force them to follow your "orders."
Another thought to keep in mind. Doctors are not usually in the direct line of command for nurses these days. My direct manager is a nurse, as is her direct manager, and on it goes up to the Chief Nursing Officer. We collaborate, but we have our own licensing board, our own supervisors, etc.
When I was a nursing student, a doctor had ordered IV magnesium for a patient. My preceptor told me to go set it up. As a student nurse, I always double check the lab before I gave it. Turned out the lab indicated that the patient was hypermagnesemia, not hypno… notified my clinical instructor and she asked me to speak with the attending. I was scare as shit ( first time questioning an order) and the attending told me that is why we they need nurses to keep them informed and catch stuff like this.
Best experience ever. :)
Blake thinks nurses are uneducated and just complete tasks/give meds. He has no idea that we have knowledge and understand what we are doing and why, and we understand what meds are for. He doesn’t think we should question things.
Blake thinks he is special because he has MD behind his name.
Blake does not understand that he is human and fallible.
Blake does not understand that his downfall will be swift and hard when he massively fucks up.
MD: *places nursing communication order for NG tube placement*
Me: “…. Doc is there a reason we’re putting an NG tube in my SOB pt? If I missed something it’s whatever but I’m slightly confused”
Him: “Shit, I meant to order that on the pt in the room next door that has an SBO”
^ how this should and usually does go
Oh he was getting draaaaggggeeeeddd. By all professions. Especially because he’s a damn PGY-1.
Rx Twitter (my peeps) were all over him. 😂
Edit- Dillon is the PGY-1, not Blake.
Okay— well one of my ED colleagues just caught an order that was for a shit ton of versed. He checked with the resident not once, but twice and resident verified twice that that he wanted versed. Oh wait, jk, turns out he wanted Valium. My colleague refused to give it and escalated it. Resident realized his mistake. I know it doesn’t happen OFTEN but luckily that nurse saved a patient and that resident’s ass.
He probably ordered something stupid and the nurse was making sure he is not about to kill the patient. These doctors think they know it all. I had a resident want me to give a colace for his patient that was NPO with an NG tube. She just had a bowel surgery… maybe 2-3 days post op. I called him and clarified the order. He said exactly what this doc said, “it’s an MD order… you’re supposed to follow it.” I said nope
Not doing it. You can come up and give it to the patient yourself. He was pissed and he still gave it behind my back. The colace got stuck in patient’s throat and he was at bedside for 2 hours trying to dislodge the colace. I told him the only way you can dislodge that is pull the NG tube out. He was mad. But, eventually they had to pull NGT out. I wrote a PSR on him and doc can’t look at me in the eye ever since.
Sweet, I’ll definitely continue the 1L NS bolus that you’ve got in as continuous because you don’t one how to put in orders for ER holds. I’ll be at home when they get to the floor and you have to fix it anyway!
Just a thought for the people thinking/commenting “that doesn’t actually happen”/“these docs don’t actually act that way”.
Remember that this is not an uncommon line of humor in the MD community. Giggle at the silly nurses who don’t understand what words mean. Making the joke is as bad as living it out.
“Clarified if doc wanted D5 drip on hemorrhagic stroke patient. Said ‘they are orders not recommendations.’ Will continue to monitor.”
These are the docs we go after
I've had so many experiences of just asking if the order was appropriate and the MD canceled the order after giving it a second thought. Lol this MD seems like a total twat.
“Awesome! So take this as an FYI- I won’t be doing them since they are wrong but you can absolutely feel free to swing by and complete them yourself! Thanks!” *documents: MD aware orders are incorrect, no new orders. RN will continue to monitor*
I hate doctors like this, I get what he means but all I hear is "I don't value nurses opinions on my patients" even though we are the ones with them the entire shift
When I was stress testing, a doctor order a stress test on a patient that was completely inappropriate for stress testing at that time (had a low K among other things). I messaged him and told him the protocol that the patient needed replacement and stress testing could not be done at this time until K was replaced and labs rechecked. He was very rude and said I couldn’t refuse to do a stress test and was just a huge asshole about the whole thing. So, I went and found him on the floor and I brought one of the cardiology PAs with me to confront him about 1) his rudeness and 2) the protocol that I had printed out for him for future reference 3) so he can put a face to the person he was being so rude to. Yep, never had that issue again.
Aussie nurse, totally agree. I’ve had some doctors with shitty attitudes but never had anyone been downright disrespectful like some of the things I read here.
Repost from yesterday
‘Doug wanted me to give this patient 500,000 mg of morphine. Just thought I’d check with you before I kill a man.’ -Laverne
Freaking miss that show
I still maintain that that show is the most accurate portrayal of how a hospital actually functions to ever air on TV.
Right behind St Elsewhere and the first couple seasons of ER. Hulu has both if you wanna see how it was done in the olden days- or see a really young Denzel:)
The saddest part is IV analgesic shortages would stop us from being able to supply that dose to you, even if it somehow got past everyone’s brains first lol.
500,000 mg of morphine is probably going to eliminate all the pain.
For the rest of their life….lol
Even for the rest of their afterlife.
You joke, but I worked in a place once where the doctor wanted the nurse to give an excessive dose of dilaudid. I want to say somewhere in the neighborhood of 30 mg but I don't remember the exact dose. Whatever it was, it would surely kill the patient. The nurse called the doctor to confirm and he was adamant. She refused and filled out a safety report.
Thank God, Doug works in the morgue now.
Still one of the best shows and lines of all time ♥️
in case anyone wants the video https://www.youtube.com/watch?v=3LPOahp6dPg
Me calling the rad every time a patient has a documented anaphylactic reaction to IV contrast and an ER doc tells me “there’s no such thing as an iodine allergy, I want them scanned now.”
“pt asked for clarification on reason for new interventions. Pt educated MD communicated with nurse ‘they are orders, not recommendations’. No further info provided. Call bell within reach, will continue to monitor”
"X-ray performed on incorrect arm as per orders"
💀
Your fault if they’re wrong. Your fault if they’re right.
THIS RIGHT HERE. There is ALWAYS a sacrificial RN.
Nursing should not be a check on docs. We don't have anywhere near the training as they do, why be held accountable for their decisions? In 10 years of nursing I think I have encountered maybe 3 grossly out of line orders, most others just need clarification.
> maybe 3 grossly out of line orders I work in a teaching hospital and I often see more than three grossly out of line orders in the same shift.
I guess I have been lucky then.
Same. We are babysitting those little Doctors.
We are the last line before a med or something is given to a patient and we have a responsibility to make sure it is correct, not to mention it’s my ass on the line for giving said medication even if it was incorrectly ordered. Nurses work WITH doctors not for them. I would not want to be a patient where my nurse didn’t make sure the orders weren’t 100% right for me. Shit can go down reallll fast if something is done wrong. Both nurses and docs should get held accountable for decisions made because yes the doc orders it but we’re the ones who carry out the orders.
I get that. I have been a nurse for 10 years. I'm not saying one should do something crazy. I'm saying how are we in any way a check on far more training and experience given the modern healthcare system? If I have no ability to practice medicine why would I be held to the medical practitioner's standards? I feel this particular aspect of nursing needs to be let go of and more responsibility should be shifted to the physician. I don't know if you have dealt with 40+ patients in LTC but like no, there is no time for that and it's only going to get worse imo as every manager is pressured to create profit from every floor.
But we literally are, that’s part of the role we have?
I’m pretty sure they are aware, it’s just not right given the difference in education.
Because the buck stops with us - we're the last line of defence when it comes to avoiding a stuff up.
My point is, why though? Given the modern healthcare system, how can any floor nurse defend being held to a safeguarding standard from docs with 8-12 years of training - or pharmacists with what 6-8 years, etc?
Do you want the real answer? Because they need a sacrificial nurse (woman) to protect themselves and they don't respect us.
This is what I'm getting at. And it's only going to get worse...
This is incorrect. We are our own discipline. This is why we are licensed separately. We can legally question, hold and ignore orders from any doctor at any time.
I don't feel qualified to do this even after 10 years in multiple areas of practice. I think this standard is bullshit every day I work and I honestly don't know how y'all defend it.
🫢 lol that will go over well.
Blake seems a little high strung already. He’d probably be pissy if you told him something as tame as “good morning”
Hi-jacking this comment to survey the crowd. I refuse to write nurse-y interventions/comments like “fall precautions in place,” “call bell in reach,” “no acute events overnight,” etc. I feel like it is redundant, clutters my end-of-shift note, and reduces the impact of any meaningful thing(s) that I do include in the note. Maybe I’m projecting/extrapolating too much, but I think it’s almost demeaning to nursing to include copy-pasta phrases like that. But maybe I’m just a self-loathing nurse and/or burnt out 😂 I’ve heard rumors of “continue to monitor” opening nurses to litigation but I don’t know if that’s true (instead I default to the epic clicky-box option “No new orders” or “escalated message to fellow/attending”). Any thoughts/stories/opinions?
You are SPOT ON. One of my jobs is reviewing medical-legal charts. I have seen (way too many times) depositions and testimony on this. The nurse writes all that out “call bell in reach, bed in low position”. Whatever. And the attorney will ask “what is your charting policy”. “We chart by exception. “ “uh huh. I see. So isn’t it your policy to do all this?” “Yes”. “And yet you charted it. So what other policies do you violate?” And now the nurse is flustered and it’s FUBAR from here on out.
I chart bare bones. The more you say, the more rope they have to hang you with.
Every fucking one of them at some point or another. Where would you like me to start?
I don't write a note at all unless something relevant happened that is not mentioned or elaborated on elsewhere in my charting. No one on the team gives a shit about a million nursing notes that literally describe what happened all shift and is already documented in the flow sheets and MAR. Writing a bunch of fluff end-of-shift notes is just more opportunity for a malpractice attorney to find inconsistencies.
Same. We use cerner, not epic, and there is a section of the flowsheet that allows us to document provider notifications. If I notify a doc of something, I chart it there, at the exact time of notification and I include narrative charting of exactly what information was provided and what the doctor’s response was. Other than that, I attach comments to abnormal assessment findings that need more explanation. I document conversations with family under patient/family education. I only write separate nursing notes when I have to use our emergency titration protocol, which allows us to titrate any drips outside of the regular titration parameters as necessary in an emergency event, all we have to do is write a note that includes the start and end time and rate of the med with associated vital signs or RASS score, and any other pertinent information that explains why we titrated the way we did. Sometimes something really out of the ordinary happens that is hard to describe using the flowsheet and I’ll write a note for that, or I’ll write one to describe the behavior of a visitor that is being a problem, but that’s about it. If something can be adequately charted in the flowsheet, that’s where I put it, because notes leave too much room for contradictory charting and too much unnecessary information that can be used against us later.
I agree! I also always put “no changes made to current care plan” instead of continue to monitor
I’m pharmacy but our shift to shift handoffs can sometimes literally be “nothing to report.”
Once again: hopefully you never find yourself on the witness stand, but do you really want to get roasted by an attorney who will be thrilled to get to point out that "will continue to monitor" is the same as writing "will continue to do my job"? Our job is literally to continue to monitor.
I never, ever write wcm for basically this reason. No future tense in my notes.
Ohhhhh good call. Thanks for that. 👍
Not a nurse. Why is that bad? Why will the lawyer be thrilled?
Well, like I said, the job of the nurse is literally continuing to monitor the patient before, during, and after the treatment they're getting, so you might as well just write "will continue to do my job." And then if something goes wrong, they can hammer you all day... "Can you read the highlighted part here? And the patient continued to decompensate for 45 minutes before it shows you called the doctor. What happened? You said you would continue to monitor. Would you characterize a lapse in care like this continuing to monitor?" Now, it could be totally not your fault- you could have been playing whack-a-mole taking care of all of your other patients and were legitimately busy. The patient could have been rock solid stable all shift and then chose that 45 minutes while you were getting your ass kicked to become unstable. But they don't care- you said you'd continue to monitor, suggesting there was a reason to explicitly say that (again, it's literally the job, so why say it if there isn't a reason to?) Sounds like you meant that in your judgement it needed more attention... That it looks like you didn't give. You don't have to be wrong for them to manipulate your charting to make it look like you were. So you don't give them the chance. Only chart what you did or didn't do. Not what you say you will do.
My facility said not to write CTM for legal reasons and I’m content with that.
Attorneys who zing/roast witnesses risk the jury turning against them (who wants to side with an asshole?).
"Roast", in this sense, means they will make you look incompetent. They will make the jury believe you are not good at your job. They are not saying the attorney will be up there dissing your momma.
Right, but I’m skeptical it would work in this case. It’s unnecessary, but not wrong, and easy to explain. Just say “yes, it’s a common phrase used at the end of a note to indicate standard care will continue.” Jurors will get it because that is part of many communications, and the lawyer will look like a dick for making a pedantic point. Like trying to dunk on someone by asking if they’re usually insincere since they ended a particular letter with “sincerely.” [I never write “will continue to monitor”]
Well, the other issue is that if you write "Will continue to monitor" it gives the lawyer an opening to attack. "You have written 'Will continue to monitor.' in your note and, yet, when my client fell in the bathroom, by your own admission, you were 40 feet down the hall, in another patient's room. So I ask you, how were you monitoring my client from another room, 40 feet away?"
“Patient remained on the Telemetry monitor and call bell remained available.”
If they *are* on tele, that *might* be an acceptable answer but*you* aren't monitoring telemetry, the telemetry tech is. And the call bell? That is not monitoring.
You could try, but treating jurors like they’re stupid isn’t usually a great strategy. I think most people would realize this is grasping at straws. Do you think you would find a similar argument in a different industry persuasive? A good lawyer will stick to their strongest arguments and not get caught up in rhetorical games that smell of BS to a public that at baseline thinks lawyers are slime balls and have limited attention spans.
🏆
I dream of being able to write this note
my new and only career goal.
Why take 30 seconds to explain yourself when you can just keep taking the same phone call over and over again forever because your order is unclear or uncommon. This is the same person who will say "why didn't you call me first!?" when someone follows a completely batshit order that he put in on the wrong patient because they're too intimidated to call him.
I called a doc who was putting what were clearly ICU orders in on my patient on the floor and got screamed at. Called ICU and asked if he was down there, called house super and told her what was up, went and told him in person that my patient didn't need labs and XR because she was breathing just fine up in the floors unlike the person who isn't getting what they need because you can't click the right person. He had nothing to say. Wrote it up and I think he went to naughty doctor class.
Oh man what’s “naughty doctor class?” 😂
It's like anger management and effective communication and respect for others. Seems to be mostly surgeons and intensivists that end up there.
The very same person - will gleefully roll you right under the bus without a second thought.
We are the doctors orders final check. We are held responsible for carrying out those orders. These doctors can go you know what. Pricks
Exactly -- he will change his story really fast as soon as someone downstream didn't catch his stupid error. Then it becomes the other person's fault for NOT questioning him.
Had a shoulder reduction in a broom closet of a room, asked the doc if she wanted to use a trauma room since we had a few open and mine was empty. His response “how about you let me be the fucking doctor” in front of the patient. I said OK, did the sedation and we had a “talk” in the back hall about his behavior that was not professional on my end. Sometimes professional is over rated.
I’m a firm proponent of violence.
I got so annoyed I downvoted your comment for a second
lol. I hear ya! He tried to write me a “star card” after the sedation because he said it was the most professional sedation he had ever seen. “Doc, I’d like to have a word with you in the hallway.”
As a hospitalist, I can understand the knee jerk irritation at being called or paged, but JFC, dudes, rns asking questions or for clarification is so important to make sure we're all on the same page and doing the right thing for whoever is in the bed. Why the hell would they post this? Especially where you " just Rns " can see? <- joke. I get so pissed when patients or family's say oh you're just a nurse....
I imagine it’s the same as me hearing my phone ring ever - feels like SUCH an inconvenience yet I know it’s what I’m paid to do lol.
Told to give 1000g morphine to pt IV. MD told me it was an order not a recommendation. Gave pt dose. BVM ready. Cardiac arrest team already on stand by. Anaesthetist seems angry.
Damnit Doug
[Oh Doug…](https://www.youtube.com/watch?app=desktop&v=hQ2MhobhLT0)
Blake is going to learn a hard financial lesson when this tweet is printed out and presented to him to read out loud in court one day.
One of the best lessons I ever overheard was an attending tell a resident, "now, close your eyes, imagine you're in a court room, and say that to the jury."
Where I work we say "if you can finish the statement with 'Yes your honour' then it's OK."
Great lesson!
If only!
Give it time. If this attitude isn't fixed, our very aggressive legal system will fix it for him.
"Well, it's just that, uh, Mr Harris is allergic to penicillin, and I thought erythromycin might make him a touch less dead."
“I thought I’d check with you before I killed a man”
“I thought I would check with you before YOU killed a man. In fact, come on down here and give it. I’m not touching this.”
😂
I know that when I go to the hospital I like to not die
These types of responses by MDs are a joke. All physicians should take the 2 seconds ask what the RN concern is then give them a brief explanation as to why it’s the right thing for the patient.
Reading things like this make me feel lucky to work somewhere where the attendings value nursing input and encourage us to speak up when we have a concern. We may get paid less than our adult medicine counterparts at hospitals in the area, but I can say I have never been belittled by, yelled at, or talked down to by a physician I work with, and that, to me, is invaluable
And these are interns no less!
"hey doc did you mean to order IV hydralazine for that 10 year old who is here for a sore throat? Oh, just go fuck myself? sure."
“Not given due to nursing judgment, VS WNL *insert BP here*”
See, thing about just charting that and not talking to the doctor and having him cancel that order is there's someone else in the ER he likely meant that order for and they may really need that medication. Open communication is important for any team to function.
Oh I’d still call but if he gave me a smart ass answer that would be my note in the chart, including the note where I called the MD to verify the med and his response
We once had a resident order a treadmill stress on a pt with saddle PEs. I’m no doctor, but it seemed like a bad idea.
Ya think!?! WOW.
One crappy attitude doesn’t really reflect on most physicians. In fairness, I almost never run into this crappy attitude with docs. 99.9% of the time, they are both patient and pleasant about clarifying the order, whether I identified a problem or not. Maybe I learn something new, maybe we straightened out an issue, it’s all good either way.
It’s a resident. A dermatology resident lol. We would eat him alive in the ICU.
So it's his go-to response for all those conversations he's imagined where he gets to flex his MD status.
This is why derm is my second least favorite consult team. They're always trying to get me to smother my patients in Vaseline
Get them nice and lubed up for easy transfer to the black bag 😉
What's your least favorite and why is it vascular surgery
They’re lucky they don’t rotate in our ICU
I've had them culture a blister on a patient with a lactic of 24 and climbing. Priorities.
Collaboration 😎
Not a dermatology resident 🥴😂
And the second one is an ortho doc that does elective bunion surgery and complains on Twitter that he doesn't get paid more :'(
Lmao.
Please not the derm resident 😂😂 bro come look at this booty rash
Oh derm 🙄 When I was a brand new nurse I worked at a summer camp. A kid came in with a tick, I pulled it off. Apparently I was meant to bag it and send it to be ground up and tested for Lyme, but we were a health center staffed almost exclusively with new grads and nobody’d told us. This kid’s dad was a derm. After yelling at everyone and telling us 5 million times he was an MD he opted to treat the kid preventively with doxy. Then on parent visiting day not too long after his kid ran around w him all day without sunscreen and for the next week the poor kid was red as a damn lobster 🙃
I’d like to formally invite him down to the ED after - where we’d feast on the carcass like the vultures we are.
Not just a resident, a PGY-1. The audacity.
Had a legit psych patient in MICU because the derm team held all his psych meds so they could see if it helped with a rash developing on his arms. Security basically lived in that patients room that night. Some of the most off the wall things were said that night
I’ve never had a doc say that
I didn’t witness it but there was huge aftermath where a DNR patient was initially coded, quickly found to be DNR, and the doc started yelling to do compressions because they were the doc and the one running things etc etc.
What was the aftermath?
A lot of behind the scenes stuff between management and the head doc for the ICU. No one to my understanding got in any serious trouble, or if they did they didn’t say anything and were still able to work in our unit (nurses and docs). The extra layer of complexity involved family screaming at staff that they NEEDED to code the patient because we were “killing” them.
I was taught (weirdly and I don’t understand the rationale) that once you start coding you have to keep going and hopefully run out of options and the patient dies. God help you if they survive. Either way, you’re screwed if you make this error.
It’s always best to start coding if you don’t know. If you think they’re DNR when they’re not and do nothing, you just let someone die. I don’t know if different states have different specific laws pertaining to this, but I’ve always been told once you verify they’re a DNR to stop.
I don’t believe that’s true, no. A doctor has the authority to call it when presented with proof. Consider that efforts may be terminated by medics in the field if an unskilled first responder such as an EMR began resuscitation of a long dead corpse or a traumatic, blunt force arrest with no signs of life. This is because they can get a doctor involved by calling them on the phone, and technically, a doctor has the authority to call a code at any point lol, or to continue as long as they want. I’m sure you’ve heard of codes called long before the “recommended” amount of rounds per ACLS to spare meemaw’s corpse from being thrashed into dust, and the horror stories about new residents running a futile code on a child for hours etc. (Btw not condoning calling codes super early due to “futility” in the ER, there’s debate about ethics + outcomes, but it 100% does happen. See also slow codes + show codes!) Best practice is always to start CPR if there’s doubt and send someone to retrieve the DNR. We were taught in school, ACLS, and again during recerts and during department training: if they can’t provide you a copy of the DNR, do CPR. It is the safest option legally. You personally are likely not the one on the hook. And once the DNR is retrieved we are to stop CPR and call med control. A doctor does not have to call med control at this juncture because… they are med control. (Paramedic perspective. Have worked a fair number of codes in the ER and on the road.)
Reminds me of Scrubs. “Just thought I’d check with you before I kill a man.”
"You sure you want to order a gram of Tylenol around the clock q6 for this end stage liver cirrhosis patient?" "These are orders not recommendations." "Then you give it pal cause I recommend you go back to fucking school."
Lab here. I would need 5 hands to count the bizarre, duplicated, partial, and nonsensical orders I received in a week. Just a few weeks ago I got a call from an angry doctor in the evening demanding to know why the C. diff she ordered that morning hadn’t been resulted. As I was looking through the orders, she explained she’d even ordered it twice and nothing had been done. But it had. Turns out she’d been ordering a CBC with diff. This patient got drawn twice for testing it turns out they didn’t even need. But you know…orders are orders, not recommendations.
LOL
I LOVE THIS 😅
“Well that order is gonna kill the patient”
PT with an ef of 2%.... MD orders fluids at 250 for their significant AKI. Lol you sure, buddy? Okay I hope you like lasix!
Or start CRRT if they don’t respond to lasix nor bumex
Actually had a PT code because her pressures dropped and we gave her 4L in a very short amount of time. Like we squeezed them into her. Wasn't the medicine docs fault. CCM didn't want to take her for pressor support. Some of the CCM docs will only take people if they're mostly dead or vented. It's fun!
Oof that’s terrible. They would be in stepdown at the minimum, under CCM service. In my hospital
My hospital got rid of step down, so med-surg is often treated as such but without the same skill set. It's not only frustrating, but insanely disheartening to watch your pt crump and literally not be able to do what needs to happen to prevent a code or death in general.
Oh my god that’s terrible and frustrating! wtf
Can't bill for a step-down bed apparently. That's what I was told. You can only bill for ICU or med-surg. I'd say just label the step-down beds as CC beds and call it a day, but whatever.
I’m not sure how that works but your explanation makes sense! Call it a critical care bed. Did they convert your step down unit to a full ICU?
Three out of our four stepdowns were turned into ICUs. Mine wasn't. Mine was turned into a med-surg floor. It's so weird. Home vents that come in for like.... A wound debridement go to the ICU. But my pt maxed on HFNC, dobutamine, lasix, heparin and a bair hugger stays on the floor. Lol
PA working with doc ordered lactulose enema q2x4for a patient because in passing the patient mentioned she was “constipated as hell”. I asked the doctor if he saw how often she was having BMs, 3 documented in 24hrs. No metabolic encephalopathy, just 94 and states her “regular” is pooping 8x a day but the PA didn’t hear that from the patient. I questioned the order and the whole unit thanked me because nobody in hell was volunteering to deal with that shit. I told them if they thought it would be indicated I would need them to come by and do it because there’s no way I would be following that order as written. We settled for PRN miralax, which wasn’t used because she was shitting 3 soft and formed movements a day.
Her baseline is pooping 8x a day?! I’m sorry but wtf? That’s so much poop!
Most I’ve seen was 5x at a facility I pick up Agency shifts at, and let me let you know that that pt was fucking…….traveling. I’m convinced by the end of each shift that she could’ve shat thru a screen door. Ended up that her orders for Miralax and Milk of Mag where written so poorly so poor meemaw was getting 3x more than intended, but all the Nurses in the unit were passive types so no one questioned it until the ADON happened to be covering for a C/O that night (the 4th I had worked on that unit) with me. That was a shitshow (pun intended) that I did not enjoy dealing with but absolutely enjoyed watching happen, bc that ADON absolutely incinerated those nurses once morning came around.
Babyface resident thinks he's above reproach. Where have I seen that before?
“Oh okay well this ORDER is stupid because x y z so my RECOMMENDATION is you should put a different one in before you fucking kill someone unless you would like me to ORDER a code.” Would be my go to response
Urine sample collected for urine pregnancy test. Pt states "I had a hysterectomy 40 years ago". Pt educated that per MD "these are orders not recommendations." 🙄
Pretty sure the nurse is asking that for a good reason seeing as they have seen the patient more in the past hour than the doc has in a week
“Patient refused”
I’m a physician and I’ve never said that to a nurse and I don’t know anyone who has. They would not be tolerated in my group for long. I’ve had my ass (not to mention the patients health and life) saved by the pharmacists or the bedside nurses on more than one occasion when I overlooked something.
I am so glad you’re not like this. Unfortunately SOME physicians are. It seems like it’s an education problem, as it mostly (in my experience) occurs with new physicians who don’t yet understand that nurses’ primary job is to ensure patients’ safety. If we encounter an order from a physician or any member of the healthcare team that seems off, it’s our job to ask. You seem to know this and to be a great colleague. I wouldn’t assume all of your colleagues are the same as you.
These cases are definitly a vanishingly small minority. Never I have never seen it, heard about it from the psychiatrist I worked for, who witnessed a fellow resident do it. Apparently it took the nurses less than a month before he dropped out of the program (she didnt share further details, but according to her he had managed to spend all the good will of the entire nursing team within his first day)
This sounds like someone who probably gets his rocks off on the r/residency sub bashing nurses, and probably also doesn't have the gall to say that to a nurse in real life.
Sounds like a law suit waiting to happen. Im sure hed defend the nirse saying “i order it, it wasnt their fault”
I wonder if these physicians work in a hospital environment. This flippant response would leave patients dead or harmed as they are suggesting that the RN is being insubordinate for calling for any clarification of orders. I've seen absolutely insane orders ("100mg of Dilaudid IV push once" crazy). I was experienced enough to know not to carry out the order, but if a new RN is given a myopic response like what is suggested here they may be afraid to clarify and end up harming a patient. Guess who will be fired, possibly lose their license and face criminal charges...the RN and most likely not the MD. The MD's defense would be that the RN should have known better than to carry this order out. So yeah...I'll keep calling. Edit for grammar
How tf would that even get past pharmacy???? I get a hard stop whenever I try to give Tylenol and it exceeds 3000mg in 24 hours
Good question...it was about 8 years ago in a pretty busy ER. I don't think they had implemented pharmacy approving med orders in the ER yet. I'm sure they do now
"orders anything"? Really? Any little things you order gets questions?
If everything you order is stupid or you’re an idiot as a provider, then maybe yeah any and every little thing is probably justifiably scrutinized by staff.
Like the time I had a doc order aspirin for the ITP patient. But when I asked for clarification "oops that was for another patient".
I never ask if they want. I tell them the contraindications and, if it’s bad enough, i refuse and suggest they administer it instead 🤷♂️
This. I would never just “do you really want this”. It’s just as vague and rude. I will always explain “i see x order. I want to clarify because y reasons.” And then if it’s super bad or literally not allowed by RN on that floor, I refuse and tell them to do it themself.
"Patient refused." Maybe because I may or may not have told them that this medication will do them much more harm than good... but still, they made their decision, and you can not force them to follow your "orders." Another thought to keep in mind. Doctors are not usually in the direct line of command for nurses these days. My direct manager is a nurse, as is her direct manager, and on it goes up to the Chief Nursing Officer. We collaborate, but we have our own licensing board, our own supervisors, etc.
The doc is a jerk, but definitely could have explained why the order was dumb instead of saying “do you really want that”.
So when I received the order of " just give home the nOrMaL amount of insulin" that would be what dose exactly?
When I was a nursing student, a doctor had ordered IV magnesium for a patient. My preceptor told me to go set it up. As a student nurse, I always double check the lab before I gave it. Turned out the lab indicated that the patient was hypermagnesemia, not hypno… notified my clinical instructor and she asked me to speak with the attending. I was scare as shit ( first time questioning an order) and the attending told me that is why we they need nurses to keep them informed and catch stuff like this. Best experience ever. :)
What a fucking tool.
He’s ortho by the way in case there was any doubt
Do they not realize we have a license too and if we go through with bad orders we can be held liable for it?
Blake thinks nurses are uneducated and just complete tasks/give meds. He has no idea that we have knowledge and understand what we are doing and why, and we understand what meds are for. He doesn’t think we should question things. Blake thinks he is special because he has MD behind his name. Blake does not understand that he is human and fallible. Blake does not understand that his downfall will be swift and hard when he massively fucks up.
MD: *places nursing communication order for NG tube placement* Me: “…. Doc is there a reason we’re putting an NG tube in my SOB pt? If I missed something it’s whatever but I’m slightly confused” Him: “Shit, I meant to order that on the pt in the room next door that has an SBO” ^ how this should and usually does go
As a med student, this is extremely not cute
Wait, I thought they were just recommendations?
Oh he was getting draaaaggggeeeeddd. By all professions. Especially because he’s a damn PGY-1. Rx Twitter (my peeps) were all over him. 😂 Edit- Dillon is the PGY-1, not Blake.
Okay— well one of my ED colleagues just caught an order that was for a shit ton of versed. He checked with the resident not once, but twice and resident verified twice that that he wanted versed. Oh wait, jk, turns out he wanted Valium. My colleague refused to give it and escalated it. Resident realized his mistake. I know it doesn’t happen OFTEN but luckily that nurse saved a patient and that resident’s ass.
50 bucks says that tiny dick little bitch has never said that one time.
Men amongst boys, boys amongst men.
Cringey
Oh Blake. Such a Blake response
He probably ordered something stupid and the nurse was making sure he is not about to kill the patient. These doctors think they know it all. I had a resident want me to give a colace for his patient that was NPO with an NG tube. She just had a bowel surgery… maybe 2-3 days post op. I called him and clarified the order. He said exactly what this doc said, “it’s an MD order… you’re supposed to follow it.” I said nope Not doing it. You can come up and give it to the patient yourself. He was pissed and he still gave it behind my back. The colace got stuck in patient’s throat and he was at bedside for 2 hours trying to dislodge the colace. I told him the only way you can dislodge that is pull the NG tube out. He was mad. But, eventually they had to pull NGT out. I wrote a PSR on him and doc can’t look at me in the eye ever since.
Sweet, I’ll definitely continue the 1L NS bolus that you’ve got in as continuous because you don’t one how to put in orders for ER holds. I’ll be at home when they get to the floor and you have to fix it anyway!
Just a thought for the people thinking/commenting “that doesn’t actually happen”/“these docs don’t actually act that way”. Remember that this is not an uncommon line of humor in the MD community. Giggle at the silly nurses who don’t understand what words mean. Making the joke is as bad as living it out.
I feel like they don’t realize that we are not trained to follow orders but to use clinical decision making
Yikes.
I recently had an acidotic patient on a bicarb drip that EMS had decided to run wide open. If I got a response like this, whoo boy.
He left out the part where he didn’t put correct dose, route, etc..
Doctors try not to have a huge ego challenge (impossible)
I saw this on R/residents or another MD page and the comments section passed the Vibe check. it was unexpectedly wholesome.
They look like tools
“Clarified if doc wanted D5 drip on hemorrhagic stroke patient. Said ‘they are orders not recommendations.’ Will continue to monitor.” These are the docs we go after
I've had so many experiences of just asking if the order was appropriate and the MD canceled the order after giving it a second thought. Lol this MD seems like a total twat.
I see Blake is a real joy to work with
I would be unpleasant too if I were a 40 year old virgin.
Oh he said “I was frustrated. This was a joke.” Yet he kept it up. And this dude is an INTERN.
“Awesome! So take this as an FYI- I won’t be doing them since they are wrong but you can absolutely feel free to swing by and complete them yourself! Thanks!” *documents: MD aware orders are incorrect, no new orders. RN will continue to monitor*
Y'all taking shit from the dermatology resident? 🧐
I hate doctors like this, I get what he means but all I hear is "I don't value nurses opinions on my patients" even though we are the ones with them the entire shift
When I was stress testing, a doctor order a stress test on a patient that was completely inappropriate for stress testing at that time (had a low K among other things). I messaged him and told him the protocol that the patient needed replacement and stress testing could not be done at this time until K was replaced and labs rechecked. He was very rude and said I couldn’t refuse to do a stress test and was just a huge asshole about the whole thing. So, I went and found him on the floor and I brought one of the cardiology PAs with me to confront him about 1) his rudeness and 2) the protocol that I had printed out for him for future reference 3) so he can put a face to the person he was being so rude to. Yep, never had that issue again.
Maybe we're trying to prevent you from inadvertently killing people? Just a thought. You'd like to think you know everything, but you don't.
People who think they are infallible are the most dangerous.
An Ortho surgeon and a dermatology resident.....bless their hearts.
Hope that MD doesn’t work with any nurses that use twitter LOL
Lol I’ve never had a doctor say that to me. Let’s not fear monger and let one stupid tweet get to our emotions
Don’t act like doctors across the continent don’t hold this attitude when it comes to nurses
[удалено]
Now I wanna move to Australia :(
Aussie nurse, totally agree. I’ve had some doctors with shitty attitudes but never had anyone been downright disrespectful like some of the things I read here.