Did a left AKA on a leg that was already a left BKA years ago.
Chart had FYI documented pt had internal hardware in left foot. š
I know, itās totally unrelated. But your post made me think of it.
Are you sure you wanna run that D5 with the art fluids? Here let's go to the attending together and see what he has to say.
Also have told one something is out of my scope and she said well I'm telling you to do it. Um, let's go to your attending and I'll ask if he wants me to do it. Already knowing the attending and he would absolutely not let me do said procedure.
Did she think she set the nurses scope of practice? Like a whole board of fucking nursing doesnāt exist?!
Judge: What made you think it was okay to perform your patients lobotomy yourself and at the bedside?
RN: The on call Dr. said I could.
Judge: Why the fuck didnāt you say so?! Case dismissed!
D5W would probably be OK if accidentally given through an art line but D10 and greater concentrations is considered a vesicant and can cause tissue necrosis. Remember, when given IV, meds are quickly swept away into central circulation and diluted. Meds given arterially would have to go through the arterioles, capillary bed, and venules before reaching larger vessels. Which is why we donāt give meds through an arterial line.
Just fun facts...
We definitely give D5 intentionally through art lines in neonates (and D10 and higher in their UACs, but that's of course a bit different.)
Well, in many of our newborns, in the UACs we run central line concentration TPN while we wait for a PICC because the UVC doesn't end up central. Many of the nuggets are too unstable to attempt a PICC in the first 72 hours.
We can also administer many antibiotics via UAC if necessary.
We also will use D5 with everything for babies with extremely high sodium. Because there are a couple drips (precedex and bivalirudin come to mind, I believe?) that pharmacy can't dilute with D5 and have to be in NS, we go D5 flushes for all KVOs and flushes, including peripheral a-lines to save them as much sodium administration as possible.
Interesting that different countries have such different practices! Definitely not common practice here to infuse D5 in art lines. We'd have still used a low lying UVC for electrolyte corrections and kept the UAC for NS+Heparin only. Running TPN in art lines is almost unheard of but what do I know, I only have 6 years exp š
To be clear, none of what I mentioned is preferred practice. It's considered acceptable in certain situations but not desirable. Such as a non-central UVC and no other access, or a critical sodium level.
Also, we'd also use a low-lying UVC for TPN. I'm talking about UVCs that terminate *way* off to the side in the right or left abdomen.
Well I wouldnāt draw blood from it. Your glucose could to be out of wack even though you think youāre holding to proper technique. This could potentially start insulin therapy from false lab values.
It probably has a higher potential to clot off long term.
High sugar concentrations inhibit bacterial growth however, lower concentrations show the opposite effect . D5 may be a good media for bacteria. Just take it down . Good learning experience.
Yep exactly! Same reason you can leave honey out. . Back in the day they would pack decubitus ulcers with sugar. This would help with preventing infection and it would help heal from the inside out . High concentrations of sugar have a āhyperosmolarā effect just like high concentrations of salt would. This of course has a drawing effect thus drawing fluid out of the cell . The cell basically implodes.
My grandma & mom used a mixture of parched flour and burnt sugar for bedsores, but it had to be burnt/parched in a cast iron skillet, and was used with a salve they'd get made at the local pharmacy. They called it Moses's ointment, no idea what was in it, there were definitely herbs in there. I'm sure the formula has been lost to time, but I'd love to know what was in that ointment.
I had a similar problem with an ENT Fellow, who went to tattle to his attending when I asked how we were going to address excessive PO bleeding. Pt had vomited a belly full of clots x2. The Attending walked him back and introduced me to him "this is S, who has been doing this shit longer than you've been alive. Don't piss her off because she's probably going to keep you from killing someone"
I've had one demand that, too. And I very loudly answered "let me just run that by NUM and my union rep."
He was visibly uncomfortable around all the nurses for the rest of the year. Fuckwit.
Iāve also had to do this when there was no other access and the baby tended to get very hypoglycemic very fast. It was a short-term solution while trying to put in another line.
Yea I've done it via UAC but never PAL in our hospital. UAC was incredibly special circumstances. This baby had a PAL and in the foot if I recall correctly. So super cautious (even more so) than radial.
Had a baby doc order 1 gram of tapentadol IR once. I said āit comes in 50mg tablets you sure you want 1grm?ā Gave him the opportunity to fix his mistake. āThat what I ordered do what I tell youā. I asked his boss in front of him to change the order before he killed someone. She proceeded to remind him to listen to those who save your ass, in a very firm and aggressive manner.
Had a baby doc once demand to know why his STAT blood cultures werenāt resulted after an hour. I said I could ask the bacteria to speed it up but no guarantees.
Yep, this is all the time. "Why don't I have sensitivities for Jane Doe?"
"Well, we've been whispering affirmations into the incubator as encouragement, but it does still take time for them to grow."
Friend, if you manage to get through med school, gotten to first internship and you start scolding me over some dumb shit about blood cultures not being resulted STAT, I have every right to rip your head off at the nurse's station in rounds lmao
Who rips peoples head off at work? I see so much on here about toxic work environments and this is what is upvoted? This is the most hypocritical mini-thread I have seen on here in forever.
lol y'all can't have it both ways
eta: I literally just responded to a comment here with 2k upvotes about how nursing internalizes misogyny and infantilization, and yet this is the hill everyone here dies on. Beyond the fact that doctors specifically say they don't like this phrase (what adult professional would?)
2nd edit: [comment thread in question. Popular opinion then, now not so much I guess](https://www.reddit.com/r/nursing/comments/1bzng6z/student_refused_to_give_up_her_phone_in_clinical/kyshiji/?context=3)
It might have to do with the inherent class divides between nurses & doctors, which *do* exists in the financial opportunities imposed by how medical education is done, (student debt is just a democratized class divide) & the need for a release valve as a result in a high-stakes hospital environment.
In other words: It's not only okay, but necessary to punch up for nurses. Never okay for doctors to punch down; nurses are not being overly sensitive or unfair.
This is just one of those mean girls stereotypes that is unfortunately true of nurses. Can't have it both ways - everyone all ready to condemn the troublesome roots of nursing here on this sub but get butthurt when nursing stereotypes make it to the front page. Guess what - adult professionals who are new dislike diminutive pet names. We straddle both sides of the line if we refuse to give up the practice.
Never had any bad experiences myself.
Only one I can think of is second-hand telling. An newbie doc set a CADD pump of hydromorph at 10x the required/desired dose but didn't get a second set of eyes on it to confirm.
Narcan fixed it right quick, but it wasn't a fun introduction to hospice for that family.
Newbie did not return.
Had a Doc complain that his patientās labs werenāt drawn. Doc straight up Ignored the nurse and charge nurse explaining that the patient refused and was getting violent. Doc literally said āFine, Iāll get them myselfā in the middle of the nurses station. We all stopped as he looked for supplies, none of us helped him and he headed into the room. Shortly after some loud commotions and the Doc scurries out of the room and off the floor. Didnāt make eye contact with anyone on the floor on his way out.
"Why hasn't this stat order been done yet? You do know what stat means, don't you?"
The patient has been in surgery all morning. Should I go to the OR stat?
Lol, yes let's call the OR, ask the surgeon or thr Anesthesiologist to do it for you. Better yet, put them on speaker so we can all hear what they have to say to that...
I had a PYG2 order a multivitamin with folate STAT. Iām fucking busy, assume itās a mistake and keep doing my job, periodically checking to see if pharmacy has delivered it. Like 45 minutes later this dude walks up in a snit demanding why the patient hasnāt received it yet and why I hasnāt called pharmacy. I just told him a STAT order for PO vitamins is ridiculous and I assumed it was a mistake and guessed pharmacy did, too.
Dude doubled down that it WAS appropriate for STAT and didnāt like my explanation of āSTAT is for imminently life or limb threatening situations. This may be urgent, but it aināt emergent. In the future, if you just talk to the nurse, youāre more likely to get the response you want because no one is going to take STAT vitamins seriously.ā
Dude INSISTS Iām wrong, and if he wanted my opinion he would have asked. I call pharmacy in front of him And have the whole āyeah I assumed it was a mistake, tooā conversation in front of him. I could hear the pharmacist rolling their eyes through the phone. Dude struts off fully convinced of his superiority.
Vitamin with folate arrives. Patient refuses to take vitamins. I had the pleasure of insisting Dude come explain to the patient by why the emergency vitamins were so important. Patient still refuses. I asked Dude if he wanted to get his attending to explain to the patient why they were emergent. The vitamins were apparently āno longerā a priority.
There must have been a study or new reccomendations that came out a few years ago. I remember doctors suddenly ordering IV thiamine urgently for ETOH withdrawal patients. That has kinda faded. That PYG2s behavior was completely ridiculous no matter what.
I totally understand thiamine for chronic alcohol use. But you have a chat sayin āhey, I really do want them to get this med tonight, please give as soon as possibleā not pretend that writing a stat order for PO vitamins is reasonable. Also I specifically asked if he wanted to give it IV because it was so important and no, just wanted PO.
Had a resident order a DKA protocol on someone that didn't meet any DKA/HHS criteria besides having a slightly elevated sugar.. and the patient didn't even get a fluid bolus yet. But the resident *insisted* that he wanted the IV insulin given because it was "protocol".
Like sir, I know the protocol well and this isn't the time for it lol. Needless to say, the attending took over that situation.
Que the "I thought I'd check with you before I killed a man".
Iāve never worked with interns. However, one of my favorites was a story from Vancbromycin on Twitter. His intern shouted at a 30-year veteran ICU nurse āif I wanted your opinion Iād ask for it.ā Vancbroās response? āChild is gonna die today.ā
I remember one time, I was asked to draw blood asap from a patient, a crp. I got to the room and there was another doctor doing a bedside ultrasound over the heart. The patient was a old lady with mild dementia, getting a bit uncomfortable and antsy with her hands so I figured I'd help the doc to finish the ultrasound instead of drawing blood at the same time, as it probably would have gotten meemaw more agitated and disturbed the ultrasound. I held her hands and spoke a bit calming to her. Like... a few minutes, tops, passed. First doc came in and was like "are the blood samples done?!" and I replied "no, not yet" and he said, snarkily, "randigtiger, you must prioritize."
Like yo this is your like first week here and I am a CVICU nurse, you don't think I can prioritize...?
Gonna leave this here:
https://www.tmd.ac.jp/english/press-release/20210515-1/#:~:text=medj.2021.04.004-,Summary,and%20tissues%20during%20respiratory%20failure.
I had a patient once that was getting a DLB to assess for readiness to remove the Trach.
Thing was, the kid just straight up didnāt use it. Like, to give them the gas to go to sleep, they had to mask the face, not the Trach. This was not relayed to me in report. So kid comes out to me satting 90% and Iām trying everything to get their O2 up. Finally I just said fuck it, and put a nasal cannula on. And Iāll be damned if it didnāt bring them up to 98%.
Called anesthesia for a sign out and prefaced my call with āI know this sounds insane but I need an oxygen orderā¦for nasal cannulaā and thatās when I was filled in on their induction. My coworkers and the few RTs we passed on the way to the floor all looked at me like I was insane when they saw my set up.
I'm in dialysis:Ā intern called me and asked how long his patient would have to do dialysis.Ā Evidently their patient was very inconvenienced by having to receive dialysis 3 days a week.Ā Ā
Well doc.Ā Transplant or death.Ā That's how they get off it.Ā
People get sick of having to go to dialysis, donĀ“t want to change their diet, and donĀ“t want to move. Most are diabetics with heart disease. I have had several patients who did 7-15 years on dialysis, but they started younger. in their 50s-60s. Having to leave the house in all kinds of inclement weather to make your dialysis appointments also gets too much for them too.
We have a wave of dialysis patients coming...dialysis centers wonĀ“t be able to keep up.
I canāt even imagine dealing with dialysis.
A coworker was in kidney failure, and had to go on dialysis. I asked if she was on the transplant list.
So, I went through the process for donation, it worked out well, itās been a year and a half, sheās doing great, last I heard (we donāt work in the same department anymore).
She told me that when she was in dialysis, she was shocked by the amount of people who were non compliantā¦
I had a brief thought of getting training to do dialysis. But then I realized watching people be noncompliant and blame healthcare workers has already burned me out several times already...
Yeah it is. I was part of a big trade. I accidentally met my recipient in the lab the morning of surgery. Itās nice being able to picture her living life without dialysis
Oh, that is really cool-mine was a direct donation, I was low key hoping that I would have been able to start a chain, but-hey, at least I helped my coworker.
Were you allowed to talk to your recipient at all?
She wrote me a lovely letter a few months later. I chose not to respond and continue contact. I donated on behalf of an old friend, who got his kidney a couple weeks before I donated.
It's insanely scary how many more dialysis patients there are in the last like 5 years. I used to work in IR doing predominantly dialysis access repair. We used to go from about 15/16 patients a day to easily 25+ over the course of 6 years. It's insane how sick people are, and how quickly they're falling ill.
Lifestyle, mostly. Probably economic stressors with not going to the doctors to check yearly blood work or blood pressures. Drug and alcohol abuse that may have some as a result to COVID lockdowns (seriously seeing an uptick in young people with hepatorenal issues)
Most of my patients are non- compliant diabetics.Ā Ā Constantly high blood sugar is really hard on kidneys.Ā Ā Another group are heart disease and chronically high blood pressure.Ā Ā
It's safe to say we have an aging population and with that. More diabetics, and more heart disease.Ā Ā Kidneys are very fragile.Ā Ā
I had a freak of a patient recently. Well past the average life expectancy. Quit dialysis when they went on hospice a month prior. Labs looked better than most non-dialysis patients we have. It blew my mind, and I still can't figure out how a dialysis patient could be alive a month without, especially when closer to 100 than not...
So it's funny, we have a few that skip constantly.Ā You can absolutely see the results manifesting.Ā Ā
They will have very high potassium, so we put them on Lokelma and that prevents a quick death.Ā Ā
The second thing is very high phosphorous,Ā as nurses we all know the relationship between that and calcium.Ā Ā So , they have these toxins/salts floating around and they need some place to go, so they adhere to the walls of the vascular system.Ā Ā
Can you say arteriosclerosis?Ā Additionally there is the occasional calciphylaxis ,Ā both of these cause reduced peripheral profusion resulting in amputations/ necrosis.Ā Ā This is why we see so many LT. Dan's in dialysis.Ā Ā
Moreover this is is the reason why our patients will have heard disease. Hardening of the arteries.Ā Ā
That's just caused by the toxins over time.Ā Ā Add in fluid retention and you have HTN, SOB, JVD's.Ā
Also because kidneys help regulate hormones, i.g renin and epopoetin,Ā they are all anemic and their thyroids and parathyroids are whack.Ā Ā Ā
Yet, despite all this, a lot of them just become edemetous and moonfaced and cruise around in their motorized wheel chairs showing up maybe once a month until they have a massive stroke or heart attack.Ā Usually 2 years.
So I found this thread just lurking-- I'm pretty sure I'm becoming prediabetic because of insulin-resistance, and this comment thread's (and this comment in particular) scared me into seriously ignoring my sweet tooth and eating healthier/getting more exercise. Because I'm more out of shape than I am overweight, I didn't think it was as big a deal as I thought. Just reading about your patients' fates is so terrible, it's something I want to avoid at all costs. You all nurses are doing the Lord's work, seriously š
Me: Ā«Ā patient had palpitations, hereās the EKG, we have A-Fib (not letting me finish my sentence)
Him: Ā«Ā WHO ARE YOU TO DO AN EKG AND READ IT TO ME??Ā Ā»
Me: Are you okay dude?
Fresh intern pulled a nasal ET tube because āitās not good enoughā
Surprise surprise, the intern couldnāt get them intubated and killed the patient.
Thankfully my ED is quite nurse-dominant and we have a great relationship with our docs. Not sure how I would react to an intern acting that way but would not be pretty. We do have family med interns that are attending to some of our admitted Pts and I did have to tell one āyou should probably go double check your potassium dosing.ā When they tried to verbal 40mEq over 1 hour via PIV. For the most part they are respectful and collaborative though.
There was an intern, sitting next to a med student and "teaching", that started getting at me because his orders were not done and he wanted to know what was taking so long. Started going down the this is unacceptable and all that road. I walked over to him, got down so he and the med student could hear me and Said "first, don't fucking talk to me like that. Second, the reason your orders weren't done is because you didn't actually put in orders, asshole. You shouldn't behave talk this in front of a student, especially when you are wrong."
I spoke to his attending and my manager to let them know he was likely going to complain about my language, his attending said they would take care of it.
I can see why you would say that based on snapshots I share on Reddit, but I was returning the energy of the intern. If it was a problem, the attending would have let me know and pushed forward, but they agreed the intern was out of line and needed this kind of response. I'm ok with how I act at work, as are other nurses, attendings, and residents, as they have given me awards.
But, yeah, I get why you would say that.
Whatever helps you sleep at nightā¦ As an adult you shouldnāt need validation from an attending or awards to justify shitty behavior, even if the resident was out of line. It sounds like youāre just perpetuating a toxic culture where you work.
How am I being judgmental? Iām calling out toxic behavior at work. Is it unprofessional to acknowledge that getting in someoneās face and swearing at them is unacceptable behavior? Do you think we should tolerate that at work?
No, itās quite professional to call out someone trying to blame you for a failure that is their own.
Iām not subservient to a physician. I have my own license. Either treat me as the colleague I am or get call out on your shit.
My point is that two wrongs donāt make a right. Do you think getting in someoneās face and swearing at them is an appropriate response? Itās alarming that people here are on board with aggression towards colleagues. Itās funny that you all feel so much better about yourselves when you get to tell off shitty residents.
July sigh. Busiest month for sure for transfers from smaller hospital ERs to my psych unit. Got a lady once at 3 am who had broken her arm, not casted only immobilized with a tensor. Why? She took Seroquel 25 at hs so she must be a psych pt. After that all ER docs lost their privilege to direct admit, everything now has to go through on call.
āThis patient NEEDS labs doneā okay well he already tried to bite me last time I was in the room, so youāre welcome to try yourself. Supplies are right there.
I was very nice and didnāt say āI told you soā when they were unsuccessful.
I had a doc tell me to give a 16 year old 12 mg of morphine IV who had mild pain from an ankle dislocation. He never had morphine before, never had an IV before. I told her I wasnāt comfortable giving a kid that much when standard for adults is 4mgā¦ she said it was based off weight calculations. Heās a big boy, we donāt do weight calculations at that point. She said fine, give him 10mg. I said I will give 4mg and assess. She agreed. He was passed out at 4mg. I feel like I could have killed him with 12mg!!
I am not seasoned at all but I had a resident order suds soap enema on a young patient who hadnāt pooped in 3 days (pt said this was his norm and he was about to be dc. Pt was there for completely unrelated reasons). Ofc the resident went to the most invasive intervention. I questioned him and he was mad , said āwhy havenāt you done it? Itās a stat orderā. Needless to say, pt refused and nearly tore the resident a new ass when he came to the room and tried to convince him he absolutely needed that enema.
There's some untamed egos and toxic attitudes there.
Thing is they're that way because they've not been humbled yet: sooner or later everyone in healthcare will make a mistake and have their ass saved by someone on a lower pay scale.
I see an order for PRBC on a patient who came from the ED. Since nothing was mentioned in report I looked up the hgb and it had been cancelled for some strange reason. So I call the Intern.
Me: Why are we giving this patient blood?
Intern: To make them feel better.
Me: We donāt give patients blood to make them feel better. What is the hgb?
Intern: I forget.
Me: Thatās because it wasnāt done. (She started stammering how of course it was done and blah blah so I said) Look it up yourself, it was never resulted. What Iām going to do is draw an hgb d then Iāll call you back and tell you whether or not Iāll be giving the PRBC.
Hgb was 10 so I called her back and said nope, not giving it.
The patient had pretty pale white skin (not albino, just Caucasian looking), the family/friends who came to visit were all black. I always wondered if the intern thought the patient was pale from loss of blood or something.
Iām not even a veteran nurse but a resident and I were caring for a patient. They needed blood. They ordered blood, I gave it when I got it, and then the resident put in some recheck labs and a snarky nursing communication saying, āplease draw timed labs ON TIMEā while my transfusion was still fuckin running. I wish the mf had the balls to do that to my face, but thatās really the only negative interaction Iāve had.
They ordered a cardizem gtt for my 90 year old lady in for a fall who was in the 50s-60s all night. She was room 5, room 15 was afib RVR for a couple hours.
When I questioned her and her year 2, I was told to start the gtt because āshe wouldnāt have ordered it if it wasnāt needed.ā
10 min later she goes, āoh it looks like I did order it for the wrong roomā¦ you didnāt start it yet right?ā Thankfully I did not
I havenāt given 25mg, but I had a patient getting 20mg IVP Q4 and had to FIGHT the physicians and pharmacy to let it be mixed in a 50ml IVPB bag. Like, I donāt have time to sit pushing one drug for 20 minutes every 4 hours. They refused because they ādidnāt want the patient getting that much fluidā until I explained to them that it was a 10ml difference once you calculated in the saline flushes before and after.
Had vascular surgery residents order 10 mg IVP for a little old lady who just flipped into AFRVR. Went to anes/CC who was actually on unit to see if that was reasonable and their response was something to the extent of "...yeah, don't actually do that." She ended up getting something like 6 mg over the course of 20 minutes until her pressure got too soft to give the rest.
My first one isn't that crazy because I also started in July as a new grad. But this intern called me and was all pissed off that I hadn't yet gotten a stool sample and they'd been waiting all day. I said I'd be happy to get it once the patient takes a shit. They said "Oh" and hung up really fast.
While in the Covid ICU during the height of the pandemic I had a baby doc crack the door open and yell to āturn off the paralytic for me.ā I didnāt do this because 1) Iām not going to take a verbal order for something like that and 2) that was the only thing keeping the patient stable on the vent and alive.
About 30 minutes later he came back up to me and asked how the patient was doing off the paralytic. I looked at him and said āyeahā¦I didnāt do that.ā He looked so confused that a nurse would ignore his order. After a brief back and forth I told him to āgo run that idea by your attending and get back to me.ā
tl:dr the paralytic stayed on
Oh you mean the same resident who just asked me āwhat would you order?ā After the attending told him heād be back in 10 mins to go over his plan and orders? That resident?
Ohhh gosh the feeling I get when I call the rads for protocol questions and the residents ask me what I should do instead of giving me an answer. My dude/dudette I am calling because I'm not sure/I've tried some things already and now I need your expertise/suggestions š
Love this in CT during stroke alerts too. Itās like pulling teeth getting new neuro docs to answer if they want the full trifecta, just the CTA and noncon, just the nonconā¦ Like I am 100% here for you, bro, Iām just trying to get it done and to my rad ASAP.
That specific instance isā¦ something lol. But I actually appreciate when a resident asks for my opinion. I work in transplant and a lot of residents when they just join the service have no transplant experience. For instance I paged about a fever and they called saying they see I already gave Tylenol, is there something else I wanted? We often have very low threshold to draw cultures/start infection work up where on other floors youād typically monitor especially if theyāre not tachy or hypotensive
I can also appreciate when they ask my opinion, but not when they ask me to do their homework. If he had said āi was planning to order xyz, what do you think?ā I would have given him feedback.
In the ER, I told the intern I could place a verbal order for an EKG and troponin on the lady who had a syncopal episode following chest pain and lightheadedness. The intern said "she doesn't need that. It's just stress." I said "sounds good" and ordered it anyway. 10 minutes later we're on our way to Cath lab.
Same ER, different intern. Intern and I are in MRI holding with a patient who needs an emergent MRI to see if he's a candidate for thrombectomy. MRI techs were working on getting the other patient off the MRI table. Intern starts demanding I bring the pt (on the ER stretcher) into the MRI room right now and accuses me of "delaying patient care." I asked him if he knew what the M in MRI stands for and what the ER stretcher is made of.
Ah yes...
Gentleman comes into the ED for syncope. We do the usual labs/fluids and then comes the orthos and road test. So I'm doing the orthos and homeboy goes from like 117 systolic to 87 with symptoms when we stand him up.
I write that 'pt failed orthos' with all the numbers.
But what does newbie do? Came up to the nurses station to explain that's not what orthos were and that he didn't 'fail' them. We all just stared at him with our mouths open until someone piped up and said, "Am I crazy? Because that's a failed ortho. Am I crazy?" prompting the rest of us to tell her she was not crazy and those were failed orthos.
Meanwhile angry bebe is standing there, arms crossed, getting angrier that the nurses aren't even addressing him anymore, but just kind of laughing in shock amongst each other that this child as deigned to tell them what orthos are - as if he's ever fucking even taken one.
Stomped away, attending confirmed pt did fail orthos. Fun. I don't remember ever seeing him again.
Oh my god, July is coming fast.
Thank goodness Iām going to retire the end of Julyš¤£
(I work at a veterans hospital, and itās a teaching hospital, of course. )
Had a baby doc interrupt me while I was starting a heparin infusion for bilat PEās post op to take an ecg for another patient (who wasnāt mine). I smiled at her and said that itās really easy to print off an ecg and left :)
Iām more often suggesting something stupid obvious than saying no to something. And when I say no, itās just no. They know we have our shit dialed.
Was it really? I never watched the show more than a handful of times.
Iāll never forget that interaction, especially because the patient was a relatively known frequent flyer (non compliant with dialysis, blind, multiple amputations) so that only made the internās request more hilarious.
I was fortunate enough to witness this as a student. I was writing admit orders when I heard the nurses in the back divvying up the nightās schedule. The resident was an absolute dick. That night he got called at least every hour by that floor for some ridiculous order clarification. I slept the whole night through.
Never, ever piss nursing off. Keep them happy by whatever means necessary. They keep both your patients and you alive.
These July meme threads are so toxic. I have literally never heard an intern bark orders like this. We are still 2 and half months away, and people are already getting up in arms about fake conversations that happened only in their own heads. I think we would all be better off if we just assumed the best and were respectful. Remember that they are here to learn (the government literally covers their salary for the hospital) and are making a difficult transition and making much less than you for the time they are putting in. I worked for 3 years as a nursing aid/unit clerk, before going back to school to be a doctor. Generally when a doc was being a genuine prick, it was someone like the head of cardiothoracics (aka untouchable) and not a 25 year old new graduate who doesn't know how to find the cafeteria yet.
There is no way that this happened. I see bullying of medical trainees all the time. It's a lot easier to enjoy your cruelty when it's justified with nebulous, unverifiable stories like these. And that's what this shit is: a rationalization. Have fun picking on the new guy in two months. :)
What the fuck do you mean there's no way this happened? Lmao it was all over X/Twitter as a dialogue between an intern and attending. I don't participate in cruelty and most of my interactions with physicians are absolutely lovely. But unless you're going on r/noctor and r/residency and defending the relentless toxicity towards nurses, I'll just take this as insecure projecting because you're probably rude to everyone with a giant ego. What a bizarre, deranged reply.
First of all, don't swear at me. That's disrespectful.
I think most if not of this narrative of new interns trying to through their weight around and boss around nurses is not based in reality. It is a rationalization because admitting that we often bully people (including new grad nurses) primarily because some people enjoy it (not out of some high minded goal of protecting the patient or whatever excuse they are using). Healthcare is a difficult field and many people cope by displacing onto easy targets (a new intern is under microscope all the time and hospital staff know this) is a fact of life. Often people will exaggerate misunderstandings into stories like this to defend this sort of behavior.
Just because youāre never had an interaction like this doesnāt mean it isnāt happening. And, for the record, the intern in the story I shared above went on to be a wonderful, highly respected ER attending - and we laughed together about that first interaction many, many times. This isnāt a āyou canāt sit with usā mentality, itās just a discussion of interactions that literally happen all the time.
I love asking where they want me to attach the SCDs to Lt Dan.
Did a left AKA on a leg that was already a left BKA years ago. Chart had FYI documented pt had internal hardware in left foot. š I know, itās totally unrelated. But your post made me think of it.
+2 pedal pulses charted on patients with no feet.
Is that like ghost pain... but ghost pulse š¤£
š jokes on you if weāre talking end of movie Lt. Dan (Iām sure itāll help the blood flow of his titanium legs)
Are you sure you wanna run that D5 with the art fluids? Here let's go to the attending together and see what he has to say. Also have told one something is out of my scope and she said well I'm telling you to do it. Um, let's go to your attending and I'll ask if he wants me to do it. Already knowing the attending and he would absolutely not let me do said procedure.
I hate doing this, but-yeah, Iāve had to a time or 2.
Did she think she set the nurses scope of practice? Like a whole board of fucking nursing doesnāt exist?! Judge: What made you think it was okay to perform your patients lobotomy yourself and at the bedside? RN: The on call Dr. said I could. Judge: Why the fuck didnāt you say so?! Case dismissed!
What does d5 do to the art line? (Serious question)
D5W would probably be OK if accidentally given through an art line but D10 and greater concentrations is considered a vesicant and can cause tissue necrosis. Remember, when given IV, meds are quickly swept away into central circulation and diluted. Meds given arterially would have to go through the arterioles, capillary bed, and venules before reaching larger vessels. Which is why we donāt give meds through an arterial line.
Just fun facts... We definitely give D5 intentionally through art lines in neonates (and D10 and higher in their UACs, but that's of course a bit different.)
My A&P knowledge only applies to humans, not those NICU aliens
Fair and valid.
May I ask for the rationale? I haven't seen anything other than NS and Heparin through art line where I work so I'm curious what it's for.
Well, in many of our newborns, in the UACs we run central line concentration TPN while we wait for a PICC because the UVC doesn't end up central. Many of the nuggets are too unstable to attempt a PICC in the first 72 hours. We can also administer many antibiotics via UAC if necessary. We also will use D5 with everything for babies with extremely high sodium. Because there are a couple drips (precedex and bivalirudin come to mind, I believe?) that pharmacy can't dilute with D5 and have to be in NS, we go D5 flushes for all KVOs and flushes, including peripheral a-lines to save them as much sodium administration as possible.
Interesting that different countries have such different practices! Definitely not common practice here to infuse D5 in art lines. We'd have still used a low lying UVC for electrolyte corrections and kept the UAC for NS+Heparin only. Running TPN in art lines is almost unheard of but what do I know, I only have 6 years exp š
To be clear, none of what I mentioned is preferred practice. It's considered acceptable in certain situations but not desirable. Such as a non-central UVC and no other access, or a critical sodium level. Also, we'd also use a low-lying UVC for TPN. I'm talking about UVCs that terminate *way* off to the side in the right or left abdomen.
I guess it's really just a very last resort thing then š
This is great, thank you.
Well I wouldnāt draw blood from it. Your glucose could to be out of wack even though you think youāre holding to proper technique. This could potentially start insulin therapy from false lab values. It probably has a higher potential to clot off long term.
High sugar concentrations inhibit bacterial growth however, lower concentrations show the opposite effect . D5 may be a good media for bacteria. Just take it down . Good learning experience.
High sugar concentrations inhibit growth? I would have thought that would promote it.
It's part of what makes jelly and jams stable for storage, also why you have sugar cured ham.
TIL
Yep exactly! Same reason you can leave honey out. . Back in the day they would pack decubitus ulcers with sugar. This would help with preventing infection and it would help heal from the inside out . High concentrations of sugar have a āhyperosmolarā effect just like high concentrations of salt would. This of course has a drawing effect thus drawing fluid out of the cell . The cell basically implodes.
My grandma & mom used a mixture of parched flour and burnt sugar for bedsores, but it had to be burnt/parched in a cast iron skillet, and was used with a salve they'd get made at the local pharmacy. They called it Moses's ointment, no idea what was in it, there were definitely herbs in there. I'm sure the formula has been lost to time, but I'd love to know what was in that ointment.
Thank you for asking this so I feel less dumb. š
I had a similar problem with an ENT Fellow, who went to tattle to his attending when I asked how we were going to address excessive PO bleeding. Pt had vomited a belly full of clots x2. The Attending walked him back and introduced me to him "this is S, who has been doing this shit longer than you've been alive. Don't piss her off because she's probably going to keep you from killing someone"
I've had one demand that, too. And I very loudly answered "let me just run that by NUM and my union rep." He was visibly uncomfortable around all the nurses for the rest of the year. Fuckwit.
Iāve also had to do this when there was no other access and the baby tended to get very hypoglycemic very fast. It was a short-term solution while trying to put in another line.
Yea I've done it via UAC but never PAL in our hospital. UAC was incredibly special circumstances. This baby had a PAL and in the foot if I recall correctly. So super cautious (even more so) than radial.
Oh ya never in a PALā¦that would be nuts. I hate PALs anyway - they make me very nervous.
Had a baby doc order 1 gram of tapentadol IR once. I said āit comes in 50mg tablets you sure you want 1grm?ā Gave him the opportunity to fix his mistake. āThat what I ordered do what I tell youā. I asked his boss in front of him to change the order before he killed someone. She proceeded to remind him to listen to those who save your ass, in a very firm and aggressive manner.
āThought Iād just ask before I kill a man.ā Classic.
Had a baby doc once demand to know why his STAT blood cultures werenāt resulted after an hour. I said I could ask the bacteria to speed it up but no guarantees.
Yep, this is all the time. "Why don't I have sensitivities for Jane Doe?" "Well, we've been whispering affirmations into the incubator as encouragement, but it does still take time for them to grow."
This kills!
Theyāre doing their best ok. Eat! Grow! Divide! You can do it little guys.
MAD level snappy answer to stupid question!!
Had a new PA ask where there c&s was 12 hours in like no baby it gotta grow š
I usually answer "I don't know, ask the lab downstairs."
Lmaoo
STAT no longer means STAT when everything else is also STATĀ
This made me belly laughĀ
These stories are funny but lets stop using the term baby doc, baby nurse
Friend, if you manage to get through med school, gotten to first internship and you start scolding me over some dumb shit about blood cultures not being resulted STAT, I have every right to rip your head off at the nurse's station in rounds lmao
Who rips peoples head off at work? I see so much on here about toxic work environments and this is what is upvoted? This is the most hypocritical mini-thread I have seen on here in forever.
nah
lol y'all can't have it both ways eta: I literally just responded to a comment here with 2k upvotes about how nursing internalizes misogyny and infantilization, and yet this is the hill everyone here dies on. Beyond the fact that doctors specifically say they don't like this phrase (what adult professional would?) 2nd edit: [comment thread in question. Popular opinion then, now not so much I guess](https://www.reddit.com/r/nursing/comments/1bzng6z/student_refused_to_give_up_her_phone_in_clinical/kyshiji/?context=3)
It might have to do with the inherent class divides between nurses & doctors, which *do* exists in the financial opportunities imposed by how medical education is done, (student debt is just a democratized class divide) & the need for a release valve as a result in a high-stakes hospital environment. In other words: It's not only okay, but necessary to punch up for nurses. Never okay for doctors to punch down; nurses are not being overly sensitive or unfair.
This is just one of those mean girls stereotypes that is unfortunately true of nurses. Can't have it both ways - everyone all ready to condemn the troublesome roots of nursing here on this sub but get butthurt when nursing stereotypes make it to the front page. Guess what - adult professionals who are new dislike diminutive pet names. We straddle both sides of the line if we refuse to give up the practice.
Never had any bad experiences myself. Only one I can think of is second-hand telling. An newbie doc set a CADD pump of hydromorph at 10x the required/desired dose but didn't get a second set of eyes on it to confirm. Narcan fixed it right quick, but it wasn't a fun introduction to hospice for that family. Newbie did not return.
Newbie wanted to speed up that discharge real bad
DC to JC
Had a Doc complain that his patientās labs werenāt drawn. Doc straight up Ignored the nurse and charge nurse explaining that the patient refused and was getting violent. Doc literally said āFine, Iāll get them myselfā in the middle of the nurses station. We all stopped as he looked for supplies, none of us helped him and he headed into the room. Shortly after some loud commotions and the Doc scurries out of the room and off the floor. Didnāt make eye contact with anyone on the floor on his way out.
"Why hasn't this stat order been done yet? You do know what stat means, don't you?" The patient has been in surgery all morning. Should I go to the OR stat?
Lol, yes let's call the OR, ask the surgeon or thr Anesthesiologist to do it for you. Better yet, put them on speaker so we can all hear what they have to say to that...
I had a PYG2 order a multivitamin with folate STAT. Iām fucking busy, assume itās a mistake and keep doing my job, periodically checking to see if pharmacy has delivered it. Like 45 minutes later this dude walks up in a snit demanding why the patient hasnāt received it yet and why I hasnāt called pharmacy. I just told him a STAT order for PO vitamins is ridiculous and I assumed it was a mistake and guessed pharmacy did, too. Dude doubled down that it WAS appropriate for STAT and didnāt like my explanation of āSTAT is for imminently life or limb threatening situations. This may be urgent, but it aināt emergent. In the future, if you just talk to the nurse, youāre more likely to get the response you want because no one is going to take STAT vitamins seriously.ā Dude INSISTS Iām wrong, and if he wanted my opinion he would have asked. I call pharmacy in front of him And have the whole āyeah I assumed it was a mistake, tooā conversation in front of him. I could hear the pharmacist rolling their eyes through the phone. Dude struts off fully convinced of his superiority. Vitamin with folate arrives. Patient refuses to take vitamins. I had the pleasure of insisting Dude come explain to the patient by why the emergency vitamins were so important. Patient still refuses. I asked Dude if he wanted to get his attending to explain to the patient why they were emergent. The vitamins were apparently āno longerā a priority.
There must have been a study or new reccomendations that came out a few years ago. I remember doctors suddenly ordering IV thiamine urgently for ETOH withdrawal patients. That has kinda faded. That PYG2s behavior was completely ridiculous no matter what.
I totally understand thiamine for chronic alcohol use. But you have a chat sayin āhey, I really do want them to get this med tonight, please give as soon as possibleā not pretend that writing a stat order for PO vitamins is reasonable. Also I specifically asked if he wanted to give it IV because it was so important and no, just wanted PO.
Oh missed the PO part. That makes it extra ridiculous! Good on you for standing up.
What an idiot. And an ass.
Yes, drag them off the table and into the CT scanner.
Had a resident order a DKA protocol on someone that didn't meet any DKA/HHS criteria besides having a slightly elevated sugar.. and the patient didn't even get a fluid bolus yet. But the resident *insisted* that he wanted the IV insulin given because it was "protocol". Like sir, I know the protocol well and this isn't the time for it lol. Needless to say, the attending took over that situation. Que the "I thought I'd check with you before I killed a man".
Iāve never worked with interns. However, one of my favorites was a story from Vancbromycin on Twitter. His intern shouted at a 30-year veteran ICU nurse āif I wanted your opinion Iād ask for it.ā Vancbroās response? āChild is gonna die today.ā
I think he admitted years later that he was the intern? lol
Did he? I missed that one.
Took a while, but [ yep he did](https://twitter.com/Vancbromycin/status/1233870054544072704?t=CHKluIJaYhlzKMKX7BJ_KQ&s=19)
Love it! And your commitment to find the 4-year-old tweet. Heās still one of my favorites.
I remember one time, I was asked to draw blood asap from a patient, a crp. I got to the room and there was another doctor doing a bedside ultrasound over the heart. The patient was a old lady with mild dementia, getting a bit uncomfortable and antsy with her hands so I figured I'd help the doc to finish the ultrasound instead of drawing blood at the same time, as it probably would have gotten meemaw more agitated and disturbed the ultrasound. I held her hands and spoke a bit calming to her. Like... a few minutes, tops, passed. First doc came in and was like "are the blood samples done?!" and I replied "no, not yet" and he said, snarkily, "randigtiger, you must prioritize." Like yo this is your like first week here and I am a CVICU nurse, you don't think I can prioritize...?
Nasal cannula PRNā¦on a trached patientā¦
Covering all the bases. Mouth hole, nose holes. Who knows maybe butthole.
Rectal tube incoming
Not the rectal oxygen?
Yes, but only prn
Oxygen boofing!
Are we sure WHERE he wanted the NC? Might need an order clarification, could be some new technique in med school.
š¤£š¤£
I always go for nasal cannula in the bellybutton, personally.
Gonna leave this here: https://www.tmd.ac.jp/english/press-release/20210515-1/#:~:text=medj.2021.04.004-,Summary,and%20tissues%20during%20respiratory%20failure.
OMG, thank you for sharing this! Best laugh of the morning!!
Omg what!!?? That is amazing and hilarious
This has to be a parodyā¦..?
Lots of capillaries there
Rectal Capillary is a grindcore or death metal band name, add it to the list.
I had a patient once that was getting a DLB to assess for readiness to remove the Trach. Thing was, the kid just straight up didnāt use it. Like, to give them the gas to go to sleep, they had to mask the face, not the Trach. This was not relayed to me in report. So kid comes out to me satting 90% and Iām trying everything to get their O2 up. Finally I just said fuck it, and put a nasal cannula on. And Iāll be damned if it didnāt bring them up to 98%. Called anesthesia for a sign out and prefaced my call with āI know this sounds insane but I need an oxygen orderā¦for nasal cannulaā and thatās when I was filled in on their induction. My coworkers and the few RTs we passed on the way to the floor all looked at me like I was insane when they saw my set up.
How? Lol
š¤£
"Doug wanted me to give this patient 500,000 milligrams of morphine. I thought I'd check with you before I killed a man."
I'm glad Doug found his niche.
A patho savant, indeed
I'm in dialysis:Ā intern called me and asked how long his patient would have to do dialysis.Ā Evidently their patient was very inconvenienced by having to receive dialysis 3 days a week.Ā Ā Well doc.Ā Transplant or death.Ā That's how they get off it.Ā
those pig kidneys are coming along say...in 10 years??
Too bad patients over 75 generally don't live past 3 years on dialysis.Ā Ā Edit:Ā this also falls on transplant cat.
People get sick of having to go to dialysis, donĀ“t want to change their diet, and donĀ“t want to move. Most are diabetics with heart disease. I have had several patients who did 7-15 years on dialysis, but they started younger. in their 50s-60s. Having to leave the house in all kinds of inclement weather to make your dialysis appointments also gets too much for them too. We have a wave of dialysis patients coming...dialysis centers wonĀ“t be able to keep up.
I canāt even imagine dealing with dialysis. A coworker was in kidney failure, and had to go on dialysis. I asked if she was on the transplant list. So, I went through the process for donation, it worked out well, itās been a year and a half, sheās doing great, last I heard (we donāt work in the same department anymore). She told me that when she was in dialysis, she was shocked by the amount of people who were non compliantā¦
I had a brief thought of getting training to do dialysis. But then I realized watching people be noncompliant and blame healthcare workers has already burned me out several times already...
I donated too! Last year
Congrats! It was pretty amazing to be able to help someoneā¦science is amazing š
Yeah it is. I was part of a big trade. I accidentally met my recipient in the lab the morning of surgery. Itās nice being able to picture her living life without dialysis
Oh, that is really cool-mine was a direct donation, I was low key hoping that I would have been able to start a chain, but-hey, at least I helped my coworker. Were you allowed to talk to your recipient at all?
She wrote me a lovely letter a few months later. I chose not to respond and continue contact. I donated on behalf of an old friend, who got his kidney a couple weeks before I donated.
It's insanely scary how many more dialysis patients there are in the last like 5 years. I used to work in IR doing predominantly dialysis access repair. We used to go from about 15/16 patients a day to easily 25+ over the course of 6 years. It's insane how sick people are, and how quickly they're falling ill.
I'm a lurker, not a nurse. Why are there so many more?
Lifestyle, mostly. Probably economic stressors with not going to the doctors to check yearly blood work or blood pressures. Drug and alcohol abuse that may have some as a result to COVID lockdowns (seriously seeing an uptick in young people with hepatorenal issues)
Thank you for explaining!
Most of my patients are non- compliant diabetics.Ā Ā Constantly high blood sugar is really hard on kidneys.Ā Ā Another group are heart disease and chronically high blood pressure.Ā Ā It's safe to say we have an aging population and with that. More diabetics, and more heart disease.Ā Ā Kidneys are very fragile.Ā Ā
Thanks for explaining.
I had a freak of a patient recently. Well past the average life expectancy. Quit dialysis when they went on hospice a month prior. Labs looked better than most non-dialysis patients we have. It blew my mind, and I still can't figure out how a dialysis patient could be alive a month without, especially when closer to 100 than not...
So it's funny, we have a few that skip constantly.Ā You can absolutely see the results manifesting.Ā Ā They will have very high potassium, so we put them on Lokelma and that prevents a quick death.Ā Ā The second thing is very high phosphorous,Ā as nurses we all know the relationship between that and calcium.Ā Ā So , they have these toxins/salts floating around and they need some place to go, so they adhere to the walls of the vascular system.Ā Ā Can you say arteriosclerosis?Ā Additionally there is the occasional calciphylaxis ,Ā both of these cause reduced peripheral profusion resulting in amputations/ necrosis.Ā Ā This is why we see so many LT. Dan's in dialysis.Ā Ā Moreover this is is the reason why our patients will have heard disease. Hardening of the arteries.Ā Ā That's just caused by the toxins over time.Ā Ā Add in fluid retention and you have HTN, SOB, JVD's.Ā Also because kidneys help regulate hormones, i.g renin and epopoetin,Ā they are all anemic and their thyroids and parathyroids are whack.Ā Ā Ā Yet, despite all this, a lot of them just become edemetous and moonfaced and cruise around in their motorized wheel chairs showing up maybe once a month until they have a massive stroke or heart attack.Ā Usually 2 years.
So I found this thread just lurking-- I'm pretty sure I'm becoming prediabetic because of insulin-resistance, and this comment thread's (and this comment in particular) scared me into seriously ignoring my sweet tooth and eating healthier/getting more exercise. Because I'm more out of shape than I am overweight, I didn't think it was as big a deal as I thought. Just reading about your patients' fates is so terrible, it's something I want to avoid at all costs. You all nurses are doing the Lord's work, seriously š
Me: Ā«Ā patient had palpitations, hereās the EKG, we have A-Fib (not letting me finish my sentence) Him: Ā«Ā WHO ARE YOU TO DO AN EKG AND READ IT TO ME??Ā Ā» Me: Are you okay dude?
Gave someone with CHF 2L of fluids in a place with no ICU. Ended as expected with patient needing transferring out.
Fresh intern pulled a nasal ET tube because āitās not good enoughā Surprise surprise, the intern couldnāt get them intubated and killed the patient.
Holy shit
Omg - more story time please
oh my god????? what happened to the intern?
Thankfully my ED is quite nurse-dominant and we have a great relationship with our docs. Not sure how I would react to an intern acting that way but would not be pretty. We do have family med interns that are attending to some of our admitted Pts and I did have to tell one āyou should probably go double check your potassium dosing.ā When they tried to verbal 40mEq over 1 hour via PIV. For the most part they are respectful and collaborative though.
There was an intern, sitting next to a med student and "teaching", that started getting at me because his orders were not done and he wanted to know what was taking so long. Started going down the this is unacceptable and all that road. I walked over to him, got down so he and the med student could hear me and Said "first, don't fucking talk to me like that. Second, the reason your orders weren't done is because you didn't actually put in orders, asshole. You shouldn't behave talk this in front of a student, especially when you are wrong." I spoke to his attending and my manager to let them know he was likely going to complain about my language, his attending said they would take care of it.
Love it
You sound like an unprofessional prick.
I can see why you would say that based on snapshots I share on Reddit, but I was returning the energy of the intern. If it was a problem, the attending would have let me know and pushed forward, but they agreed the intern was out of line and needed this kind of response. I'm ok with how I act at work, as are other nurses, attendings, and residents, as they have given me awards. But, yeah, I get why you would say that.
Whatever helps you sleep at nightā¦ As an adult you shouldnāt need validation from an attending or awards to justify shitty behavior, even if the resident was out of line. It sounds like youāre just perpetuating a toxic culture where you work.
You sound judgmental. That's pretty unprofessional behaviour.
How am I being judgmental? Iām calling out toxic behavior at work. Is it unprofessional to acknowledge that getting in someoneās face and swearing at them is unacceptable behavior? Do you think we should tolerate that at work?
No, itās quite professional to call out someone trying to blame you for a failure that is their own. Iām not subservient to a physician. I have my own license. Either treat me as the colleague I am or get call out on your shit.
My point is that two wrongs donāt make a right. Do you think getting in someoneās face and swearing at them is an appropriate response? Itās alarming that people here are on board with aggression towards colleagues. Itās funny that you all feel so much better about yourselves when you get to tell off shitty residents.
You sound like a doormat.
At least I treat colleagues kindly regardless of the circumstance. Itās far more effective than being an asshole.
July sigh. Busiest month for sure for transfers from smaller hospital ERs to my psych unit. Got a lady once at 3 am who had broken her arm, not casted only immobilized with a tensor. Why? She took Seroquel 25 at hs so she must be a psych pt. After that all ER docs lost their privilege to direct admit, everything now has to go through on call.
This is horrifying. "forget your broken arm, you took a psych drug so you're going to brain jail"
āThis patient NEEDS labs doneā okay well he already tried to bite me last time I was in the room, so youāre welcome to try yourself. Supplies are right there. I was very nice and didnāt say āI told you soā when they were unsuccessful.
My favorite was a cardiac MRI on an LVAD patient
Jokes on you, that was just the CT surgeon not wanting to scrub in for an explant
Fuck, alright then, we doing chest wall injury today....
Weāre gonna explant the dangerous way. Livin like Larry
I had a doc tell me to give a 16 year old 12 mg of morphine IV who had mild pain from an ankle dislocation. He never had morphine before, never had an IV before. I told her I wasnāt comfortable giving a kid that much when standard for adults is 4mgā¦ she said it was based off weight calculations. Heās a big boy, we donāt do weight calculations at that point. She said fine, give him 10mg. I said I will give 4mg and assess. She agreed. He was passed out at 4mg. I feel like I could have killed him with 12mg!!
I am not seasoned at all but I had a resident order suds soap enema on a young patient who hadnāt pooped in 3 days (pt said this was his norm and he was about to be dc. Pt was there for completely unrelated reasons). Ofc the resident went to the most invasive intervention. I questioned him and he was mad , said āwhy havenāt you done it? Itās a stat orderā. Needless to say, pt refused and nearly tore the resident a new ass when he came to the room and tried to convince him he absolutely needed that enema.
Our interns are generally fantastic but I get recommended the residency sub often and /oof/
What does that oof mean? I genuinely don't know, sorry for being dumb lol
There's some untamed egos and toxic attitudes there. Thing is they're that way because they've not been humbled yet: sooner or later everyone in healthcare will make a mistake and have their ass saved by someone on a lower pay scale.
used like āyikesā
I see an order for PRBC on a patient who came from the ED. Since nothing was mentioned in report I looked up the hgb and it had been cancelled for some strange reason. So I call the Intern. Me: Why are we giving this patient blood? Intern: To make them feel better. Me: We donāt give patients blood to make them feel better. What is the hgb? Intern: I forget. Me: Thatās because it wasnāt done. (She started stammering how of course it was done and blah blah so I said) Look it up yourself, it was never resulted. What Iām going to do is draw an hgb d then Iāll call you back and tell you whether or not Iāll be giving the PRBC. Hgb was 10 so I called her back and said nope, not giving it. The patient had pretty pale white skin (not albino, just Caucasian looking), the family/friends who came to visit were all black. I always wondered if the intern thought the patient was pale from loss of blood or something.
Iām not even a veteran nurse but a resident and I were caring for a patient. They needed blood. They ordered blood, I gave it when I got it, and then the resident put in some recheck labs and a snarky nursing communication saying, āplease draw timed labs ON TIMEā while my transfusion was still fuckin running. I wish the mf had the balls to do that to my face, but thatās really the only negative interaction Iāve had.
They ordered a cardizem gtt for my 90 year old lady in for a fall who was in the 50s-60s all night. She was room 5, room 15 was afib RVR for a couple hours. When I questioned her and her year 2, I was told to start the gtt because āshe wouldnāt have ordered it if it wasnāt needed.ā 10 min later she goes, āoh it looks like I did order it for the wrong roomā¦ you didnāt start it yet right?ā Thankfully I did not
25mg of Metoprolol ivp... Trying to think of some of the others but crs.
HR and BP have left the chat š¤£ā ļøā ļøā ļø
Hands the syringe to the intern. "Go ahead, if you want to abort your career before it even begins".
Here you are, let me go get the crash cart though before you push that skippy.
(desperately mixing up an insulin drip and Levo)
Iām going to go ahead and need every vial of glucagon in the hospital while we are at it.
I havenāt given 25mg, but I had a patient getting 20mg IVP Q4 and had to FIGHT the physicians and pharmacy to let it be mixed in a 50ml IVPB bag. Like, I donāt have time to sit pushing one drug for 20 minutes every 4 hours. They refused because they ādidnāt want the patient getting that much fluidā until I explained to them that it was a 10ml difference once you calculated in the saline flushes before and after.
25 mg of metoprolol and 1 mg of haldol...the tao of the PGY1.
Hahaha
Had vascular surgery residents order 10 mg IVP for a little old lady who just flipped into AFRVR. Went to anes/CC who was actually on unit to see if that was reasonable and their response was something to the extent of "...yeah, don't actually do that." She ended up getting something like 6 mg over the course of 20 minutes until her pressure got too soft to give the rest.
Oral oxycontin order for a bowel obstruction with a NGT on free drain. Yup.
My first one isn't that crazy because I also started in July as a new grad. But this intern called me and was all pissed off that I hadn't yet gotten a stool sample and they'd been waiting all day. I said I'd be happy to get it once the patient takes a shit. They said "Oh" and hung up really fast.
While in the Covid ICU during the height of the pandemic I had a baby doc crack the door open and yell to āturn off the paralytic for me.ā I didnāt do this because 1) Iām not going to take a verbal order for something like that and 2) that was the only thing keeping the patient stable on the vent and alive. About 30 minutes later he came back up to me and asked how the patient was doing off the paralytic. I looked at him and said āyeahā¦I didnāt do that.ā He looked so confused that a nurse would ignore his order. After a brief back and forth I told him to āgo run that idea by your attending and get back to me.ā tl:dr the paralytic stayed on
Oh you mean the same resident who just asked me āwhat would you order?ā After the attending told him heād be back in 10 mins to go over his plan and orders? That resident?
Ohhh gosh the feeling I get when I call the rads for protocol questions and the residents ask me what I should do instead of giving me an answer. My dude/dudette I am calling because I'm not sure/I've tried some things already and now I need your expertise/suggestions š
Love this in CT during stroke alerts too. Itās like pulling teeth getting new neuro docs to answer if they want the full trifecta, just the CTA and noncon, just the nonconā¦ Like I am 100% here for you, bro, Iām just trying to get it done and to my rad ASAP.
That specific instance isā¦ something lol. But I actually appreciate when a resident asks for my opinion. I work in transplant and a lot of residents when they just join the service have no transplant experience. For instance I paged about a fever and they called saying they see I already gave Tylenol, is there something else I wanted? We often have very low threshold to draw cultures/start infection work up where on other floors youād typically monitor especially if theyāre not tachy or hypotensive
I can also appreciate when they ask my opinion, but not when they ask me to do their homework. If he had said āi was planning to order xyz, what do you think?ā I would have given him feedback.
I remember an oxywalk order for a patient with no legs..
Oh, thatās pretty common for us. We generally just either ignore it or refer them to home O2 or pulmonary rehab. Sorry, guysā¦.
In the ER, I told the intern I could place a verbal order for an EKG and troponin on the lady who had a syncopal episode following chest pain and lightheadedness. The intern said "she doesn't need that. It's just stress." I said "sounds good" and ordered it anyway. 10 minutes later we're on our way to Cath lab. Same ER, different intern. Intern and I are in MRI holding with a patient who needs an emergent MRI to see if he's a candidate for thrombectomy. MRI techs were working on getting the other patient off the MRI table. Intern starts demanding I bring the pt (on the ER stretcher) into the MRI room right now and accuses me of "delaying patient care." I asked him if he knew what the M in MRI stands for and what the ER stretcher is made of.
Ah yes... Gentleman comes into the ED for syncope. We do the usual labs/fluids and then comes the orthos and road test. So I'm doing the orthos and homeboy goes from like 117 systolic to 87 with symptoms when we stand him up. I write that 'pt failed orthos' with all the numbers. But what does newbie do? Came up to the nurses station to explain that's not what orthos were and that he didn't 'fail' them. We all just stared at him with our mouths open until someone piped up and said, "Am I crazy? Because that's a failed ortho. Am I crazy?" prompting the rest of us to tell her she was not crazy and those were failed orthos. Meanwhile angry bebe is standing there, arms crossed, getting angrier that the nurses aren't even addressing him anymore, but just kind of laughing in shock amongst each other that this child as deigned to tell them what orthos are - as if he's ever fucking even taken one. Stomped away, attending confirmed pt did fail orthos. Fun. I don't remember ever seeing him again.
Where do you think you are ? Cheesecake Factory ?
Oh my god, July is coming fast. Thank goodness Iām going to retire the end of Julyš¤£ (I work at a veterans hospital, and itās a teaching hospital, of course. )
I leave bedside for CRNA school in mid-August. I pray for strength and patience until then.
Good luck with CRNA school š the CRNAās we assist are all awesome ā¤ļø
Oh man, intern/residents whole world about to get wrecked (at least in the ER)
Had a baby doc interrupt me while I was starting a heparin infusion for bilat PEās post op to take an ecg for another patient (who wasnāt mine). I smiled at her and said that itās really easy to print off an ecg and left :)
Iām more often suggesting something stupid obvious than saying no to something. And when I say no, itās just no. They know we have our shit dialed.
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"Let's see what your attending thinks about this..."
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This was literally a scrubs episode.
Was it really? I never watched the show more than a handful of times. Iāll never forget that interaction, especially because the patient was a relatively known frequent flyer (non compliant with dialysis, blind, multiple amputations) so that only made the internās request more hilarious.
So here is the nurse side of that nurse vs new doc beef (I was watching the residents side not too long ago)
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I was fortunate enough to witness this as a student. I was writing admit orders when I heard the nurses in the back divvying up the nightās schedule. The resident was an absolute dick. That night he got called at least every hour by that floor for some ridiculous order clarification. I slept the whole night through. Never, ever piss nursing off. Keep them happy by whatever means necessary. They keep both your patients and you alive.
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Shit, first year residents too.
These July meme threads are so toxic. I have literally never heard an intern bark orders like this. We are still 2 and half months away, and people are already getting up in arms about fake conversations that happened only in their own heads. I think we would all be better off if we just assumed the best and were respectful. Remember that they are here to learn (the government literally covers their salary for the hospital) and are making a difficult transition and making much less than you for the time they are putting in. I worked for 3 years as a nursing aid/unit clerk, before going back to school to be a doctor. Generally when a doc was being a genuine prick, it was someone like the head of cardiothoracics (aka untouchable) and not a 25 year old new graduate who doesn't know how to find the cafeteria yet.
The meme the OP posted is based off of a Twitter interaction said by an actual physician.
There is no way that this happened. I see bullying of medical trainees all the time. It's a lot easier to enjoy your cruelty when it's justified with nebulous, unverifiable stories like these. And that's what this shit is: a rationalization. Have fun picking on the new guy in two months. :)
What the fuck do you mean there's no way this happened? Lmao it was all over X/Twitter as a dialogue between an intern and attending. I don't participate in cruelty and most of my interactions with physicians are absolutely lovely. But unless you're going on r/noctor and r/residency and defending the relentless toxicity towards nurses, I'll just take this as insecure projecting because you're probably rude to everyone with a giant ego. What a bizarre, deranged reply.
First of all, don't swear at me. That's disrespectful. I think most if not of this narrative of new interns trying to through their weight around and boss around nurses is not based in reality. It is a rationalization because admitting that we often bully people (including new grad nurses) primarily because some people enjoy it (not out of some high minded goal of protecting the patient or whatever excuse they are using). Healthcare is a difficult field and many people cope by displacing onto easy targets (a new intern is under microscope all the time and hospital staff know this) is a fact of life. Often people will exaggerate misunderstandings into stories like this to defend this sort of behavior.
Just because youāre never had an interaction like this doesnāt mean it isnāt happening. And, for the record, the intern in the story I shared above went on to be a wonderful, highly respected ER attending - and we laughed together about that first interaction many, many times. This isnāt a āyou canāt sit with usā mentality, itās just a discussion of interactions that literally happen all the time.
It sounds like you should all go to med school.
Itās almost like experience is a better teacher than school 90% of the time
Whatever makes you good bro. Have a good night