Steve (or is it katiemama?) mentioned how a couple of interns at his hospital get written up frequently by nurses. It made me wonder what the working conditions there are like. I can't imagine that it's a positive working environment if you are going to get "written up" all the time.
And what's with getting written up anyways? Is that supposed to scare me? It's not like the useless nurse managers have any authority over me anyways. (A note about nurse managers: they are not actual working nurses. They wear business clothes, wear a long white coat, eat in the doctor's lounge, park in the doctor's lot, and do nothing in terms of patient care as far as anyone can tell.)
The vast majority of the time, the nurses treat us okay, and we treat them okay. We all have to work together. It would be tough to do that if we were writing each other up all the time. So I was wondering, do you guys have this issue in your hospitals?
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i once got written up by a nurse on CCU at the VA because my cardiac enzymes weren't getting drawn on time and my morning EKG's were not getting done on time so i would write orders such as "please get a 12-lead ekg at 06:00 and do not take it upon yourself to determine that this order does not need to be followed, just get the EKG at 06:00 as ordered and do not wait until i have asked 3 different times for it to be done at 08:00 when it was ordered at 06:00". well when the nurse manager came up to my attending with the complaint from the nurses the attending backed me up and nothing ever came of it.
That's awesome. Love that order.
My fellow intern here once wrote an order for a stat gravy bolus for an annoying obese patient. It was supposed to be a joke, but someone put it on the chart. He had to go up later and cancel the gravy bolus after the pharmacy paged him for an oder clarification.
One of our ER docs here was told by the nurse "this patient's stool smells like c. diff, can I get an order to check for c. diff?" the ER doc then wrote the order "nurse to smell pt.'s sh** 3 times". Needless to say it didn't go over well. But danged funny though.
Haven't had any trouble about getting written up, but I really had it out with a social worker one day and I came close.
-Adam
Don't get me started on nurses and techs smelling things to diagnose something. I get this all the time. "Doc, this smells like MRSA."
Why do you think they're on Vanco genius? Could it be because 75% of our patients cellulitis/abscess patients have MRSA? Did the 20 times we mentioned MRSA on the last 3 days of progress notes and lab reports not tip you off?
So far as I know, I almost got written up once. We had a guy code on our rehab floor w/o IV access. The rehab unit's code cart had nothing sterile except the triple lumen kit itself. No sterile gloves, no drapes. And besides, it's an emergency. So I put in a line with just normal gloves, not sterile. At our place you can do this, and then replace the line once you resuscitate and get to the ICU.
A FMG house officer arrived after the line was placed and freaked out about it. Told me to find an article supporting emergent nonsterile line placement, and present to him later that day. I said "You're not my boss. You're not even an attending. Look it up yourself."
He told a nurse manager to write me up. She sort of went through the motions, but abandoned it right after he left. Probably wasn't a good idea to tell the guy to look something up himself, but I didn't get in trouble.
I like when a nurse calls you and says something like, "do you mind if I order a UA on this pt. because I think she has a UTI?" when, in reality, she's already ordered the test and the results are already up. I had a nurse ask me that and I was on the computer already looking at the results...I said, "No, it's okay, we don't need a UA." Then she gets all nervous and goes into all of these reasons why the pt needs the UA, that ALL doctors order UA's on these types of patients, and that I just had to order it. I tried about 5 different times to not order it and then finally gave in. I really should have called her on it, but I was in a good mood. Nurses do it all the time...but what I do LOVE is when nurses draw blood and call you and say, "I've drawn 5 tubes of blood, would you like to add anything to the orders?" A very nice way to be helpful and to remind you to make orders you may have forgotten.
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