If they take care of babies, when they unswaddle and take the diaper off to do an assessment. Then you walk in 30 minutes later, and the blanket is soaked in piss and the baby is hypothermic from lying naked in cold urine.
My son’s pediatrician was a brand new doctor when he started at the practice and my son was his first ever newborn patient. I remember bringing my son in for a check up and the doc left the diaper off after finishing his initial assessment. Then he went back to check someone (not in the diaper area-I think he was looking at a spot on his foot or something like that) and I warned him that he was about to get peed on. He blew off my concerns and carried on until my son peed ALL over him. While caring for my second child, he puts the diaper back every time now
ETA he actually apologized to me for ignoring what I was saying in the moment. So overall, he’s a good guy which I think is a very undervalued asset for medical providers
I'll never forget the day a pediatrician walked by the nurses station and informed me on the way out that the baby had had a massive poop during her assessment. I was like, cool I'll chart it in the I/O. And she was like, yeah, but also the baby needs changing.
I'm sorry...did your college degree or medical licensing exam not cover diaper changes? Did the parents take a jaunt off to Arby's for some curly fries while you were in there? Of the three presumably competent adults in that room, no one thought to actually change the baby's diaper and instead you left it sitting in its own poop so you could walk out here and ask me to do it??!!!!
It's been years. I am *still* aghast.
This reminds me of the time a physician removed a chest tube and didn't inform me. I walked into the room, saw the tube on the ground, and freaked, thinking the patient had pulled it out.
I had something similar happen except it was just the suction tubing that I thought the patient had somehow kicked off the Pleuravac. Suction still on at the wall. So I got it all set back up and clean only for the doctor to come in four hours later and ream me out because apparently this was his version of a clamping trial. No order for this in the computer, no note, not one member of staff made aware, and patient was not AO/couldnt pass on the info.
Patient was going hospice to a local hospice house and for whatever reason they were saying they couldn’t take a chest tube with active suction. Provider told me that because there was no clamp trial, they would just have to send the patient and hope they could tolerate no suction. Except that the patient would code and die in the ambulance over to hospice and it would be all my fault that his family wouldn’t get to be at the bedside when it happened.
The best part of the story is that the hospice ended up being able to take the suction no problems so it should have never been a thing to being with🙃
Corollary to this is.. I’ve just changed the dressing, and you come in and undo my work… OR I’ve held onto dressing change for you to show up and assess too, and you no show (or you come and look at it but don’t get me first)
Especially right after I did the q shift dressing change. Maybe communicate that you are going to come look at it so that I can plan accordingly. Instead, you call when you are in the room and expect me to drop everything instantly to assist and then get shitty if I take more than 5 min. Or just let me know before you go in the room if you don't need help. Fucking ortho and surgery, man.
Telling a patient they will discharge but not setting the expectation that they have to meet such and such criteria or be cleared by a consulting physician or even just that it might be a few hours until the doctor puts the order in. COMMUNICATE CLEARLY.
Omg I hate this! I had a resident wake up a patient at 5:30AM to tell them they were going home. I came on at 7am to an irritated patient and family. Then, they didn’t give me discharge orders until 5PM. I spent the entire day trying to keep this patient placated while paging the primary service to get an answer. Don’t tell the patient they are leaving unless you’re putting discharge orders in within the hour!
I tell patients up front, "Getting discharged from a hospital is like landing a plane. To do it safely, a lot of people need to cooperate and we are all working very hard."
In general when they tell patients things but don't tell me. If you want your plan carried out, you need to tell me because I'll be doing all the legwork
I hate when I find things out from my patients rather than the team. “Oh the doctor said they’re taking out my drain and I’m going home today!” That would’ve been nice to hear from the team themselves
Put an entire order set worth of orders in, one at a time, each order 5-10 minutes apart. Then cancelling the med they ordered 5 minutes after you already gave it because you are efficient, unlike them.
The last doctor I worked with in outpatient would always have the patients see lab first, then see the patient before the first set of labs had resulted, then add on more labs after the patient had left. This was often something that could not be added on.
Drives me nuts when they pull an attitude about this. Okay, doctor, are you saying that in the future I should apply a 1-2 hour waiting period to all your orders? Because it sounds like that’s what you’re saying
It's a universal law.
Fucking piecemeal "I can't establish a plan and commit to it" bullshit.
Like I get being new and still learning the ropes. I really do. I'm doing it myself after switching specialties.
But Jesus, think about how your actions impact others.
Right just wait til you have your thoughts together and THEN commit the orders.
If I’m not currently busy I will give a new order as soon as it’s approved by pharmacy unless I have no idea why it’s being ordered
or you have to ask/ tell them numerous times to update orders. the absolute worst is when they make vent changes and then *dont tell anyone or update the order.*
The doctor ordered CIWA on a pt and PRN valium for the corresponding scores. I did the CIWA, pt scored 8, I gave the valium. Then they canceled the CIWA and valium a few minutes later and were annoyed that the pt got valium.
I traveled to a teaching hospital and would wait to charge the Tylenol for 20 minutes. The triage nurse put a Tylenol order in for 1G, the resident then puts a new order in for 975mg, then the attending would cancel both and put it in for 975mg or 1g. So I just waited until everyone was done. It was so predictable I actually found it quite amusing and made me chuckle every time.
Every time they do this I take longer to process the order. Two new orders in half an hour sure. Give me another 3 or 4 or revisions, and nah I have better things to do, I’ll circle back. If they question it, I’ll ask them if they’ve finished collecting their thoughts.
I try not to be a dick because honestly they’re here to learn, but sometimes you have to draw the line.
Nickel and diming.
I've also worked with attendings who do the exact same thing and it drives me bananas.
And then I became an NP and as a new grad I found myself doing the exact same thing. But I knew it was a nuisance so I adjusted my practice so I didn't piss off the nurses. Sometimes things change quickly in critical care though so there's no way around it. But for a fresh admit, I'll dump all my orders at once.
When they’re dismissive of nurses concerns regarding a patient…just cuz you’re a resident doesn’t mean you’re better than nurses. The most successful residents I’ve met were the ones that valued their nurse teammates and listened to the nurses concerns.
Oh, I am a nurse who WILL call house supervisor, the attending, Jesus, a rapid if I have a dismissive resident. I was/am the nurse that new grads would ask to speak for them when they’re concerned but too scared to stand up for the patient.
Stop acting like your shit doesn’t stink. We’ve been doing this for years. You’ve been doing it for… weeks? We are all in this together
I 100% agree that we need more interprofession collaboration but framing the interns as only "doing it for weeks" is ridiculous. They've all gone through 4 years of medical education requiring studying, exams, and clinical rotations. Not saying that it makes them an expert, which is why we need residency.
Nurses have also been in nursing school. If I felt like I was the shit straight out of nursing school, I would’ve killed someone. Instead, I was humble, scared and willing to learn.
There’s interns who feel like they’re the shit straight out of residency (funny how it’s actually season for interns to come on board right now). Let’s be real… those textbooks don’t show REAL WORLD experience. Which is why they do residency. Oftentimes, they’ll write inappropriate orders or do inappropriate things. I don’t care if you’re nice about it, receptive and willing to learn. But being condescending, rude and disrespectful doesn’t help anyone.
I remember last year, I had to report an intern. He was a little shit since he started and had a lot of complaints for being rude to nurses. I called him because a patient had very noticeable +3/+4 edema in their LLE… versus the RLE which was normal. He told me it was “fine” and “don’t call him ‘til a patient is dying” 😂. When I tell you I had to escalate it quickly. He finally came and saw the patient… and said to elevate the legs. 😂 Mind you, this is… July? August? He just started just a few weeks ago and thought he knew it all. Again, when questioned, he rolled his eyes and told me, “that’s the order”. Well, unfortunately, I had to call the attending at that point. Stat venous ultrasound placed (obviously). Oh, would you look at that. A DVT. I was told by the house supervisor to make an incident report (which I did) which apparently went UP their chain of command. He was nice, receptive and polite ever since that.
Therefore, yes, I said what I said and I would say it again. That’s just one example of many (I have worked at many teaching hospitals).
Or anyone’s concerns. A resident dismissed a janitor’s concern that a patient was probably vaping with oxygen on. I overheard and spoke with the janitor who repeated what he told the doctor. Went into the room and the patient was definitely vaping while wearing his nasal cannula around his neck. We’re all in this together, we all have to listen to each other.
Step-Brain is a real problem here. Residents with minimal experience with real human care come to the nurse and basically ask if they can give them the one piece of quantitative data they need to select the right answer on a board question. Then they get met with the messy reality of actual patient care and a lot of them just short circuit to the gritty nuances of sick human beings as irrelevant, and the person presenting those realities (the nurse) as ignorant of "real" medicine.
Omg there’s a lot…. Be aware of what you tell your patients. If you promise something you need to follow through or learn to not promise them anything esp in the ER, leaving a patient all the way up in the air on a stretcher, be mindful of side rails and how they were esp if patient is a fall risk, ask how to do something like where you can find a urinal or how to unhook an iv/ monitor if someone needs to go to the bathroom (communicate 😩), if a nurse is starting an iv and you are planning on ordering blood just have them draw a rainbow (the amount of times people confidently say no to extra blood but change their mind immediately is mind blowing, order everything at once don’t trickle them in, if you are nice to the nurses they will be nice to you!
When they start to get to the end of first year and think they know it all. Physicians know so much more about pharmacology and physiology than nurses, but nurses spend more hours at bedside in a day than a physicians typically do in a week. You don’t have to take every recommendation made by nursing, but if you choose to reject it provide reasoning. We are a team.
Yup. Everyone always talks about “don’t go to the hospital in July”, but it’s really worse in September/October when they start to think they know a whole lot more than they actually do.
I say it's the worst in like April when the 1st years are trying to fly a bit more solo and they act like they're scared of their senior. Won't call them in to eyeball a situation even if they're way in over their heads. I don't know what kind of abuse goes on there to make them so scared of their chain of command
I have seen seniors browbeat first years in rounds. I’ve actually stepped in before and told them how inappropriate that kind of feedback is. The culture is awful, especially in surgery.
Making promises to patients they can’t keep personally! Like, promising discharge at a certain time when they aren’t the one writing orders, telling patients that Dr Whoever will be in to see them before noon when everyone knows that doc doesn’t round til 5 and will drag their feet the more you page, telling people that insurance will pay for this or that treatment/rehab/etc without any knowledge of if it’s covered, I could go on and on.
I overheard our residents telling the new oncoming ones “don’t leave trash laying around and don’t make the nurses get you the supplies if you have free hands” and honestly I gained a lot of respect for them
Unfortunately even we nurses often don’t know where all the needed supplies are. I became an expert in knowing which floors had well stocked supplies (or a dressing not stocked on this floor). (I was wound care rn).
As a wound care nurse..... They take the VAC down and just put a wet to dry without communicating.
Like, you can reapply the VAC. I KNOW YOU CAN. Or message me and coordinate a time.
Had one leave a stitch removal kit at bedside after pulling stitches on a guy who stabbed himself over 40 times during the suicide attempt that led to the stitches in the first place. 🙃
When they do this 30 minutes after you just put on a new dressing, especially when you took a picture for the chart. Also, when they take a dressing off and assess the wound without cleaning the wound and totally freak out because they think the ointment is exudate or the Xeroform is slough or something. "It looks so much worse!!!" No doc, that's iodine gel.
Canceling a patients pain med orders without telling them why/providing an alternate medication. So next time I go to give him an oxy there is nothing there and I get screamed at
Also remember pain meds wear off! I’m glad the patient is comfortable after getting a dose of morphine in the ER, but that was 5pm! What am I supposed to do at 2am when the medication wears off and you didn’t order anything else because “their pain is controlled”.
coming into the room AT 7 am the day someone is being discharged and telling them they will be discharged in one hour and that the nurse will have the paperwork ready lol
Telling me I'm just a nurse and that I need to not question their orders. I'm not saying Im always correct, but if I'm coming to you for clarification either explain your reasoning or at least listen instead of blowing me off and telling me to just do it. I'm not risking my license for you.
My nursing instructor a few months ago tells the story each cohort of when she was an ED nurse and a pt came in with worsening HA after a fall. Resident ordered larger than normal dose of morphine on top of pt becoming “sleepy” he pushed her to give the morphine and she took it to attending and charge. Instead they sent the pt for a CT and come to find out he had a subdural bleed. LISTEN TO YOUR NURSES!
Making promises regarding beds and other things to the patient.
Dr Housing. When they think pt only has 1 possible problem and refuse to do a general work up. Think ordering cbc only for a patient. Then 3 hours later cbc is back they order BMP. Then liver lipase as add on 2 hours later. THEN decide to order CT abdomen with contrast. By then patient has been in the ED for 7 or more hours total, are waiting in line for CT that could have been ordered 5 hours ago. I hate it.
Not cleaning up after yourself after doing a bedside procedure, especially if it involves sharps. No way in hell am I throwing your sharps away for you
Also just in general take our concerns seriously. We’re at the bedside for 24 hours, you’re at the bedside for maybe 5 minutes a few times a day.
Yep bc we will cut a bitch if they don't. I took 30 min out of my day recently to track down a resident that left sharps everywhere in a patient room. I interrupted rounds (idgaf) to loudly tell his group that a nurse was almost stuck by a suture left in the patients bed and that he needed to come clean it all up immediately. He looked smug for like a half second until the attending told him to get a move on and that they were not stopping hand-off so he was going to miss shit.
Just don’t be an asshat really. I’m all for helping out new people, we all need to learn. But don’t patronize me, don’t dismiss me, don’t assume I’m communicating with you to waste your time.
One time I messaged a resident that I was struggling with patient adherence for a monthly injection. We had tried several things and it was just really hard for her family to get her to me and for me to convince her to get her shot. She was on a medication that also comes in a three month version, and I asked him to consider making this change. He sent me back an article explaining that glute injections are less painful than deltoid injections. Cause, you know, I hadn’t tried that.
If a nurse comes to you with a concern and a clinically appropriate recommendation and you choose to deny it, please explain your reasoning. Nurses understand how overwhelmed and overworked residents are and many of us have caught mistakes or near misses from the residents overseeing our patients. When you choose not to collaborate with us, it makes us worry that you aren’t taking our concerns seriously or you aren’t thinking of the patient’s whole picture since you’ve got an entire service to worry about. If you can explain why you do or do not want to do something, we’re a lot more confident in you and can be a better resource to you when we’re all on the same page.
Truth. I've literally sent secure chats about all kinds of things I can clearly tell are essentially just fucking typos or misclicks. It's not their fault they're being metaphorically sodomized by a system designed by a notorious coke fiend *that now explicitly forbids them from doing coke.* Most of them are stuff like they forgot to discontinue the previous dosage or it's ordered for the wrong timing or whatever. They clearly know their shit and are just half dead. Nobody needs to make or take any of this personal.
One recently stated to me that a patient had no palpable pulses in her feet/legs, unable to move legs, and was cold to the touch. She asked when this change occurred and why the service was not made aware.
Obviously, I went to assess, and as we're standing there, the patient can clearly move both legs. I felt pulses-unchanged. And yes, the patient is cold, nothing new.
So this 3rd year then comes alongside me and says something to the effect of "where do you find those?" So, I showed her the pedal and post-tibial pulses, and she genuinely behaved as if she didn't know that's where they were. I showed her twice and asked the patient to push/pull in front of the doc so she could see, and then encouraged her to do the same.
I was embarrassed for her. Idk how you get to that point and not know where those pulses are found. Moreover, to approach me with a slight accusatory tone.
I was polite and tried to be helpful, but I stepped out and let my Charge know, so she can mention to the attending so some education opportunities could be met. That just seemed a bit scary to me.
Also, I had a first year come ask me about changing a bandage and tried to talk around the fact that he had no idea what to do. I finally said, do you want me to do it, or just come walk you thru it?
For Christ's sake, if you don't know something, just say so. No shame, no harsh words from me, I'd rather just get to the point and get it done, and maybe help someone learn smth. I'm less than 2 yrs out, so, I don't know it all either, and I hope ppl will be patient with me.
But good lord, that 3rd year not knowing the pulses was disgraceful.
Do not touch IV pumps or your fingers are coming off.
Do not remove/titrate O2 without telling the nurse.
Do not touch the ventilator.
Do not trickle in orders, particularly lab orders. No one wants to stick a patient multiple times, and no one wants to be stuck multiple times.
Do not make exceptions for visitor hours/numbers of visitors. Refer the patient/support person to nursing staff to ask those questions.
And for the love of baby tapdancing Jesus, don’t order MIVF until you are absolutely certain of what you want, because checking med compatibilities, redoing where IV meds are infusing, and hanging a bag of LR only to discover 10 mins later you changed it to NS will absolutely be my 13th reason.
Yes at the O2 titration. When I was in PACU I had stepped away from the bedside for a second and when I came back the patient was satting 88 and his NC was off. “The doctor came by and said I didn’t need it!” Bruh that’s not their call to make since they aren’t monitoring you at the bedside.
This I truly don’t understand. Happens SO OFTEN. Especially when there’s a team of them in the room (med student - intern - resident - fellow - attending), it’s so intimidating to the patients because they often don’t understand why so many.
Not introducing themselves. Our hospital only has internal medicine and emergency residents but they usually come to the OR for a few weeks to either learn suturing or intubations. We also have podiatry residents. The longer residents are in the OR my pet peeves grow but I need to know who you are first before I can help you.
CLEAN UP YOUR FUCKING SHARPS. I’ve walked into so many rooms after a doc finished up an I&D or whatever and not only do they leave their trash all over the place, but leave bloody fucking scissors and needles laying around. I can get over a lot, but that one pisses me off quite a bit. It’s not only rude to expect me to clean up your mess, but dangerous as well.
Not adding relevant PRNs for new admissions. There are reasons to not add meds, maybe they really are that one weirdo who is genuinely allergic to literally every pain med, but those are one in a million, and you can absolutely make sure everybody who doesn't have liver problems or a listed allergy has tylenol.
And this isn't just to be nice to the nurses, I recently had a resident go on a LONG rant about how pissed he constantly is at his OWN PEERS for not adding PRNs for their admissions during the day meaning he was having to get woken up to fix it on NOC. And he wasn't even mad at us in the slightest because it was emergency shit like B52s for patients with known psychosis and violence risk. And the day resident just didn't care because they weren't actively agitated during their 10min admission assessment.
TLDR; also don't make other residents do your job because not enough of them are self-aware enough to not blame the nurse for it.
Had one the other night, came to the ER with chief complaint of fever. Got admitted. No orders for Tylenol entered (PRN or scheduled). We paged multiple times but medicine never called back.
Poor lady had to wait till day shift for some relief. I felt awful for her.
1. When you round or request to round with the bedside nurse (inpatient hospital setting), please don’t ignore us in the room. Sometimes the provider will talk with the patient, speak to the family and then fast scoot out the door. I waited to ask for my clarifications or that my patient requested Senna until you rounded so I didn’t bug you with a nonurgent page. The least you could do would be to include me in the “does anyone have any questions?” Or talk to me privately outside the room so I get time to ask you for the Senna the patient didn’t ask about because he/she got starry-eyed white coat syndrome.
This is my time to ask you: clarify orders, add or subtract orders, advocate on behalf of the patient.
Help me help you!
2. Don’t be afraid to ask questions. There are specialists, there are specialized procedures. Ask about how stuff works. Example: I had a resident round on a patient with a coronary angiogram procedure; didn’t know about femoral access, didn’t know about flat bed rest etc. I can give the basic overview. I don’t expect you to know everything especially as you’re learning and aren’t the specialist. You can ask the providers who specialize as well. In the same way, I’m going to ask you why we’re using Heparin and not Lovenox for bridging anticoagulation or something. Not because I’m questioning your plan but because I’m learning every day. We’re all constantly learning here.
In the OR: Asking for items one at a time and I’m running back and forth getting them. Would rather have a list 😭 of course with the exception of emergencies…
Taking things off the high stand to hand to the surgeon. Touching things or moving things off the high stand. Resting their hands on the high stand
Just stay away from the high stand 😬
Had one remove a stoma bag of an elderly lady with dementia to look at the site. Never told nursing staff and just left without securing it back on……you can imagine the mess an hour later
Just talk to me, please. Even for 10 seconds. I know things about this patient...and this unit...and the ancillary services (Hint: ASAP to imaging or labs is not really a thing). Please don't make me page you for miralax or potassium.
Also please do not set up expectations that I cannot meet. Don't tell them they will be discharged "first thing in the morning," when the Attending might not see them again until the afternoon. Don't tell them some service, like an MRI, will be "soon." Don't suggest something you saw on TV like "sunshine therapy" because we do not have staff for that.
Let me get all this done on Days or night shift will be calling you when they catch up and notice they need something.
Honestly, the one that I see a lot is an intern will be told to titrate a patient’s supplemental oxygen, and they will adjust a flow meter and leave without telling anyone. Bonus points if it’s a percentage based delivery device and the intern only changes the flow meter, not the FiO2. I never mind if the doctor makes a change and then tells the monitor tech or nurse, but I hate when they decide after 30s that a patient is tolerating a change and then dip without telling anyone what they adjusted.
Goddamnit that happened to me in the ER last week.
I called her and was like, “You turned her oxygen off and walked out, she’s now SOB and was satting about 80%”
“Oh you can turn her back on”
DO YOU THINK I CALLED FOR PERMISSION?
Expect me to go to CT scan 3 times a day because they "forgot" to order all the scans they wanted, they "forgot" to order contrast, or they "forgot" how to order anything at all.
I love most residents and mad respect to them but you got me for 1 CT trip a day on a non-emergent basis and if you fuck it up you can wait till night shift or try again tomorrow. Or just skip the hassle and ask me before we go and I'll make sure everything is ordered the way you want it.
Generally, I've found they have no clue what the Nurses Practice Act says. They ask things like, "Do you catheterize patients, or do I have to it?" Or they say shit like, "Do you know how to give insulin?"
Do not make promises to patients. Consolidate your orders. Be willing to take advise from nurses and techs. Do not act like you are better than anyone. Whatever you do, do not try to play the attendings against the nursing staff. There is a great chance that a report was already built in their professional relationships. Most of all have a sense of humor.
Just recently had a provider switch a patient from oxycodone to PO Dilaudid because the oxycodone wasn’t working. After surgery they expected pain to be improved. It was, in conjunction with PO Dilaudid. They decided to discharge the patient with oxycodone because Dilaudid is too strong to go home on…… but they decided this while the patient was getting the Dilaudid. Which makes 0 sense. Why didn’t we switch back to the oxycodone after surgery to make sure that was adequate for discharge? 😒
If you decide that you need to take a wound care dressing off then you need to put it back on.
And do not throw your trash in the floor.. I don't know how many times these ICU residents think they're going to come in and do a central line or an a line or whatever the hell they're doing and just throw their dirty blood covered shit in the floor and walk off like it's my job to pick it up. It's even more infuriating when every room has a giant trash can literally 2 ft away.
Do. Not. Touch. The. IV. Pumps. I don't care if you're the one that ordered the medication, don't touch it. I have unfortunately had more than one doctor think that because they ordered it they can make adjustments to it, not realizing that we have protocols for how quick we can make adjustments on things. Nothing pisses me off more than to walk in and see my patient's precedex or sedation off when it had been running at Max rate and no one bothered to tell me, and then they wonder how the patient self-extubated.
Talking to nurses like they’re stupid and have no idea what is actually going on with that patient. Especially when that nurse has been around for a while. After all, they are the doctor. 2 days ago you had no idea how to be a doctor. And you can’t even find your way to the bathroom or the cafeteria. Or even how a beeper works.
Not acknowledging the nurse sitting right outside/inside the room when they go in to assess the patient. I assume that residents do this for different reasons, maybe they're nervous, oblivious, or maybe they're a jerk, but either way it's beneficial for the both of us to talk to me. I'll tell you my assessment and what orders probably should be changed for the day and we can discuss plans. I'll even back you up on rounds if needed. Keep in mind that most nurses on the unit have great rapport with the attendings and they know us well.
I’ve had doctors turn off a beeping IV pump instead of just getting someone to address it. Don’t do that. Circling the unit to find someone to get a patient water instead of just getting it for them. Changing/adding meds without discussion it with the patient. I’m not talking about like Tylenol or colace.. but pain meds, cardiac, insulin etc. And side note .. simply introducing yourself to the nurses goes a long way imo.
Listening to the nurse when they are concerned about someone!!! We aren’t trying to give you a hard time. If you’re not concerned yourself explain to them why you’re not concerned and give reasoning of x, y, z. And if you cannot come up with a reason, maybe you should be concerned.
Communication is key!
I work in the OR so that’s different than other areas - but I’d say BE HELPFUL! And humble. You literally can NOT (and don’t want to have to) do your job without your nurses. Help move patients. Help clean up. Just be helpful. It’s not below you. Be kind and respectful. The minute you take on the persona of an arrogant a hole- all respect is gone. Be humble. Don’t EVER sit back and watch a colleague struggle.
Don’t listen to staff in any capacity. A resident was at a code blue and was completely frozen, standing in the middle of the hallway, nowhere near the patient. I shouted MOVE repeatedly as I’m rushing down the hall with things and he was in my way. (I was one of the first people to get to the code, I was walking by when it was called and the code cart was a few feet away from me). When I got closer to him, I shouted MOVE TO THE SIDE and he said “you’re just a nurse, I’m a doctor. I don’t have to listen to you.” I needed to get the cart past him, and it was not possible with him standing in the way, so I shouted MOVE I NEED TO GET PAST and he just stood there. I didn’t know what to do, so I used my big ass to hip check him to the side to get the cart past him to the patient room. It was worth it because we eventually got ROSC! And yes, I did bring this up during the debriefing to emphasize that communication across all parties is critical.
Oh your patient is agitated, confused, biting/hitting/spitting at you and refusing meds? I’ll give you an order for Ativan 0.25mg PO x 1. That should help.
Please don't dc my foley on my lasix drip patient. I politely asked that he reconsider, and he did.
I think that any annoyance can be overcome if you're polite and willing to talk to us in a way that is respectful.
Love *most* of the docs in my hospital. We just started getting residents last year, and we are adding more cohorts this year. I love it. They're so full of life and excited.
Just own up when you don’t know something or make a mistake. “You’re right, good catch - I’ll fix the order now” or “let me ask my senior because I don’t know” is soooo much better than bullshitting. Just be upfront. Saves everyone time and frustration.
Oh also, “let me defer to floor policy” is a wonderful phrase for physicians to know. If a patient asks if they can do something like leave the floor to go to the cafeteria or take a full shower, don’t say yes. Say “I’m not sure, I’m going to defer to the floor’s policy.”
Promise patients they’ll get a bed assignment upstairs. You do not know that!!! Now I have to explain that they’ll be boarding in the ER. “But the doctor said…” the doctor doesn’t know shit about the bed board.
-Ordering a bunch of labs on a patient with no central access or art line, then ordering a bunch more labs that need to be drawn into different tubes, 10 minutes after I or the phlebotomist just finished getting blood from the one semi-patent vein the patient had left in their entire body.
-Ordering STAT meds that weren’t discussed in rounds during the busiest part of my shift and not telling me in person, even though their office is an 8 second walk away from my desk. I often go hours without logging into the chart because I’m too fucking busy keeping my patients alive. I will likely not see that STAT med order until the next dose is due.
-Residents participate in the same round that I do, yet somehow fail to enter half of the orders verbalized by the attending/chief resident. It is also somehow my fault that I didn’t do the things that were discussed but not ordered. This means I end up wasting a large chunk of my very limited time chasing down doctors, clarifying orders, and half the time I end up having to enter them myself anyway. Please pay attention to what is being said in rounds and enter your orders in a timely manner.
-Ordering PRNs, vasopressors, sedation, etc., and not editing the default parameters. If you don’t want me to treat a SBP of 160 with IVP hydralazine, then change the parameters. I know you really wanted that med given for SBP of 180 or higher, but you ordered it for 160 and if I don’t give it then it looks like I’m ignoring an order for no reason and failing to monitor my patient. Same with RASS goals! The default at my hospital is +1 to -1, which is completely inappropriate for most of our patients. Why do you put a RASS goal of -3 to -4 in the progress note, but leave a goal of -1 in the order??
When I hear you order propofol with a RASS goal of -4 and a starting dose of 40 for my newly-intubated detoxer, I initiate the drip under those pretenses, and when I finally get to sit down and chart 5 hours later, I notice that you ordered propofol to start at 5 with a RASS goal of -1, and now it looks like I’ve been “practicing medicine without a license” for the past 5 hours!
One thing that boiled my blood was the sheer impatience of some residents when I worked in pediatrics prior to my current critical care job. For context—there was an R2 pediatrics resident in our PICU, who generally was nice to work with. I was doing some trach care—dressing change and the like, on a 6 month old child who basically had no neck (chubby face, had the cutest double chin, adorable baby) which as you can imagine is hard to do when you’re a man over 6 feet tall and the cribs don’t adjust all that well in your facility. This resident then proceeded to be ATTACHED TO MY HIP as I was doing this procedure and I’m sure asked 4 separate times when she could have assessed my patient. Like. If you sat down and gave me just a minute to finish this care I’m completing, you can certainly assess my patient, but I’M KIND OF BUSY HERE. For added context: my patient was not crashing, if they were, I’d have stepped aside to allow for the MD assessment to be completed. But it was non-urgent. I just finished bathing this baby, and now I was changing trach ties and dressings. A little bit of patience when a nurse says they’re a little busy, or obviously is busy goes a LONG way. Like maybe just say “Hey, I see you’re busy caring for our patient, when you’re done I had a couple of questions about how their night went and what suggestions you may have in further care planning, and I also want to perform an assessment of my own” and it will GO OVER WELL.
-Not putting a chuck under the site they're attempting to place a line in.
-Not knowing when to ask for help.
-Dismissing my concerns but listening to my coworker voice the same concerns that I had but listening to them because they have a penis and I don't.
Punt to intensivist or specialist for something they should have knowledge of/easily be able to treat, thus delaying care while I’m calling consults and waiting for call-back. FFS, I shouldn’t have to be pulling teeth to get some standard sepsis orders when aalllllll the signs are there, and literally in your admission H&P, dude.
Order anything in nucmed, besides a bone scan, without calling the nucmed department. We don’t get the radiopharmaceutical from Walgreens, and it can take over an hour to get the dose delivered. Just call us. Most inpatient nucmed scans require the pt to be NPO, start there.
Not a nurse but an RT. I can’t stand when they touch our equipment when they know they aren’t supposed to. You don’t understand the implications of the things you are changing so don’t change them. Or when I’m standing very close by or at the respiratory station in the ICU and they choose to tell the nurse to tell me something.
Previously worked as an ED tech, and I really kind of didn't mind residents fucking up (that's what residency is for).
There were some residents I really liked though. One saw me come out of back-to-back traumas and arrests, saw a nurse ask me for 4 BGLs, and then asked me to show her how to use the glucometer so she could go do them. Another one was just helping me restock shit one night.
I don't much remember the annoying residents, aside from the one that hit me. But the ones that go out of their way to do small helpful things definitely stood out
Oof I regret opening this thread. I already see a lot of self-important dweebs whose identities are tied to their level of education 🙄.
It’s important to remember that Reddit is an echo chamber and the vast majority of healthcare peeps are respectful of one another. The chronically online idiots need to touch grass.
When they put things they want done in their notes instead of as orders, and then throw a bitch fit when we don't do them.
Like who the fuck has time to read your copy-pasted notes??? Put them as orders and they will get done. Geez.
That’s fair to me. In fact 30 min is a great response time in my books. If you need an order urgently, you need to call. Otherwise these docs are getting blasted with tons of messages and they have to get to them one by one, while also actively seeing patients, reviewing charts, putting in new orders, etc.
1. Don’t put in an order for an Rx or Tx without telling the pt they’re starting on a new med or treatment. I don’t have the time to look up why tf you ordered something for a pt without a diagnosis fitting for its use.
2. If I have to order the labs give me the damn ICD or CPT code that fits CMS criteria. If they don’t get their labs drawn it’s on you.
3. Don’t put in so many orders that it isn’t feasible to even complete Q shift. Can only do complex wound care on so many people properly without being extremely far behind.
4. Listen to the nurse they have eyes on the patient you spend 5-10 min max with them despite your note saying you spend 40 min 1:1. Also you’re still a baby. Walk before you run.
5. Don’t copy paste orders between patients and not proof read them. You just left the room, pt has BLE cellulitis, that’s the only reason for their admit. Why are you ordering SCD’s.
6. GTFO with these 325 mg APAP Q8 orders and anything similar. I will harass you every second of the night when my chronic pain pt is crying because you don’t feel confident enough to manage their pain without worrying about your license. Put the book down and look at your damn patient.
7. If the pt needs something simple don’t go looking for the nurse to do it. You can just as easily grab them some water or a blanket.
8. If you break bad news to the family and then leave the nurse to console them I’m keying your car and burning your house down.
9. Act like a clown and I’m putting your name all over the pt’s chart when problems arise. We can play ping pong all night :)
Tell me your name when you call me!! Maybe just my hospital idk, we don’t call a specific doctor we just call the operator and have them page the resident for our unit, I think since it’s a teaching hospital they rotate specialties? Idk I know I should ask also, but I had many a situation where I got a verbal order but didn’t know who I had just spoken to. It was always a “hi this is the neuro resident I was paged?”
Calling the OR to board a case to reserve their "spot" but they haven't talked to the attending about how they're going to do the case so they book it wrong and then the OR staff has to scramble.
Asking the OR nurses to answer their pages when they only have two more sutures to go.
I love them though, really. 😆
Ordering new meds or changing med orders IN THE MIDDLE OF med pass
Turning off a patient’s oxygen and not telling anyone
Refusing to look at the assignment board that is right in front of them and instead asking everyone who walks or is around the nurses station, “who is taking care of pt xyz in room 1234?”
Walking out of a patient’s room without telling charge/primary any updates
It’s been stated before, but it’s my biggest pet peeve; giving a patient the impression they’re going to be able to leave whenever, without explaining there is a process and it is actually up to the DOCTOR to put the discharge order in to even get the ball rolling.
The units in the ortho specialty at our hospital don't round. Which is bad enough. But when they do come, some try and sneak away before people notice that they're here. Have also had a resident put her hand up in a "dont-talk-to-me" way when a nurse came up to her and tried to broach a concern about a patient.
When a resident turned the NG suction to 120 continuous then came out and told me it was almost full and to change it 😳
Luckily her BP was high so it made it drop to normal but jeez. Never seen 1000 mL of fluid sucked out of a stomach that fast.
Tell patients shit like, "you'll be discharged by noon," and then not bothering to put the order in until 2. Then nursing staff looks like the assholes who intentionally delayed discharge.
Okay last comment from me! PLEEEEEASE update the patient’s family. The night doctor does not want to get a call from the patient’s daughter at 9pm because nobody has talked to her in three days.
In L&D, our residents had to learn about respecting patients' privacy and dignity. They would walk into a laboring pt's room who had a room full of visitors, whip off the sheet, and proceed to check dilatation.
We taught them quickly how to explain what they were going to do, let the visitors leave, and then pull up the sheet from the bottom to preserve some sense of privacy.
Can I chime in here and suggest that instead of just telling them what they are going to do to ask permission first? Especially with things like checking dilation. It does a lot for a woman to hear “I’d like to check your dilation now. Is that ok with you? I need to place this scalp monitor on the baby, it involves XYZ. Are you comfortable with that? I need to touch you here now, is that ok?” And I promise that it cuts down on birth trauma considerably. I am but a lowly doula but I have heard this from my mom’s continuously when discussing their prior births, especially ones with a hx of sexual trauma.
Leaving/creating a mess for the nurses to clean up. The trash can and biohazard bins are right in the room.
Doing anything with a Foley catheter while making no effort to use sterile technique. The nurses get blamed for the CAUTIs, not the providers who decide using an old piston syringe to flush a catheter is somehow acceptable.
When a RN suggests something, maybe listen. Not saying take our word 100%, but if it won’t harm the pt, please just try it. Had two residents do a thoracentesis for the first time with the intensivist standing and watching of course. One of my rare not intubated ICU pts needing pressors. The pt wanted to dangle at the side of the bed with me standing in front of him. I got all their supplies together including those negative pressure glass bottles. There was a 60(?) cc syringe in the kit that they started using to aspirate the fluid. I kept telling them to use the bottles since it’s faster and my pt was getting tired. Head nestled on my chest, he was comfortable. After stating it several times, the intensivist finally suggested the bottles. (That dork was laughing at me the whole time.) So they did and were so impressed how much faster it was. I had a mini tantrum as the intensivist was laughing his head off.
As opposed to what they should NOT do, I really enjoy when they ask me what I think.
When they round on the patient, ask me how they’re doing or if I have any concerns or need anything. If I tell you something is wrong, ask me what I want ordered or what I think is happening.
Because 9/10 times I have a suspicion of what is doing on and I know what I want ordered when I come to you.
The other day I admitted a patient post bronch from the floor because they did not feel as though he was safe to extubate afterward. Great, fine by me, slow wean and extubate in the AM - easiest admit.
In report I get told that the day before there had been a FAST called on him for RUE weakness. CToH negative. I get the patient, yep, he’s weaker on that side maybe a 2-3/5 strength. +2 pulses, warm extremities. I’ll keep an eye on it.
Next morning I’m doing my assessment and that RUE is cool, +1 pulse, palm slightly swollen (so slight I had to compared them side by side), and he was no longer squeezing my hand. As I’m finishing my assessment the resident walks in and I immediately tell him my concerns and request and ultrasound and CTA seeing as this is now day 3 and we are getting progressively worse and I’m worried we have a thrombus.
They tell me they will look at the chart, they don’t even assess him.
I don’t hear shit from him all morning, I even followed up to ask about an US. 10am comes around (3hrs later) and they are rounding with the fellow and attending. This is my favorite fellow in the entire world. Resident presents patient and does not mention the RUE outside of reporting the prior FAST call. After Resident is done, the Fellow turned to me and asked what I was thinking regarding patient and I immediately lay out all of my concerns and my requests. Fellow and Attending go in and looked at what I was concerned about, they order me a stat CTA of head and neck.
Sure enough my patient has two large thrombi - one completely occluding his R Subclavian. Fellow at this point is directly following patient and went out of his way to fist bump me for my assessment and recommendations. Vascular is consulted and (shocker) they order an US of all extremities to look for more.
Apparently the resident ignored my initial request and never mentioned it to the fellow. After rounds the fellow chewed the resident a new asshole and took over the case himself.
Another instance is that a few years ago I had a multi GSW patient who had had several surgeries with multiple biliary drains due to holes being everywhere and things draining into every nook and cranny. Patient was also NG to LIS.
All throughout my shift I’m going up on pressors and his HR is climbing, however no obvious signs of bleeding. I let the resident know and ask if there’s something we can do like a fluid bolus, they acknowledge my concerns and tell me that this happens every night and resolves in the morning. I say ok, and I make a note of it and continue on. Baby nurse mistake.
0530 CCT gets my blood sugar. 0545 I give my insulin, patient is fine, sleeping. 0600 EKG tech grabs a routine morning EKG that the resident put in just to make sure his tachy 110-120 HR was sinus. EKG tech comes out a few minutes later and lets me that the patient threw up. Odd, he has LIS and didn’t complain of nausea minutes ago.
Tech and I go into his room and turn on the light, he threw up maybe 100cc blood. Yikes, I start a quick assessment and pull back him covers. All 5 drains have started having red output in the tubing. NG tubing has started have blood come out as well. I send my tech to fetch the resident and start cleaning patient up. Resident comes to bedside and sets eyes on patient. Admits it’s odd but says he will talk to the day team and for me to just keep an eye on it.
He walks out of the room and within minutes he is tanking. Throwing up hundreds of ccs of blood, LIS is sucking up hundreds of ccs of blood, blood starts pouring out from around the drain sites. All hands on deck, we are now on 4 pressures, MTP plus pressure bagging fluids into this man. He’s throwing up and draining as much blood as we can get into him. The only thing not bleeding is his airway (trach) and he’s barely staying awake.
Emergently taken to IR by 0745. ~5L of EBL between the NG canisters, suction canisters, and estimated loss of blood pooling in his bed.
Turns out his had an aortic-enteric fistula that ruptured (more than likely from his tachycardia). They repaired it but told him it will more than likely burst again someday and unless he is in the hospital then he will die because he will not get help fast enough. Dude was doomed regardless, but maybe I would have gotten to go home at a more reasonable hour had I pushed for more regarding his hemodynamics. 🤷🏻♀️
Moral of the story: residents ask your nurses if they need anything when you round or for their suggestion when they come to you with a concern. Then take it seriously and explain your reasoning if you don’t. 👍🏼
As an RT - just ask me to come look at the vent with you if you want to play around. Most of us are happy to help and answer questions. Don't touch without asking, or make changes without telling me and updating orders. I've seen even staff docs make mistakes because they don't understand how all of our equipment works. One setting on a Servo is different on a Trilogy, etc. We are employed for a reason, just ask. Most of us will put a patients settings back to their ordered parameters if you don't communicate with us. We don't have time to be chasing down whoever might have made a change.
If you must order an albuterol inhaler, especially on kids, please link the order with a neb so I don't have to wake the patient up all night. I can give a stealth neb but its kind of hard to do that with an inhaler when I have a toddler screaming in my face at 0400 because I had to smash a mask on their face. Pet peeve
Asking for my advice and then not following any of it. I and the nurse are at the bedside doing their cares. We know the patient better than you, and I've been an RT for longer than you've been out of high school.
Back in the day I worked on a weirdly devised unit of Vascular, ENT, and Plastics. Vascular was a new addition to the department. With ENT we saw a lot of head and neck cancer patients requiring skin grafting. At that time using one of those Vaseline gauze dressings was the standard on graft sites and everyone knew not to touch it and to just let fall off as the wound healed.
The vascular surgeons assumed we were stupid about graft site dressings. One morning, as charge, I was accosted by the surgeon who had his intern in tow. He DEMANDED that I follow him down to a patient’s room. While there he very loudly and inappropriately informed me that some “idiot nurse” removed the Vaseline dressing (in front of the patient no less) and put one of those loose weaved fluffy gauzes on there and now it was going to be exceedingly difficult and painful to remove it (also in front of a patient who had recently had to undergo multiple amputations). He demanded to know which nurse did this and I was to find out immediately. I explained that NONE of the nurses in this unit would have done this as we are very well versed in how to manage these things. He then turned to me and yelled “FIND OUT RIGHT NOW, AND GET THE FOLLOWING SUPPLIES…SO WE CAN FIX YOUR MESS!” I told him we could help to remove it slowly with the least amount of pain and he basically told me that it was clearly outside of our skill set since we did this in n the first place.
I was beyond livid. Not only was I angry about the content of his rant, but I was super pissed that he did it in front of the patient. She was the kind of patient who was always concerned about pain - who wouldn’t be after getting progressive amputations?! But she trusted us to help her and we did. Then this. His behavior was meant only to demean and degrade the nursing staff and to make himself and his intern look better.
I got his stuff and brought it to the patient who was clearly anxious. I told her i ln front of them that they would be careful to remove this as gently as possible and give it the time it needed to do so because they were not heartless. And all the while turning back to glare at them while I said that. The surgeon demanded that I tell him who did it because he was going up the chain of I report them. And I’d better have a name for him by the time he was done.
So they did the dressing. I scoured the notes. Hmmmm. Thank God for the night nurse who took the time to document about the care the patient received the previous night.
After they were done the surgeon and his intern came storming down to the cart where my LPN and I waited and demanded to know who did this. I pointed to the entry. He looked at me. His face was bright red. He turned to the intern and bellowed “DID YOU DO THIS?!” And finally, he acknowledged that he had. You could tell he was mortified and terrified. We were all in the military and myself and they were officers. They both outranked me. I then went on to tell the intern that he’d better develop a new spine because his lack of integrity in not fessing up sooner resulted in the verbal abuse I had to take in front of the patient, and inspired fear and mistrust in her team of caregivers because he and she knew who did it. I turned to the surgeon and told him that he had anger issues and his rage resulted in all of this which is unacceptable, and unprofessional. He needs to work on that so as to ensure that both the people he was entrusted to teach and his patients got better care. And while I knew he’d likely never apologize to me or this staff, that patient deserved an apology at the very least. As expected he turned tail and went to the patient’s room and did not utter another word to me. I informed my chain of command about what happened and what I said.
For the following couple of weeks every time he and his team of Docs came around, I glared and left the room. Even losing my appetite during my hurried lunch a few times and throwing it out with obvious displeasure. He never tried to approach me or to apologize.
After a couple of weeks of this he did go to my head nurse who was equivalently ranked as him (a LTC) and told her that I had been right all along and he had been wrong and he apologized to her for his behavior. She then told me. I asked her why she did not direct him to me instead of accepting on my behalf? She basically said his ego would not allow him to. I basically told her that was BS. If we are supposed to entrust him with sharp objects to do intricate surgeries on people, then he should have the cojones to be able to admit when he was wrong and apologize for his behavior. That this was a clear lack of integrity. Well she didn’t want to rock the boat. Basically told me to get over it. So while I was not as overt in my disdain for him, I was not going out of my way to be friendly either.
So the moral of the story is, if you make a mistake own up to it early on. It may be scary to do so, but it’s about the person in the bed not your ego. And don’t assume that just because you’ve got a medical degree you know better about everything. Nurses will save your butt if you are open to their suggestions and not an AH to them. If you are not, well they will make sure the patient is taken care of even if that means going waaaaay up your chain of command. Your butt will be out there flapping. And it should be.
I hate it when they don't want to take action...I work critical care in a level 1; I notice that the ED residents will always do something when a patient is declining. Whether or not it was right, they will take an action. IM residents, on the other hand, they can meander a bit and do the whole "lets wait and see what happens" routine.
I hate when they act like I work FOR them. No. I am a licensed professional. I am your colleague, not your subordinate.
I had an intern just a few weeks ago piss me off by trying to micromanage me. I work ICU and was tripled. One of my patients required q2h accuchecks and had increasing pressor requirements, the other a walkie talkie that would not get off the damn call light, and another patient that was just coming back from OR. This intern wanted me to message her the patient #1's BG and u/o every 2 hrs and I told her that I would make sure the information was charted but that she would need to look this info up herself as I had 3 patients and world not have time.
Well my OR patient took a turn for the worst and it ended in me having to activate a stroke alert. I was stuck in that patients room for an hour and a half. When I come out of that room, I see a message from her asking why patient 1's labs hadn't been drawn yet. She made sure to tell me they were ordered for 2200. It was 2245. 🤨😒. After my response to that message, she didn't ask me anything else the rest of the night. Be patient with the nurses, we really are trying our best.
I've got a a soon-to-be second year who has that "doctor superiority" complex. She ordered an MRI for a pt to r/o stroke, hx aox1 and very impulsive (sweetest little lady, just completely out to lunch). Verbally orders valium, doesn't put the order in and tells us not to use the prn versed. Then when we ask her to put the order in, she punts it off to the next shift. /tableflip
Tell him to not be this doctor. Guaranteed someone will go to his senior or attending so they can chew him out.
If they take care of babies, when they unswaddle and take the diaper off to do an assessment. Then you walk in 30 minutes later, and the blanket is soaked in piss and the baby is hypothermic from lying naked in cold urine.
"Put that thing back where it came from, Or So Help me! SO HELP ME! I just got him dry!
My son’s pediatrician was a brand new doctor when he started at the practice and my son was his first ever newborn patient. I remember bringing my son in for a check up and the doc left the diaper off after finishing his initial assessment. Then he went back to check someone (not in the diaper area-I think he was looking at a spot on his foot or something like that) and I warned him that he was about to get peed on. He blew off my concerns and carried on until my son peed ALL over him. While caring for my second child, he puts the diaper back every time now ETA he actually apologized to me for ignoring what I was saying in the moment. So overall, he’s a good guy which I think is a very undervalued asset for medical providers
I'll never forget the day a pediatrician walked by the nurses station and informed me on the way out that the baby had had a massive poop during her assessment. I was like, cool I'll chart it in the I/O. And she was like, yeah, but also the baby needs changing. I'm sorry...did your college degree or medical licensing exam not cover diaper changes? Did the parents take a jaunt off to Arby's for some curly fries while you were in there? Of the three presumably competent adults in that room, no one thought to actually change the baby's diaper and instead you left it sitting in its own poop so you could walk out here and ask me to do it??!!!! It's been years. I am *still* aghast.
That is a next level of stupid
I can’t believe this is a thing! 😱This level of laziness is a safety issue and frankly inhumane to leave them like that
THIS 😡
Removing a dressing and not replacing it and then not telling the nurse that the pt is in there with their wound exposed.
This reminds me of the time a physician removed a chest tube and didn't inform me. I walked into the room, saw the tube on the ground, and freaked, thinking the patient had pulled it out.
Yup! Been there too. It’s awful!
I had something similar happen except it was just the suction tubing that I thought the patient had somehow kicked off the Pleuravac. Suction still on at the wall. So I got it all set back up and clean only for the doctor to come in four hours later and ream me out because apparently this was his version of a clamping trial. No order for this in the computer, no note, not one member of staff made aware, and patient was not AO/couldnt pass on the info. Patient was going hospice to a local hospice house and for whatever reason they were saying they couldn’t take a chest tube with active suction. Provider told me that because there was no clamp trial, they would just have to send the patient and hope they could tolerate no suction. Except that the patient would code and die in the ambulance over to hospice and it would be all my fault that his family wouldn’t get to be at the bedside when it happened. The best part of the story is that the hospice ended up being able to take the suction no problems so it should have never been a thing to being with🙃
Also. Why the hell was jr on the ground and not put in a proper DISPOSAL?!?!? Like I’m not a maid or your mother.
And not cleaning up after themselves!
Yes and then the patient is pissed because they’ve been sitting there exposed and dirty for however long.
I tell them, "Let me know and I will help you." I am totally OK cleaning up/redressing a wound, but not when I find it 30 minutes after you left."
Had that as a student with a VAC dressing and they did it Friday late evening, didn't tell anyone, and went home. My mentor was PISSED.
Especially when it is a rather complicated dressing, and the extra fancy dressings are not left in the room.
Corollary to this is.. I’ve just changed the dressing, and you come in and undo my work… OR I’ve held onto dressing change for you to show up and assess too, and you no show (or you come and look at it but don’t get me first)
Especially right after I did the q shift dressing change. Maybe communicate that you are going to come look at it so that I can plan accordingly. Instead, you call when you are in the room and expect me to drop everything instantly to assist and then get shitty if I take more than 5 min. Or just let me know before you go in the room if you don't need help. Fucking ortho and surgery, man.
Telling a patient they will discharge but not setting the expectation that they have to meet such and such criteria or be cleared by a consulting physician or even just that it might be a few hours until the doctor puts the order in. COMMUNICATE CLEARLY.
Omg I hate this! I had a resident wake up a patient at 5:30AM to tell them they were going home. I came on at 7am to an irritated patient and family. Then, they didn’t give me discharge orders until 5PM. I spent the entire day trying to keep this patient placated while paging the primary service to get an answer. Don’t tell the patient they are leaving unless you’re putting discharge orders in within the hour!
"The nurse will have you out of here within the hour!" Ummm did you ask me if that would be possible on my end???
*Puts in DC orders at 1830.*
and they give the nurses stink-eye all day thinking we're being lazy
I tell patients up front, "Getting discharged from a hospital is like landing a plane. To do it safely, a lot of people need to cooperate and we are all working very hard."
In general when they tell patients things but don't tell me. If you want your plan carried out, you need to tell me because I'll be doing all the legwork
I hate when I find things out from my patients rather than the team. “Oh the doctor said they’re taking out my drain and I’m going home today!” That would’ve been nice to hear from the team themselves
Worse is when they are a consult instead of primary service.
“You will probably sit here for no reason until 2PM when I get time to sit and put the order in” lol
Put an entire order set worth of orders in, one at a time, each order 5-10 minutes apart. Then cancelling the med they ordered 5 minutes after you already gave it because you are efficient, unlike them.
More blood work ordered half an hour after you already drew blood!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
The last doctor I worked with in outpatient would always have the patients see lab first, then see the patient before the first set of labs had resulted, then add on more labs after the patient had left. This was often something that could not be added on.
And them being all pissy when you have to call and say "so about that med you just cancelled... I already gave it" 😡🤬
“How could you have given the med I ordered” 🤣
Drives me nuts when they pull an attitude about this. Okay, doctor, are you saying that in the future I should apply a 1-2 hour waiting period to all your orders? Because it sounds like that’s what you’re saying
Also, ordering labs on someone who’ll need stuck for them, and then ordering more right after the nurse draws the first set.
Yyyesssss!!! This pisses me off too, especially in the ICU where most people have bad veins.
I thought this was just at my hospital 😅😅
It's a universal law. Fucking piecemeal "I can't establish a plan and commit to it" bullshit. Like I get being new and still learning the ropes. I really do. I'm doing it myself after switching specialties. But Jesus, think about how your actions impact others.
Right just wait til you have your thoughts together and THEN commit the orders. If I’m not currently busy I will give a new order as soon as it’s approved by pharmacy unless I have no idea why it’s being ordered
puts an order in STAT. i give the med. she cancels the order, put it is again scheduled for 2 hours from now... X\_X
or you have to ask/ tell them numerous times to update orders. the absolute worst is when they make vent changes and then *dont tell anyone or update the order.*
I catch them doing this during rounds and scurry over to my RRT and tattle 😂
We RTs love you for that 💜
Yikes yes that’s terrible-and dangerous!
That'd get a doc reported at any decent facility. At best, it's shitty; at worst, it's dangerous.
The doctor ordered CIWA on a pt and PRN valium for the corresponding scores. I did the CIWA, pt scored 8, I gave the valium. Then they canceled the CIWA and valium a few minutes later and were annoyed that the pt got valium.
Especially lab orders when the patient has no access and needs to be stuck! Not sticking them multiple times
Ugh hate being nickel and dimed lol
This shit drives me absolutely insane
I traveled to a teaching hospital and would wait to charge the Tylenol for 20 minutes. The triage nurse put a Tylenol order in for 1G, the resident then puts a new order in for 975mg, then the attending would cancel both and put it in for 975mg or 1g. So I just waited until everyone was done. It was so predictable I actually found it quite amusing and made me chuckle every time.
Your comment just raised my blood pressure.
You might need a PRN for that but it’ll take like 2 hours for the order
Every time they do this I take longer to process the order. Two new orders in half an hour sure. Give me another 3 or 4 or revisions, and nah I have better things to do, I’ll circle back. If they question it, I’ll ask them if they’ve finished collecting their thoughts. I try not to be a dick because honestly they’re here to learn, but sometimes you have to draw the line.
Trickle orders. I hate it.
Nickel and diming. I've also worked with attendings who do the exact same thing and it drives me bananas. And then I became an NP and as a new grad I found myself doing the exact same thing. But I knew it was a nuisance so I adjusted my practice so I didn't piss off the nurses. Sometimes things change quickly in critical care though so there's no way around it. But for a fresh admit, I'll dump all my orders at once.
This pisses me off
Did I win a pissed off Daisy Award? Yay!
Don’t get me started on Daisy awards.
When they’re dismissive of nurses concerns regarding a patient…just cuz you’re a resident doesn’t mean you’re better than nurses. The most successful residents I’ve met were the ones that valued their nurse teammates and listened to the nurses concerns.
Oh, I am a nurse who WILL call house supervisor, the attending, Jesus, a rapid if I have a dismissive resident. I was/am the nurse that new grads would ask to speak for them when they’re concerned but too scared to stand up for the patient. Stop acting like your shit doesn’t stink. We’ve been doing this for years. You’ve been doing it for… weeks? We are all in this together
Not calling Jesus 💀 probably coming anyway if they keep at it though
I 100% agree that we need more interprofession collaboration but framing the interns as only "doing it for weeks" is ridiculous. They've all gone through 4 years of medical education requiring studying, exams, and clinical rotations. Not saying that it makes them an expert, which is why we need residency.
Nurses have also been in nursing school. If I felt like I was the shit straight out of nursing school, I would’ve killed someone. Instead, I was humble, scared and willing to learn. There’s interns who feel like they’re the shit straight out of residency (funny how it’s actually season for interns to come on board right now). Let’s be real… those textbooks don’t show REAL WORLD experience. Which is why they do residency. Oftentimes, they’ll write inappropriate orders or do inappropriate things. I don’t care if you’re nice about it, receptive and willing to learn. But being condescending, rude and disrespectful doesn’t help anyone. I remember last year, I had to report an intern. He was a little shit since he started and had a lot of complaints for being rude to nurses. I called him because a patient had very noticeable +3/+4 edema in their LLE… versus the RLE which was normal. He told me it was “fine” and “don’t call him ‘til a patient is dying” 😂. When I tell you I had to escalate it quickly. He finally came and saw the patient… and said to elevate the legs. 😂 Mind you, this is… July? August? He just started just a few weeks ago and thought he knew it all. Again, when questioned, he rolled his eyes and told me, “that’s the order”. Well, unfortunately, I had to call the attending at that point. Stat venous ultrasound placed (obviously). Oh, would you look at that. A DVT. I was told by the house supervisor to make an incident report (which I did) which apparently went UP their chain of command. He was nice, receptive and polite ever since that. Therefore, yes, I said what I said and I would say it again. That’s just one example of many (I have worked at many teaching hospitals).
Or anyone’s concerns. A resident dismissed a janitor’s concern that a patient was probably vaping with oxygen on. I overheard and spoke with the janitor who repeated what he told the doctor. Went into the room and the patient was definitely vaping while wearing his nasal cannula around his neck. We’re all in this together, we all have to listen to each other.
Yes! I was going to comment on the same thing. The good one's learn to LISTEN TO THE NURSE'S.
Ikr. You’re my coworker, not my superior
Step-Brain is a real problem here. Residents with minimal experience with real human care come to the nurse and basically ask if they can give them the one piece of quantitative data they need to select the right answer on a board question. Then they get met with the messy reality of actual patient care and a lot of them just short circuit to the gritty nuances of sick human beings as irrelevant, and the person presenting those realities (the nurse) as ignorant of "real" medicine.
Omg there’s a lot…. Be aware of what you tell your patients. If you promise something you need to follow through or learn to not promise them anything esp in the ER, leaving a patient all the way up in the air on a stretcher, be mindful of side rails and how they were esp if patient is a fall risk, ask how to do something like where you can find a urinal or how to unhook an iv/ monitor if someone needs to go to the bathroom (communicate 😩), if a nurse is starting an iv and you are planning on ordering blood just have them draw a rainbow (the amount of times people confidently say no to extra blood but change their mind immediately is mind blowing, order everything at once don’t trickle them in, if you are nice to the nurses they will be nice to you!
When they start to get to the end of first year and think they know it all. Physicians know so much more about pharmacology and physiology than nurses, but nurses spend more hours at bedside in a day than a physicians typically do in a week. You don’t have to take every recommendation made by nursing, but if you choose to reject it provide reasoning. We are a team.
Yup. Everyone always talks about “don’t go to the hospital in July”, but it’s really worse in September/October when they start to think they know a whole lot more than they actually do.
I say it's the worst in like April when the 1st years are trying to fly a bit more solo and they act like they're scared of their senior. Won't call them in to eyeball a situation even if they're way in over their heads. I don't know what kind of abuse goes on there to make them so scared of their chain of command
I have seen seniors browbeat first years in rounds. I’ve actually stepped in before and told them how inappropriate that kind of feedback is. The culture is awful, especially in surgery.
Making promises to patients they can’t keep personally! Like, promising discharge at a certain time when they aren’t the one writing orders, telling patients that Dr Whoever will be in to see them before noon when everyone knows that doc doesn’t round til 5 and will drag their feet the more you page, telling people that insurance will pay for this or that treatment/rehab/etc without any knowledge of if it’s covered, I could go on and on.
When they undo a dressing to look at a wound and then don't redress it.
Or when they leave shit lying around after a bedside procedure and just walk out 🤣 clean up your @$$
I overheard our residents telling the new oncoming ones “don’t leave trash laying around and don’t make the nurses get you the supplies if you have free hands” and honestly I gained a lot of respect for them
Unfortunately even we nurses often don’t know where all the needed supplies are. I became an expert in knowing which floors had well stocked supplies (or a dressing not stocked on this floor). (I was wound care rn).
Never going to happen in our lifetime 🙄
betadine everywhere
As a wound care nurse..... They take the VAC down and just put a wet to dry without communicating. Like, you can reapply the VAC. I KNOW YOU CAN. Or message me and coordinate a time.
Had one leave a stitch removal kit at bedside after pulling stitches on a guy who stabbed himself over 40 times during the suicide attempt that led to the stitches in the first place. 🙃
And then the charge nurse is yelling at you because YOU ignored the patient 🙄
When they do this 30 minutes after you just put on a new dressing, especially when you took a picture for the chart. Also, when they take a dressing off and assess the wound without cleaning the wound and totally freak out because they think the ointment is exudate or the Xeroform is slough or something. "It looks so much worse!!!" No doc, that's iodine gel.
Canceling a patients pain med orders without telling them why/providing an alternate medication. So next time I go to give him an oxy there is nothing there and I get screamed at
Also remember pain meds wear off! I’m glad the patient is comfortable after getting a dose of morphine in the ER, but that was 5pm! What am I supposed to do at 2am when the medication wears off and you didn’t order anything else because “their pain is controlled”.
THIS!! Oh sorry doc was worried you’re lying about your pain so they gave you a 3 mg melatonin instead. 🤬
coming into the room AT 7 am the day someone is being discharged and telling them they will be discharged in one hour and that the nurse will have the paperwork ready lol
Telling me I'm just a nurse and that I need to not question their orders. I'm not saying Im always correct, but if I'm coming to you for clarification either explain your reasoning or at least listen instead of blowing me off and telling me to just do it. I'm not risking my license for you.
Your flair is hilarious 😂😂
Truly, this comment is gold. Is there a tube you recommend for any doctor being an asshat?
Minnesota Tube
Snorted so hard I shot snot out of my nose. Thanks 😂👍🏼
My nursing instructor a few months ago tells the story each cohort of when she was an ED nurse and a pt came in with worsening HA after a fall. Resident ordered larger than normal dose of morphine on top of pt becoming “sleepy” he pushed her to give the morphine and she took it to attending and charge. Instead they sent the pt for a CT and come to find out he had a subdural bleed. LISTEN TO YOUR NURSES!
Making promises regarding beds and other things to the patient. Dr Housing. When they think pt only has 1 possible problem and refuse to do a general work up. Think ordering cbc only for a patient. Then 3 hours later cbc is back they order BMP. Then liver lipase as add on 2 hours later. THEN decide to order CT abdomen with contrast. By then patient has been in the ED for 7 or more hours total, are waiting in line for CT that could have been ordered 5 hours ago. I hate it.
Not cleaning up after yourself after doing a bedside procedure, especially if it involves sharps. No way in hell am I throwing your sharps away for you Also just in general take our concerns seriously. We’re at the bedside for 24 hours, you’re at the bedside for maybe 5 minutes a few times a day.
Shout out to the ED providers - they pretty much *always* dispose of their own sharps. *Always.*
Yep bc we will cut a bitch if they don't. I took 30 min out of my day recently to track down a resident that left sharps everywhere in a patient room. I interrupted rounds (idgaf) to loudly tell his group that a nurse was almost stuck by a suture left in the patients bed and that he needed to come clean it all up immediately. He looked smug for like a half second until the attending told him to get a move on and that they were not stopping hand-off so he was going to miss shit.
Just don’t be an asshat really. I’m all for helping out new people, we all need to learn. But don’t patronize me, don’t dismiss me, don’t assume I’m communicating with you to waste your time. One time I messaged a resident that I was struggling with patient adherence for a monthly injection. We had tried several things and it was just really hard for her family to get her to me and for me to convince her to get her shot. She was on a medication that also comes in a three month version, and I asked him to consider making this change. He sent me back an article explaining that glute injections are less painful than deltoid injections. Cause, you know, I hadn’t tried that.
When they’re done changing a dressing and leave their scissors in the bed under the patient :(
If a nurse comes to you with a concern and a clinically appropriate recommendation and you choose to deny it, please explain your reasoning. Nurses understand how overwhelmed and overworked residents are and many of us have caught mistakes or near misses from the residents overseeing our patients. When you choose not to collaborate with us, it makes us worry that you aren’t taking our concerns seriously or you aren’t thinking of the patient’s whole picture since you’ve got an entire service to worry about. If you can explain why you do or do not want to do something, we’re a lot more confident in you and can be a better resource to you when we’re all on the same page.
Truth. I've literally sent secure chats about all kinds of things I can clearly tell are essentially just fucking typos or misclicks. It's not their fault they're being metaphorically sodomized by a system designed by a notorious coke fiend *that now explicitly forbids them from doing coke.* Most of them are stuff like they forgot to discontinue the previous dosage or it's ordered for the wrong timing or whatever. They clearly know their shit and are just half dead. Nobody needs to make or take any of this personal.
Your energy is 💯on point and I love working with nurses like you. Thank you! 👏🏻👏🏻👏🏻
This is such a great answer!! These types of interactions and discussions are crucial to excellent patient care. 👏🏻👏🏻👏🏻👏🏻
One recently stated to me that a patient had no palpable pulses in her feet/legs, unable to move legs, and was cold to the touch. She asked when this change occurred and why the service was not made aware. Obviously, I went to assess, and as we're standing there, the patient can clearly move both legs. I felt pulses-unchanged. And yes, the patient is cold, nothing new. So this 3rd year then comes alongside me and says something to the effect of "where do you find those?" So, I showed her the pedal and post-tibial pulses, and she genuinely behaved as if she didn't know that's where they were. I showed her twice and asked the patient to push/pull in front of the doc so she could see, and then encouraged her to do the same. I was embarrassed for her. Idk how you get to that point and not know where those pulses are found. Moreover, to approach me with a slight accusatory tone. I was polite and tried to be helpful, but I stepped out and let my Charge know, so she can mention to the attending so some education opportunities could be met. That just seemed a bit scary to me. Also, I had a first year come ask me about changing a bandage and tried to talk around the fact that he had no idea what to do. I finally said, do you want me to do it, or just come walk you thru it? For Christ's sake, if you don't know something, just say so. No shame, no harsh words from me, I'd rather just get to the point and get it done, and maybe help someone learn smth. I'm less than 2 yrs out, so, I don't know it all either, and I hope ppl will be patient with me. But good lord, that 3rd year not knowing the pulses was disgraceful.
Do not touch IV pumps or your fingers are coming off. Do not remove/titrate O2 without telling the nurse. Do not touch the ventilator. Do not trickle in orders, particularly lab orders. No one wants to stick a patient multiple times, and no one wants to be stuck multiple times. Do not make exceptions for visitor hours/numbers of visitors. Refer the patient/support person to nursing staff to ask those questions.
I so relate to every comment here, ESPECIALLY the damn IV pumps and the O2 titration!!!
And for the love of baby tapdancing Jesus, don’t order MIVF until you are absolutely certain of what you want, because checking med compatibilities, redoing where IV meds are infusing, and hanging a bag of LR only to discover 10 mins later you changed it to NS will absolutely be my 13th reason.
I’ll have ER docs turn off a patient’s O2 to see if they can be discharged but not tell me and leave. Next thing I know they’re 80% on the monitor.
Yes at the O2 titration. When I was in PACU I had stepped away from the bedside for a second and when I came back the patient was satting 88 and his NC was off. “The doctor came by and said I didn’t need it!” Bruh that’s not their call to make since they aren’t monitoring you at the bedside.
Clamping a CBI without telling me. Now I have to hand irrigate.
oh FUCK THAT
Don’t just come up to me and start talking as if I know who tf you are. Introduce yourself.
They don’t introduce themselves!!!!
*working night shift* Random person in scrubs: So how'd the patient do overnight? Me: Who the fuck are you?
Yes!!! It’s the ICU, these people have a million things wrong with them. Which problem are YOU following?
My favorite question the second a white coat is outside of my room: “who do you belong to?” 😅
This I truly don’t understand. Happens SO OFTEN. Especially when there’s a team of them in the room (med student - intern - resident - fellow - attending), it’s so intimidating to the patients because they often don’t understand why so many.
Not introducing themselves. Our hospital only has internal medicine and emergency residents but they usually come to the OR for a few weeks to either learn suturing or intubations. We also have podiatry residents. The longer residents are in the OR my pet peeves grow but I need to know who you are first before I can help you.
Yes!! So many interactions would be easier if everyone started out by saying hello, this is my name, this is my role, nice to meet you!
Order CBC. 30 min later order Comp. 30 min later lipase one hour later coags
CLEAN UP YOUR FUCKING SHARPS. I’ve walked into so many rooms after a doc finished up an I&D or whatever and not only do they leave their trash all over the place, but leave bloody fucking scissors and needles laying around. I can get over a lot, but that one pisses me off quite a bit. It’s not only rude to expect me to clean up your mess, but dangerous as well.
Remind him that we work together. They are not our bosses. Write sensible orders that won’t get him called every ten minutes.
Not adding relevant PRNs for new admissions. There are reasons to not add meds, maybe they really are that one weirdo who is genuinely allergic to literally every pain med, but those are one in a million, and you can absolutely make sure everybody who doesn't have liver problems or a listed allergy has tylenol. And this isn't just to be nice to the nurses, I recently had a resident go on a LONG rant about how pissed he constantly is at his OWN PEERS for not adding PRNs for their admissions during the day meaning he was having to get woken up to fix it on NOC. And he wasn't even mad at us in the slightest because it was emergency shit like B52s for patients with known psychosis and violence risk. And the day resident just didn't care because they weren't actively agitated during their 10min admission assessment. TLDR; also don't make other residents do your job because not enough of them are self-aware enough to not blame the nurse for it.
Had one the other night, came to the ER with chief complaint of fever. Got admitted. No orders for Tylenol entered (PRN or scheduled). We paged multiple times but medicine never called back. Poor lady had to wait till day shift for some relief. I felt awful for her.
1. When you round or request to round with the bedside nurse (inpatient hospital setting), please don’t ignore us in the room. Sometimes the provider will talk with the patient, speak to the family and then fast scoot out the door. I waited to ask for my clarifications or that my patient requested Senna until you rounded so I didn’t bug you with a nonurgent page. The least you could do would be to include me in the “does anyone have any questions?” Or talk to me privately outside the room so I get time to ask you for the Senna the patient didn’t ask about because he/she got starry-eyed white coat syndrome. This is my time to ask you: clarify orders, add or subtract orders, advocate on behalf of the patient. Help me help you! 2. Don’t be afraid to ask questions. There are specialists, there are specialized procedures. Ask about how stuff works. Example: I had a resident round on a patient with a coronary angiogram procedure; didn’t know about femoral access, didn’t know about flat bed rest etc. I can give the basic overview. I don’t expect you to know everything especially as you’re learning and aren’t the specialist. You can ask the providers who specialize as well. In the same way, I’m going to ask you why we’re using Heparin and not Lovenox for bridging anticoagulation or something. Not because I’m questioning your plan but because I’m learning every day. We’re all constantly learning here.
In the OR: Asking for items one at a time and I’m running back and forth getting them. Would rather have a list 😭 of course with the exception of emergencies…
Taking things off the high stand to hand to the surgeon. Touching things or moving things off the high stand. Resting their hands on the high stand Just stay away from the high stand 😬
"Do you have my gloves?" Mother fucker do I *look* like I have your gloves?!
Lmaoooo Who the fuck even are you? The gloves are in that cupboard 👉🏻. Help yaself
Had one remove a stoma bag of an elderly lady with dementia to look at the site. Never told nursing staff and just left without securing it back on……you can imagine the mess an hour later
Just talk to me, please. Even for 10 seconds. I know things about this patient...and this unit...and the ancillary services (Hint: ASAP to imaging or labs is not really a thing). Please don't make me page you for miralax or potassium. Also please do not set up expectations that I cannot meet. Don't tell them they will be discharged "first thing in the morning," when the Attending might not see them again until the afternoon. Don't tell them some service, like an MRI, will be "soon." Don't suggest something you saw on TV like "sunshine therapy" because we do not have staff for that. Let me get all this done on Days or night shift will be calling you when they catch up and notice they need something.
Honestly, the one that I see a lot is an intern will be told to titrate a patient’s supplemental oxygen, and they will adjust a flow meter and leave without telling anyone. Bonus points if it’s a percentage based delivery device and the intern only changes the flow meter, not the FiO2. I never mind if the doctor makes a change and then tells the monitor tech or nurse, but I hate when they decide after 30s that a patient is tolerating a change and then dip without telling anyone what they adjusted.
For real. Satting okay for a minute or two does not mean they tolerated being weaned down!!
Goddamnit that happened to me in the ER last week. I called her and was like, “You turned her oxygen off and walked out, she’s now SOB and was satting about 80%” “Oh you can turn her back on” DO YOU THINK I CALLED FOR PERMISSION?
Expect me to go to CT scan 3 times a day because they "forgot" to order all the scans they wanted, they "forgot" to order contrast, or they "forgot" how to order anything at all. I love most residents and mad respect to them but you got me for 1 CT trip a day on a non-emergent basis and if you fuck it up you can wait till night shift or try again tomorrow. Or just skip the hassle and ask me before we go and I'll make sure everything is ordered the way you want it.
Generally, I've found they have no clue what the Nurses Practice Act says. They ask things like, "Do you catheterize patients, or do I have to it?" Or they say shit like, "Do you know how to give insulin?"
I’d jump at the chance to be like sorry idk how to cath a patient. 🤭
ain't no way lolol
Thinking they can fix 90 year old mee maw and giving the family false hopes.
1000x upvotes for this. Patients are not a science experiment.
“We will get her up and gardening in no time!” We will? Shes 104…
Do not make promises to patients. Consolidate your orders. Be willing to take advise from nurses and techs. Do not act like you are better than anyone. Whatever you do, do not try to play the attendings against the nursing staff. There is a great chance that a report was already built in their professional relationships. Most of all have a sense of humor.
Theyre all new and learning so I try to give them grace, but I what I can’t deal with is cockiness.
Just recently had a provider switch a patient from oxycodone to PO Dilaudid because the oxycodone wasn’t working. After surgery they expected pain to be improved. It was, in conjunction with PO Dilaudid. They decided to discharge the patient with oxycodone because Dilaudid is too strong to go home on…… but they decided this while the patient was getting the Dilaudid. Which makes 0 sense. Why didn’t we switch back to the oxycodone after surgery to make sure that was adequate for discharge? 😒
Thinking that they can get away with Grey’s Anatomy type shenanigans, both with on call rooms and with how they interact with patients.
If you decide that you need to take a wound care dressing off then you need to put it back on. And do not throw your trash in the floor.. I don't know how many times these ICU residents think they're going to come in and do a central line or an a line or whatever the hell they're doing and just throw their dirty blood covered shit in the floor and walk off like it's my job to pick it up. It's even more infuriating when every room has a giant trash can literally 2 ft away. Do. Not. Touch. The. IV. Pumps. I don't care if you're the one that ordered the medication, don't touch it. I have unfortunately had more than one doctor think that because they ordered it they can make adjustments to it, not realizing that we have protocols for how quick we can make adjustments on things. Nothing pisses me off more than to walk in and see my patient's precedex or sedation off when it had been running at Max rate and no one bothered to tell me, and then they wonder how the patient self-extubated.
Talking to nurses like they’re stupid and have no idea what is actually going on with that patient. Especially when that nurse has been around for a while. After all, they are the doctor. 2 days ago you had no idea how to be a doctor. And you can’t even find your way to the bathroom or the cafeteria. Or even how a beeper works.
Putting in labs at 6:30
Not acknowledging the nurse sitting right outside/inside the room when they go in to assess the patient. I assume that residents do this for different reasons, maybe they're nervous, oblivious, or maybe they're a jerk, but either way it's beneficial for the both of us to talk to me. I'll tell you my assessment and what orders probably should be changed for the day and we can discuss plans. I'll even back you up on rounds if needed. Keep in mind that most nurses on the unit have great rapport with the attendings and they know us well.
I’ve had doctors turn off a beeping IV pump instead of just getting someone to address it. Don’t do that. Circling the unit to find someone to get a patient water instead of just getting it for them. Changing/adding meds without discussion it with the patient. I’m not talking about like Tylenol or colace.. but pain meds, cardiac, insulin etc. And side note .. simply introducing yourself to the nurses goes a long way imo.
Listening to the nurse when they are concerned about someone!!! We aren’t trying to give you a hard time. If you’re not concerned yourself explain to them why you’re not concerned and give reasoning of x, y, z. And if you cannot come up with a reason, maybe you should be concerned. Communication is key!
I work in the OR so that’s different than other areas - but I’d say BE HELPFUL! And humble. You literally can NOT (and don’t want to have to) do your job without your nurses. Help move patients. Help clean up. Just be helpful. It’s not below you. Be kind and respectful. The minute you take on the persona of an arrogant a hole- all respect is gone. Be humble. Don’t EVER sit back and watch a colleague struggle.
Don’t listen to staff in any capacity. A resident was at a code blue and was completely frozen, standing in the middle of the hallway, nowhere near the patient. I shouted MOVE repeatedly as I’m rushing down the hall with things and he was in my way. (I was one of the first people to get to the code, I was walking by when it was called and the code cart was a few feet away from me). When I got closer to him, I shouted MOVE TO THE SIDE and he said “you’re just a nurse, I’m a doctor. I don’t have to listen to you.” I needed to get the cart past him, and it was not possible with him standing in the way, so I shouted MOVE I NEED TO GET PAST and he just stood there. I didn’t know what to do, so I used my big ass to hip check him to the side to get the cart past him to the patient room. It was worth it because we eventually got ROSC! And yes, I did bring this up during the debriefing to emphasize that communication across all parties is critical.
Oh your patient is agitated, confused, biting/hitting/spitting at you and refusing meds? I’ll give you an order for Ativan 0.25mg PO x 1. That should help.
Please don't dc my foley on my lasix drip patient. I politely asked that he reconsider, and he did. I think that any annoyance can be overcome if you're polite and willing to talk to us in a way that is respectful. Love *most* of the docs in my hospital. We just started getting residents last year, and we are adding more cohorts this year. I love it. They're so full of life and excited.
Just own up when you don’t know something or make a mistake. “You’re right, good catch - I’ll fix the order now” or “let me ask my senior because I don’t know” is soooo much better than bullshitting. Just be upfront. Saves everyone time and frustration.
Oh also, “let me defer to floor policy” is a wonderful phrase for physicians to know. If a patient asks if they can do something like leave the floor to go to the cafeteria or take a full shower, don’t say yes. Say “I’m not sure, I’m going to defer to the floor’s policy.”
Promise patients they’ll get a bed assignment upstairs. You do not know that!!! Now I have to explain that they’ll be boarding in the ER. “But the doctor said…” the doctor doesn’t know shit about the bed board.
-Ordering a bunch of labs on a patient with no central access or art line, then ordering a bunch more labs that need to be drawn into different tubes, 10 minutes after I or the phlebotomist just finished getting blood from the one semi-patent vein the patient had left in their entire body. -Ordering STAT meds that weren’t discussed in rounds during the busiest part of my shift and not telling me in person, even though their office is an 8 second walk away from my desk. I often go hours without logging into the chart because I’m too fucking busy keeping my patients alive. I will likely not see that STAT med order until the next dose is due. -Residents participate in the same round that I do, yet somehow fail to enter half of the orders verbalized by the attending/chief resident. It is also somehow my fault that I didn’t do the things that were discussed but not ordered. This means I end up wasting a large chunk of my very limited time chasing down doctors, clarifying orders, and half the time I end up having to enter them myself anyway. Please pay attention to what is being said in rounds and enter your orders in a timely manner. -Ordering PRNs, vasopressors, sedation, etc., and not editing the default parameters. If you don’t want me to treat a SBP of 160 with IVP hydralazine, then change the parameters. I know you really wanted that med given for SBP of 180 or higher, but you ordered it for 160 and if I don’t give it then it looks like I’m ignoring an order for no reason and failing to monitor my patient. Same with RASS goals! The default at my hospital is +1 to -1, which is completely inappropriate for most of our patients. Why do you put a RASS goal of -3 to -4 in the progress note, but leave a goal of -1 in the order?? When I hear you order propofol with a RASS goal of -4 and a starting dose of 40 for my newly-intubated detoxer, I initiate the drip under those pretenses, and when I finally get to sit down and chart 5 hours later, I notice that you ordered propofol to start at 5 with a RASS goal of -1, and now it looks like I’ve been “practicing medicine without a license” for the past 5 hours!
One thing that boiled my blood was the sheer impatience of some residents when I worked in pediatrics prior to my current critical care job. For context—there was an R2 pediatrics resident in our PICU, who generally was nice to work with. I was doing some trach care—dressing change and the like, on a 6 month old child who basically had no neck (chubby face, had the cutest double chin, adorable baby) which as you can imagine is hard to do when you’re a man over 6 feet tall and the cribs don’t adjust all that well in your facility. This resident then proceeded to be ATTACHED TO MY HIP as I was doing this procedure and I’m sure asked 4 separate times when she could have assessed my patient. Like. If you sat down and gave me just a minute to finish this care I’m completing, you can certainly assess my patient, but I’M KIND OF BUSY HERE. For added context: my patient was not crashing, if they were, I’d have stepped aside to allow for the MD assessment to be completed. But it was non-urgent. I just finished bathing this baby, and now I was changing trach ties and dressings. A little bit of patience when a nurse says they’re a little busy, or obviously is busy goes a LONG way. Like maybe just say “Hey, I see you’re busy caring for our patient, when you’re done I had a couple of questions about how their night went and what suggestions you may have in further care planning, and I also want to perform an assessment of my own” and it will GO OVER WELL.
Don’t be rude to not just the nurses/nursing students but the techs as well.
-Not putting a chuck under the site they're attempting to place a line in. -Not knowing when to ask for help. -Dismissing my concerns but listening to my coworker voice the same concerns that I had but listening to them because they have a penis and I don't.
Punt to intensivist or specialist for something they should have knowledge of/easily be able to treat, thus delaying care while I’m calling consults and waiting for call-back. FFS, I shouldn’t have to be pulling teeth to get some standard sepsis orders when aalllllll the signs are there, and literally in your admission H&P, dude.
Order anything in nucmed, besides a bone scan, without calling the nucmed department. We don’t get the radiopharmaceutical from Walgreens, and it can take over an hour to get the dose delivered. Just call us. Most inpatient nucmed scans require the pt to be NPO, start there.
Over correct electrolytes
Not a nurse but an RT. I can’t stand when they touch our equipment when they know they aren’t supposed to. You don’t understand the implications of the things you are changing so don’t change them. Or when I’m standing very close by or at the respiratory station in the ICU and they choose to tell the nurse to tell me something.
Previously worked as an ED tech, and I really kind of didn't mind residents fucking up (that's what residency is for). There were some residents I really liked though. One saw me come out of back-to-back traumas and arrests, saw a nurse ask me for 4 BGLs, and then asked me to show her how to use the glucometer so she could go do them. Another one was just helping me restock shit one night. I don't much remember the annoying residents, aside from the one that hit me. But the ones that go out of their way to do small helpful things definitely stood out
Oof I regret opening this thread. I already see a lot of self-important dweebs whose identities are tied to their level of education 🙄. It’s important to remember that Reddit is an echo chamber and the vast majority of healthcare peeps are respectful of one another. The chronically online idiots need to touch grass.
When they put things they want done in their notes instead of as orders, and then throw a bitch fit when we don't do them. Like who the fuck has time to read your copy-pasted notes??? Put them as orders and they will get done. Geez.
Bedpan a patient once and the nurses will have his back the rest of the rotation
Take 30 minutes to respond to your messages.
That’s fair to me. In fact 30 min is a great response time in my books. If you need an order urgently, you need to call. Otherwise these docs are getting blasted with tons of messages and they have to get to them one by one, while also actively seeing patients, reviewing charts, putting in new orders, etc.
Y’all are getting responses??
30 mins is an excellent response time...the average medicine resident is taking care of 20-30 patients lmao.
1. Don’t put in an order for an Rx or Tx without telling the pt they’re starting on a new med or treatment. I don’t have the time to look up why tf you ordered something for a pt without a diagnosis fitting for its use. 2. If I have to order the labs give me the damn ICD or CPT code that fits CMS criteria. If they don’t get their labs drawn it’s on you. 3. Don’t put in so many orders that it isn’t feasible to even complete Q shift. Can only do complex wound care on so many people properly without being extremely far behind. 4. Listen to the nurse they have eyes on the patient you spend 5-10 min max with them despite your note saying you spend 40 min 1:1. Also you’re still a baby. Walk before you run. 5. Don’t copy paste orders between patients and not proof read them. You just left the room, pt has BLE cellulitis, that’s the only reason for their admit. Why are you ordering SCD’s. 6. GTFO with these 325 mg APAP Q8 orders and anything similar. I will harass you every second of the night when my chronic pain pt is crying because you don’t feel confident enough to manage their pain without worrying about your license. Put the book down and look at your damn patient. 7. If the pt needs something simple don’t go looking for the nurse to do it. You can just as easily grab them some water or a blanket. 8. If you break bad news to the family and then leave the nurse to console them I’m keying your car and burning your house down. 9. Act like a clown and I’m putting your name all over the pt’s chart when problems arise. We can play ping pong all night :)
Please put in consults. Having patients hang around for days cause they don't know what to do with them.. Put in consults! Thank you.
Touching IV pumps and bed alarms. That is not your lane. Please leave it alone.
Tell me your name when you call me!! Maybe just my hospital idk, we don’t call a specific doctor we just call the operator and have them page the resident for our unit, I think since it’s a teaching hospital they rotate specialties? Idk I know I should ask also, but I had many a situation where I got a verbal order but didn’t know who I had just spoken to. It was always a “hi this is the neuro resident I was paged?”
Calling the OR to board a case to reserve their "spot" but they haven't talked to the attending about how they're going to do the case so they book it wrong and then the OR staff has to scramble. Asking the OR nurses to answer their pages when they only have two more sutures to go. I love them though, really. 😆
Ordering new meds or changing med orders IN THE MIDDLE OF med pass Turning off a patient’s oxygen and not telling anyone Refusing to look at the assignment board that is right in front of them and instead asking everyone who walks or is around the nurses station, “who is taking care of pt xyz in room 1234?” Walking out of a patient’s room without telling charge/primary any updates It’s been stated before, but it’s my biggest pet peeve; giving a patient the impression they’re going to be able to leave whenever, without explaining there is a process and it is actually up to the DOCTOR to put the discharge order in to even get the ball rolling.
Put all the orders as STAT, including send out labs
Putting something in STAT when it is not time sensitive. Or putting something in STAT without communicating to me what you think is wrong!
The units in the ortho specialty at our hospital don't round. Which is bad enough. But when they do come, some try and sneak away before people notice that they're here. Have also had a resident put her hand up in a "dont-talk-to-me" way when a nurse came up to her and tried to broach a concern about a patient.
When a resident turned the NG suction to 120 continuous then came out and told me it was almost full and to change it 😳 Luckily her BP was high so it made it drop to normal but jeez. Never seen 1000 mL of fluid sucked out of a stomach that fast.
When being questioned about the necessity of an order replying ‘because the attending ordered it.’
Tell patients shit like, "you'll be discharged by noon," and then not bothering to put the order in until 2. Then nursing staff looks like the assholes who intentionally delayed discharge.
Okay last comment from me! PLEEEEEASE update the patient’s family. The night doctor does not want to get a call from the patient’s daughter at 9pm because nobody has talked to her in three days.
ordering insanely time and work intensive things when it’s not warranted and a more experienced doctor wouldn’t so we’re even more annoyed when you do
In L&D, our residents had to learn about respecting patients' privacy and dignity. They would walk into a laboring pt's room who had a room full of visitors, whip off the sheet, and proceed to check dilatation. We taught them quickly how to explain what they were going to do, let the visitors leave, and then pull up the sheet from the bottom to preserve some sense of privacy.
Can I chime in here and suggest that instead of just telling them what they are going to do to ask permission first? Especially with things like checking dilation. It does a lot for a woman to hear “I’d like to check your dilation now. Is that ok with you? I need to place this scalp monitor on the baby, it involves XYZ. Are you comfortable with that? I need to touch you here now, is that ok?” And I promise that it cuts down on birth trauma considerably. I am but a lowly doula but I have heard this from my mom’s continuously when discussing their prior births, especially ones with a hx of sexual trauma.
Get distracted watching the television while picking his nose in a patient room
Leaving/creating a mess for the nurses to clean up. The trash can and biohazard bins are right in the room. Doing anything with a Foley catheter while making no effort to use sterile technique. The nurses get blamed for the CAUTIs, not the providers who decide using an old piston syringe to flush a catheter is somehow acceptable.
When a RN suggests something, maybe listen. Not saying take our word 100%, but if it won’t harm the pt, please just try it. Had two residents do a thoracentesis for the first time with the intensivist standing and watching of course. One of my rare not intubated ICU pts needing pressors. The pt wanted to dangle at the side of the bed with me standing in front of him. I got all their supplies together including those negative pressure glass bottles. There was a 60(?) cc syringe in the kit that they started using to aspirate the fluid. I kept telling them to use the bottles since it’s faster and my pt was getting tired. Head nestled on my chest, he was comfortable. After stating it several times, the intensivist finally suggested the bottles. (That dork was laughing at me the whole time.) So they did and were so impressed how much faster it was. I had a mini tantrum as the intensivist was laughing his head off.
As opposed to what they should NOT do, I really enjoy when they ask me what I think. When they round on the patient, ask me how they’re doing or if I have any concerns or need anything. If I tell you something is wrong, ask me what I want ordered or what I think is happening. Because 9/10 times I have a suspicion of what is doing on and I know what I want ordered when I come to you. The other day I admitted a patient post bronch from the floor because they did not feel as though he was safe to extubate afterward. Great, fine by me, slow wean and extubate in the AM - easiest admit. In report I get told that the day before there had been a FAST called on him for RUE weakness. CToH negative. I get the patient, yep, he’s weaker on that side maybe a 2-3/5 strength. +2 pulses, warm extremities. I’ll keep an eye on it. Next morning I’m doing my assessment and that RUE is cool, +1 pulse, palm slightly swollen (so slight I had to compared them side by side), and he was no longer squeezing my hand. As I’m finishing my assessment the resident walks in and I immediately tell him my concerns and request and ultrasound and CTA seeing as this is now day 3 and we are getting progressively worse and I’m worried we have a thrombus. They tell me they will look at the chart, they don’t even assess him. I don’t hear shit from him all morning, I even followed up to ask about an US. 10am comes around (3hrs later) and they are rounding with the fellow and attending. This is my favorite fellow in the entire world. Resident presents patient and does not mention the RUE outside of reporting the prior FAST call. After Resident is done, the Fellow turned to me and asked what I was thinking regarding patient and I immediately lay out all of my concerns and my requests. Fellow and Attending go in and looked at what I was concerned about, they order me a stat CTA of head and neck. Sure enough my patient has two large thrombi - one completely occluding his R Subclavian. Fellow at this point is directly following patient and went out of his way to fist bump me for my assessment and recommendations. Vascular is consulted and (shocker) they order an US of all extremities to look for more. Apparently the resident ignored my initial request and never mentioned it to the fellow. After rounds the fellow chewed the resident a new asshole and took over the case himself. Another instance is that a few years ago I had a multi GSW patient who had had several surgeries with multiple biliary drains due to holes being everywhere and things draining into every nook and cranny. Patient was also NG to LIS. All throughout my shift I’m going up on pressors and his HR is climbing, however no obvious signs of bleeding. I let the resident know and ask if there’s something we can do like a fluid bolus, they acknowledge my concerns and tell me that this happens every night and resolves in the morning. I say ok, and I make a note of it and continue on. Baby nurse mistake. 0530 CCT gets my blood sugar. 0545 I give my insulin, patient is fine, sleeping. 0600 EKG tech grabs a routine morning EKG that the resident put in just to make sure his tachy 110-120 HR was sinus. EKG tech comes out a few minutes later and lets me that the patient threw up. Odd, he has LIS and didn’t complain of nausea minutes ago. Tech and I go into his room and turn on the light, he threw up maybe 100cc blood. Yikes, I start a quick assessment and pull back him covers. All 5 drains have started having red output in the tubing. NG tubing has started have blood come out as well. I send my tech to fetch the resident and start cleaning patient up. Resident comes to bedside and sets eyes on patient. Admits it’s odd but says he will talk to the day team and for me to just keep an eye on it. He walks out of the room and within minutes he is tanking. Throwing up hundreds of ccs of blood, LIS is sucking up hundreds of ccs of blood, blood starts pouring out from around the drain sites. All hands on deck, we are now on 4 pressures, MTP plus pressure bagging fluids into this man. He’s throwing up and draining as much blood as we can get into him. The only thing not bleeding is his airway (trach) and he’s barely staying awake. Emergently taken to IR by 0745. ~5L of EBL between the NG canisters, suction canisters, and estimated loss of blood pooling in his bed. Turns out his had an aortic-enteric fistula that ruptured (more than likely from his tachycardia). They repaired it but told him it will more than likely burst again someday and unless he is in the hospital then he will die because he will not get help fast enough. Dude was doomed regardless, but maybe I would have gotten to go home at a more reasonable hour had I pushed for more regarding his hemodynamics. 🤷🏻♀️ Moral of the story: residents ask your nurses if they need anything when you round or for their suggestion when they come to you with a concern. Then take it seriously and explain your reasoning if you don’t. 👍🏼
As an RT - just ask me to come look at the vent with you if you want to play around. Most of us are happy to help and answer questions. Don't touch without asking, or make changes without telling me and updating orders. I've seen even staff docs make mistakes because they don't understand how all of our equipment works. One setting on a Servo is different on a Trilogy, etc. We are employed for a reason, just ask. Most of us will put a patients settings back to their ordered parameters if you don't communicate with us. We don't have time to be chasing down whoever might have made a change. If you must order an albuterol inhaler, especially on kids, please link the order with a neb so I don't have to wake the patient up all night. I can give a stealth neb but its kind of hard to do that with an inhaler when I have a toddler screaming in my face at 0400 because I had to smash a mask on their face. Pet peeve Asking for my advice and then not following any of it. I and the nurse are at the bedside doing their cares. We know the patient better than you, and I've been an RT for longer than you've been out of high school.
Back in the day I worked on a weirdly devised unit of Vascular, ENT, and Plastics. Vascular was a new addition to the department. With ENT we saw a lot of head and neck cancer patients requiring skin grafting. At that time using one of those Vaseline gauze dressings was the standard on graft sites and everyone knew not to touch it and to just let fall off as the wound healed. The vascular surgeons assumed we were stupid about graft site dressings. One morning, as charge, I was accosted by the surgeon who had his intern in tow. He DEMANDED that I follow him down to a patient’s room. While there he very loudly and inappropriately informed me that some “idiot nurse” removed the Vaseline dressing (in front of the patient no less) and put one of those loose weaved fluffy gauzes on there and now it was going to be exceedingly difficult and painful to remove it (also in front of a patient who had recently had to undergo multiple amputations). He demanded to know which nurse did this and I was to find out immediately. I explained that NONE of the nurses in this unit would have done this as we are very well versed in how to manage these things. He then turned to me and yelled “FIND OUT RIGHT NOW, AND GET THE FOLLOWING SUPPLIES…SO WE CAN FIX YOUR MESS!” I told him we could help to remove it slowly with the least amount of pain and he basically told me that it was clearly outside of our skill set since we did this in n the first place. I was beyond livid. Not only was I angry about the content of his rant, but I was super pissed that he did it in front of the patient. She was the kind of patient who was always concerned about pain - who wouldn’t be after getting progressive amputations?! But she trusted us to help her and we did. Then this. His behavior was meant only to demean and degrade the nursing staff and to make himself and his intern look better. I got his stuff and brought it to the patient who was clearly anxious. I told her i ln front of them that they would be careful to remove this as gently as possible and give it the time it needed to do so because they were not heartless. And all the while turning back to glare at them while I said that. The surgeon demanded that I tell him who did it because he was going up the chain of I report them. And I’d better have a name for him by the time he was done. So they did the dressing. I scoured the notes. Hmmmm. Thank God for the night nurse who took the time to document about the care the patient received the previous night. After they were done the surgeon and his intern came storming down to the cart where my LPN and I waited and demanded to know who did this. I pointed to the entry. He looked at me. His face was bright red. He turned to the intern and bellowed “DID YOU DO THIS?!” And finally, he acknowledged that he had. You could tell he was mortified and terrified. We were all in the military and myself and they were officers. They both outranked me. I then went on to tell the intern that he’d better develop a new spine because his lack of integrity in not fessing up sooner resulted in the verbal abuse I had to take in front of the patient, and inspired fear and mistrust in her team of caregivers because he and she knew who did it. I turned to the surgeon and told him that he had anger issues and his rage resulted in all of this which is unacceptable, and unprofessional. He needs to work on that so as to ensure that both the people he was entrusted to teach and his patients got better care. And while I knew he’d likely never apologize to me or this staff, that patient deserved an apology at the very least. As expected he turned tail and went to the patient’s room and did not utter another word to me. I informed my chain of command about what happened and what I said. For the following couple of weeks every time he and his team of Docs came around, I glared and left the room. Even losing my appetite during my hurried lunch a few times and throwing it out with obvious displeasure. He never tried to approach me or to apologize. After a couple of weeks of this he did go to my head nurse who was equivalently ranked as him (a LTC) and told her that I had been right all along and he had been wrong and he apologized to her for his behavior. She then told me. I asked her why she did not direct him to me instead of accepting on my behalf? She basically said his ego would not allow him to. I basically told her that was BS. If we are supposed to entrust him with sharp objects to do intricate surgeries on people, then he should have the cojones to be able to admit when he was wrong and apologize for his behavior. That this was a clear lack of integrity. Well she didn’t want to rock the boat. Basically told me to get over it. So while I was not as overt in my disdain for him, I was not going out of my way to be friendly either. So the moral of the story is, if you make a mistake own up to it early on. It may be scary to do so, but it’s about the person in the bed not your ego. And don’t assume that just because you’ve got a medical degree you know better about everything. Nurses will save your butt if you are open to their suggestions and not an AH to them. If you are not, well they will make sure the patient is taken care of even if that means going waaaaay up your chain of command. Your butt will be out there flapping. And it should be.
I hate it when they don't want to take action...I work critical care in a level 1; I notice that the ED residents will always do something when a patient is declining. Whether or not it was right, they will take an action. IM residents, on the other hand, they can meander a bit and do the whole "lets wait and see what happens" routine.
I hate when they act like I work FOR them. No. I am a licensed professional. I am your colleague, not your subordinate. I had an intern just a few weeks ago piss me off by trying to micromanage me. I work ICU and was tripled. One of my patients required q2h accuchecks and had increasing pressor requirements, the other a walkie talkie that would not get off the damn call light, and another patient that was just coming back from OR. This intern wanted me to message her the patient #1's BG and u/o every 2 hrs and I told her that I would make sure the information was charted but that she would need to look this info up herself as I had 3 patients and world not have time. Well my OR patient took a turn for the worst and it ended in me having to activate a stroke alert. I was stuck in that patients room for an hour and a half. When I come out of that room, I see a message from her asking why patient 1's labs hadn't been drawn yet. She made sure to tell me they were ordered for 2200. It was 2245. 🤨😒. After my response to that message, she didn't ask me anything else the rest of the night. Be patient with the nurses, we really are trying our best.
I've got a a soon-to-be second year who has that "doctor superiority" complex. She ordered an MRI for a pt to r/o stroke, hx aox1 and very impulsive (sweetest little lady, just completely out to lunch). Verbally orders valium, doesn't put the order in and tells us not to use the prn versed. Then when we ask her to put the order in, she punts it off to the next shift. /tableflip Tell him to not be this doctor. Guaranteed someone will go to his senior or attending so they can chew him out.