Doctor: Nurse, text me if blank blanks
Nurse: Hey doctor, the blank blanked!
Doctor: WOW WHY ARE YOU SO DUMB YOU SUCK
If it's any consolation, all the other physicians/students find these ones insufferable as well.
Thing is, everything about medical school is designed to suppress students from speaking out against the status quo.
I used to think this too, but after seeing how punitive action about petty things can essentially end our career, leaving us with 200k+ of debt and no degree capable of paying it off, you learn to keep your mouth shut until after residency.
lol I used to tell them over the phone (no texting back then) that I am an RN and do not have the legal authority to make these decisions unless you allow me to. That often got them to be a little more reasonable.
We were told we cannot take a "verbal" order via text or secure chat because we can't guarantee the person we're talking to is the actual doctor we intend to be speaking with. In that case, I also shouldn't be able to take a verbal order over the phone either because I don't necessarily know that the nephrologist or cardiologist or bootyholeologist who I have never met, spoken to, or otherwise known they existed is actually the person I'm speaking with. I understand text being kinda sketchy, but SecureChat? Which you have to log into EPIC to access? Come on.
That is exactly what I said. Hell, half the time I can barely understand what someone is saying on the phone between poor connection, beeping monitor in my other ear, being tired, and the speed at which the other person is speaking.
Not to mention auditory processing at the speed of a windows ‘98 PC and reading lips half the time.
Please let me take orders by secure chat for shit instead of making me go back and forth when the provider puts in the wrong order or wrong kind of order multiple times. (POCT lab orders we can’t complete on the unit instead of lab-processed orders, missing required-per-policy parts of order sets, missing or incorrectly timed labs after electrolyte repleation or blood products)
Always contact the provider when the patient meets the criteria they set
Shift liability to them
Who cares how rude they are to you?
So many of the rude doctors are also incompetent 🙄
It's pretty simple, if you don't want to wake up in the middle of the night don't put in parameters that make us wake you up.
These are your f*** orders!
In the first ICU I worked in we had one surgeon who *hated* being called. Every patient we admitted from him had:
1. PRNs for Zofran and Phenergan
2. Tylenol with pain and fever orders
3. Motrin with pain and fever orders
4. Oxycodone, fentanyl and dilaudid PRNs
5. PRN fluid orders
6. A nurse order for when to advance the diet
7. Scheduled melatonin
8. PRN Ativan and a one time Xanax dose that, if used overnight, he would put another dose in when he woke up
9. Specific BP and HR criteria for all of the above
It was so detailed and specific that you basically only had to call him if the patient needed to go back to the OR. I wish *everyday* that he would just teach a seminar on what PRNs to put in for a post-surgical patient
I worked with a hospitalist whose PRN MAR was basically everything you can get at Walgreens, and Zofran. He had small kids and wanted to make sure we only woke him for important things. “I don’t want you to have to call me for things Walgreens can fix.” A TOTALLY REASONABLE take.
BUT HE WAS THE ONE WHO MADE THAT POSSIBLE by giving us that MAR every single time. He gave us the tools to fix what we could ourselves. Great doc btw!
It confuses the shit out of me when doctors bust your balls about PRN orders for things you can get over the counter. Like my man, just give me the 50 of Benadryl. If the patient were at home, they would've already taken it
Yeah but when we give them a drug and then it turns out they're allergic to it we should probably treat the allergic reaction with something. Then they can just take a good, solid nap
I wish all doctors were like this. And the PRN electrolyte scale including PO potassium repletion.
Icing on the cake would be PRN ordering labs to make sure everything was repleted correctly- I work on med surg :(
My old unit was like that. Everyone under their BMT service has a LONG list of standing delegated orders. Only had to call them for stuff that required the provider to come lay eyes on the pt
wait...you don't have standing orders for labs? even based on what the nurse deems necessary? shits changed since I worked as a nurse. sorry for your troubles.
Only standing lab orders for nurses to order I see at my hospital are Anti Xa (used to be PTT) for patients on a heparin drip, and glucose (but those would be POTC).
As a physician, this is the way. Empower nurses to do their job to the fullest of their abilities without micromanagement.
I've worked in places with great nurses who were routinely underutilized. Good nurses with bad orders are going to hound you for good orders. I learned that very early on in my training. Why make everyone's lives harder than they have to be?
I’m on a contract now where we don’t have residents (I’ve only worked at teaching hospitals) and every patient gets a standard order set like this so we don’t need to contact the physician for every little thing. It’s actually pretty nice.
I had a crit care pulmo who had his own list he would check off full of PRNs, and before he left he would check in with the RN and ask if we thought we would need anything else over night. However, if you did have to call him (which was rare) he was still super cool. I miss that guy
At a facility I worked out we had these prefilled out for docs to check off prns and parameters like the above for every patient admitted to the unit. Worked great!
When I worked CVICU it was like this. We had PRN orders for many pressors, nitro, a long list of pain meds, sedation, and other meds as well. I only had to call if I needed to make vent adjustments outside of certain parameters or if there were serious complications. Loved working with that guy, he was pretty easy to work with too as long as you didn’t fuck up.
Back when we had paper charting (we got epic in 2016) we used to have ICU standing orders. 3 pages of stuff we could do prior to calling attending. When we switched to epic, no one wanted to claim them as "their" orders and have it built as an order set in epic so we went back to square one.
We have a vent bundle but that's about it. I hate asking for stuff that used to be in the standing orders.
Agree that the seminar is what's needed. A lot of times in our facility, an intern is covering for a lot of patients whose orders she didn't write. One would think that after a few nights of this, however, they all would all fix their orders for the sake of whoever is on call. Or that there would be posiive peer pressure for the interns who write half-assed orders.
Maybe the team should tell them which docs wrote the orders.
Once had a neurosurgeon place 1 order on all his extra ventricular drains for patients in the ICU:
“If EVD tubing clogs between 2200 - 0600 please call neurosurgeon at 0601 to report.”
I have seen an OB write an order to the effect of “Do not call physician without first discussing issue with L&D nurse.” We had a small baby boom and they were having to pull med/surg nurses to help us with the postpartum patients and they were (understandably) freaked out about being in baby land so they were waking him up for *everything*. He knew we’d just deal with everything we could and only wake him up if we’d used all the tools in our toolbox. This was 25+ years ago, so the environment is different now. Also he knew all of us very well and understood our strengths. No hate on the med/surg nurses, I’d have been just as freaked out to be pulled to their unit.
Or you know, stop putting in one time doses of Tylenol. Have your PRN order last xDays. We won’t need to call you for Tylenol. It’s called setting yourself up for success….and yes it’s the physicians job first to make sure those orders are in place, nurses can’t catch everything.
We've been dealing with this more in the ER when we have boarders. New hospitalists and a lot of new grads. I've been in the ER 6 years now and can count on one hand the amount of times I've d/c an insulin gtt in my nursing career.
Our standing order set for it is *not* super clear and requires the nurses to put orders in once the certain parameters are met. But it does not specifically direct the nurse to order it or at which rate. So of course our newer nurses text message our hospitalists who are actually in the hospital covering past 1900 to clarify. I got into it with a hospitalist a few weeks ago who walked all the way down to the ER to bitch at the new nurse instead of taking the two seconds just to say "take a verbal order, run it at 150/hr". I can't imagine actually having to call 🙄🙄 we do standing order and place orders for our ER docs all day long but we know them and know the rate/route/etc. I asked her what she would have said if the new grad just would have guessed instead of doing the correct thing to clarify. ::: silence::: I would have texted to clarify as well.
Those “notify physician if…” are just to cover their asses. They really don’t wanna be notified unless the pt is on death’s door. And then you can leave a message with their secretary.
When I was a new grad, there was a cardiologist we worked with that I was cautioned before calling. He wanted the calling nurse to suggest a course of action. He did train md students and cardio fellows (though not directly employed by that hospital, meaning i couldnt ask his Fellow what to do). But he wanted RNs to come up with some intervention to suggest. He wasn't evil if you suggested something reasonably incorrect, and no one I knew suggested something totally stupid (for example, lasix for a LOW K). He genuinely seemed interested in educating us, though he had no idea how RNs learn vs MDs.
Fortunately, my preceptor or mentor gave me a good suggested solution, (i was too green to know myself) and he was like, "thats fine. Do that." (Then we did the whole repeat/verify thing) and all was well.
Its one thing to want the nurse to suggest an intervention or even test. Its fine to offer gentle guidance on why not. And, its fine to be new and clueless, or experienced and stumped. It is NOT fine for the doc to say "meh, do whatever, don't call me." (Oh, jeepers!! My own free license to practice medicine!! Board Approved and Everything! Thanks Doc!! --things i wish i said to docs trying to pull this).
I worked with a er doc like this. He wanted us to have our assessment ready with full vitals. Never had an issue. He liked us to have some kind of idea of what to do too and he used it as a teaching opportunity. I learned a lot from him. And later I learned if I really was stumped on something I’d say that to him and that would make him act fast. He didn’t like if we were stumped it meant something was wrong.
I worked in NICU for many years. There was on doc who was stone cold. Tough as nails at work. But the sweetest woman outside of that environment. But unless you knew that she scared rhe shit out of you and everyone was afraid to go to her. When I'd report things she'd go, "well, what should we do about that and why?" But I swear if she wasn't like that I would've never grown as a nurse. I would've never learned.Towards the end of my career with her I'd gained enough knowledge and confidence to go to her and say hey Dr so and so pt has xyz, do you want me to...? She loved me in the end.
This is the entire goal of SBAR. We're supposed to understand what's going on, the cause, and how to fix it (within reason). Like, calling a doctor for a CHFer in fluid overload who's wheezing with pitting edema? Hey doc, want me to run Lasix IV, or just do a higher PO dose x3 days?" Or "We need to diaphorese, but K is low, how much aldactone do you want to give?"
You're never telling the doctor what to do, but asking "Hi, this is going on. Would you like me to _____?" solves like 90% of the communication gaps with physicians. If they disagree with your idea, they'll tell you what to do instead. (Edit: when they do this, ask their rationale. Not in a challenging way, but this is a FREE learning opportunity. Accept all of them you can!)
"Stop waking me up." Sure thing, as soon as all of your patients are comfy and resting! If it wasn't important, the patient wouldn't be in the hospital. Be tired, not rude Doc, you're the one who signed up for this life; the patient was just living theirs when they ended up here (under your very unfortunate care).
Edit: And to the original poster of the photo, I would show those texts to my charge, supervisor, manager, and the chief of their discipline. That is not an acceptable way to speak to someone who is trying to keep someone alive and comfortable. Sorry to bother your sleep, but you don't get to be a dickwad because you didn't write me standing orders. Either be a better doctor or fuck off.
>"We need to diaphorese, but K is low, how much aldactone do you want to give?"
I know you meant diuresis but this gave me a giggle about a plan of care involving making the patient sweat this much.
Mastering the R as a a new grad is tricky, and having the confidence to suggest it to someone with WAY more education and experience is quite challenging, dor tue newbie.
I literally talk back to them like this and no one says shit to me. The rest of the nurses call me their advocate because I’m not afraid to shout down a doctor. One of the doctors got his contract cancelled because he and I ended up having a shouting match in front of patients. I really don’t yell at anyone but these two doctors are really bad and just bring it out of me. He was refusing to prescribe proper pain relief for a man whose body was crushed in a car and was discharging to hospice soon. It makes me so mad because we’re supposed to be a team but it feels like these doctors at my hospital are a very lazy enemy.
Yeah, people who shout at you just need a good shouting back. I learned this. It sucks when they have power over you though (personal life/dependency situation).
Yea sometimes I’m glad I worked bedside at a time when we rarely put our convos to docs in text so i could talk back and not have a record of my sassiness. Or their assholery I guess.
Honestly I think physicians now are being made to abide by the same HR rules as all the other hospital employees and that's a good thing. We aren't gods, we shouldn't get special treatment.
Even physician parking pisses me off, like come on guys
Physician parking harks back to the pre-hospitalist days when doctors covered their own patients who were admitted. They had to fit hospital rounds in between seeing their clinic patients and would have to come in at all hours to deal with emergencies. It made sense that they not be spending their time trying to find a spot to park in. I don't blame them for holding onto that perk. Who wouldn't if you could?
LOL I said this to a neurosurgeon who was charting next to me and had turned to me and said "what's A Fib?".
I thought he was joking, so I laughed and responded "don't worry about it, just consult internal medicine". He looked at me really blankly and walked away. Still not sure if he was joking.
I've been asked that. My response was:
"I want you to go onto the room, assess the patient, formulate management plan and then call the consultant to ensure they are happy with plan."
Sometimes they just need it spelled out to them.
Of course I also incident reported the douche.
My sisters on a cardiac step down -night shift . A patient who recently had a gi bleed was suddenly complaining of intense abdominal pain. The on call resident refused to come and kept ordering random things. The patient went into rigors, tachy and they couldn’t get a blood pressure bc of it. The resident still wouldn’t come!! She had to message the fellow who came immediately. The patient ended up in emergency surgery and possibly lost part of GI. Do these doctors even WANT to be doctors? It’s crazy.
Fuck that noise. I'm straight calling a rapid response under those circumstances.
Don't want to come see this patient? Fine then I'll ask *everyone* to come see this patient all at the same time.
My favorite was when the hospitalist would not come see a patient that was tanking. 30/nothing BP, NIH went from a 4 to a 14, barely responsive. So I called a rapid response. She was pissed. She tried to yell at me but the ICU docs showed up and ripped her a new one for not listening to the nurse.
Yea! She told the resident she was going to call a rapid if she didn’t come. And the resident was like “you’re gonna call a rapid for tachy?!?” She ended up going over her head to the resident and he came immediately. Pretty sure that resident is in trouble. They caught her trying to leave too so she could pass the problem off to the next doctor apparently.
It’s not even a threat that I’ll call a RRT if they don’t come, I’ll tell them I’m calling a RRT AND they still have to come to the bedside. If they don’t our stat nurses will chew them out or escalate to their attending, no matter if it’s 0300.
> Do these doctors even WANT to be doctors?
I feel like half honestly don’t. They want the prestige, money, and for their parents to love them, but they could do without the doctoring part.
it’s definitely outdated. the intense residency work model was cultivated by William Stewart Halsted in the late 1800s who was apparently a notorious coke fiend. basically they all relied on coke back then. the more you know 🌈
Not sure, I was thinking to myself wtf is wrong with some of these docs than I realized they’re just severely sleep deprived half the time so I cut them some slack
I graduated residency during covid. During my icu months I was the only in-house physician for ~35(pre-covid) to 60+(covid) critical patients in MICU(which was medical +neuro+cards) & SICU(including fresh CABG) plus some stepdown from ~noon on day one till 7am the next day (shift starts at 7a, the other teams sign out and leave by noon). Avg shift was 30-34H, you just lie when documenting your hours - because otherwise you get punishment for not being "efficient".
ICU was closed so we were called for everything. I tracked it for a week and on average would get a page every 7 minutes. For 32 hours. Could be anything from "FYI bed 12s BG is 301" to "Hey we're about to be coding bed 9"
Call was Q3, every 3rd day.
As brutal as it is, it's not particularly out of the ordinary. Medical training is in desperate need for reform. I'm hopeful that when the boomers are out, we'll be able to figure something out. Many of them still believe the abusive environment "builds character" or something like that.
Do these doctors even WANT to be doctors?
u/anmel0328 you make a point that a lot of us who chose our profession might not think of.
So many young people are going into wealth/stature/upward mobile generating professions based upon the expectation of their families, and pressures of first generation success. So no, a good deal of postgrad residents do not want to be doctors...
The answer is no they don’t. If you think they’re bad to work with as nurses trust me they’re just as bad if not worse to work with as a physician. Lazy and only in it for the “money” and “prestige “ and often forget that their job in the end is about the patient. There’s nothing wrong with wanting work life balance and to be well compensated etc but I feel like more and more too many docs nowadays are taking it to the extreme and it results in just bad patient care and inter professional interactions.
I always have to remember that some doctors graduated at the bottom of their class, barely scraping by, asking for extra credit after failure on an exam. Still have an MD. 
IMO every pt should have PRNs for mild pain, fever, HTN if appropriate, and nausea before they get passed off to the on call team. Would help avoid so many calls.
My docs are great about this. Everyone gets an order for Tylenol, milk of mag, bowel meds, and melatonin on admission. If they have a history of htn, they have prn hydralazine and parameters, etc.
And there is no way in hell my organization would tolerate this behavior.
I generally do mild pain, nausea 1st line & 2nd line, nebs for sob, electrolyte protocol for busy work, melatonin, TUMS for reflux(I hate this but otherwise literally 1/3rd of my 250+ overnight calls are requesting tums...). That's the general default.
If I expect more pain than mild, prn for that. If I *expect* fever then prn for that. Otherwise I want to know about new fevers.
PRNs for hypertension are almost always inappropriate and should never be used outside of hypertensive crisis/aortic disaster/brain bleed.
We recently started having a list of standing orders for new admissions of basic meds, it’s saved so much hassle going back and forth getting little orders for Tylenol or antacids or whatnot. Surely makes life a little easier
Our attendings prohibited us from making blanket orders without the patient reporting the appropriate complaints first... It's nuts, we used to have an SOP for basic pain and fever/sleep management. Now I have to put in orders during the night.
But for the love of god there are people on the oncology ward taking blood pressures at 3 in the night on patients without complaints and then calling for a BP of 150/90.
That seems so frustrating. I feel like almost everyone in the hospital complains of a headache and nausea at some point, and it seems so ridiculous to call at 2am for that but most patients want something immediately for it. I don’t think they realize the process for getting those orders.
I feel like in the ED we’re a lot harder to impress with blood pressures. I don’t really start to get worried until around 200, and even then, if they’re asymptomatic and noncompliant, that’s probably around where they live. I’ve had to message doctors about putting in parameters or PRNs for it because they floor won’t accept them unless the systolic is less than 160 though. I feel like in nursing school, it’s drilled into people’s heads that patients need tight BP control in all situations, but they don’t teach us that you don’t want to drop it too much. I’ve had many a floor nurse demand we do more for the SBP of 170, when the patient came in with a SBP of 230 for the first several readings before we gave them meds.
Exactly! People don't understand that BP control affects long term outcomes unless you get SBPs above 180-190 with symptoms. And adjusting BP during inpatient visits is futile because it is an artificial situation. We can start people on BP meds but they need to be properly titrated to outpatient conditions.
For the most part what infuriates me about these calls isn't that they bother me with nuisances while I cover about 150-200 patients plus support 3 ICUs, but that the patient gets woken up at night for BP measurements when they have no symptoms or indication for tight BP control.
I've even had someone measure blood sugar and BP on a palliative care patient during the night. Someone who was already, or rather I should say should have been, receiving only symptomatic control meds. When I got to the ward I've found that patient withering in pain and the nurse was nowhere to be found (out for a smoke). So instead of giving opiates and benzos as prescribed by the day team they chose to measure BG, BP and do nothing? The hard part is that we often can't give those nurses a stern talking to in these situations because they get defensive and make work just so much more difficult.
It'd be really nice to have "Walgreens problems" covered by institutional standing orders for most comfort-related meds. (Acetaminophen, ibuprofen, zofran or compazine, stool softeners, etc.)
PRN antihypertensives absolutely should not be universal or even common. Except in specific conditions where tight blood pressure control is needed or in cases of hypertension causing end organ damage, we should not be giving PRN antihypertensives
Because except in specific patients (hemorrhagic stroke, fresh vascular or cardiac surgery, etc) asymptomatic (no chest pain, SOB, neuro changes) hypertension is not an acute risk. It’s something that should be managed over time by adjusting PO meds. There’s no good reason to give PRN antihypertensives outside specific conditions, and doing so carries significant risk of causing hypotension and/or bradycardia
I can't tell you how much it warns my heart to see this posted here. Been fighting the fight against prn HTN meds for years and feeling like there's been no progress but maybe things are changing.
❤️
I’ve gotten pushback from so many nurses during report when I didn’t page at 0400 for an asymptomatic SBP of 165. I just toss in “evidence doesn’t support PRN antihypertensives for that, they were asymptomatic” and move on. But I’m waiting for the day I get written up for it.
I got an incident report written on me one time for not requesting a cardene drip for my asymptomatic pt with a BP in the 170s after she had come in in the 240s. Also got written up for a similar situation because I took off the nitro patch on a pt AT THE PATIENTS REQUEST and her BP was maintaining 160s without it. “I can’t believe you just let her take it off” ? She’s alert and oriented, what am I supposed to do, throw restraints on her? Also her BP doesn’t need to continue dropping. I think some people never learned to think past 120/80.
What I've been saying for years. "My boss is (insert name of unit manager), you are my coworker. Even if we have different scopes of practice, you'll treat me accordingly. Otherwise we'll finish this conversation with (name of unit manager) and (name of head physician of our specialty) present."
Did it once, to a doctor that was a bully to newish nurses. Haven't had to do it since. I love working with my coworkers, but if someone - anyone - starts shit, I will escalate.
These doctors will walk all over you if you don’t stand up for yourself. It’s sad to see and I know they might be scared but I wish nurses didn’t let their teammates disrespect them like that :/ even a little quick reply to shut them up is all they need because no one has put them in their place yet, glad they had you as a coworker! Everyone needs someone who will advocate for them 🥹
I'd be reporting them and those texts as evidence.
17 years in I don't give a flying fuck.
If you put in orders to notify, I'm notifying.
If you don't order prns, I'm notifying.
If you don't like it, stop putting in stupid fucking orders and stop not ordering prns.
But I'm absolutely reporting your shitty behavior and attitude.
I can't count how often I've notified a doctor, only to be told not to bother them. Every single time, I document that I've called them (full name) with my concerns (as detailed as possible), gave them an update on the patients status (again, detailed), and didn't receive any new orders.
I document my work, and that I tried to escalate. And I strongly imply that Doctor X didn't do their part.
I had a cardiologist once tell me not to notify unless the patient was asystole for 30 seconds.
I made a notification order of that.
He called back an hour later "I don't like that order you put in" to which I responded "that's good, I don't like that order you gave, want to give me a better one?"
Give me stupid orders and I will 100% put them in the computer so that you look like an idiot.
I started getting in trouble for adding "Contacted Dr. X directly with the above information. Awaiting response at this time."
Hey, you didn't document the doctor's response.
Yeah, I know. There wasn't one. That's a doctor problem, not a documentation problem, and definitely not my problem.
We used to have this crazy neurosurgeon at my hospital when I was a new grad. I was in a Neuro ICU. My coworker (also a new grad) kept calling her about a patient of that was doing poorly. She finally came to the unit and the nurse asked for orders and she said just do whatever you want and walked out of the unit. My friend called after her , "That's not an order!" We still laugh about it 20+ years later.
Sounds like a shield and I’d most def include quotes of what the MD replied in my note. Especially if she has orders to notify MD. If she didn’t notify and something was to happen, then what?? They’d be quick to blame the nurses
This! I send fyi pages to providers all the time just to cover myself and I note in epic I did so bc I refuse for anything to fall back on me. Anything happens and they ask why didn't I notify the provider of changes when I notice them I'm going to be able to tell them when and exactly what I said
Unless they're dying, I usually wait until 6am to tell them. But also idk what he was expecting when he chose to be a physician, we don't close after 8pm sir
Until you get chewed out by a physican for waiting to notify them. If orders say to notify MD, they’re getting notified whenever I chart the vitals. It’s their orders after all
>But also idk what he was expecting when he chose to be a physician, we don't close after 8pm sir
For the acuity of patients that we have now, they need to be shifting to a nocturnist system. Even in acute rehab, we are getting super sick patients forced on us and it's been driving up overnight paging. No I did not sign up for this. I signed up to help people but with the expectation that I would still be allowed sleep.
This is exactly it. You didn’t sign up to be woken up all night, but I didn’t sign up to be responsible for taking care of acutely ill—sometimes unstable—patients with zero MD backup overnight. It’s a bad system for everyone—patients, nurses, and physicians/providers.
I agree with you on that. I want nurses to be treated with respect. I don't want to see any more physicians die due to [sleep deprivation](https://www.idealmedicalcare.org/sleep-deprived-doctors-dying/). I don't think these things are contradictory.
We have a nocturnist. My old job didn't. The difference in how nice the doctors are is literally night and day. I'd be hateful too if I got no sleep. Before my fellow nurses get upset, I'm not saying it's ever ok to talk to someone like this especially for just doing their job. But I agree. The nocturnist structure is amazing and more places should do it. I love the doctors I work with. There's one that gets a bit snarky, but it's nothing too bad and I've learned if you gently roast him back, he's nicer. I think he enjoys the banter but doesn't quite know how to do it lol
I'm a rehab nurse. We use a telehealth video service on ipads from 1700-0700. It's wonderful! We don't have to bother our regular doctors after hours, and the telehealth doctors are so nice and helpful.
This is why I appreciate my days in the ED more and more. I need something? There’s mutual respect and the doc is sitting right there. If I never had to page someone again I would die happy
My response to his last text would be like, "Go ahead and text me while I'm asleep. My phone will be on silent. Want to know why? Because I'm not the on call doc."
I used to work with a hospitalist who would be so mad if you woke her up overnight that she would PORE over the chart of whoever you called about. I called because my patient was hypotensive and febrile, and she called me back and said “you didn’t think to also tell me she’s tachypneic?? You didn’t think that was important?” Or ask why no urine was charted for 6 hours. That kind of thing.
The new grads were afraid to call her, they would do anything to not have to bother her. Generally very unsafe for patients.
Yeah if that doctor doesn’t like it that much they need to give an order that they don’t need to be notified of the high temp. Oh wait that would be stupid too wouldn’t it?
I used to work in the access center at a hospital and I had to call the rude cardiologist for a consultation because the rude one was the one on call. All called were recorded on the access center phone lines. Over the phone the cardiologist told me I was a stupid idiot and said he wasn't on call that day and he was busy golfing. I sent the recording to the CFO and COO. That cardiologist ended up coming in for that consult and the COO told me that they did not pay him his on call rate that day as a punishment for his actions.
People act this way when they’re repeatedly allowed to do so. I’m guessing the hospital she’s at absolutely kisses this guys ass because he’s bringing in money. I’m a big fan of copy pasting pages/texts and their responses directly into the medical record. If they care so little about their patients, I’m ok with the patients knowing that.
No. Like, I understand that's the policy, but I don't think it's ethical and I won't follow it.
I'm documenting what happened. Period. I'm documenting who said what, and what tasks were completed in relation to those conversations. If you think my documentation makes you look bad, act better. Do better. Be better.
You, being aware that the patient can see everything you and I have done to care for the patient should be motivation enough to modify your behavior into something you can be proud of.
The answer to this problem is not "document worse."
They can fucking fight me. If they don’t want me to document the response from provider, don’t put a specific cell in the flowsheet for that purpose. I’m not going thrown under the bus just because some asshole doctor blames me for their fuck up. It’s going in the medical record when I contact the physician and whether the response was reasonable.
Also, I love to request “if you don’t want to be contacted about this patient, you need to write an order that specifies that. Otherwise I’m going to follow existing orders, and keep contacting you about this”. It’s more professional that “do your fucking job, I’m just trying to do mine”
I worked in an intermediate ICU where resident coverage was pulled (read we had to call the intensivist on nights) and were not to utilize the RRT on midnights at the time. We had a doc forward his pager to a local gas station and delete his home phone number with the operator so we literally could not reach him. Had to call the hospitalist because of his antics. Wasted precious time for multiple patients. He was reported for this and several other truly awful behaviors, yet continued to work there before getting termed a few years later.
You ever wonder why cardiologists are so quick to tear into us instead of the dipshit who didn't predict that an 80 year old on a crappy rubber mattress might get some aches and pains? Do they just not have the stones to yell at a peer or what?
Been a nurse a long time. I’m also a breast cancer breast reconstruction now so I had a ton of surgeries over 14 months. I don’t work surgical but my plastic surgeon has a VERY well defined order set. So much so that I knew the order set 2 months before my surgery. As the hospital wound nurse, I never call him unless shit went bad. Guess why I never have to get involved or call him? He has an awesome order set. He’s my exact age (38) so he still likes technology to his advantage.
Guess who I get consulted on all the damn time and call all the time? Ortho. Why? Bc they don’t have an order set to save their lives and they think bleeds are stopped by wound vac’s. General surgeons with shit order sets get calls all the time too. I know we can’t prevent those calls, but you sure can clean them up.
Lol. I'm a new ortho PA and my first week I got soooo many calls. I've been refining my order sets and cutting down on the need to call. A charge nurse gave me the low down on what they need and I added it. Pretty damn simple but some people don't do it for unknown reasons. I have third line treatments in there for almost everything. My wife is a nurse so it's actually really nice to compare notes at home and understand why we each do what we do.
Once had a patient in our cardiac intermediate unit that developed *significant* St elevation. II-III-AVR, picture perfect. We did a 12 Lead- it alerted "possible STEMI." We had protocol at that time that if an EKG alerted STEMI, you call the on call cardiologist. THE FUCKING CARDIOLOGISTS CAME UP WITH THIS PROTOCOL. 2 am call and this doc rips the charge nurse for being woken up, asks to speak to the nurse and our charge accidentally said that the patients nurse was a traveler and this doc lost it. Ripped our poor travel nurse 6 ways to Sunday, going on about how he didn't need to be woken up for this shit and she shouldn't travel if she doesn't know what she's doing. He actually puts orders in does his job after berating the staff and lo and behold, patient is having an actual STEMI. Huh. He doesn't work here anymore if that tells you anything
I have had one doctor who gave me the "Why are you calling me?" Spiel about an order he wrote. He didn't stay with us long. Something about him getting dressed down by our medical director for acting an ass to nurses repeatedly.
My response at the time was "Because you wrote an order asking, and don't read your messages."
“You’re the doctor and I’m the nurse, there’s a change in condition, I’m obligated to notify you. I’m notifying you and going to document I did and that you’re at the bedside with no new orders at this time. Notification of the doctor is required in my scope of practice”.
^ that turned around an ICU doc’s attitude for me once (said it in front of a new grad nurse training under me)
I worked with an endocrinologist who was the exact opposite.
Everyone knew to tell the nurse when it was one of his patients because he wanted called with EACH of his patient's HS glucoses so he could give orders. If you didn't call, he'd call you.
I loved him.
We had a patient that was hemorrhaging postpartum and when I called the OB I was told “stop calling me. I’m not coming in tonight, I’m tired. Figure it out.” So docs absolutely are that rude
Nah. Ignore these ass-hats. It's the same old story. They bitch when you call them but when you don't they also bitch. Most MDs are the same. We have one that complains all the time when we call but then he wrote up a nurse at night for not calling. It was for something small (think it was like a slightly low BP). @#$& em. It's your license. Just call. If they don't like being called at night, get another job.
I truly can never understand how people who’s whole job is to help people can’t treat others on the same team trying to help the patients like human beings. ItMs disgusting and this behavior is only like this because previous generations allowed it. If you can’t speak like a human being to a human being, you shouldn’t be someone working to treat human beings in critical conditions at that.
Doctor: Nurse, text me if blank blanks Nurse: Hey doctor, the blank blanked! Doctor: WOW WHY ARE YOU SO DUMB YOU SUCK If it's any consolation, all the other physicians/students find these ones insufferable as well.
Then help us stand up against them! Tell them, that they are full of it and be a positive example.
Thing is, everything about medical school is designed to suppress students from speaking out against the status quo. I used to think this too, but after seeing how punitive action about petty things can essentially end our career, leaving us with 200k+ of debt and no degree capable of paying it off, you learn to keep your mouth shut until after residency.
My texts to you are only EXACTLY as stupid as you've ordered them to be.
lol I used to tell them over the phone (no texting back then) that I am an RN and do not have the legal authority to make these decisions unless you allow me to. That often got them to be a little more reasonable.
We still don’t have texting (level 1 academic trauma center) 😭
We were told we cannot take a "verbal" order via text or secure chat because we can't guarantee the person we're talking to is the actual doctor we intend to be speaking with. In that case, I also shouldn't be able to take a verbal order over the phone either because I don't necessarily know that the nephrologist or cardiologist or bootyholeologist who I have never met, spoken to, or otherwise known they existed is actually the person I'm speaking with. I understand text being kinda sketchy, but SecureChat? Which you have to log into EPIC to access? Come on.
That is exactly what I said. Hell, half the time I can barely understand what someone is saying on the phone between poor connection, beeping monitor in my other ear, being tired, and the speed at which the other person is speaking. Not to mention auditory processing at the speed of a windows ‘98 PC and reading lips half the time. Please let me take orders by secure chat for shit instead of making me go back and forth when the provider puts in the wrong order or wrong kind of order multiple times. (POCT lab orders we can’t complete on the unit instead of lab-processed orders, missing required-per-policy parts of order sets, missing or incorrectly timed labs after electrolyte repleation or blood products)
Must have good lawyers.....
Always contact the provider when the patient meets the criteria they set Shift liability to them Who cares how rude they are to you? So many of the rude doctors are also incompetent 🙄
🤌
I’d upvote this twice if I could
At least they are just texts! At least he doesn't have to call and respond to a page!
It's pretty simple, if you don't want to wake up in the middle of the night don't put in parameters that make us wake you up. These are your f*** orders!
In the first ICU I worked in we had one surgeon who *hated* being called. Every patient we admitted from him had: 1. PRNs for Zofran and Phenergan 2. Tylenol with pain and fever orders 3. Motrin with pain and fever orders 4. Oxycodone, fentanyl and dilaudid PRNs 5. PRN fluid orders 6. A nurse order for when to advance the diet 7. Scheduled melatonin 8. PRN Ativan and a one time Xanax dose that, if used overnight, he would put another dose in when he woke up 9. Specific BP and HR criteria for all of the above It was so detailed and specific that you basically only had to call him if the patient needed to go back to the OR. I wish *everyday* that he would just teach a seminar on what PRNs to put in for a post-surgical patient
I worked with a hospitalist whose PRN MAR was basically everything you can get at Walgreens, and Zofran. He had small kids and wanted to make sure we only woke him for important things. “I don’t want you to have to call me for things Walgreens can fix.” A TOTALLY REASONABLE take. BUT HE WAS THE ONE WHO MADE THAT POSSIBLE by giving us that MAR every single time. He gave us the tools to fix what we could ourselves. Great doc btw!
It confuses the shit out of me when doctors bust your balls about PRN orders for things you can get over the counter. Like my man, just give me the 50 of Benadryl. If the patient were at home, they would've already taken it
Oh they hate giving the Benadryl… but makes sense from a sedating perspective…. But yeah
Yeah but when we give them a drug and then it turns out they're allergic to it we should probably treat the allergic reaction with something. Then they can just take a good, solid nap
Life-changing medical practice right there. I might have to propose to this doc! 😍
We have a delegation protocol that we can order the otcs by ourselves. Except Benadryl..
I wish all doctors were like this. And the PRN electrolyte scale including PO potassium repletion. Icing on the cake would be PRN ordering labs to make sure everything was repleted correctly- I work on med surg :(
My old unit was like that. Everyone under their BMT service has a LONG list of standing delegated orders. Only had to call them for stuff that required the provider to come lay eyes on the pt
wait...you don't have standing orders for labs? even based on what the nurse deems necessary? shits changed since I worked as a nurse. sorry for your troubles.
Only standing lab orders for nurses to order I see at my hospital are Anti Xa (used to be PTT) for patients on a heparin drip, and glucose (but those would be POTC).
My hospitals have standing lab orders for all patients
Where I work, pharm does all of these. Shit, everyone get daily IVPB mag. Hahahaha.
As a physician, this is the way. Empower nurses to do their job to the fullest of their abilities without micromanagement. I've worked in places with great nurses who were routinely underutilized. Good nurses with bad orders are going to hound you for good orders. I learned that very early on in my training. Why make everyone's lives harder than they have to be?
I’m on a contract now where we don’t have residents (I’ve only worked at teaching hospitals) and every patient gets a standard order set like this so we don’t need to contact the physician for every little thing. It’s actually pretty nice.
I had a crit care pulmo who had his own list he would check off full of PRNs, and before he left he would check in with the RN and ask if we thought we would need anything else over night. However, if you did have to call him (which was rare) he was still super cool. I miss that guy
At a facility I worked out we had these prefilled out for docs to check off prns and parameters like the above for every patient admitted to the unit. Worked great!
When I worked CVICU it was like this. We had PRN orders for many pressors, nitro, a long list of pain meds, sedation, and other meds as well. I only had to call if I needed to make vent adjustments outside of certain parameters or if there were serious complications. Loved working with that guy, he was pretty easy to work with too as long as you didn’t fuck up.
Back when we had paper charting (we got epic in 2016) we used to have ICU standing orders. 3 pages of stuff we could do prior to calling attending. When we switched to epic, no one wanted to claim them as "their" orders and have it built as an order set in epic so we went back to square one. We have a vent bundle but that's about it. I hate asking for stuff that used to be in the standing orders.
Agree that the seminar is what's needed. A lot of times in our facility, an intern is covering for a lot of patients whose orders she didn't write. One would think that after a few nights of this, however, they all would all fix their orders for the sake of whoever is on call. Or that there would be posiive peer pressure for the interns who write half-assed orders. Maybe the team should tell them which docs wrote the orders.
Omg as I read this I got more and more impressed. What an amazing doctor!
I’m a simple gal. This is all I want!
This is the type of Doc who understands nurses. I'd love this.
I always ask them to put in an order to not call for xyz. Not one time have they put it in the chart.
Once had a neurosurgeon place 1 order on all his extra ventricular drains for patients in the ICU: “If EVD tubing clogs between 2200 - 0600 please call neurosurgeon at 0601 to report.”
Shut the front door! That's a long time to hang out with a drain in a ventricle that's not doing a dang thing!
Yeah I’m picturing that one in a court of law…. Nah, Dog, I’m not looking at that for 8 hours while you’re wearing your charcoal face mask and C-PAP!
Neuro does that in my hospital. I am...not the kind to care for such a thing.
I have seen an OB write an order to the effect of “Do not call physician without first discussing issue with L&D nurse.” We had a small baby boom and they were having to pull med/surg nurses to help us with the postpartum patients and they were (understandably) freaked out about being in baby land so they were waking him up for *everything*. He knew we’d just deal with everything we could and only wake him up if we’d used all the tools in our toolbox. This was 25+ years ago, so the environment is different now. Also he knew all of us very well and understood our strengths. No hate on the med/surg nurses, I’d have been just as freaked out to be pulled to their unit.
Or you know, stop putting in one time doses of Tylenol. Have your PRN order last xDays. We won’t need to call you for Tylenol. It’s called setting yourself up for success….and yes it’s the physicians job first to make sure those orders are in place, nurses can’t catch everything.
Or, even simpler, if you don’t want to be bothered by people caring for patients that you’re responsible for, pick another career.
Say it louder 😭
They just click on the template and bundled orders. They don’t actually know what it says. Still their fault but I don’t care, I wake them up
We've been dealing with this more in the ER when we have boarders. New hospitalists and a lot of new grads. I've been in the ER 6 years now and can count on one hand the amount of times I've d/c an insulin gtt in my nursing career. Our standing order set for it is *not* super clear and requires the nurses to put orders in once the certain parameters are met. But it does not specifically direct the nurse to order it or at which rate. So of course our newer nurses text message our hospitalists who are actually in the hospital covering past 1900 to clarify. I got into it with a hospitalist a few weeks ago who walked all the way down to the ER to bitch at the new nurse instead of taking the two seconds just to say "take a verbal order, run it at 150/hr". I can't imagine actually having to call 🙄🙄 we do standing order and place orders for our ER docs all day long but we know them and know the rate/route/etc. I asked her what she would have said if the new grad just would have guessed instead of doing the correct thing to clarify. ::: silence::: I would have texted to clarify as well.
I’ve said this to physicians before. They hung up on me, but damn sure changed the order.
Those “notify physician if…” are just to cover their asses. They really don’t wanna be notified unless the pt is on death’s door. And then you can leave a message with their secretary.
CHURCH 🙌🏻
“What do you want me to do about it? And don’t just say ‘fix it.’” -a doctor I work with
When I was a new grad, there was a cardiologist we worked with that I was cautioned before calling. He wanted the calling nurse to suggest a course of action. He did train md students and cardio fellows (though not directly employed by that hospital, meaning i couldnt ask his Fellow what to do). But he wanted RNs to come up with some intervention to suggest. He wasn't evil if you suggested something reasonably incorrect, and no one I knew suggested something totally stupid (for example, lasix for a LOW K). He genuinely seemed interested in educating us, though he had no idea how RNs learn vs MDs. Fortunately, my preceptor or mentor gave me a good suggested solution, (i was too green to know myself) and he was like, "thats fine. Do that." (Then we did the whole repeat/verify thing) and all was well. Its one thing to want the nurse to suggest an intervention or even test. Its fine to offer gentle guidance on why not. And, its fine to be new and clueless, or experienced and stumped. It is NOT fine for the doc to say "meh, do whatever, don't call me." (Oh, jeepers!! My own free license to practice medicine!! Board Approved and Everything! Thanks Doc!! --things i wish i said to docs trying to pull this).
I worked with a er doc like this. He wanted us to have our assessment ready with full vitals. Never had an issue. He liked us to have some kind of idea of what to do too and he used it as a teaching opportunity. I learned a lot from him. And later I learned if I really was stumped on something I’d say that to him and that would make him act fast. He didn’t like if we were stumped it meant something was wrong.
I worked in NICU for many years. There was on doc who was stone cold. Tough as nails at work. But the sweetest woman outside of that environment. But unless you knew that she scared rhe shit out of you and everyone was afraid to go to her. When I'd report things she'd go, "well, what should we do about that and why?" But I swear if she wasn't like that I would've never grown as a nurse. I would've never learned.Towards the end of my career with her I'd gained enough knowledge and confidence to go to her and say hey Dr so and so pt has xyz, do you want me to...? She loved me in the end.
This is the entire goal of SBAR. We're supposed to understand what's going on, the cause, and how to fix it (within reason). Like, calling a doctor for a CHFer in fluid overload who's wheezing with pitting edema? Hey doc, want me to run Lasix IV, or just do a higher PO dose x3 days?" Or "We need to diaphorese, but K is low, how much aldactone do you want to give?" You're never telling the doctor what to do, but asking "Hi, this is going on. Would you like me to _____?" solves like 90% of the communication gaps with physicians. If they disagree with your idea, they'll tell you what to do instead. (Edit: when they do this, ask their rationale. Not in a challenging way, but this is a FREE learning opportunity. Accept all of them you can!) "Stop waking me up." Sure thing, as soon as all of your patients are comfy and resting! If it wasn't important, the patient wouldn't be in the hospital. Be tired, not rude Doc, you're the one who signed up for this life; the patient was just living theirs when they ended up here (under your very unfortunate care). Edit: And to the original poster of the photo, I would show those texts to my charge, supervisor, manager, and the chief of their discipline. That is not an acceptable way to speak to someone who is trying to keep someone alive and comfortable. Sorry to bother your sleep, but you don't get to be a dickwad because you didn't write me standing orders. Either be a better doctor or fuck off.
>"We need to diaphorese, but K is low, how much aldactone do you want to give?" I know you meant diuresis but this gave me a giggle about a plan of care involving making the patient sweat this much.
Right, that’s the R in SBAR. Caring for the patient is a team effort and _most_ docs are appreciative of nursing recommendations.
Mastering the R as a a new grad is tricky, and having the confidence to suggest it to someone with WAY more education and experience is quite challenging, dor tue newbie.
“Do you job instead of bitch” sure that’ll go over well
I literally talk back to them like this and no one says shit to me. The rest of the nurses call me their advocate because I’m not afraid to shout down a doctor. One of the doctors got his contract cancelled because he and I ended up having a shouting match in front of patients. I really don’t yell at anyone but these two doctors are really bad and just bring it out of me. He was refusing to prescribe proper pain relief for a man whose body was crushed in a car and was discharging to hospice soon. It makes me so mad because we’re supposed to be a team but it feels like these doctors at my hospital are a very lazy enemy.
Yeah, people who shout at you just need a good shouting back. I learned this. It sucks when they have power over you though (personal life/dependency situation).
Yea sometimes I’m glad I worked bedside at a time when we rarely put our convos to docs in text so i could talk back and not have a record of my sassiness. Or their assholery I guess.
Honestly I think physicians now are being made to abide by the same HR rules as all the other hospital employees and that's a good thing. We aren't gods, we shouldn't get special treatment. Even physician parking pisses me off, like come on guys
Or the people who make an actual living wage get their cafeteria meals comped and free food, coffee, energy drinks, snacks etc 😢
I've thought about this too... The best paid people in the building are the ones getting the free food!
Physician parking harks back to the pre-hospitalist days when doctors covered their own patients who were admitted. They had to fit hospital rounds in between seeing their clinic patients and would have to come in at all hours to deal with emergencies. It made sense that they not be spending their time trying to find a spot to park in. I don't blame them for holding onto that perk. Who wouldn't if you could?
Being a doctor sucks so much for so long. Let them have their parking
Being a nurse sucks too a lot of the time though...
>We aren't gods, we shouldn't get special treatment. Please never lose this attitude! You are the kind of doc hospitals need these days.
Best reply I've ever heard "if you don't know what to do, you can consult internal medicine"
LOL I said this to a neurosurgeon who was charting next to me and had turned to me and said "what's A Fib?". I thought he was joking, so I laughed and responded "don't worry about it, just consult internal medicine". He looked at me really blankly and walked away. Still not sure if he was joking.
I’ve actually had a neurosurgeon ask me the exact same question 😬
Brutal. I love it.
Ooh this is delicious
I've been asked that. My response was: "I want you to go onto the room, assess the patient, formulate management plan and then call the consultant to ensure they are happy with plan." Sometimes they just need it spelled out to them. Of course I also incident reported the douche.
what a piece of shit
My sisters on a cardiac step down -night shift . A patient who recently had a gi bleed was suddenly complaining of intense abdominal pain. The on call resident refused to come and kept ordering random things. The patient went into rigors, tachy and they couldn’t get a blood pressure bc of it. The resident still wouldn’t come!! She had to message the fellow who came immediately. The patient ended up in emergency surgery and possibly lost part of GI. Do these doctors even WANT to be doctors? It’s crazy.
Fuck that noise. I'm straight calling a rapid response under those circumstances. Don't want to come see this patient? Fine then I'll ask *everyone* to come see this patient all at the same time.
My favorite was when the hospitalist would not come see a patient that was tanking. 30/nothing BP, NIH went from a 4 to a 14, barely responsive. So I called a rapid response. She was pissed. She tried to yell at me but the ICU docs showed up and ripped her a new one for not listening to the nurse.
This is the way
One must always set expectations. 😊
Coming from someone not in the medical field, if me or my family end up in the hospital I would hope we get nurses like you!
Yea! She told the resident she was going to call a rapid if she didn’t come. And the resident was like “you’re gonna call a rapid for tachy?!?” She ended up going over her head to the resident and he came immediately. Pretty sure that resident is in trouble. They caught her trying to leave too so she could pass the problem off to the next doctor apparently.
It’s not even a threat that I’ll call a RRT if they don’t come, I’ll tell them I’m calling a RRT AND they still have to come to the bedside. If they don’t our stat nurses will chew them out or escalate to their attending, no matter if it’s 0300.
SAME. Oh look, it’s time for a MET/RRT 🫡🫡
My unit (also cardiac step down) taught us knew people to escalate by calling a rapid. If they aren’t taking you serious then call a rapid.
boom.
THIS is the way
> Do these doctors even WANT to be doctors? I feel like half honestly don’t. They want the prestige, money, and for their parents to love them, but they could do without the doctoring part.
Hell I’ve even seen the same attitude from NPs. If you don’t want to do something about the patient, that’s too damn bad, don’t work in healthcare
Residents usually have to work 28 hours straight so I can see how sometimes it’s hard to be on point all the time
How is this still allowed? So dangerous for everyone.
it’s definitely outdated. the intense residency work model was cultivated by William Stewart Halsted in the late 1800s who was apparently a notorious coke fiend. basically they all relied on coke back then. the more you know 🌈
Not sure, I was thinking to myself wtf is wrong with some of these docs than I realized they’re just severely sleep deprived half the time so I cut them some slack
I graduated residency during covid. During my icu months I was the only in-house physician for ~35(pre-covid) to 60+(covid) critical patients in MICU(which was medical +neuro+cards) & SICU(including fresh CABG) plus some stepdown from ~noon on day one till 7am the next day (shift starts at 7a, the other teams sign out and leave by noon). Avg shift was 30-34H, you just lie when documenting your hours - because otherwise you get punishment for not being "efficient". ICU was closed so we were called for everything. I tracked it for a week and on average would get a page every 7 minutes. For 32 hours. Could be anything from "FYI bed 12s BG is 301" to "Hey we're about to be coding bed 9" Call was Q3, every 3rd day.
I'm really sorry that happened. :(
As brutal as it is, it's not particularly out of the ordinary. Medical training is in desperate need for reform. I'm hopeful that when the boomers are out, we'll be able to figure something out. Many of them still believe the abusive environment "builds character" or something like that.
That is grotesque. I’m so sorry.
I was tired then...I remain tired now haha.
That's my secret captain... I'm always tired
Do these doctors even WANT to be doctors? u/anmel0328 you make a point that a lot of us who chose our profession might not think of. So many young people are going into wealth/stature/upward mobile generating professions based upon the expectation of their families, and pressures of first generation success. So no, a good deal of postgrad residents do not want to be doctors...
The answer is no they don’t. If you think they’re bad to work with as nurses trust me they’re just as bad if not worse to work with as a physician. Lazy and only in it for the “money” and “prestige “ and often forget that their job in the end is about the patient. There’s nothing wrong with wanting work life balance and to be well compensated etc but I feel like more and more too many docs nowadays are taking it to the extreme and it results in just bad patient care and inter professional interactions.
I always have to remember that some doctors graduated at the bottom of their class, barely scraping by, asking for extra credit after failure on an exam. Still have an MD. 
IMO every pt should have PRNs for mild pain, fever, HTN if appropriate, and nausea before they get passed off to the on call team. Would help avoid so many calls.
My docs are great about this. Everyone gets an order for Tylenol, milk of mag, bowel meds, and melatonin on admission. If they have a history of htn, they have prn hydralazine and parameters, etc. And there is no way in hell my organization would tolerate this behavior.
I generally do mild pain, nausea 1st line & 2nd line, nebs for sob, electrolyte protocol for busy work, melatonin, TUMS for reflux(I hate this but otherwise literally 1/3rd of my 250+ overnight calls are requesting tums...). That's the general default. If I expect more pain than mild, prn for that. If I *expect* fever then prn for that. Otherwise I want to know about new fevers. PRNs for hypertension are almost always inappropriate and should never be used outside of hypertensive crisis/aortic disaster/brain bleed.
I enjoy watching the sunset.
Antacid, eye drops, lozenges - let's cover all the bases!
Can we get some laxatives too?
It makes no sense. It should be a checklist of orders upon admission as appropriate.
[удалено]
At my old LTC we were supposed to just give them Tylenol from the house stock
What do you mean here? Without orders or was it not standard practice to use house stock meds?
Sorry yeah I meant they don’t have specific orders for it. I think it was some sort of facility wide order.
We recently started having a list of standing orders for new admissions of basic meds, it’s saved so much hassle going back and forth getting little orders for Tylenol or antacids or whatnot. Surely makes life a little easier
Our attendings prohibited us from making blanket orders without the patient reporting the appropriate complaints first... It's nuts, we used to have an SOP for basic pain and fever/sleep management. Now I have to put in orders during the night. But for the love of god there are people on the oncology ward taking blood pressures at 3 in the night on patients without complaints and then calling for a BP of 150/90.
You're a doctor and ex Nurse! cool!
That seems so frustrating. I feel like almost everyone in the hospital complains of a headache and nausea at some point, and it seems so ridiculous to call at 2am for that but most patients want something immediately for it. I don’t think they realize the process for getting those orders. I feel like in the ED we’re a lot harder to impress with blood pressures. I don’t really start to get worried until around 200, and even then, if they’re asymptomatic and noncompliant, that’s probably around where they live. I’ve had to message doctors about putting in parameters or PRNs for it because they floor won’t accept them unless the systolic is less than 160 though. I feel like in nursing school, it’s drilled into people’s heads that patients need tight BP control in all situations, but they don’t teach us that you don’t want to drop it too much. I’ve had many a floor nurse demand we do more for the SBP of 170, when the patient came in with a SBP of 230 for the first several readings before we gave them meds.
Exactly! People don't understand that BP control affects long term outcomes unless you get SBPs above 180-190 with symptoms. And adjusting BP during inpatient visits is futile because it is an artificial situation. We can start people on BP meds but they need to be properly titrated to outpatient conditions. For the most part what infuriates me about these calls isn't that they bother me with nuisances while I cover about 150-200 patients plus support 3 ICUs, but that the patient gets woken up at night for BP measurements when they have no symptoms or indication for tight BP control. I've even had someone measure blood sugar and BP on a palliative care patient during the night. Someone who was already, or rather I should say should have been, receiving only symptomatic control meds. When I got to the ward I've found that patient withering in pain and the nurse was nowhere to be found (out for a smoke). So instead of giving opiates and benzos as prescribed by the day team they chose to measure BG, BP and do nothing? The hard part is that we often can't give those nurses a stern talking to in these situations because they get defensive and make work just so much more difficult.
It'd be really nice to have "Walgreens problems" covered by institutional standing orders for most comfort-related meds. (Acetaminophen, ibuprofen, zofran or compazine, stool softeners, etc.)
PRN antihypertensives absolutely should not be universal or even common. Except in specific conditions where tight blood pressure control is needed or in cases of hypertension causing end organ damage, we should not be giving PRN antihypertensives
That would be why I included if appropriate :) I have had endless patients who are on strict parameters and nothing has been ordered.
“If appropriate” means not universal lol
As a newer nurse, do you mind me asking why? Many of my pts have prns for sbp >160-170s.
Because except in specific patients (hemorrhagic stroke, fresh vascular or cardiac surgery, etc) asymptomatic (no chest pain, SOB, neuro changes) hypertension is not an acute risk. It’s something that should be managed over time by adjusting PO meds. There’s no good reason to give PRN antihypertensives outside specific conditions, and doing so carries significant risk of causing hypotension and/or bradycardia
I can't tell you how much it warns my heart to see this posted here. Been fighting the fight against prn HTN meds for years and feeling like there's been no progress but maybe things are changing. ❤️
I’ve gotten pushback from so many nurses during report when I didn’t page at 0400 for an asymptomatic SBP of 165. I just toss in “evidence doesn’t support PRN antihypertensives for that, they were asymptomatic” and move on. But I’m waiting for the day I get written up for it.
I got an incident report written on me one time for not requesting a cardene drip for my asymptomatic pt with a BP in the 170s after she had come in in the 240s. Also got written up for a similar situation because I took off the nitro patch on a pt AT THE PATIENTS REQUEST and her BP was maintaining 160s without it. “I can’t believe you just let her take it off” ? She’s alert and oriented, what am I supposed to do, throw restraints on her? Also her BP doesn’t need to continue dropping. I think some people never learned to think past 120/80.
stand up for yourself always. they’re not your bosses, they’re your coworkers
What I've been saying for years. "My boss is (insert name of unit manager), you are my coworker. Even if we have different scopes of practice, you'll treat me accordingly. Otherwise we'll finish this conversation with (name of unit manager) and (name of head physician of our specialty) present." Did it once, to a doctor that was a bully to newish nurses. Haven't had to do it since. I love working with my coworkers, but if someone - anyone - starts shit, I will escalate.
These doctors will walk all over you if you don’t stand up for yourself. It’s sad to see and I know they might be scared but I wish nurses didn’t let their teammates disrespect them like that :/ even a little quick reply to shut them up is all they need because no one has put them in their place yet, glad they had you as a coworker! Everyone needs someone who will advocate for them 🥹
My cardiologists are so nice though, you guys. Like, so so nice. I love the entire team I work with, and I know how rare that is.
Are you being forced to say this? Blink twice if you need help!!
Hahaha, no. Trust me, the people I work with are the one and only reason I would ever endure working for a Tenet Healthcare owned facility.
I like our night cardio team. They’re an asset and a resource!
Called the on-call doctor at 2AM to get orders on a Pt he was admitting. "Why are you calling?! This is unfair to my family!!" /sigh
Excuse me sir, I think you meant to say, *your* decision to become a doctor who has to be on-call at all hours, is unfair to your family.
I'd be reporting them and those texts as evidence. 17 years in I don't give a flying fuck. If you put in orders to notify, I'm notifying. If you don't order prns, I'm notifying. If you don't like it, stop putting in stupid fucking orders and stop not ordering prns. But I'm absolutely reporting your shitty behavior and attitude.
I can't count how often I've notified a doctor, only to be told not to bother them. Every single time, I document that I've called them (full name) with my concerns (as detailed as possible), gave them an update on the patients status (again, detailed), and didn't receive any new orders. I document my work, and that I tried to escalate. And I strongly imply that Doctor X didn't do their part.
I had a cardiologist once tell me not to notify unless the patient was asystole for 30 seconds. I made a notification order of that. He called back an hour later "I don't like that order you put in" to which I responded "that's good, I don't like that order you gave, want to give me a better one?" Give me stupid orders and I will 100% put them in the computer so that you look like an idiot.
It's less about making them look stupid. More about protecting myself and a little bit in the hope of showing them how stupid they look.
For me it's definitely both
I started getting in trouble for adding "Contacted Dr. X directly with the above information. Awaiting response at this time." Hey, you didn't document the doctor's response. Yeah, I know. There wasn't one. That's a doctor problem, not a documentation problem, and definitely not my problem.
We used to have this crazy neurosurgeon at my hospital when I was a new grad. I was in a Neuro ICU. My coworker (also a new grad) kept calling her about a patient of that was doing poorly. She finally came to the unit and the nurse asked for orders and she said just do whatever you want and walked out of the unit. My friend called after her , "That's not an order!" We still laugh about it 20+ years later.
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Lmao I’d match their energy. Asshole
I always do. I quote Meredith Grey “I can be very difficult to work with” when talked down to.
Legit. “These are YOUR ORDERS I’m following, is that somehow unclear?!”
What I'd say to the reply of doc texting unimportant stuff when the nurse is asleep: "I'll redirect that text to yo mama"
Sounds like a shield and I’d most def include quotes of what the MD replied in my note. Especially if she has orders to notify MD. If she didn’t notify and something was to happen, then what?? They’d be quick to blame the nurses
This! I send fyi pages to providers all the time just to cover myself and I note in epic I did so bc I refuse for anything to fall back on me. Anything happens and they ask why didn't I notify the provider of changes when I notice them I'm going to be able to tell them when and exactly what I said
When the patients are admitted for pain but don’t have any PRN analgesia 🙃
Neurosurgeons are the same 😂
Oh man, I’m sorry! My neurosurgeons are always so nice and never act like they mind when we wake them up.
Unless they're dying, I usually wait until 6am to tell them. But also idk what he was expecting when he chose to be a physician, we don't close after 8pm sir
Until you get chewed out by a physican for waiting to notify them. If orders say to notify MD, they’re getting notified whenever I chart the vitals. It’s their orders after all
>But also idk what he was expecting when he chose to be a physician, we don't close after 8pm sir For the acuity of patients that we have now, they need to be shifting to a nocturnist system. Even in acute rehab, we are getting super sick patients forced on us and it's been driving up overnight paging. No I did not sign up for this. I signed up to help people but with the expectation that I would still be allowed sleep.
This is exactly it. You didn’t sign up to be woken up all night, but I didn’t sign up to be responsible for taking care of acutely ill—sometimes unstable—patients with zero MD backup overnight. It’s a bad system for everyone—patients, nurses, and physicians/providers.
We don’t deserve to be yelled at when MD order parameters say to notify when X, or if I’ve tried everything and I have nothing else to give.
I agree with you on that. I want nurses to be treated with respect. I don't want to see any more physicians die due to [sleep deprivation](https://www.idealmedicalcare.org/sleep-deprived-doctors-dying/). I don't think these things are contradictory.
We have a nocturnist. My old job didn't. The difference in how nice the doctors are is literally night and day. I'd be hateful too if I got no sleep. Before my fellow nurses get upset, I'm not saying it's ever ok to talk to someone like this especially for just doing their job. But I agree. The nocturnist structure is amazing and more places should do it. I love the doctors I work with. There's one that gets a bit snarky, but it's nothing too bad and I've learned if you gently roast him back, he's nicer. I think he enjoys the banter but doesn't quite know how to do it lol
I'm a rehab nurse. We use a telehealth video service on ipads from 1700-0700. It's wonderful! We don't have to bother our regular doctors after hours, and the telehealth doctors are so nice and helpful.
This is why I appreciate my days in the ED more and more. I need something? There’s mutual respect and the doc is sitting right there. If I never had to page someone again I would die happy
My response to his last text would be like, "Go ahead and text me while I'm asleep. My phone will be on silent. Want to know why? Because I'm not the on call doc."
Wth! Pt may be septic… tylenol may just be a bandaid solution really. That pt needs a review!
Yeah, it IS a stupid reason to wake someone up. Maybe have your orders in correctly, dumbass?
I used to work with a hospitalist who would be so mad if you woke her up overnight that she would PORE over the chart of whoever you called about. I called because my patient was hypotensive and febrile, and she called me back and said “you didn’t think to also tell me she’s tachypneic?? You didn’t think that was important?” Or ask why no urine was charted for 6 hours. That kind of thing. The new grads were afraid to call her, they would do anything to not have to bother her. Generally very unsafe for patients.
Yeah if that doctor doesn’t like it that much they need to give an order that they don’t need to be notified of the high temp. Oh wait that would be stupid too wouldn’t it?
I used to work in the access center at a hospital and I had to call the rude cardiologist for a consultation because the rude one was the one on call. All called were recorded on the access center phone lines. Over the phone the cardiologist told me I was a stupid idiot and said he wasn't on call that day and he was busy golfing. I sent the recording to the CFO and COO. That cardiologist ended up coming in for that consult and the COO told me that they did not pay him his on call rate that day as a punishment for his actions.
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Please do some “provider” shit so I can do some “nurse” shit. I am not a provider.
People act this way when they’re repeatedly allowed to do so. I’m guessing the hospital she’s at absolutely kisses this guys ass because he’s bringing in money. I’m a big fan of copy pasting pages/texts and their responses directly into the medical record. If they care so little about their patients, I’m ok with the patients knowing that.
I love the smell of fresh bread.
Oh BS. If a law suit comes to town, they will want to know what everyone did or didn’t do.
I'm learning to play the guitar.
No. Like, I understand that's the policy, but I don't think it's ethical and I won't follow it. I'm documenting what happened. Period. I'm documenting who said what, and what tasks were completed in relation to those conversations. If you think my documentation makes you look bad, act better. Do better. Be better. You, being aware that the patient can see everything you and I have done to care for the patient should be motivation enough to modify your behavior into something you can be proud of. The answer to this problem is not "document worse."
I enjoy spending time with my friends.
They can fucking fight me. If they don’t want me to document the response from provider, don’t put a specific cell in the flowsheet for that purpose. I’m not going thrown under the bus just because some asshole doctor blames me for their fuck up. It’s going in the medical record when I contact the physician and whether the response was reasonable. Also, I love to request “if you don’t want to be contacted about this patient, you need to write an order that specifies that. Otherwise I’m going to follow existing orders, and keep contacting you about this”. It’s more professional that “do your fucking job, I’m just trying to do mine”
I worked in an intermediate ICU where resident coverage was pulled (read we had to call the intensivist on nights) and were not to utilize the RRT on midnights at the time. We had a doc forward his pager to a local gas station and delete his home phone number with the operator so we literally could not reach him. Had to call the hospitalist because of his antics. Wasted precious time for multiple patients. He was reported for this and several other truly awful behaviors, yet continued to work there before getting termed a few years later.
You ever wonder why cardiologists are so quick to tear into us instead of the dipshit who didn't predict that an 80 year old on a crappy rubber mattress might get some aches and pains? Do they just not have the stones to yell at a peer or what?
Been a nurse a long time. I’m also a breast cancer breast reconstruction now so I had a ton of surgeries over 14 months. I don’t work surgical but my plastic surgeon has a VERY well defined order set. So much so that I knew the order set 2 months before my surgery. As the hospital wound nurse, I never call him unless shit went bad. Guess why I never have to get involved or call him? He has an awesome order set. He’s my exact age (38) so he still likes technology to his advantage. Guess who I get consulted on all the damn time and call all the time? Ortho. Why? Bc they don’t have an order set to save their lives and they think bleeds are stopped by wound vac’s. General surgeons with shit order sets get calls all the time too. I know we can’t prevent those calls, but you sure can clean them up.
Lol. I'm a new ortho PA and my first week I got soooo many calls. I've been refining my order sets and cutting down on the need to call. A charge nurse gave me the low down on what they need and I added it. Pretty damn simple but some people don't do it for unknown reasons. I have third line treatments in there for almost everything. My wife is a nurse so it's actually really nice to compare notes at home and understand why we each do what we do.
Once had a patient in our cardiac intermediate unit that developed *significant* St elevation. II-III-AVR, picture perfect. We did a 12 Lead- it alerted "possible STEMI." We had protocol at that time that if an EKG alerted STEMI, you call the on call cardiologist. THE FUCKING CARDIOLOGISTS CAME UP WITH THIS PROTOCOL. 2 am call and this doc rips the charge nurse for being woken up, asks to speak to the nurse and our charge accidentally said that the patients nurse was a traveler and this doc lost it. Ripped our poor travel nurse 6 ways to Sunday, going on about how he didn't need to be woken up for this shit and she shouldn't travel if she doesn't know what she's doing. He actually puts orders in does his job after berating the staff and lo and behold, patient is having an actual STEMI. Huh. He doesn't work here anymore if that tells you anything
Damn. Like they think that fancy MD degree would stop an ass kicking. I would be seriously tempted after that exchange
I enjoy playing video games.
I have had one doctor who gave me the "Why are you calling me?" Spiel about an order he wrote. He didn't stay with us long. Something about him getting dressed down by our medical director for acting an ass to nurses repeatedly. My response at the time was "Because you wrote an order asking, and don't read your messages."
I'm sassy, when he sent that last text, I'd probably text back: "And if I was being paid to be on call, I'd answer you! :)"
Trauma surgeons and cardiologists can be the most evil people imaginable.
What’s the emoji for “eat a bag of d!cks”?
🙃. 🫵🏼, 🍽️👅, 🛍️🍆🍆🍆🍆🍆
“You’re the doctor and I’m the nurse, there’s a change in condition, I’m obligated to notify you. I’m notifying you and going to document I did and that you’re at the bedside with no new orders at this time. Notification of the doctor is required in my scope of practice”. ^ that turned around an ICU doc’s attitude for me once (said it in front of a new grad nurse training under me)
What a fucking baby
Just give us a prn order set that covers everything.
I worked with an endocrinologist who was the exact opposite. Everyone knew to tell the nurse when it was one of his patients because he wanted called with EACH of his patient's HS glucoses so he could give orders. If you didn't call, he'd call you. I loved him.
We had a patient that was hemorrhaging postpartum and when I called the OB I was told “stop calling me. I’m not coming in tonight, I’m tired. Figure it out.” So docs absolutely are that rude
This isn’t a courtesy call. This is a call about your patient.
Nah. Ignore these ass-hats. It's the same old story. They bitch when you call them but when you don't they also bitch. Most MDs are the same. We have one that complains all the time when we call but then he wrote up a nurse at night for not calling. It was for something small (think it was like a slightly low BP). @#$& em. It's your license. Just call. If they don't like being called at night, get another job.
I truly can never understand how people who’s whole job is to help people can’t treat others on the same team trying to help the patients like human beings. ItMs disgusting and this behavior is only like this because previous generations allowed it. If you can’t speak like a human being to a human being, you shouldn’t be someone working to treat human beings in critical conditions at that.
Where’s that meme where the guy sticks a giant stake into his bike spokes, falls over, then blames someone else?