Part I
Nurse Jo: "Because it's a timed test that has to be done by the lab. It can't be drawn through a central line."
Dr. X: "Why haven't you drawn it yet?"
NJ: "Because...it's...timed. As in, it shouldn't be drawn until a...specific time."
Dr. X, growing upset: "But you could draw it right now! Out of the central line!"
NJ: "No. I can't. It can't be drawn through a central line. The heparin lock we use will screw up the test results, and besides, it's a timed test. It's not due to be drawn until 1630."
Dr. X: (incoherent ranting about incompetence of nursing staff.)
NJ: (finds herself on the opposite end of the hall, unsure of how that bruise got on her forehead. Oh, wait. It was Head-Meet-Wall again.)
Part II
Dr. Y: "Why did you change my patient from calcium gluconate to a calcium citrate and magnesium supplement?"
Nurse Jo: "Because that's our protocol for people who have had gastric bypass surgery."
Dr. Y: "But this patient didn't have a gastric bypass! She had a parathyroidectomy!"
Nurse Jo: "Yes, I know. However, the patient's history shows that she had a bypass six years ago, and her blood calcium levels have been low enough to warrant IV repletion. Therefore, according to protocol, we changed her over to citrate and mag, and her calcium levels have come up."
Dr. Y: "Are you a doctor? I didn't write that order!"
NJ: "It's the standard hospital nutritional protocol for patients who have had bypass surgery. Here it is on the computer (clicks twice)."
Dr. Y: "I didn't write that order! You had no right to change that patient's medication!"
NJ: "Her calcium has been stable at 9.2 for three days, after being between 2 and 3.5 for the proceeding week. Is there a problem?"
Part III
Dr. Z: "Why didn't you replete this patient's magnesium and transfuse blood?"
Nurse Jo, looking worried: "Because I didn't see an order for it."
Dr. Z: "Her hemoglobin is ten! TEN!! Why didn't you transfuse her??"
NJ: "Um... ... ...because her hemoglobin is ten. And has been ten for the last four days. And her magnesium is 2.0 and has been for the last four days."
Dr. Z: "But I always transfuse patients with a hemoglobin less than twelve!"
NJ, taking chart in hand: "See this preprinted sheet? You filled out this preprinted sheet. It says right here that if hemoglobin is less than nine or crit is less than 25, we transfuse. It says we replete magnesium for mag levels of less than 1.7. Her crit and hemoglobin and mag have all been above those levels for four. days."
Dr. Z: "But that's not how I do it!"
NJ: Considers banging head on desk, then decides that the bruise that's already there is enough, and wonders why on EARTH the new docs in rotation aren't briefed on our protocols.
11 comments:
((Sean swoops open door in a loud and obnoxious manner. Walks up to dear nurse Jo and gives her the heaviest HIGH FIVE he can muster))
Screaming at the top of my lungs: "You go girl"
And when you figure this out.. let me know so that I can pass it on!
HA HA HA.
Gotta also wonder why new docs in rotation have such major attitude when they could be learning instead of berating?
Perhaps you should start wearing a crash helmet to work to save your poor forehead.
You knew this was coming, because you were nervous about coming back to work, the new transition coming, etc. and the Aliens planted him to piss on your cheerios. Aliens 0, NJ 1. Sweet....
lol. your poor forehead. i've been wondering that myself, especially after the docs have managed to screw up the labs for at least one of my patients every night i've worked over the past two months.
(hhhm, if a patient is on a hypertonic saline solution, ya think ya might wanna check the sodium, right?)
Oof.
Can I hope that this is an exceptional day, and not something you have to encounter all the time? I'm about to enter nursing school, and stories like this make me nervous. :)
anonymous:
Be prepared to be nervous!
Don't you just love docs who can't read?
Hmmm...maybe you should've mentioned to Dr. X that it was a timed test, and that it couldn't be drawn through the central line. Oh...wait....
:D
So Jo-
no need to worry yourself about whether you know your values for magnesium. And in our ICU, all we care about is ionized calcium...the Hell with the total (green top, on ice.)
You are SO okay for critical care. I'm almost ready to drive to Texas and have an accident.
Because the Residents and Fellows in ICU can be just as numb as the ones you are describing.
I haven't been briefed in your protocols either, but even I could manage to figure out that the order I signed is what will be done or that a timed test needs to be done AT THE CORRECT TIME.
If I could hand you my cookie through the computer, I would. Yeesh.
I think I know that resident!!!!
Oh, several years ago a casemanager informed me Medicare mandated the criteria for payment for blood administration and that the hemoglobin had to be below a 10 for reimbursement, unless the patient had active bleeding.
We all know that money talks and protocols are written with the hope of reimbursement for what is done.
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