Friday, December 18, 2009

The Week of Grumpsters! refreshing to be back to work after having nearly 2 weeks off...NOT! Monday night was ok....busy, but doable & ok. Then Tuesday night came....sit back, it's gonna be a long one...

I came into work taking back the 5 patients I had the night before. Ordinarily, this would be a good thing & report would be quick & I could be on my way to taking care of my patients. NOT! Two of my patients were ok for the most part. The third was to be discharged...but for some reason, case management thought it was necessary to go discuss with the patient & his wife their hospital bill. This patient was in the hospital for less than 18 hours...diagnosis chest pain. He had an echocardiogram done and a stress test as well as a couple of sets of cardiac enzymes. Case management tells him his bill is $50,000 of which his insurance company will pay 90% and could he please pay them $5,000 before he leaves. What?????? Seriously....what??? This isn't something you say to someone that just 18 hours ago came into the hospital with CHEST PAIN. Were they trying to cause it again? So I get there & the patient asks if I think that amount is excessive. Such a fine nurses we are supposed to be our patient's advocate....they are the top priority of nursing care. At the same time...I get paid by the hospital. So what am I to do or say? I do only what I know honest & say yes...I think it is excessive for not even being in the hospital for 24 hrs. No way can a stress test cost that much. I advise them to go to financial services & ask for a printout of the charges & take it from there. They should not have to go home worrying about this stuff.

Ok, that was not even my top concern as far as patients go. I had another patient who had a son that was one of those that...I swear if he could jump on my back, he would do it. The type that thinks you are the personal nurse of their family member & you have nothing better to do than meet whatever needs they may have or just to listen to them talk. Sometimes I have the time, sometimes I don't. This was one of those times that I didn't have the time. Of course you can't come out & say that...nor can you tell them what is a higher priority at the moment. All you can do is try to slip away without being too obvious & hope it doesn't piss them off.

My top priority was a patient that came back during the day after having a heart cath & she developed a hematoma at the insertion site (femoral artery). By the time my shift started...this hematoma was from her groin all the way over to her hip. It was the largest hematoma I've ever seen. Luckily, the cardiologist had rounded earlier & seen it himself & ordered an ultrasound to rule out a pseudoaneurysm. The patient went down to ultrasound & I attempted to do some charting & start giving the other patients their medications.

Less than 30 min later I get a call from the ultrasound tech saying my patient is positive for a pseudoaneurysm. I was not really sure what that even was exactly as I've never dealt with it before...but I knew it had to be important if the tech was calling me to inform me. I then called the cardiologist...had to page him twice cause he wasn't calling back. He calls back & immediately orders for this patient to be transferred to our bigger hospital for a femostop protocol...again, not familiar with it, but it sounded pretty important. So I inform my charge nurse & we get the ball rolling to get this patient transferred as quickly as possible. I tell the patient & her family about what is going on. The cardiologist comes in & also discusses it at length with them. He tells them "I hope to get you over there within the next 8 hours." I get a call from the other hospital & I already have a bed assigned & transportation is on their way!!

I'm feeling really good about this because it hasn't even been an hour since I got these orders...way under the 8 hr window the cardiologist was hoping for. Transportation arrives...the patient is loaded up & sent on her way...I call report to the receiving nurse. I think "Wow, I did so well!!" I then place a courtesy call to the attending doctor to inform him of what is going on & that his patient has been transferred.

I get a call back & from the time I answered my phone...all he did was yell at me. For a second I was thinking "Are we even talking about the same patient?" Although it wasn't "we talking" it was him a 3 yr old having a tantrum. He insists the transfer is not necessary & that he has cancelled it...he then starts giving me orders. I interrupt him & tell him "The patient has left this hospital." How am I going to take orders on a patient who isn't even there? Seriously! I didn't say that, but I sure did want to. He yells at me "No she hasn't, I cancelled the transfer" & then carries on again. Ummmm...I just saw the hot EMS guys that took her & she is not here. So he rants on & wouldn't have surprised me if he had a heart attack with how he was behaving. He then insists on talking to my charge nurse...where he continues his tantrum. She didn't really care....I guess it's typical of this doctor to always be yelling. That's so unprofessional!!!

He has gone as far as reporting it to my manager, who now wants to have a meeting to see how we could have handled this better. I'm hoping she's just doing this because it will please admin & the jerky doctor....not because she seriously thinks we didn't handle this correctly. Because I do not believe anything we did was wrong. It was a complication caused by a cardiac procedure that the cardiologist did that day. Everything was run by the cardiologist...the one doctor that was actively seeing that patient after the complication began. If she was post-surgical & developed a complication...I'd be calling the surgeon, if it was a renal complication...I'd call the nephrologist, if it was a GI complication, I'd call the GI doctor, etc. I would not be calling the primary to handle a secondary complication....unless I could not get in touch with the specialist. Sorry, primary doctors are just not at the top of my list as the "go to" doctors when a serious complication arises.

Wednesday night was another busy night. The son I spoke of earlier was even more of a pest. I try to be understanding & put myself in his shoes. His mother is very sick, but even still...lose the thought process that we are to bow down to your every need. He tells me she didn't eat much that day. I acknowledge what he says & he stands there looking at me like I should do something about that. Ummm, if she doesn't want to eat...what makes you think I can force her? If it were my mom...I wouldn't be relying on the nurse to talk my mom into eating.....I would be doing it myself - because if she isn't going to listen to her own children, it's highly doubtful she'll listen to anyone else. I can let the doctor know in the morning, but I'm not calling him now...because really...what is he going to do at 10:00 at night anyways?

I don't know...maybe people have a different illusion about what we can do as nurses. I wish they'd remember we are human too & most of us are doing the best that we can....even when getting yelled at for no reason.

I had another doctor who promised one of my other patients that he would order her cough medicine so she could not cough so much & hopefully get some rest that night. So I go in to talk to her & assess her & she asks "Where's my cough medicine?" Umm, let me look at what is ordered for you. Nope, no cough medicine. She then shows me the piece of paper where she made the doctor give him her name because he made that promise. Gotta love

So I call this doctor & luckily he's on call. I remind him of what he promised this patient & his reply was "So." So you never ordered it. He then rambles off Hycodan & the rest I could not understand a word of he wanted me to be thrown off & it's not because of a language barrier. He was American. I ask him to repeat it....which brings up another thing. We are told that when we get orders over the phone, we are to repeat it back to the doctor. Only it seems like 99.99999% of them don't want to do this. Usually it's something like "Tylenol 650 mg PO every 6 hours as needed......GOODBYE." And they hang up. It's just so rude. Anyways...I ask him to repeat himself because he mumbled his way through the order. He repeats it & I just add (to clarify) you want this PRN (as needed)? Because that is what I'm used to when it comes to cough medicine....take as needed, right? He replies in what I can only describe as a very rude manner..."DID I SAY PRN???????????" I wanted to laugh out loud....seriously. It's like dealing with 4 yr olds...or worse. At least 4 yr olds are fun. Instead I said "Nope, no you didn't, ok thanks!!!!" Which I think pissed him off even more as he was probably hoping to make me feel bad. Sorry, not gonna happen. Maybe as a new nurse all these grumpy docs would get under my skin....but not now. Not when I'm only doing my job & putting my patients first.

I'm off for a few nights & then back to work on Sunday for 4 in a row. I signed up for overtime...hopefully they won't call me off. I need to finish up the Christmas shopping on Fri & Sat as I won't have any more time to do it before Christmas. I can't believe it's only a week away.

Have a great weekend everyone!

1 comment:

kimber said...

I'm an NP Hospitalist and former ER/CCU nurse. Your post sounds just like something I would post. Good to know all the crap is not located in just one area of the country :)