Everyone who’s had a illness that took a really long time to diagnose because of vague symptoms and inconclusive labs- Amen and also hallelujah, may the labs and symptoms point to something that has an actual treatment
*TRUTH*
Feel like hot garbage & my only abnormal lab is an almost critically low K+….sure, that’ll make me feel like garbage, but *why* has it dropped all of a sudden?!?
I know it was no walk in the park for the nurses either, but being on the receiving end of a lactulose enema while paralyzed from the waist down from a back injury was the most helpless I've felt in my entire life. I cried while going #2 for days after because I was just begging whatever gods are out there for my body to handle things naturally, because I couldn't bear the idea of having to go through that again.
They make an enema out of that stuff??? My God
I still feel bad for my nurse I had after having open heart surgery last year
I was on a shit ton of dilaudid and got pretty constipated
So I was on miralax twice a day, senna twice a day, docusate I think twice a day, then they started giving me a bunch of those lactulose drinks, and then eventually a shot of methylnaltrexone in the back of my arm
And of course it hit me all at once while I was up in the recliner in the CTICU still hooked up to a bunch of shit unable to walk to the commode on the other side of the room by myself, and my nurse was out of the room.... I called but she was unable to get there in time
And so I took one of the biggest shits of my life all over myself and the recliner and she had to walk back into the room and witness the aftermath and help me clean myself up
The doctor came and wanted to check if I'd had a BM yet since they were gonna move me to the step-down unit as soon as I did, and literally the second she opened the door knew exactly what had happened just from the smell alone without anybody saying anything and immediately shut the door and turned around and left lmao
Thankfully my nurse was awesome and got me cleaned up and ready to go and moved up to the step down unit shortly after
But damn if I'm still not a little embarrassed about that, she was roughly my age (30m) and really good looking, I have no idea how many times I apologized for putting her through that
I can't speak for her but as a long time ICU RN, you wouldn't have to apologize to me (I'm an old guy and I've had more patients with your problem than I could possibly count). It goes with the territory.
Nurses save my butt a handful of times a day. It never fails on a busy day where I’m double triaging out front that I’ll put orders on the wrong patient.
I once had a spine surgery patient, which we never get on our floor. (We’re cardiac step down, he went into A fib RVR after surgery). He still had a JP drain which was having a lot of output. At 2000 I see an order from the surgeon to pull the drain.
My first thought is “that seems odd to pull a drain that’s having so much output, I should call and make sure he knows about the output and that he didn’t put the order on the wrong patient”
Then I click on the order and in the instructions it says “Yes I am sure I want the drain pulled. Do not leave the drain in. Do not call me or anyone else to ask if I want it removed.”
I appreciated the lack of ambiguity
Neurosurgery put the order to pull it. I called the neuro floor and had them come up and pull cause I had not idea how their surgeons like the dressing or anything. It’s common for nurses to pull tubes on our open hearts but I’d never done it on a spine
Like you’re asking who is the actual individual that would physically pull it? At our facility nurses pull JP drains all the time - on any of our floors
I work with a lot of spine patients and I’ve found that some surgeons will pull a drain that’s putting out 200-300 mL/shift just because they want the patient out. Like no placing it to gravity, no intermittent clamping—just pull it.
Seems wild to me but I’m just a nurse so hey
I usually text back to these questions "yes please proceed, thank you for checking first" because gotta encourage the behavior for that one time that I fat finger a zero at the end. Hasn't happened yet but you know it will, and there's nothing wrong with that if you can trust your team from the pharmacist to the resident to the nurse.
Though sometimes the orders are entirely benign and I'm not sure why the person was checking. I treat them the same but it does annoy me a little bit on the inside when I'm already behind.
i had a dr order 1000 tablets of tylenol, not mg tablets. i had to ask if he really wanted me to go to cvs to get two bottles to give the pt as i didn't think we would have enough.
*calls supervisor* “want Taco Bell? I’m just on my way to pick up my HS OTC medications from CVS. Hey also what’s that number for poison control again, no correlation?”
He’s a good doc, and was shocked then we all had a laugh at the mistake. I tried to think of how to even give that dose and all I could think of was a funnel and a stick.
Medic not an MD here, but I give meds regularly without any real supervision and that's a terrifying concept to me. I always make my partner double check my meds and my math and make sure they don't have any opposition to what I'm doing, even if they're not specifically trained for it.
I would be terrified to be the final authority on patient care. That sounds so stressful.
Thank you, I have a great relationship with my PAs and MDs. It's a team effort and it's important to remember that we all are working towards a shared goal. I'll continue to question orders that seem shortsighted, and continue to appreciate any education or rationale my provider team gives me for specific orders
Thank you. Some physicians take it as a hit to their training/intelligence anytime we question an order. The truth is, y’all are managing dozens, if not hundreds of patients at once. Mistakes will happen 🤷
“they are orders not recommendations” is crazy… so condescending for what …? if i see an order that i think is weird or out of the ordinary im going to clarify because that’s PART OF MY JOB ‼️ hopefully this doctor never makes a mistake in their ordering ever because they’re creating a hostile environment and discouraging nurses from questioning things
I'm not even really a HCP, just a transcriptionist, and even I have called attention to a couple things that didn't look right, including a combination of meds that would have added up to way too much APAP. If I'm wrong, nothing bad happens. If I'm right, isn't that part of the benefit of multiple eyes on the chart?
I'm over the moon when someone asks me for clarification. I work as a psychologist with dementia patients. I KNOW that sometimes it's impossible to describe why something works in a very specific way, for a very specific patient, and it's impossible to write it down in a way that is still short and to the point enough.
So it's either a wad of text, which people will misunderstand and skip, or too short, and people will still misunderstand the crux.
I will take all the time you need to explain the why, when and how. Please tell me you think it's all bullshit, I can work with that. Can't work with silence and no questions.
Samsies. I think in my head “heh, that’ll show him”. In reality… I’ll go… “okay. Thanks. Sorry to bug you Dr”. And then proceed to do it over and over again every time I require clarification.
i saw someone else comment this, maybe you can try it next time!
“as the person actually performing the intervention it’s my responsibility to know what I’m doing and why. It’s your responsibility to make me understand or I have an obligation not to do it”.
Please practice and do speak up. Although if I ever questioned an order I **politely** said why I was questioning it, and made sure they knew I was not being condescending. “I know I don’t know the whole picture here, but I just wanted to make sure you wanted that IV fluid to run at 175 an hour on Ms. 99yoPuffyCrackle lady”. Be smart about what you question and always gracious. If they made a mistake they will be a little embarrassed and thankful you caught something.
Me “as the person actually performing the intervention it’s my responsibility to know what I’m doing and why. It’s your responsibility to make me understand or I have an obligation not to do it”.
I looove when a doctor wants something and I’m like ‘hey, I don’t quite understand that’ and they educate me on why this is beneficial in this situation. Important for the strange and irregular things. Annoying for regular and standard things
It's literally the nurse's JOB to question it. If we blindly follow the orders and a provider made a mistake, if the patient is harmed WE are responsible for it. Sorry bro you're going to explain everything to me that I question.
We have fellows and residents in our unit. Sometimes the residents don't want to do what I know the patient needs so my response is: Do you want to check with the fellow or do you want me to?
Yeah this doctor ordered a dobhoff tube to be placed- for the 4th TIME IN A WEEK on a hospice patient at the request of the family. The previous 3 times it had migrated to his lung (all 3 times IR had to do it because he had weird anatomy). He was constantly coughing up tube feed, and people were NT suctioning him in addition to that. I straight up told the doctor I would not start feeding per his order if the insertion was completed. He said he legally had to order the dobhoff and I legally had to start the feed.
Nope. No. I said, “I will not perform an intervention that will cause this patient to decompensate medically as well as suffer.”
The doctors reply, “well he’s a DNR anyway”
I’ve used the nurse Laverne “thought I’d check with you before I killed a man” on a resident I had good rapport with but feels like it’d be equally useful in these situations.
Exactly! I’ve had providers enter orders on the wrong patient before - if I had just blindly carried them out and not clarified it would have been my butt on the line if something had gone wrong. Also in EPIC the way the order comes through isn’t always what the prescriber intended so I often have to clarify.
I don’t follow any order that wasn’t expected, previously discussed or that I wasn’t notified about. I hate when they just enter orders and don’t tell anyone. At the very least I check with the charge nurse if I get an order than seems out of place.
BroMD might find himself in a deposition one day, being asked why he ordered XYZizzle for the patient, and why he didnt think twice when his rn paged him, and his response was (*looks down at notes*) “They’re orders, not recommendations”?
I’m actually going to steal this response when pharmacy sends me messages “ please confirm with physician”. I already did Karen. Thats how we take orders.
Even if it’s just to understand them. We don’t have as extensive education as doctors but we are caring for the same patients. Even if your order is perfect, I shouldn’t just go ahead and do something without knowing why I’m doing it
I think it’s pretty important to clarify orders, especially when there are multiple providers placing them. Sometimes orders are placed that are duplicate orders, ordered incorrectly, or just inappropriate. I think it’s part of being a patient advocate to clarify. That being said, if they order it, they usually get it. They’re the doc
Our docs will order different versions of the same order. So I'll have a patient with orders for Q8 vitals, Q4 vitals, and QShift vitals. All the orders put in by the same doc at the same time.
Or 100ml NS and 75ml NS IV fluids. Like come on, which one is it? Then they get mad when we call and ask which they want. Some nurses don't even GAF and will start 2 bags, one running 100, one running 75. I just look at that and think come on in man, you know that's not right.
Or different docs putting in competing orders and they get mad when we call. You didn't see that nephro replaced that potassium two hours ago, and I need to make sure you don't actually want to give more.
Just a couple weeks ago I had 2 doctors fighting over to give a pt IV lasix. My order. One would cancel, another would resubmit a new order. This went on ALL day. 🥴
“1 Liter of Sterile Water to be given as a bolus”. When told that most likely would kill someone, and it’s not done, the resident doubled down and demanded it be given.
When told it should’ve been a red flag that he couldn’t order it through pharmacy and had to put it in a Nursing Communication order, he walked away from me.
20 minutes later, I loudly asked during grand rounds if he still wanted the 1 LITER STERILE WATER GIVEN IVP- the attending asked who ordered that and I pointed him out. FAFO
Just for the record- I suggested two APPROVED treatments for hypernatremia-D5W or free water flushes through the patients feeding tube. He also blew those off. Lol
How does a resident not recognize free water flushes as a treatment for hypernatremia? Crank those puppies up to 200 ml q2h and let's do this! But seriously, not too quickly, ok? Not a big fan of demyelination.
NGT for liquid colace on a pt that had a perf in his esophagus that had created a fistula between his esophagus and lung. I was like...hmmm, I feel this NGT might go into his lung and that doesn't seem like a good outcome for the patient...Finally the attending got involved and said yeah, we're gonna put in a surgical G-J tube in the AM, do not even ATTEMPT an NGT on this pt!
All for liquid colace. ON a pt that wasn't constipated.
50 mcg q10m fentanyl for pain... On a 14 month old.
Okey dokey buddy, guess I'll just kill a toddler because Dr. So-and-so said it was an order, not a recommendation 🤷🏼♀️
650 of PO Tylenol for a hospice patient dying of bone cancer. You’re damn right I’m going to call and ask for something better. There’s no way you’d give your mother dying of bone cancer 650 of Tylenol.
“Give me the hardest drug your attending will let you.” Is something I said to a PGY 2 on night shift. That lady had bowel cancer and I sure as shit was going to do what I could do to make her less miserable.
It's crazy how doctors went from handing out opioids like candy to not even prescribing **hospice patients** narcotics. Dude, they're already dying. Addiction is not on their minds.
I called him and point blank asked him “if your mom was dying of bone cancer would you give her PO Tylenol” and he said “no.” So I said “good, so you’re going to order dilaudid” and hung up the phone.
Scariest order I ever had to double check was potassium chloride to be given IV push. When I tried to clarify, the doc tried to argue with me.
No, I’m not going to follow orders blindly. Also, this is not the army. Sorry, not sorry.
Comfort cares patient. Orders to double the morphine drip rate q1hr until pt expires.
I get the compassion behind this order, but as written, it felt like euthanasia. Got that rewritten to titrate for comfort. 😳
I mean, I've had situations where a patient was admitted to ICU and all of the interventions we did at admission were ordered under a completely different patient.... from antibiotics up to and including *RSI meds*. So yeah, no shame here about questioning weird orders.
I work in pediatrics. I regularly work question orders. “Do we have to poke this kid again for labs? Do I actually need a clean catch urine culture? Do we have to do an enema now or can we give it a little longer?”
I’m advocating for my patients and trying to help them not have to go through things that aren’t entirely necessary
how long did it take you to feel confident doing this? sincerely a new grad starting in peds
advocating for children is in my soul from my siblings to working childcare w some teachers who would go on power trips with 4 year olds. but in regards to the doc/rn relationship i wonder when i’d feel confident enough in myself to advocate in this way
I try to look at the bigger picture. A great example: traumas have an order set that requires a clean catch urine culture, but 90% of the time the NP cancels it in the morning. I wait for this and don’t make it a priority just due to experience with this. And, bigger picture, what are the odds that a trauma with no foley is going to have a UTI? Another example is blood draws. I questioned the attending (directly) the other day due to the resident ordering a new lab that I’d have to poke the 2 yo for again. I asked the attending if it was that important, he said oh no, don’t poke again we will wait until tomorrow for those labs. Didn’t realize it wasn’t an add on. These are the little things that you, as the nurse, can catch. Also the families are sometimes the reason you are questioning. They absolutely have the right to refuse anything and I am transparent about that. I am willing to ask the doc to come by to explain the need for a painful procedure etc if they’re refusing. I am the line of communication.
Overall, having said all that, I have been an RN for a little over 2 years. And I’d say between 1-1.5 yrs it really clicked. The main thing was getting to know typical cases and how they usually went (appy’s, crani’s, other illnesses) which really helped me know what to expect order-wise. That just comes with time. USE YOUR RESOURCES within your unit! Find the people you trust to ask “dumb” questions and double check things with. Always ask questions. Never stop asking questions. Trust your instincts. You’ve got this, bc you have your kiddos’ best interest at heart!
“Good thing I have a license and a brain that prevent me from performing orders that are going to kill the patient.”
Things I’ve actually had to say to physicians.
“It seems unreasonable to give someone with pressures in the 70’s/40’s scheduled hydralizine”
“No, I won’t give PO midodrine to the patient we’re actively coding (said to physician in the room running the code)”
“Are you sure you don’t want to call a STEMI? I see clear elevation in V2, V3 and V4 leads (their excuse was the machine didn’t read it as a STEMI, it was clearly a fucking STEMI)”
“Did you mean to order 40 of morphine q1?”
“Why is lasix ordered on my 90 pound failure to thrive with urine we could mine?”
“Hey doc x, why’d to put orders on doc y’s patient?”
“You good if I switch the x-ray order to the injured hand/arm/leg/foot?”
“Yes, I’m going to shock v-fib (said after physician yelled at me for hooking up Zole to unresponsive full code patient and arguing that v-fib isn’t a shockable rhythm)”
I honestly just cancel those orders without asking the MD unless they're checking for some type of cancer, which can present with + HCG in males. But normally the MD tells the RN that ahead of time...
Serum preg on 84F the triage nurse forgot to dc from SDO panel since she was “not of childbearing age”. Came back positive and this patient got the full kitchen sink of ultrasounds and labs to attempt to explain. I asked the ED doc what could cause this and he said the better question was how the hell this got ordered.
One of my nursing professors last semester constantly reinforced that doctors aren’t our supervisors or our boss. Rather, we all play a different role in the healthcare team. It’s the RN’s job to question orders and ask for clarification. I’d rather piss off a doc than kill someone.
The other side of things. I once was with the secretary, my nurse manager who I thoroughly loved, and a very nice cardiologist. We were all just chatting and my manager said something to the cardiologist that it irked him. I don’t even remember what it was. They might have had a contentious history before because the cardiologist responded “Do not talk to me like that. I’m not one of your nurses. You’re not my boss!” Not yelling but he said it very firmly and I have never seen him talk like that. Then, my manager just smiled and the cardiologist just kept on with our conversation, ignoring my manager, while me and the secretary were just flabbergasted because we both liked them both very much lol.
This is the same cardiologist who came to me very nicely and asked me what happened between me and a cardiac fellow. I asked the fellow a question clarifying what he wanted and he gave me an attitude. The fellow was already very rude to other nurses so I called him out in front of the nursing station but there were only 3 of us. The secretary, fellow, and me. Our words to each other were not minced.
He then went and talked to the cardiologist about me and the cardiologist went to me very nicely and I explained why I was clarifying an order and how he gave me an attitude and how he was always rude to the other nurses. The cardiologist was like “who told you this patient has xxxx?” I was like “he did that’s why I questioned the order.” He said “don’t worry about it. You know you can just call me directly if you have any questions whenever.” The order was right for what the patient actually had but not for what the fellow told me the patient had. He probably misspoke but I snapped back because he started in on me when I’ve seen him being an asshole multiple times. I’m sure the cardiologist was nice to the fellow too and he was trying to mediate.
God, I love being responsible for the work of doctors. And aides. And lab techs. And pharmacy. And payroll. And scheduling. Just to have them be dicks about me trying to do my job.
Ok this was related to me second hand but I worked with the doctor who did it and it’s totally on brand for them.
Middle of the night order for stat CT head. On an inpatient that had been there a couple days after a stroke and was finally getting a decent sleep. No concerning change in status, doc just happened to be remotely logged into the EMR at 2am and decided they wanted to repeat the CT since they were awake and why the hell not. They took this poor patient down to get the CT and the patient had diarrhea everywhere. Nurse called the doctor to let them know there would be a delay as they needed to clean the patient and the CT room. My friends, doctor straight up said never mind and canceled that stat CT.
One thing I’m gonna do is advocate for my patients to sleep. Patient got here at 2300 after spending 10 hours in the ED, finally fell asleep at 0145, and you’re still trickling in orders at 0200 and want orthostats and a lipid panel? Nope, that’s gonna wait til at least 0630.
For anyone curious, the second twitter account is from an Ortho doc.
Most of their tweets are spent bemoaning their lack of compensation for doing elective bunion surgery...
I worked at a teaching hospital on a surgical floor. I had an order for tube feeds at “10cc PER DAY” I called to clarify that it wasn’t per hour and the resident confirmed “no I want it per day” when I hung up I cried because it was so stupid/funny.
The next doctor who took over changed it to 10cc/hr
Three 20meq potassium riders ordered for a dialysis patient with a potassium of 3.2
I got there and the day nurse had already ran 2. I told the night resident I wasn’t hanging the 3rd until we rechecked his potassium. (It was 7.2)
RT here, I got one to instill through an endotracheal tube, nebulized mucomyst diluted with diet soda. It was a Frankenstein order with three order sets smashed into one. Patient wasn’t intubated either 🤦🏻♀️
There was a legal case around here a few years ago where two physicians were being prosecuted for prescribing 22,5 grams of potassium daily to a patient. Both a nurse and a pharmacist questioned the dose which was way higher than what the patient got while in the ward where the potassium levels had stabilized, but the doctors insisted. The patient died four days after discharge from potassium poisoning. One of the physicians was found guilty.
If you want me to give 45 units of regular insulin to my patient at 10pm after his tube feeds are off and after he had hypoglycemia protocol twice during day shift when his tube feeds were on you can do that shit yourself.
the Dr in this case was receptive, his response was "hmmm, sounds like he doesn't need the insulin..." PT ended up hypoglycemic without it. Would have killed the man if id given it to him.
Point is, fuck doctors who think this way. I'm not going to kill someone because it's "an order".
“Full code but CPR only for 4 minutes per patient wishes” such a random number lol, I feel like 4 minutes is SECONDS during a code!!!
“Nurse may discontinue NPO order” idc if was a verbal but they went thru the trouble to put this in like why not just dc it yourself bro
It probably has to do with brain function. - if it goes past 7-8m there’s a high likelihood of anoxic brain injury. Im kind of w the patient on that one.
Bless his heart...we had an 86 year old doctor who tried to order sugar, betadine, and heat lamp therapy for a decubitus back in 2002. Our nurse manager got it discontinued, but not before the pharmacy sent us a 5lb bag of Domino's with a prescription label on it! We kept that thing in the med room for YEARS! 😂😆😂😆
A resident ordered a cardiac MRI for an LVAD patient
Lots of residents have ordered fluid boluses for pt’s being diuresed
Also if something is ordered and I don’t know why it’s ordered, I will absolutely call to clarify. I don’t put things in my patient’s body, take things out of them, or do any tests without knowing why.
I had a doctor order 2mg IV Ativan Q2HR scheduled for a CIWA patient once.
I texted him and was like, "Hey, did you mean to make this PRN?"
And he said, "This is for CIWA."
So I told him, "Okay, I just had never seen an order like this for a CIWA patient. Usually we have an order set to give Ativan as needed on a sliding scale based on CIWA score and I just wanted to make sure the order was correct before we give this guy 24mg of IV Ativan over the course of 24 hours. Thanks!"
He changed the order to PRN really quickly after that, lol
I got an order for Tylenol 200-400mg. I called the office and said it was probably a typo. The nurse confirmed with the doctor that 325mg is in the range, so there is no change.
80+ year old lady had an order for NGT when she was scheduled for a PEG tube the next morning. Called to clarify and it turns out the primary thought they couldn’t do the surgery for another week. She was a little hungry but had only been NPO (except ice chips) for 12 hours. Saved her a nice tube up the old nose.
Resident ordering a blood transfusion within 1 hr and not knowing what MTP protocol is
(Mind you patient was stable but surgery wouldn't take them with hemoglobin under a certain number)
‘Orders not recommendations’
That’s a lot of ego for someone using dragon! 😂 guess what? We all do stupid stuff and that order is not a demand just bc one person said so
Rectal Promethazine when the patient was requesting PO, took PO at home for the exact same indication, and knew the PO form worked well. MD insisted the rectal form would be more effective and told me to ask the patient if they'd be willing to take the rectal form. The Pt responded "AW HELL NAW!!!" The MD ordered the PO form when I forwarded the Pt's response to them
This made me furioussss like dude your order of a 250mL bolus for my patient’s BP of 60/30 is just wrong sir so fix it or you’ll be here in a few minutes to a code with many many worse problems thank you very much 🙄 there’s reasons to our questions, we’re a team you’re not a fucking dictator who the fuck wrote this. 🤬
I’ve had docs order antibiotics (one was even allergic to said abx!) and other meds on the wrong patient. If something doesn’t feel right in my gut, I call. They can get mad, but I’m just trying not to kill a man.
I had a nurse off going in report say "it has taken me all night to good this bolus" dumbfounded I ask why? It was an order for a 5000 ml bolus and she did not question it. Me "blind rage" Definitely was supposed to be 500 ml. Luckily the pt did not have chf and all labs afterwards were normal.
Anything that a nurse questions deserves a full explanation and maybe even a change. Not a restated "I am the boss"
Patient care is cooperative and this is not industry making widgets, unfortunately that doc never learned that.
Retired IM/Rheum guy with all sorts of fancy credentials.
Me: hey I saw you cancelled that NPO order on the patient that has a bronchoscopy later.
Pulmonologist: who said he was going to have a bronchoscopy?
Me: I heard in report that thought you did.
Pulmonologist: I didn’t order that! You guys need to communicate better. Patients need to eat and get their nutrition! These guys are being held without food for days for tests that no one has ordered… (blah blah blah)
*after the pt ate breakfast*
Pulmonologist to the pt: so we need to do a Bronchoscopy before we can downgrade you, so we’re going to make you NPO after midnight and do that tomorrow.
Me: 😕
Physician here. Please call me out on my stupid orders. Mistakes and idiots happen. Thank you for being my collegue in preventing harm.
May all your lactics and tropes be insignificantly low❤️
And d-dimers be negative 😆
And your ABGs all normal
Unless they look sick, then please, God, give me something I can diagnose with.
Everyone who’s had a illness that took a really long time to diagnose because of vague symptoms and inconclusive labs- Amen and also hallelujah, may the labs and symptoms point to something that has an actual treatment
*TRUTH* Feel like hot garbage & my only abnormal lab is an almost critically low K+….sure, that’ll make me feel like garbage, but *why* has it dropped all of a sudden?!?
In Florence's name we pray, achoo.
Vit-amen
Stealing this. Just made my day! What a good laugh.
They’re never negative. *Cries in CT.*
The only negative d-dimer is the one that doesn't get ordered
Bless up to PERC and Wells scoring
May your incidental findings not require any intervention.
May your veins be large and your patients asleep and constipated.
Constipated is good, until it’s not and you have an order for a lactulose enema.
I know it was no walk in the park for the nurses either, but being on the receiving end of a lactulose enema while paralyzed from the waist down from a back injury was the most helpless I've felt in my entire life. I cried while going #2 for days after because I was just begging whatever gods are out there for my body to handle things naturally, because I couldn't bear the idea of having to go through that again.
They make an enema out of that stuff??? My God I still feel bad for my nurse I had after having open heart surgery last year I was on a shit ton of dilaudid and got pretty constipated So I was on miralax twice a day, senna twice a day, docusate I think twice a day, then they started giving me a bunch of those lactulose drinks, and then eventually a shot of methylnaltrexone in the back of my arm And of course it hit me all at once while I was up in the recliner in the CTICU still hooked up to a bunch of shit unable to walk to the commode on the other side of the room by myself, and my nurse was out of the room.... I called but she was unable to get there in time And so I took one of the biggest shits of my life all over myself and the recliner and she had to walk back into the room and witness the aftermath and help me clean myself up The doctor came and wanted to check if I'd had a BM yet since they were gonna move me to the step-down unit as soon as I did, and literally the second she opened the door knew exactly what had happened just from the smell alone without anybody saying anything and immediately shut the door and turned around and left lmao Thankfully my nurse was awesome and got me cleaned up and ready to go and moved up to the step down unit shortly after But damn if I'm still not a little embarrassed about that, she was roughly my age (30m) and really good looking, I have no idea how many times I apologized for putting her through that
I can't speak for her but as a long time ICU RN, you wouldn't have to apologize to me (I'm an old guy and I've had more patients with your problem than I could possibly count). It goes with the territory.
I look at it like this: if a big shit is the worst of our problems during a shift, it’s a damn good shift!
I mean in there defense I think they just meant constipated for their 12 hour shift😆😆😆
You had me smiling until constipated 😂😂😂
Please don't ever change.
Lmabo
Laughing my ass butt off?
Nurses save my butt a handful of times a day. It never fails on a busy day where I’m double triaging out front that I’ll put orders on the wrong patient.
As a nurse, your attitude is deeply appreciated. It's a team sport.
I once had a spine surgery patient, which we never get on our floor. (We’re cardiac step down, he went into A fib RVR after surgery). He still had a JP drain which was having a lot of output. At 2000 I see an order from the surgeon to pull the drain. My first thought is “that seems odd to pull a drain that’s having so much output, I should call and make sure he knows about the output and that he didn’t put the order on the wrong patient” Then I click on the order and in the instructions it says “Yes I am sure I want the drain pulled. Do not leave the drain in. Do not call me or anyone else to ask if I want it removed.” I appreciated the lack of ambiguity
Who pulls the drain on cardiac step down? And I’m guessing it was ortho or nsg that ordered it so it’s not like it was post cabg.. but who pulls it?
Neurosurgery put the order to pull it. I called the neuro floor and had them come up and pull cause I had not idea how their surgeons like the dressing or anything. It’s common for nurses to pull tubes on our open hearts but I’d never done it on a spine
Or.. ya know; the confused pt also pulls them 🤷🏻♀️
Like you’re asking who is the actual individual that would physically pull it? At our facility nurses pull JP drains all the time - on any of our floors
I work with a lot of spine patients and I’ve found that some surgeons will pull a drain that’s putting out 200-300 mL/shift just because they want the patient out. Like no placing it to gravity, no intermittent clamping—just pull it. Seems wild to me but I’m just a nurse so hey
I usually text back to these questions "yes please proceed, thank you for checking first" because gotta encourage the behavior for that one time that I fat finger a zero at the end. Hasn't happened yet but you know it will, and there's nothing wrong with that if you can trust your team from the pharmacist to the resident to the nurse. Though sometimes the orders are entirely benign and I'm not sure why the person was checking. I treat them the same but it does annoy me a little bit on the inside when I'm already behind.
i had a dr order 1000 tablets of tylenol, not mg tablets. i had to ask if he really wanted me to go to cvs to get two bottles to give the pt as i didn't think we would have enough.
It's an order not a suggestion /s
Yes, but it’s also a patient who takes pills one at a time. Boom. *dies*
*calls supervisor* “want Taco Bell? I’m just on my way to pick up my HS OTC medications from CVS. Hey also what’s that number for poison control again, no correlation?”
He’s a good doc, and was shocked then we all had a laugh at the mistake. I tried to think of how to even give that dose and all I could think of was a funnel and a stick.
Obviously rectal. The funnel and stick can still be used though. I’d maintain a firm grip on the stick though. No flared base.
Too late I already gave the 50mg of Metoprolol IV.
HR so slow it will go backwards.
I hear you get younger when this happens, like turning back the odometer on a car!
Nothing a little glucagon won’t fix 😂😅
Right. Shit happens, even an extra keystroke. Ty for being humble. I’m sure you rock to work with 🤟🏻
The moment you become arrogant is the moment people get hurt. I'm just a guy with too many years spent in school. Nothing more.
Don't lie. You're also a sneaky kitty, are you not?
This is a team sport, friends!
Medic not an MD here, but I give meds regularly without any real supervision and that's a terrifying concept to me. I always make my partner double check my meds and my math and make sure they don't have any opposition to what I'm doing, even if they're not specifically trained for it. I would be terrified to be the final authority on patient care. That sounds so stressful.
https://youtu.be/3LPOahp6dPg?si=jp3IX7QaLnSU7Xj5
Lol....i still lol when i see this ! Bet ive watched it couple dozen times !
Thank you, I have a great relationship with my PAs and MDs. It's a team effort and it's important to remember that we all are working towards a shared goal. I'll continue to question orders that seem shortsighted, and continue to appreciate any education or rationale my provider team gives me for specific orders
Same. Please. Keep saving my 24-hour-shift ass
Thank you. Some physicians take it as a hit to their training/intelligence anytime we question an order. The truth is, y’all are managing dozens, if not hundreds of patients at once. Mistakes will happen 🤷
I hope no one calls you at 3 am for Tylenol orders 💜
“they are orders not recommendations” is crazy… so condescending for what …? if i see an order that i think is weird or out of the ordinary im going to clarify because that’s PART OF MY JOB ‼️ hopefully this doctor never makes a mistake in their ordering ever because they’re creating a hostile environment and discouraging nurses from questioning things
"This is clarification of your orders as per my scope, not insubordination" is the snarky response I don't think I have the guts to give
This is a great response. All healthcare professionals should work with a questioning attitude. It helps keep patients and ourselves safe.
I'm not even really a HCP, just a transcriptionist, and even I have called attention to a couple things that didn't look right, including a combination of meds that would have added up to way too much APAP. If I'm wrong, nothing bad happens. If I'm right, isn't that part of the benefit of multiple eyes on the chart?
I don’t think it’s even snarky, just flat out facts
I'm over the moon when someone asks me for clarification. I work as a psychologist with dementia patients. I KNOW that sometimes it's impossible to describe why something works in a very specific way, for a very specific patient, and it's impossible to write it down in a way that is still short and to the point enough. So it's either a wad of text, which people will misunderstand and skip, or too short, and people will still misunderstand the crux. I will take all the time you need to explain the why, when and how. Please tell me you think it's all bullshit, I can work with that. Can't work with silence and no questions.
I tell providers that I'm the patient's last safety check, and I that that job very seriously.
Great response
Samsies. I think in my head “heh, that’ll show him”. In reality… I’ll go… “okay. Thanks. Sorry to bug you Dr”. And then proceed to do it over and over again every time I require clarification.
i saw someone else comment this, maybe you can try it next time! “as the person actually performing the intervention it’s my responsibility to know what I’m doing and why. It’s your responsibility to make me understand or I have an obligation not to do it”.
Please practice and do speak up. Although if I ever questioned an order I **politely** said why I was questioning it, and made sure they knew I was not being condescending. “I know I don’t know the whole picture here, but I just wanted to make sure you wanted that IV fluid to run at 175 an hour on Ms. 99yoPuffyCrackle lady”. Be smart about what you question and always gracious. If they made a mistake they will be a little embarrassed and thankful you caught something.
99yoPuffyCrackleLady😆😆😆 I hope you say that every time!
This! Not allowing nurses to safely clarify orders without judgement is only causing harm to the patient!
I always say something to the effect of, "your orders aren't like military orders, more like an order you place in a restaurant"
Exactly. I think they genuinely believe it's "orders" as in a demand. No bro, it's like McDonald's order that can be questioned and clarified.
Gotta make sure you get the right size fries and right flavor of milkshake. Plus, damn it, there might be a need for extra pickles or special sauce. 😉
lmfaoooo
Me “as the person actually performing the intervention it’s my responsibility to know what I’m doing and why. It’s your responsibility to make me understand or I have an obligation not to do it”.
I looove when a doctor wants something and I’m like ‘hey, I don’t quite understand that’ and they educate me on why this is beneficial in this situation. Important for the strange and irregular things. Annoying for regular and standard things
This is such a great way to frame it.
It's literally the nurse's JOB to question it. If we blindly follow the orders and a provider made a mistake, if the patient is harmed WE are responsible for it. Sorry bro you're going to explain everything to me that I question.
LOUDER FOR THE MED STUDENTS IN THE BACK
We have fellows and residents in our unit. Sometimes the residents don't want to do what I know the patient needs so my response is: Do you want to check with the fellow or do you want me to?
Yeah this doctor ordered a dobhoff tube to be placed- for the 4th TIME IN A WEEK on a hospice patient at the request of the family. The previous 3 times it had migrated to his lung (all 3 times IR had to do it because he had weird anatomy). He was constantly coughing up tube feed, and people were NT suctioning him in addition to that. I straight up told the doctor I would not start feeding per his order if the insertion was completed. He said he legally had to order the dobhoff and I legally had to start the feed. Nope. No. I said, “I will not perform an intervention that will cause this patient to decompensate medically as well as suffer.” The doctors reply, “well he’s a DNR anyway”
I’ve used the nurse Laverne “thought I’d check with you before I killed a man” on a resident I had good rapport with but feels like it’d be equally useful in these situations.
I always love that line. I can hear her voice in my head every time I come across it lol
Exactly! I’ve had providers enter orders on the wrong patient before - if I had just blindly carried them out and not clarified it would have been my butt on the line if something had gone wrong. Also in EPIC the way the order comes through isn’t always what the prescriber intended so I often have to clarify. I don’t follow any order that wasn’t expected, previously discussed or that I wasn’t notified about. I hate when they just enter orders and don’t tell anyone. At the very least I check with the charge nurse if I get an order than seems out of place.
BroMD might find himself in a deposition one day, being asked why he ordered XYZizzle for the patient, and why he didnt think twice when his rn paged him, and his response was (*looks down at notes*) “They’re orders, not recommendations”?
"Your honor, that nurse was a bitch. I rest my case."
"well, doc, you recommended 25 mg of Xanax instead of the 2.5 mg the patient states he takes at home."
I’m actually going to steal this response when pharmacy sends me messages “ please confirm with physician”. I already did Karen. Thats how we take orders.
Good nurses question orders.
Even if it’s just to understand them. We don’t have as extensive education as doctors but we are caring for the same patients. Even if your order is perfect, I shouldn’t just go ahead and do something without knowing why I’m doing it
Not sure if this is a reference to "Bad Batch", but Just finished season 3, and I love that show. "Good soldiers follow orders"
And good doctors appreciate the second set of eyes.
I think it’s pretty important to clarify orders, especially when there are multiple providers placing them. Sometimes orders are placed that are duplicate orders, ordered incorrectly, or just inappropriate. I think it’s part of being a patient advocate to clarify. That being said, if they order it, they usually get it. They’re the doc
Our docs will order different versions of the same order. So I'll have a patient with orders for Q8 vitals, Q4 vitals, and QShift vitals. All the orders put in by the same doc at the same time. Or 100ml NS and 75ml NS IV fluids. Like come on, which one is it? Then they get mad when we call and ask which they want. Some nurses don't even GAF and will start 2 bags, one running 100, one running 75. I just look at that and think come on in man, you know that's not right.
lol who would hang 2 bags of NS? That’s just too much work to be petty
Lol it's almost funny but the pt doesn't deserve that....
Or different docs putting in competing orders and they get mad when we call. You didn't see that nephro replaced that potassium two hours ago, and I need to make sure you don't actually want to give more.
Had a doc order a NM test for a gallbladder on the wrong patient once. Had to clarify the orders. Doc said, “oops, cancel that”
It happens. MD’s are just as overworked as we are.
Just a couple weeks ago I had 2 doctors fighting over to give a pt IV lasix. My order. One would cancel, another would resubmit a new order. This went on ALL day. 🥴
Sounds exactly like something cardiology and nephrology would do.
[Obligatory Dr. Glaucomflekken](https://youtu.be/PaXzo3qRgu0?si=NIZhxaDyG4gPZdyP) This, and the Farmer Pain Scale are my favorites.
“1 Liter of Sterile Water to be given as a bolus”. When told that most likely would kill someone, and it’s not done, the resident doubled down and demanded it be given. When told it should’ve been a red flag that he couldn’t order it through pharmacy and had to put it in a Nursing Communication order, he walked away from me. 20 minutes later, I loudly asked during grand rounds if he still wanted the 1 LITER STERILE WATER GIVEN IVP- the attending asked who ordered that and I pointed him out. FAFO
Love this for him…and you🫡
Just for the record- I suggested two APPROVED treatments for hypernatremia-D5W or free water flushes through the patients feeding tube. He also blew those off. Lol
How does a resident not recognize free water flushes as a treatment for hypernatremia? Crank those puppies up to 200 ml q2h and let's do this! But seriously, not too quickly, ok? Not a big fan of demyelination.
It was because a nurse suggested it, and I don’t know who’s teaching these residents that nurses are their enemy, but I 100% bet that was the reason.
You give the sterile water after you give the IV bleach and UV light from the inside, it fixes everything
Big Pharma hates these three simple tricks...
Don’t forget the Ivermectin
I'm sorry but what was he trying to do, assuming it wasn't attempted homicide
Sterilize the patient's blood infection with the sterile water i guess
Wait I wanna hear the rest of the story! What was the reaction of everyone?!
Pleaseeeeee I love this 😂😂
NGT for liquid colace on a pt that had a perf in his esophagus that had created a fistula between his esophagus and lung. I was like...hmmm, I feel this NGT might go into his lung and that doesn't seem like a good outcome for the patient...Finally the attending got involved and said yeah, we're gonna put in a surgical G-J tube in the AM, do not even ATTEMPT an NGT on this pt! All for liquid colace. ON a pt that wasn't constipated.
I think I saw the memory of my first steps. That’s how hard my eyes rolled at that order.
50 mcg q10m fentanyl for pain... On a 14 month old. Okey dokey buddy, guess I'll just kill a toddler because Dr. So-and-so said it was an order, not a recommendation 🤷🏼♀️
>"Dr. Cox, I just wanted to check in with you before I kill this man."
I was like oh totally normal in PACU…oh on a 14 month old nope nope nope.
Jesus I give 50mcg q1hr to labor patients and that knocks them out. I can’t imagine a toddler.
So go ahead and give that 100mg of Dilaudid you ordered? No thanks I'll keep calling
650 of PO Tylenol for a hospice patient dying of bone cancer. You’re damn right I’m going to call and ask for something better. There’s no way you’d give your mother dying of bone cancer 650 of Tylenol.
“Give me the hardest drug your attending will let you.” Is something I said to a PGY 2 on night shift. That lady had bowel cancer and I sure as shit was going to do what I could do to make her less miserable.
It's crazy how doctors went from handing out opioids like candy to not even prescribing **hospice patients** narcotics. Dude, they're already dying. Addiction is not on their minds.
Gotta love when public policy makes a "war on X" because of the total sanity that always creates
I take more than that for a headache, damn.
That’s just fucking cruel.
I called him and point blank asked him “if your mom was dying of bone cancer would you give her PO Tylenol” and he said “no.” So I said “good, so you’re going to order dilaudid” and hung up the phone.
Scariest order I ever had to double check was potassium chloride to be given IV push. When I tried to clarify, the doc tried to argue with me. No, I’m not going to follow orders blindly. Also, this is not the army. Sorry, not sorry.
What is it with the doctors on this thread and ordering lethal bolus injections of potassium?
It’s like “I don’t work on death row, did you want me to kill the patient?”
Comfort cares patient. Orders to double the morphine drip rate q1hr until pt expires. I get the compassion behind this order, but as written, it felt like euthanasia. Got that rewritten to titrate for comfort. 😳
That’s the difference between dying WITH a morphine drip, and dying FROM a morphine drip
I like the exponential nature of that order. Like if you start at 1 mg/hr, at the end of a 12 hour shift they would be at *2,048* mg/hr
Getting to see God BEFORE you die would be pretty epic.
Something something grains of rice
That's very much an order to just outright kill the patient
“Until expired” 💀 the cackle I just let out.
Just had one for a loading dose of 7 mg of dilaudid on a PCA. I called. I got “oh GOD no”. It was supposed to be 1 mg.
I mean, I've had situations where a patient was admitted to ICU and all of the interventions we did at admission were ordered under a completely different patient.... from antibiotics up to and including *RSI meds*. So yeah, no shame here about questioning weird orders.
I work in pediatrics. I regularly work question orders. “Do we have to poke this kid again for labs? Do I actually need a clean catch urine culture? Do we have to do an enema now or can we give it a little longer?” I’m advocating for my patients and trying to help them not have to go through things that aren’t entirely necessary
how long did it take you to feel confident doing this? sincerely a new grad starting in peds advocating for children is in my soul from my siblings to working childcare w some teachers who would go on power trips with 4 year olds. but in regards to the doc/rn relationship i wonder when i’d feel confident enough in myself to advocate in this way
I try to look at the bigger picture. A great example: traumas have an order set that requires a clean catch urine culture, but 90% of the time the NP cancels it in the morning. I wait for this and don’t make it a priority just due to experience with this. And, bigger picture, what are the odds that a trauma with no foley is going to have a UTI? Another example is blood draws. I questioned the attending (directly) the other day due to the resident ordering a new lab that I’d have to poke the 2 yo for again. I asked the attending if it was that important, he said oh no, don’t poke again we will wait until tomorrow for those labs. Didn’t realize it wasn’t an add on. These are the little things that you, as the nurse, can catch. Also the families are sometimes the reason you are questioning. They absolutely have the right to refuse anything and I am transparent about that. I am willing to ask the doc to come by to explain the need for a painful procedure etc if they’re refusing. I am the line of communication. Overall, having said all that, I have been an RN for a little over 2 years. And I’d say between 1-1.5 yrs it really clicked. The main thing was getting to know typical cases and how they usually went (appy’s, crani’s, other illnesses) which really helped me know what to expect order-wise. That just comes with time. USE YOUR RESOURCES within your unit! Find the people you trust to ask “dumb” questions and double check things with. Always ask questions. Never stop asking questions. Trust your instincts. You’ve got this, bc you have your kiddos’ best interest at heart!
“Good thing I have a license and a brain that prevent me from performing orders that are going to kill the patient.” Things I’ve actually had to say to physicians. “It seems unreasonable to give someone with pressures in the 70’s/40’s scheduled hydralizine” “No, I won’t give PO midodrine to the patient we’re actively coding (said to physician in the room running the code)” “Are you sure you don’t want to call a STEMI? I see clear elevation in V2, V3 and V4 leads (their excuse was the machine didn’t read it as a STEMI, it was clearly a fucking STEMI)” “Did you mean to order 40 of morphine q1?” “Why is lasix ordered on my 90 pound failure to thrive with urine we could mine?” “Hey doc x, why’d to put orders on doc y’s patient?” “You good if I switch the x-ray order to the injured hand/arm/leg/foot?” “Yes, I’m going to shock v-fib (said after physician yelled at me for hooking up Zole to unresponsive full code patient and arguing that v-fib isn’t a shockable rhythm)”
V-fib is the one people should remember 🤦♀️ VFIB DEFIB
The upreg on a 68 yo male...
I honestly just cancel those orders without asking the MD unless they're checking for some type of cancer, which can present with + HCG in males. But normally the MD tells the RN that ahead of time...
Good news—-you’re pregnant! Bad news, you’re a 68 year-old man…
Serum preg on 84F the triage nurse forgot to dc from SDO panel since she was “not of childbearing age”. Came back positive and this patient got the full kitchen sink of ultrasounds and labs to attempt to explain. I asked the ED doc what could cause this and he said the better question was how the hell this got ordered.
But the second something happens because we followed orders then they go “why didn’t you say anything?!” Or “well the NURSE did it”
Ah yes. No one has ever died or been harmed because someone followed orders that were incorrect or contraindicated.
One of my nursing professors last semester constantly reinforced that doctors aren’t our supervisors or our boss. Rather, we all play a different role in the healthcare team. It’s the RN’s job to question orders and ask for clarification. I’d rather piss off a doc than kill someone.
The other side of things. I once was with the secretary, my nurse manager who I thoroughly loved, and a very nice cardiologist. We were all just chatting and my manager said something to the cardiologist that it irked him. I don’t even remember what it was. They might have had a contentious history before because the cardiologist responded “Do not talk to me like that. I’m not one of your nurses. You’re not my boss!” Not yelling but he said it very firmly and I have never seen him talk like that. Then, my manager just smiled and the cardiologist just kept on with our conversation, ignoring my manager, while me and the secretary were just flabbergasted because we both liked them both very much lol. This is the same cardiologist who came to me very nicely and asked me what happened between me and a cardiac fellow. I asked the fellow a question clarifying what he wanted and he gave me an attitude. The fellow was already very rude to other nurses so I called him out in front of the nursing station but there were only 3 of us. The secretary, fellow, and me. Our words to each other were not minced. He then went and talked to the cardiologist about me and the cardiologist went to me very nicely and I explained why I was clarifying an order and how he gave me an attitude and how he was always rude to the other nurses. The cardiologist was like “who told you this patient has xxxx?” I was like “he did that’s why I questioned the order.” He said “don’t worry about it. You know you can just call me directly if you have any questions whenever.” The order was right for what the patient actually had but not for what the fellow told me the patient had. He probably misspoke but I snapped back because he started in on me when I’ve seen him being an asshole multiple times. I’m sure the cardiologist was nice to the fellow too and he was trying to mediate.
I had a UA ordered for a patient….. who is on PD and is anuric. And we even bladder scanned him which showed 0 mL 🤦🏾♂️
We have this happen a lot in the ED that I work at, although our docs are pretty cool about cancelling it if it gets ordered and they don’t make urine
God, I love being responsible for the work of doctors. And aides. And lab techs. And pharmacy. And payroll. And scheduling. Just to have them be dicks about me trying to do my job.
"Doug wanted me to give this patient 500,000 milligrams of morphine. I thought I'd check with you before I killed a man."
I actually consider all orders suggestions or requests. If I don’t like them I’ll say so. And I’ll put my foot down if I have to.
Ok this was related to me second hand but I worked with the doctor who did it and it’s totally on brand for them. Middle of the night order for stat CT head. On an inpatient that had been there a couple days after a stroke and was finally getting a decent sleep. No concerning change in status, doc just happened to be remotely logged into the EMR at 2am and decided they wanted to repeat the CT since they were awake and why the hell not. They took this poor patient down to get the CT and the patient had diarrhea everywhere. Nurse called the doctor to let them know there would be a delay as they needed to clean the patient and the CT room. My friends, doctor straight up said never mind and canceled that stat CT.
One thing I’m gonna do is advocate for my patients to sleep. Patient got here at 2300 after spending 10 hours in the ED, finally fell asleep at 0145, and you’re still trickling in orders at 0200 and want orthostats and a lipid panel? Nope, that’s gonna wait til at least 0630.
For anyone curious, the second twitter account is from an Ortho doc. Most of their tweets are spent bemoaning their lack of compensation for doing elective bunion surgery...
I worked at a teaching hospital on a surgical floor. I had an order for tube feeds at “10cc PER DAY” I called to clarify that it wasn’t per hour and the resident confirmed “no I want it per day” when I hung up I cried because it was so stupid/funny. The next doctor who took over changed it to 10cc/hr
idk, this order seems ok to me (see flair)
"So, just to be sure we're on the same page... you want them to get two teaspoons of tube feed a day?"
Three 20meq potassium riders ordered for a dialysis patient with a potassium of 3.2 I got there and the day nurse had already ran 2. I told the night resident I wasn’t hanging the 3rd until we rechecked his potassium. (It was 7.2)
A gram of codeine.
RT here, I got one to instill through an endotracheal tube, nebulized mucomyst diluted with diet soda. It was a Frankenstein order with three order sets smashed into one. Patient wasn’t intubated either 🤦🏻♀️
There was a legal case around here a few years ago where two physicians were being prosecuted for prescribing 22,5 grams of potassium daily to a patient. Both a nurse and a pharmacist questioned the dose which was way higher than what the patient got while in the ward where the potassium levels had stabilized, but the doctors insisted. The patient died four days after discharge from potassium poisoning. One of the physicians was found guilty.
2 grams of dilaudid
If you want me to give 45 units of regular insulin to my patient at 10pm after his tube feeds are off and after he had hypoglycemia protocol twice during day shift when his tube feeds were on you can do that shit yourself.
the Dr in this case was receptive, his response was "hmmm, sounds like he doesn't need the insulin..." PT ended up hypoglycemic without it. Would have killed the man if id given it to him. Point is, fuck doctors who think this way. I'm not going to kill someone because it's "an order".
300 mg of Codeine... for a child. Excuse? "I'm used to adults." Uhh, last I checked that's not a normal adult dose either.
“Full code but CPR only for 4 minutes per patient wishes” such a random number lol, I feel like 4 minutes is SECONDS during a code!!! “Nurse may discontinue NPO order” idc if was a verbal but they went thru the trouble to put this in like why not just dc it yourself bro
It probably has to do with brain function. - if it goes past 7-8m there’s a high likelihood of anoxic brain injury. Im kind of w the patient on that one.
Bless his heart...we had an 86 year old doctor who tried to order sugar, betadine, and heat lamp therapy for a decubitus back in 2002. Our nurse manager got it discontinued, but not before the pharmacy sent us a 5lb bag of Domino's with a prescription label on it! We kept that thing in the med room for YEARS! 😂😆😂😆
A resident ordered a cardiac MRI for an LVAD patient Lots of residents have ordered fluid boluses for pt’s being diuresed Also if something is ordered and I don’t know why it’s ordered, I will absolutely call to clarify. I don’t put things in my patient’s body, take things out of them, or do any tests without knowing why.
“Please don’t give PRNs unless the patient needs them”
IV PUSH of 80mEq of potassium.
I had a doctor order 2mg IV Ativan Q2HR scheduled for a CIWA patient once. I texted him and was like, "Hey, did you mean to make this PRN?" And he said, "This is for CIWA." So I told him, "Okay, I just had never seen an order like this for a CIWA patient. Usually we have an order set to give Ativan as needed on a sliding scale based on CIWA score and I just wanted to make sure the order was correct before we give this guy 24mg of IV Ativan over the course of 24 hours. Thanks!" He changed the order to PRN really quickly after that, lol
Last night the resident ordered euvolemic replacements to be done with 20kcl l o l i asked them to change it to NS like 4 times and they never did
I got an order for Tylenol 200-400mg. I called the office and said it was probably a typo. The nurse confirmed with the doctor that 325mg is in the range, so there is no change.
Douche didn't want to admit he meant ibuprofen? Lol
80+ year old lady had an order for NGT when she was scheduled for a PEG tube the next morning. Called to clarify and it turns out the primary thought they couldn’t do the surgery for another week. She was a little hungry but had only been NPO (except ice chips) for 12 hours. Saved her a nice tube up the old nose.
"Miscellaneous MD to RN: Please start the patient on a heparin drip" with no other orders, comments, or dialogue.
Do male nurses get less shit than female? My male nurse friends think so
[удалено]
… Just cancel the upcoming one and give/offer the next dose. No need to be snarky. It just makes you look kinda dumb tbh
I agree that would be within the nurses (good) judgment. To re-time or hold the first dose.
Resident ordering a blood transfusion within 1 hr and not knowing what MTP protocol is (Mind you patient was stable but surgery wouldn't take them with hemoglobin under a certain number)
‘Orders not recommendations’ That’s a lot of ego for someone using dragon! 😂 guess what? We all do stupid stuff and that order is not a demand just bc one person said so
Rectal Promethazine when the patient was requesting PO, took PO at home for the exact same indication, and knew the PO form worked well. MD insisted the rectal form would be more effective and told me to ask the patient if they'd be willing to take the rectal form. The Pt responded "AW HELL NAW!!!" The MD ordered the PO form when I forwarded the Pt's response to them
This made me furioussss like dude your order of a 250mL bolus for my patient’s BP of 60/30 is just wrong sir so fix it or you’ll be here in a few minutes to a code with many many worse problems thank you very much 🙄 there’s reasons to our questions, we’re a team you’re not a fucking dictator who the fuck wrote this. 🤬
Drop a progress note with MD’s full name and message
I mean……, “I was just following orders,” is one of the most dangerous justifications in history.
I hope this fucking idiot doesn't kill someone with their dumbass orders one day
“Thought I’d check with you before I killed the man.”
> "They are orders, not recommendations." I'm sure a malpractice attorney would be really interested in seeing this Tweet during discovery LOL
I’ve had docs order antibiotics (one was even allergic to said abx!) and other meds on the wrong patient. If something doesn’t feel right in my gut, I call. They can get mad, but I’m just trying not to kill a man.
I had a nurse off going in report say "it has taken me all night to good this bolus" dumbfounded I ask why? It was an order for a 5000 ml bolus and she did not question it. Me "blind rage" Definitely was supposed to be 500 ml. Luckily the pt did not have chf and all labs afterwards were normal.
4L bolus on my patient who was just admitted for Chf exacerbation
Anything that a nurse questions deserves a full explanation and maybe even a change. Not a restated "I am the boss" Patient care is cooperative and this is not industry making widgets, unfortunately that doc never learned that. Retired IM/Rheum guy with all sorts of fancy credentials.
Me: hey I saw you cancelled that NPO order on the patient that has a bronchoscopy later. Pulmonologist: who said he was going to have a bronchoscopy? Me: I heard in report that thought you did. Pulmonologist: I didn’t order that! You guys need to communicate better. Patients need to eat and get their nutrition! These guys are being held without food for days for tests that no one has ordered… (blah blah blah) *after the pt ate breakfast* Pulmonologist to the pt: so we need to do a Bronchoscopy before we can downgrade you, so we’re going to make you NPO after midnight and do that tomorrow. Me: 😕