Saturday, October 24, 2009

Why don't you try it, then?

Dude. I have a week so far. I'm paying because all of my patients and family members earlier this week were super nice and complementary- telling me how sweet I was, how much I helped them, explained things and that I was an awesome nurse. Naturally, life couldn't stay that way, and the last 2 days I have had the most awful family members EVER. All the patients related to these people have been fine- really sweet, actually. But their family members have seemed to feel the need to tell me how to do my job, even though they medically knew slim to none.
It started with a poor little lady who came in with abdominal pain and turned out to have pneumonia. She also ended up being pretty anemic when we did our blood work, so the doctor went ahead and order a unit of packed red cells to be transfused on the floor. I went in to draw the type and cross before I sent her upstairs, and I explained to the patient in the family what I was drawing and why I was drawing it. Her daughter freaked.
"A blood transfusion? Why are you doing that? She could get AIDs!"
"Well, Ma'am, with the precautions they take with blood donors and the tests they run on blood now, the risk of catching HIV from a blood transfusion is just about none."
"Well that's not what I HEARD! Can't you just give her some iron tablets or something?"
I went on to explain that the doctor wanted to treat her aggressively since she already was not oxygenating well with pneumonia, but that the choice was up to them and that I would go ahead and draw the blood to give them the option, and they could talk with the doctor later. They agreed and were actually very sweet and reasonable. If only I was so lucky with the next patient.

This woman brings in her mom, who was 90. She had fallen the week before on her knee and shoulder. They x rayed the knee, nothing was broken. They apparently didn't x ray the shoulder but referred her to an orthopedist- apparently sometime in that week, the daughter decided since her mom hadn't recovered immediately, that she needed to be admitted to our hospital for rehab. The orthopedist, I'm guessing to shut her up, told her to come to our emergency room and we would admit her, that he called the ER doctor and gave him orders. This is totally not how that works, or what happened, so this old lady had been sitting in a hall bed for an hour and a half waiting to be seen by the time I got to work. I tried explaining that since the ortho didn't admit her directly, that the descision would ultimately be up to the ER doc whether to admit, and that he had to do x-rays first. I probably told her this 4 times, and every time she just stared and said, " But doctor so and so said he was going to admit her!" The whole time, the mom was just sitting in the hall bed chilling, while her daughter demanded blankets for her, because she gets cold, and when is she going to get a bed, Dr. so and so said he would admit her, why doesn't she have a bed yet? I explained the same. things. over. and over. and over. until I thought I was going to strangle this woman. Finally, our ER doc caved and admitted her, because he didn't want to deal with this woman's crap. I had to start an IV on her, so I went ahead and gave all her stuff to the secretary to get her admitted while I knocked the IV out. Miscalculation on my part- the daughter spent about 15 minutes asking my question I'd already answered, so by the time I got to looking for a vein, the patient already had a room. I then spent another 5 explaining that the floor wouldn't take her without and IV, and no, they couldn't start it upstairs.
So I go to start an IV on this woman. It is about as difficult as most IV starts on 90 year olds- not easy- but the whole time the daughter is hovering over me, literally and figuratively. "That needle is so big!" ( I used the baby size) "That tourniquet is so tight!" "She needs more blankets!" And as soon I stuck her mom " OUCH OUCH OUCH you're hurting her!!!" (The patient said nothing). As soon as I draw blood from the IV she screams. I have to explain to her that blood return is the sign of a working IV. You don't know that, but you want to tell me how to insert the IV. Awesome. I then spend another 20 minutes taking the patient to the bathroom, because the daughter insists she can bear no weight at all on either foot, and that I need to pick her up and place her in the wheelchair. Oh hell no. I do this with the assistance of another nurse, but as soon as I get the patient in the bathroom and away from her daughter, I'm able to lift her arms while she stands in front of the toilet. I put her back in the wheelchair and the nurse floating on our side takes her upstairs, with the daughter following her the whole way-" Watch her foot! Watch her foot! Her foot really hurts!" (The patient put her pain at a zero 10 minutes before and refused meds).
And last night, I worked in yellow zone and I had my first note pad lady. Now, I don't necessarily mind that people that want to write stuff down- I tend to overexplain things, so they tend to like me anyway. But there's writing things down because you actually want to know, and writing things down because you are looking for me to screw up. We don't really take patients in this area necessarily- we kind of work in one big team. So the other nurse I'm working with goes to start the IV on this girl there with adominal pain, who's in her 30's- her mom is there with her writing everything down. The first IV blew, so she starts another that won't draw, but that flushes-not unusual for people who are hard sticks- the entire time this woman is hovering over her asking if she can start the IV herself. Uh, no. So, I go in later to give meds, and she's asking me questions about the dosages and indication in a very demanding manner, even though I told them that, as I do with every patient, first thing when I walked into the room. Writing furiously. Then demands to know the name and title of the nurse who started the IV, the PA's name, my name, even though we've already told her, and it's on the board in the room. I explain after giving her daughter morphine that we'll monitor her oxygen sat and may give her a little if it drops. She responds by very haughtily saying, "Well. I don't see any oxygen." I very sweetly explain to her that it's right there, on the wall, and we'll get a cannula, if we need it. We had her drink contrast for a CT, which requires at least 2 hours between the time the contrast as finished and the time the CT is done- she comes out exactly two hours after her daughter finished the contrast, demanding to know where the CT tech is. At some point during this whole exchange, I ask her if she's an RN, too. Her response, " Oh, no, I'm a lab technician. But I have nursing skills. So, yeah, I basically am." Fool, NO. You basically aren't. If you have to ask me what Zofran is for, you totally aren't. That makes me freaking crazy. I understand what labs mean- that doesn't mean I can do your job, so just because you understand nursing doesn't mean you can do my job. Which was obviously what she thought- that she had to watch all of us like hawks so we didn't screw up a job that she could totally do herself.
Out of all of these people, she had the most medical knowledge, and she didn't have much. I have absolutely no problem with questions. I love questions. I have no problems with the patients and family looking at the charts, or giving me tips on where to draw blood. Involvement in care is awesome- it makes for better patient outcomes. But. As soon as people come around with absolutely no medical background whatsover, or just enought medical background to be dangerous, and try to tell me how to do my job- Eff no. I busted my butt in nursing school. I was at the top of my class, and I still have questions everyday. My job is still a challenge. I would just once, love to be able to make the offer to all the people that seem to think my job is easy, for them to try it. Just for about an hour. Try starting an foley on a 450 pound lady. Why don't you start an IV on a screaming three year old whose family is yelling at you? Why don't you run in the room with the demented patient who is throwing his own feces and try adminster a medication? It's a breeze, right? Go for it. If you can knock that out without a problem, come back and tell me how to do my job. But until then, back the hell off.


  1. How you stay patient with all these wackos is beyond me! You ROCK!!!

  2. Lab techs know nothing other than how to draw blood. I know this because when I see that my timed PTT is cancelled & lumped in with "morning labs"....they are clueless when I tell them it's timed for a reason....Heparin. Hello!! Or cardiac not cancel the timed draw just so you can draw it when it's convenient for you. They don't know lab values & they definitely don't know nursing.

    I think if families were not allowed near the patients, things would run much smoother. I'm getting to the point where I kick the family out while I'm doing my initial assessment.

  3. I wish I could throw some of these fools out without shit totally getting out of control. I actually would have thrown the second lady out had her mom not been in a hall bed- but I had nowhere to send her! I have never thrown a family member out, either.