I kinda want to get those step counter thingies that calculate the distance you've walked so I can see how much running around I do at work. Today was ridiculous and it just reminded me of how I strongly dislike doctors sometimes (sorry Egon). It's so frustrating that regardless of how much we know/do and how well we know our patients, nurses cant do shit without the okay from a doctor. Are the doctors the ones providing hands-on care to the patient 24/7? I fully appreciate the knowledge doctors have, but sometimes they don't understand what is going on with patients because they're just not around enough.
We have a 24yo patient on our unit who had 2 small bowel transplants gone bad, he had the 2nd one removed a few weeks ago (yep, he has no small bowel) and just had major heart surgery 3 days ago. He is in awful shape and is not exactly the most stable patient. But, not only is he medically "heavy" but on top of that, he is also obnoxious and super needy. Yesterday he started vomiting liters - LITERS - of blood. The doctors were like, "oh ok, just monitor him and we'll probably give him some blood." FYI docs: if your patient is vomiting liters with a blood pressure that is dropping, he needs constant care - something he cannot get on a regular in-patient unit. Each nurse on our floor has 4-5 patients to take care of, and when you have a patient like Mr. H, your other patients tend to get neglected, which unfortunately happens and you deal with it, but you find ways to remedy that (i.e. transfer him a unit where he can receive 1-to-1 care). We tried to talk to the doctors to get him transferred to the ICU where he could get that, but noooo, the doctors didnt want to. Today I was the lucky one who got to take care of him. Overnight he got 4 units of blood, 2 units of FFP, and his H&H were still only 9 & 23. I came on to my shift and his heart rate was 110 and O2 sat was 82%. (That number should never drop below 92%.) He gets pain medicine every hour, Benadryl every 4, nausea meds every 6, Ativan every 6, labs drawn every 6 hours, vital signs every 4 hours, and IV antibiotics every 8. Of course none of those are scheduled for the same time, so everything is spread out during the day so its not like you can take care of more than one thing with each trip into the room. And that's just what was scheduled, that doesnt include added interventions. For example, halfway through my shift he started having irregular heart rhythms which required interventions and thus more care, and his lab levels were low and needed 4 hours of electrolyte replacements. I was probably in his room every half hour, and I had 3 other patients. He wouldnt be such a handful if he didnt get the pain medicine every hour. Typically patients who require pain meds that frequently get put on a pain button, which I convinced the resident to do, but then the stupid fellow who I absolutely CANNOT stand, said no. I'm sorry, are you going to come in and give this guy meds every hour? Are you going stay in his room for 20 minutes to try to get his pillow positioned just right so he doesnt scream bloody murder? Are you gonna sit there and listen to him when he starts talking about how he doesnt want to live anymore? No. We have to do that. You just write orders of a piece of paper and never go in to see your patients. Yeah, you're a fantastic doctor. (sidenote: why the hell is this patient still a Full Code? Because the doctors are too stubborn and refuse to admit that this kid is dying? oh ok, thats a good reason.)
I really think that med students should be required to do a rotation following a nurse. Even for just a week, just so they can realize exactly what it is we do all day. Siiigh.
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