Nurses know best. :-P

It still baffles me how doctors can write orders and "care for" patients without ever assessing their patients. I realize that this is part of their job and training to be able to do this to an extent, but I just dont understand how they can be the ones ordering treatments, medications, interventions, etc when they're not the ones at the bedside constantly evaluating the patients.

Last night I had a patient (W.) who was pretty lethargic, didnt want to keep his eyes open for me, and when he did open his eyes he had this blank stare on his face. He was just "off." W is pretty familiar to us but during previous admissions he'd always had kind of a weird affect, which of course made taking care of him last night that much more challenging because I couldnt tell if he was just being weird or if something was actually wrong. About 3 hours into my shift I decided to bring the doctors to take a look at the patient just for my own comfort and reassurance. We get to the W.'s room and of course he's sitting up in bed, eyes wide open and the docs look at me, give me a hard time and laugh, "Come on, Nikki. He's fine." And I just tried to defend myself and claim that he hadnt been like that the last 3 times I'd gone in to see him. I can tell they kind of believed me, but unfortunately they cant do anything since what they see is a patient who is alert and responsive. For the rest of the night I was constantly battling with W. to actually stay alert. He developed a low-grade fever (100.6) and the docs just said to give him Tylenol. I continued to claim that he was "off" but when the doctor would go in there, W. would either be asleep and the doc didnt want to wake him, or I would've just harassed W. and woken him up enough to a point where he could actually answer a question. They attributed his weirdness and lethargy to the fever, which is fair, but they still didnt want to do any more. I kept checking on him and his temp just kept increasing. By the time my shift was over, he was febrile (temp=103.6), tachy (HR=130's), tachypnic (respiratory rate=32-34), and borderline hypertensive (BP=145/100). Septic much? I think so. The day nurse ended up transferring him to the ICU 2 hours after I left and W. had a seizure within an hour of arriving to the ICU. ...Yeah, sure Dr. C, "He's fine."

...Just another reason doctors should listen to nurses.... :-P