Saturday, August 23, 2008

Take every 6 hrs as needed for indifference

Every couple of months the class of new nurses with whom I started meets for continuing education. The day’s agenda always includes time to talk about the challenges of the job. Essentially it’s a good-natured bitch session. Last time we met, someone brought up calling residents for orders and getting a less-than-confident or lackadaisical answer. Residents are still training as doctors and don’t know everything so nurses often coach them along. A common response from the docs is, “What do you usually do?” or “What do you want to do?”

I prefer the first question because it falls back on the routines of the attending physicians. They’re usually asking because hospitals differ in their preferences, not because they are clueless. At Hospital A, the typical orders for nausea are medication X at such-and-such dose and timing, while at Hospital B it’s medication Z. The second question, “What do you want to do?” is more annoying to me, because, you know, they’re the doctor with prescriptive authority. It’s putting the onus on the nurse with the doctor just agreeing or not with the suggestion. The worst though is when they obviously aren’t engaged. As one fellow nurse dramatized it:

Nurse: Doctor, Mr. Smith is getting increasingly hypertensive.

Doc: Uhh. Hydralazine 10 mg, or whatever. I don’t care.

In class I wistfully offered how great it would be if we could write out the order and fax it to the pharmacy just like that.

8/23/08 1935 Hydralazine 10 mg, or whatever. I don’t care.
TORB (telephone order read back) Dr. Apathy/St. Murse, RN

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