No comment, nurses are built different

“Admitting MD currently walking back to office at this time”

This is so funny but also true. When I went through nursing school in ‘93, the instructor drilled it into us that charting can break or make a case in malpractice court. I actually had to defend myself in a malpractice court. Cost me money because I didn’t have malpractice insurance at the time but it was money well spent. I now tell that and advocate malpractice insurance to new nurses also. Believe me, your facility will throw you under the bus.

​@@carolemerle9995wait nurses have to insure themselves?!?! That's insane. Did you at least make it out of that case alright?

I wouldn’t say he asked to be glorified, just that the negative references to him in the nurses notes be mitigated. Providers not infrequently get burned by some nurses who maintain a defensive approach to their interactions and who document exchanges in minute details intended as peremptory exonerations in case some unanticipated negative consequence accrues.

Or charged with murder

but perhaps deserves to be? edit. thank you to those who took the time to educate me. please, newcomers, read the rest of this thread first.. thank you ps. i bloody love nurses and think you all need better pay and conditions. my gripe has been explained in the rest of this thread

@@Plethorality Nope.

@@Plethorality 🤦🏻‍♀️🤦🏻‍♀️🤦🏻‍♀️

@@thomasmitchell4128 you thought that her behaviour in this skit was helping the patient?

Sorry, can you explain what that means please? It sounds bad

@@thomasmitchell4128 when patient sues for various reasons a few years later and the nurse is asked to testify, all the nurse has to protect/ prove themselves is their documentation in the patients file. Documentation takes up a ton of time so most new nursesor inexperienced nurses tend to skimp on documentation just so they finish on time. A nurse who takes time to document every minor little thing is usually someone who had been called in to recall a past situation and are now aware of how important documentation is. The joke in this video probably isn't evident to someone who hasn't worked in Healthcare but unlike TV, nurses don't go running after an MD yells out a medication order. Even during a code blue there's one nurse who's job is just to stand in the corner and document everything.

@@tearlesereph Thank you for letting me know. I'm a nursing student and you just put the fear of God in me. **my notes will be novels**

@@thomasmitchell4128 - At first, they probably should be, but over time, you'll learn what does and doesn't matter.

Yes!!! 😂😂😂

Plenty of nurses pressuring (junior) doctors to break rules to make their jobs easier, too…

@@gigi6539 like what?????

i have said to a few docs “well clearly those nurses are nicer than me!”

I've been asked to chart PRN anxiolytics without seeing the patient or reviewing their notes. PRN requests for antiemetics are regular, and fair, but I need to at least check the notes first to makes sure they haven't been admitted with a contraindication. Demands to see patients out of priority orders (to go review a patient for a job that can wait a few hours when there is a clinical review that has to be seen in 30 minutes pending). Demands tosign off that a patient needs one to one nursing because of a falls risk, when it contradicts the policy for assessment of one to one nursing needs and after they refused to call a ward to get a falls mat or any other intervention. Basically, doctors aren't perfect. Nurses aren't perfect. No one's perfect, much like humans since hospital staff are those too, in their spare time.

@@kufresh1988 I want to stress - I love nurses. My Mum is one and I have a great relationship with 90% of them. I particularly love the ones that push back (professionally!) when they see me making the wrong decision. And I know there are plenty of doctors who are ducks to nurses/everyone. My comment was intended to point out that this false nurse-doctor dichotomy is not always the Angels vs Demons it is portrayed as. But seeing as you asked so emphatically... An example from this week was a nurse asking me to formally palliate a patient I had never met and was on a different site so I had no way of reviewing. I am the only doctor more senior than intern in the hospital overnight so I can't leave in case there's an arrest. Apparently it had been 'handed over' to the night team to 'get' the registrar to do it. I wouldn't have minded if she'd backed off when I pointed out this wasn't appropriate, but she was nasty. *She* knows the patient so surely *I* should just do it because she says so? Another from this week: ITU nurse calls me while dealing with the aftermath of a nasty peri-arrest. Interns in tears. Patient moribund. Ward nurses traumatised. But ITU only have 3 telemetry units left, I *must* come and review them immediately to see who can come off in the morning (again, abrasive attitude being the main problem, not the fact they asked me to review telemetry provision). No, I can't right now. Cue another unpleasant phone call 30 minutes later while I'm trying to have an EoL conversation with the patient's family... And now cue the incident report... Mix in with these examples the many less specific a) my patient is difficult to nurse, can you sedate him? Pressure to comply when I say no because he's not at risk and that's unethical b) pressure to discharge when it's not medically safe c) pressure to modify parameters because he keeps scoring high so needs lots of monitoring d) constant pressure to come see stable patients in ED when I'm spreading myself across six ongoing dumpster-fires on the ward... Again - not necessarily the requests that are the problem. It's the toxic attitude they come with when I say no. And again - it's a minority.

Yup. CYA.

I write this every time it’s relevant !!

That’s honestly the best part

I have literally written that note before

After saying the md was passive aggressive

Yep. “Pt’s family requested pretzels and got notably upset and verbally agressive, abusing staff in the halls while staff were dealing with a critical situation. Provider aware and visitors escorted out by security.” Reality: staff were dealing with a meth head who tried to rape a staff member taking his BP, was stopped and then began jacking off in hallways and some random family member from another nearby room thought “yes. Everything is about me” and rushed out to bitch about not getting pretzels with the snap of a finger then got offended when RN gave em a long overdue reality check and told them “fuck off” while a meth head is actively cumming on a wall behind them, blood all over the floor and 6 cops getting ready to take em down. All staff, RN, PCT, cops etc. all continue to work the next 10 hours following event like nothing happened and are expected to just take the shit from entitled assholes who are there for some stupid shit that $10 and a trip to CVS wouldve solved in 1 hour. But of course, god forbid we dont test you for everything under the sun since you can come back and sue us because after all, we were the ones that told you to get fat as fuck, not work out and do stupid shit thinking there are no consequences. True story… sadly. Entitled fucktards are everywhere i swear…

Says everything and nothing all at the same time

I actually heard you can get in trouble for writing that, you’re not supposed to write things you have not done yet.

@@thetnta Yep. It's now being said that charting "will continue to monitor" after identifying a problem implies a possible delay in the implementation of appropriate intervention(s). In other words, they're taking the phrase "will continue to monitor" to mean "I see this issue but I'm gonna wait until it gets worse before I actually intervene".

@@nastaishia normally, I'll write it when pt refuses vitals or blood draws and what methods in which I tried to obtain them then comes "will continue to monitor. Afterwards I try other methods about 30-45 minutes later to get the stuff I need for their charts. Not the best thing but it proves I have tried multiple methods in getting orders done.

We don't do that anymore 😂

Therefore: Admitting MD is that bad after all…

True...,.but has nothing to do with patient, therefore has no business being in PATIENT'S HEALTHCARE RECORD. ( RN for 29 yrs)

@@reneemayes421 It happened in front of patient

@@DeathnoteBB Yes but is the patient a good reporter? Is the patient interviewable? Is that person still alive when state or federal surveyors are there?

It’s still not done. 5 notes on silly things but the patient still comes to the floor with untreated Chest Pain or elevated BP 🙄

Firing a doctor is near impossible. Don asked how we could retain staff. I asked if they're not going to commit to filling roster gaps, then will they support our registration when we're forced to work in extremly unsafe conditions. Was advised our registrations are our own problem. Nurses aren't expendable either. But we're easier to fire to hide the real problem. (it's the doctors... I'm kidding, it's management)

Trueeeeeeeeee

Yup i had multiple times where thank god the nurse was there one nurse pushed a doctor away from me to save my life he was trying to push pain meds that i was allergic to he started coming to me and the nurse told him no he was rude to her and said oh ik she then pushed him away and stood to defend me and would not leave my side she was a hero she new i could not defend my self so she did sad thing i have not seen her since

As someone with chronic pain whos been routinely injured by nurses covering their own asses, I blame them. Hospitals do not trust their patients lived experience.

@@candace3493 nobody trust a patients account or the patients statements. I've been inpatient 4xs this year alone. Every time was worse & worse, nurses, doctors, technicians. It's all of them. The field is collapsing and there is nothing we as patients can do then to continue to advocate for ourselves. Even if that means we are "nasty" or "pain in the ass" patients. Unfortunately due to past medical staff induced trauma I have no choice but to be extremely firm & blunt. I ask for what exactly works for me and argue (if necessary) my point to the nurse, doctors etc.

Hahahahhaah spot on

Funnily enough, I've written a note similar to that. More than once, actually. Yay, psych ward!

Kiki V Absolutely true. I’ve worked in psyche wards also 😂

Useful so all personnel can don their hazmat suit before treating them.

OMG I HAVEN'T LAUGHED THAT HARD IN A GOOD LONG TIME THANKS

In nursing home, if it not in note's..... It didn't happen. Official policy!

Definitely the same in the UK. If it isn’t documented it didn’t happen.. There have been times when a single sentence has saved the hospital from being sued!

Do doctors document everything they say or order, too?

@@donatodiniccolodibettobardi842I don't know for sure but I think they may. I know they write a lot of notes during shift so that may their documentation

I’m healthcare admin and my professor always said this too.

THIS!

And malpractice insurance

And because it's almost always a nurse's fault.

Lmao, I just started my nursing classes and the reason we can't take verbal orders for narcotics/pain meds. Is because it's illegal and if reported we'll have our licenses immediately revoked. (This also means the hospital will get investigated and might lose funding)

Are you aware that morphine depresses respirations ? That would not be the drug of choice. Actually, the info needed is to know if the patient is a full code, or DNR. That way you are prepared to resuscitate the patient if necessary.

@@frugalityishername827 bruh, I’m not a medical expert, I do social work for a living. Jokes don’t need to be scientifically correct. 🤷🏼‍♂️

@@frugalityishername827 depends on why they're dying. If it's a STEMI, morphine helps with vasodilation, it's one of the urgent meds first used.

All of these replies are the reason we document so much…

Nurses actually act passive aggressive to doctors like this? I thought was satire, and that's what they want to say.

​@@stupidveganworld They were referring to the accuracy of nurses documenting a lot, not saying that we act like this IRL 🤦🏻‍♂️ We have a duty to document every relevant infomation regarding the patients care so we don't get sued or thrown under the bus by the hospital.

​@@stupidveganworldYes, nurses chart passive aggressively very frequently. Also MOA's or MA's...you have to watch out for them in the doctor's offices.

Any nurse who takes an MD order over the phone should be writing it down in the chart as a phone order.

@@vinavorasane2237 she actually did 😂

Will continue to monitor

Maybe ED is the place for me after all… I cannot STAND flowsheets. Just let me write a note about all the care I provided and not have to shuffle through 13 flowsheets with minute by minute rows/columns to chart what would take just a few minutes in a note, paint a better clinical picture, and refresh my memory better in the future.

I keep hearing the acronym "ED", and now I'm realizing that it means a very different thing to medical professionals compared to the general public.

Lol! That didn't happen!

Omgosh, they read them ALL THE TIME. ESPECIALLY when they know they’re wrong and expect to be called out.

Doctors love to yell at everyone around them, then have *surprised Pikachu face* when they get clapback.

Z

I document the way I do so that anyone coming to the note behind me knows exactly what's going on, what's been done, and what's yet to be done. I just consider that good communication.

Just be aware that if you are going to chart on a patient problem you better chart your assessment and what you did about it or your charting can also be used against you. I've seen a lot of very bad charting and in that case less is more.

Are you referring to swabs and smear tests? Because in the ED where i work at it's not mandatory to indicate where the swab was taken from, just which pathogens we want to to test for.

@@gigi6539 maybe we all understand that because we're all incredibly busy, but patients and their families who are sue happy couldn't care less, and nurses are seen as an overhead expense by hospitals, whereas providers are seen as revenue bringers since they bill for their services. From a business standpoint, nurses are the best option to throw under the bus; notice how administration is never held accountable for their awful policies and the unsafe patient ratios they promote? The nurse is coordinating care between the DRs/PAs/NPs, RT, PT, OT, ST, imaging, case management, dietary, tele, lab, patients/family, etc. It's no wonder that "nurses get blamed for everything" is a thing when we're trying to make sure all the pieces of the puzzle of full patient care falls into place while other professions can just pop in and out, get their task done and leave.

Yeah because doctors tending to end of life conversations, rapid responses, sepsis, chest pain, and 10,000 other things in the hospital with their 20 other patients are so rude. Demonize the doctor, everyone already blames doctors for everything anyway.

@@gigi6539 oh please, don't insinuate that I don't prioritize my patients by who is more critical. I don't prioritize by "who may sue me" because, quite frankly, I don't care, I care about keeping people alive. Your statement was made to devalue nurses and act like we're just here to pester doctors and that were oblivious to your obligations and hard work. I do everything in my scope to take care of patients and put as little strain on doctors as possible because I know what a shit show it is (at least in my country).

@@Scar-jg4bn Even in Navy Hospital Corps school we were taught, very early on, if it isn't charted it didn't happen. Having been a surgical patient recently multiple times in several major US hospitals, it's definitely all about the nurses. In fact I was discharged by a hospital PA, I didn't see my surgeon again until my follow-up several weeks later. I think he did have a student check me that morning, though. Everything else was really excellent nursing care. From what I understand US hospitals also make providers use really annoying charting software too. And they follow up with very in depth customer service surveys that don't really give the staff much recourse if a patient is unfair. (Press Ganey- yes I got sent one for every surgery)

@@gigi6539 So you don’t work in this environment and don’t understand it but felt that you had no choice but to comment despite your admitted ignorance. Yes. Yes you did have a choice.

Exactly. Lol. And that sewage could’ve been avoided with that click on that docs phone had it just been ordered the first time needed. Good point

We don't have charts in the ED, the system only lets us put in Notes. It's very intuitive and open to use, all relevant data regarding the patients care is accessable on the spot.

They sure do

Yes exactly

Absolutely. Make a grid at the start of shift and note Everything that happened in your 12 hours. Including beds filled and staff that called off.

The field has been and is dying for the last 50 years. Nurses have become more techs rather than nurses. So yes techs are covering their ass.

More like covering your own asses when you treat patients like shit. I've worked in a hospital for a few years and nurses are quite literally some of the worst people I've ever had the displeasure of meeting in my life. Like high school bullies who never grew out of their "popular clique" phase

That's so true. I wish they were set more like a timeline once patient is in your care.

The video is showing a typical situation in an ER/ED, not a regular floor. Don't know about your ER but in ours the docs are always present unless there's an emergency in a different dept.

@@gore0802 Yeah definitely the MDs are more present in emerg than on the floor, but even when I worked in emerg, I always had to look for the MD caring for patient to discuss. Not saying its their fault but they were spread very thin and always running. Now im in caseroom and I would say the MDs are more accessible but they dont stay, we call them when delivery is imminent.

Oh, is that why I had to spend forty minutes getting a PICC implanted, and as soon as radiology came in to see the line was lying properly, here comes the case manager saying that I'm being discharged to rehab? (I was PISSED) it was this total run around, waffling BS about me getting discharged to acute rehab for TWO DAYS! So yeah, they removed the PICC five minutes after putting it in (the team that implanted were still in the room, and they were pissed, too)

No, they come up with old orders because we initially stabilised them enough so we can take care of less stable and critical NEW patients who come in after. If you don't understand emergency care just try to educate yourself on it

@SC0212 I worked ED for 9 years and then did 3 years of ICU. Everyone one knows that’s a lie. Yes some days were genuinely been crazy but most of the time it’s because we were too lazy to do it. I’ve matured enough to where I can say that it was wrong to do. And let’s be honest- ERs are basically faster primary care these days. 90%+ of patients are there for things that could and should be seen at an urgent care or PCP. If you don’t believe me, go look up the numbers and tell me how many ESI 1s/true 2s come in, and tell me how many ESI 3-5 come in annually. Numbers don’t lie

We have to document thoroughly because different than doctors, the hospital can fire us very easily. Firing a doctor is almost impossible unless they knowingly performed treatment that was illegal.

@@gore0802 I’m also a nurse though, who doesn’t document like that. Why does ED have to? Are you talking about ED nurses can get fired easily?

@Raychel98 ED doesn’t have to, they just haven’t been taught otherwise. I’ve worked ED and never charted like that. It just uses up space with a bunch of useless info. I’d always just open one note and addend it as needed so it’s all consolidated in a single note. I’m guessing that nurse up there is a newer nurse

Thanks 😁

What is WCTM?

@@arthurhusein4661 will continue to monitor

@@NonnahsB Ohh thank you!

Since it’s been a while for this nurse: What is “GCS15?” I remember VSS. “This nurse” hadn’t become part of documentation, also no laptops at bedside or in the hall; notes written by hand, then signed by name, RN.

@@flautalee3090 Glasgow Coma Scale

@@beeootyful Yes!

If the notes said anything it would be useful. I can't tell you how many times I'll see notes like this but absolutely nothing documented in an actual assessment. I don't care that the call bell was in reach every hour when the patient has had changes in their pupils, no sensation to their foot, needed their dressings reinforced 3x, and their GCS has fluctuated over the last 9 hours.

Can you elaborate on some of the ways your notes saved your career? Just curious :)

😁

It's really just in case a lawsuit occurs and they need the notes in class. Essentially if you didn't write it down you never did it.

@@plls2880 absolutely this. also, if blood tests start showing up a little weird and there's no documented IV, the likely IV contamination might be missed

What it so unfortunate about documentation? It's for protection and accountability. My license is important.

@@drydz8670 Because of the absolute ludicrous level of documentation. There's a major loss in actual health care performance due to occupation with administrative tasks like these. Administrative tasks which more often than not aren't even proven to be effective in actually reducing any rate of complication or morbidity patients may experience. So for who's protection are we really documenting here? And with that, what are we documenting? It's rather selective what is even documented, it's not even an absolute truth what is documented, it is self protection what is being documented. And I've been in incident committees plenty enough times to know that documented IV removals for example are no guarantee whatsoever. Better yet, if anything, it may even be harmful because we're reaching the day and age in which if a computer says there's no IV left in place, patients go home with one and return with cellulitis, sepsis or angry relatives if they don't speak up themselves. But at least the documentation showed everything was in order 🙃.

@@docfornix oh I agree 100%. But like I said, it's for protection. Nurses are the first to be thrown under the bus considering they literally liaise with just about each and every member of healthcare team for the benefit of the patient. They also mostly do everything on the floor-unit support workers will not touch the blood splattered bathrooms, nor will they mop poop ridden floors until nurses have done the initial cleaning and removing with hospital grade wipes. We also partly become physio to patients that need mobility exercises and that q4h turning of 360 lbs patient. Nurses are also responsible for making sure that breathing exercises for COPD pxs are done per doc's orders. Did I also mention that we are also part time phlebotomist? So yeah, we will continue to write everything we have done to make sure that in case a litigation occurs we will have that protection.

Thanks!

Actually … It’s usually doctors saying, “well try 4g/24h of Tylenol first… I’m like “sure, expect a phone call at 2am when the pt is in a pain crisis.”🤷🏻‍♀️

Yes it’s called an “addendum” feature. Use it sometime. You can blabber away all you want but it’ll all be consolidated in one note. Just use time stamps and voila!