What is truly appalling is the LACK of competence that seems to run wild. I actually heard someone say "if they aren't going to pay for my ACLS then I'm just not going to take it." I was nearly shaking I was so pissed off! I actually gave report to the stupidest nurse ever the other day. We had just tubed a Xanax and etoh OD and the doctor (a known jokster) told her we would keep the patient down with rectal tylenol and lidocaine. Her answer was.... "can we give a little versed too?" HOLY SHIT!!! She wasn't kidding.
I just had to start triage AKA Tri-agony. We have the screener who has to put people in the computer and get the general idea of what brought them in (and is responsible for incessantly calling to see if so-and-so can have a visitor) and then there is straight old-fashioned why the hell-are-you-here triage. Everyone has 10/10 pain and some sort of psych disorder that means they just can't wait in the waiting room. What I've noticed is that certain nurses will handle the flow of patients well, where others get the mentality that everyone seriously needs to go straight back. I swear I had a nurse bring me a bleeding hemorrhoid right back....a stable patient. Ugh. But on that note, some nurses are truly nasty when you bring patients back. There is one (one of the unhappy bitches I have mentioned before) who gives a smart comment no matter what you bring. An 88 year old with chest pain and dizziness??? Gets an eye roll and the paper snatched out of my hands so hard I got a paper cut.
Another morale dropper.... here is a situation that one of my friends found herself in...
50-something guy with chest pain. EKG shows not an acute MI, but changes that warrant a trip to the ICU. He has lines x2 and is still having pain. We have a pathway that gets followed in this situation. The first year ED resident wanted the nurse to start a nitro drip.... at 100mcg. Ummm.... we tend to start at 20mcg (3cc/hr) and titrate up based on pain and BP. When the nurse refused the intern gave her a hard time and then changed her order to 3cc/hr (she still didn't know the dosing). The nurse still refused 1)because the intern obviously didn't know what the correct does was and 2) the patient's blood pressure had dropped to 90 systolic. Our policy states that we don't start nitro drips on systolics 90 or below. The attending told her to start it and she still refused. She went to the nursing coordinator in the ED who told her she had to do the order and threatened her with insubordination if she didn't! Ummm.... I thought the Nurse Practice Act allowed us to not give something if we were uncomfortable with it and could articulate why. So she had to meet with her nurse manager (who is a complete C*^T) and then had to schedule a meeting with all of nursing leadership and the physicians in question. She wisely went to our head nurse manager, explained her story and was promptly let off the hook. Still... thats a frightening realization..... in a teaching facility that nursing with years of experience beyond the resident can get in trouble for not following through on an incorrect order.
God I miss flying!