Dr. PetPeeve

I think that the relationship between physicians and nurses has come a long way over the years.   There is more collaboration now and less opposition.  I work at a teaching hospital, and for the most part, we all get along well together.  

I do, however, have three major pet peeves where physicians are concerned.

The first thing I'm going to bitch about is the computer.

There are 29 computers on the ICU where I work.  When patients are climbing out of bed, call lights are blaring, IV pumps are alarming and a doctor comes and plops his ass down at the computer I'm signed onto, my hand reaches spastically for a large bore needle and adenosine.

Several vials of adenosine. 

My bag and my stethoscope are lying right next to the keyboard in plain view.  What should I read into this behavior?  

Has my touch rendered this ONE computer into a SUPER COMPUTER?  Will orders placed on THIS computer result in a miraculous cure, the patient leaping out of bed, embracing staff, rushing home and donating a quifazillion dollars to the physician?

I guess I can see the appeal.

Or, perhaps the physician is is just too damned self-important to see that I have been working from that very spot all night? 

Move your educated ass 27.9 inches down the desk.  Find a computer no one is using.

Ain't you got no raisin'?

The second thing I'm going to bitch about is IV push pain medication, like fentanyl.  


Too often I see the order, "Fentanyl 25-50 mcgs Q 1 hour PRN".  In some alternate universe where god is a nurse, computers would be wired to deliver a 53,956 joule shock to anyone placing that order.  An white-hot bolt of electricity would shoot up from the keyboard, stopping their heart. 

For good.

If they have one.

In case there are any doctors out there who grew up in a burlap bag prior to residency, here's an update:

Narcotics are abused, so they are tightly controlled.  IV narcotics are VERY closely monitored, checked and cross-checked.  They are watched as obsessively as the waistline of a Bel Air trophy wife.  

Fentanyl only comes in 100 mcg vials.  If a doctor writes, "Fentanyl 25-50 mcgs Q 1 hour PRN", then every time the patient needs pain medication the nurse has to grab another nurse--taking them away from whatever they were doing--drag them along with her to the pyxis, withdraw a vial of fentanyl, pull the drug up in a syringe, waste the appropriate amount in front of the other nurse, have the other nurse sign for the waste in the pyxis's computer, then go give the dose.

Sound complicated?  Time consuming?  Wasteful of not ONE but TWO nurses's time?  It is!  And yet, if you order fentanyl every hour, that little dance must be repeated every hour.  With two nurses.

As a result, many nurses just pull out the vial of fentanyl, give the ordered dose and then put the vial with the remainder of the drug in their pocket or in the bedside server.  They know the patient will want more in about 45 minutes. 

But legally, fentanyl cannot reside ANYWHERE other than in the pyxis, in the patient or wasted down the sink.

This is a perfect example of how bad orders create an environment where narcotics are NOT properly handled because doing the right thing is just so damned inconvenient.   Stop threatening the nurses's licenses! 

If the patient is in enough pain to warrant an order of Q1 or Q2 hours of a controlled substance, order a PCA.  The drug dosages and frequencies can be exactly the same, but it is MUCH less work for the nurse. 

The PCA is set up, the patient gets their little button, the narcotic is secure, the nurses can actually do some work instead of standing in front of a pyxis watching and witnessing fentanyl being wasted, and everyone is happy.  Smiles all around!



Here's my third pet peeve:  verbal orders. 

About verbal orders, I don't like 'em.  

I have once--just ONCE, mind you, but that's really all it takes--had a physician deny that they gave me an order.  It's ugly.  The resident in question gave an order in the night, and when staff arrived in the morning and raked him over the coals his response was to protest that he never told me to do that.  It was all the nurse's fault!  He was innocent! 

That's a pretty serious charge.  "Practicing medicine without a license", I believe it is called.  It all might have turned out badly for me--ending with my children being raised in a homeless shelter--except there were four other nurses involved who had witnessed the whole thing; one had actually taken the phone orders from this dickless shithead when I was in the patient's room. 

All the nurses involved were brought in, questioned, fingerprinted, and waterboarded by our nurse manager, the parking attendant, the state police, the FBI, the CIA, the ACLU, the KGB and the PTA.  We signed statements and held up our right hands and sang songs and pledged allegiance.   

When faced with this avalanche of testimony against him, this asshole--sorry, I meant to write, "doctor"--said that he had been asleep and he must have just forgotten the whole thing. 


I've had physicians protest on the phone that they can't put in an order in because they are busy placing a line or coding a patient.  But, I can read "STAFF LOUNGE"  on the caller ID. 

My trust level with verbal and telephone orders is pretty low.  Avoid the infamous, "He said, she said," cliche. 

Put your own orders in under your own name.