Doctor-Nurse Relationship

The relationship between the doctor and nurse can have a difference in the care of  a patient.  Nurses are generally the ones who see what is going on with a patient. They are at the bedside giving the care, noticing changes and communicating these findings to the doctor.  Hopefully the doctor utilizes the expertise of the nurse to treat their patients.  However, in my many years of nursing I have found some doctors really don't respect nurses at all which puts a strain on the respect a nurse has for the doctor and jeopardizes the care a patient gets.  Nurses are advocates for their patients and when they feel a plan of treatment is not right for the patient, doctors should at least listen to why they feel this way.  Doctors and nurses will not always agree but we must show enough respect to each other and discuss it professionally for the best outcome for the patient.

I work in a teaching hospital and one of the best advice an attending can give a medical student is to listen to and befriend the nurses.  We love doctors who will at least listen whether they agree with us or not.  Then you have the doctors who know it all and think nurses only do anything they can to get out of working.  These are the doctors who will jeopardize patient care because the nurse can't assist someone who knows it all already. 

It is important to note that the doctor-nurse relationship is sacrosanct and building a professional relationship is essential. Patient care should not be a tug-of-war between nurses and doctors, but instead it should be about professionals working together for the good of the patients. The medical team of doctors, nurses and other medical professionals that engage and respect each other will create a positive working environment and perform at an elevated level which can produce quality patient care with exceptional patient outcomes. This is the ultimate goal. 

What do you think? Share your thoughts and concerns. 

It's So Hard to Say Goodbye

Many times families struggle with letting their loved ones go.  It is easy to say what we want to happen to our family member and not examine what he or she would want for themselves. Working in the ICU, I see this on a regular basis.  A patient merely exists because their family selfishly keeps them alive when all odds are against their survival.  They say God will give us a miracle!  I too believe in God and his miracles but he also gave us common sense to know when it is time to let go.  If it is his will for he or she to survive, they will.  I don't know many people who would want to live their life and not be able to enjoy it.  We must look at "quality" of life and not "quantity".  When your family is lying in that bed, put yourself in their shoes.  Ask yourself is this how I would want to live the rest of my life?  Love them enough to let go and enjoy the happy times you had with them.  I would hope my family loved me enough to not let me suffer that way if all hope for a life of quality was  nonexistent.

What would your wishes be?  What would you do? Share your thoughts, comments or experiences.

Has the use of Milk of Amnesia (Propofol) been tarnished?

Ever since Propofol has been introduced to the public by the death of Michael Jackson, people are afraid of having it used on their loved one in the intensive care setting. Propofol has been safely used in this setting for years. What people need to realize is that when used properly in the correct setting it is as safe a drug as Tylenol. Propofol is used to sedate individuals who are receiving mechanical ventilation. In critically ill patients it has been found to be superior to lorazepam (Ativan) both in effectiveness as well as overall cost; as a result, the use of Propofol for this indication is now encouraged whereas the use of Lorazepam for this indication is discouraged. Propofol is also used for sedation, for example, prior to endoscopic procedures, and has been found to have less prolonged sedation and a faster recovery time compared to midazolam (Versed). When used for sedation on mechanical ventilation patients, they wake up faster because the drug's duration of clinical effect is much shorter. This is mainly because Propofol is rapidly distributed into peripheral tissues. Since patients and their families use the internet to try and dictate their care, why not use the resource to educate yourselves on the use of Propofol and how safe it really is!

3 am fixer uppers

This topic was suggested by a friend!

Don't you just hate it when you have your last assessment charted, vital signs complete and morning meds ready to be given so u can just give report and leave and then bam u have an admission coming because decided they been having chest pain for 2 weeks and at 3 am it's time to go to the ER!

Maybe they never heard of going to the doctor's office or stopping by the clinic to get checked out! Maybe they stopped by after leaving the club and said "hey now is a good time to check on that chest pain!" I just don't get it. The ER is for "emergencies" not a convenient 24 hour doctor visit! Utilize your physician and clinics for the non-emergent treatments and stop wasting the ER resources for your convenience. And you wonder why the average wait time is 5 hours lol.

This is Foxxy and that's just the way I see it!

Are you done yet?

As nurses we have to understand that everyone's job is important. It really bothers me when we interrupt or delay someone else's job. If your patient needs to go for an xray, dopplar study or any other procedure,you don't need to do a complete assessment, vital signs and give your medications before they leave. This holds up the person transporting the patient and also delays their diagnostic testing or procedure. If the nurse's aide or patient care assistant is in the middle of giving your patient a bath, don't interrupt to take your vitals or give their meds. You can wait till they are done but if you are in that big of a hurry, help do the bath to speed up the process!

We have nurses who think their duties are more important than the next persons. In some aspect this is true but you also have to realize if it isn't an emergency it can wait.

This is Foxxy and that's just the way I see it! If you agree or disagree let me know how you see it!

Do Not Resuscitate

I know death is never easy especially for immediate family but I believe it is necessary to respect the patient's wishes. Recently we had a patient who was dying of lung cancer and decided he wanted to be a DNR because he was tired of the battle. On the last day of his battle the wife was very upset and wanted the doctor to undo the DNR but was unsuccessful because the doctor told her she had to respect his wishes. Later that night he died and the son went bezerk. He fought with his sister and demanded we do an autopsy because he believed the respiratory therapist killed him(nevermind the fact he was actively dying of end stage cancer). He was told the autopsy would cost $2500 and he said he would pay it. Then he decided he wanted the crime lab to do the autopsy so the funeral home decided they didn't want anything to do with the family. The body was taken to the morgue and the family was left with the responsibility of getting the body transported out by the next morning. Needless to say the family left three hours later but I am sure the drama continued.

My guess is this was his way of coping with his dad's death. People react different ways and usually need someone to blame! I can't imagine what would have happened if the patient had not made his wishes clear up front. I believe it is better to be prepared especially if you are terminally ill. It relieves the family of painful decisions and can also but not always avoid drama.

All comments are greatly appreciated!!!!!!!!

Drill Seargent

Attention!!!!! I have been given the title of drill seargent on my unit. We receive post op heart surgery patients and early ambulation is a key factor in recovering. I am the nurse who doesn't take no for an answer! I don't ask you if you are ready to walk, I tell you it's time to walk. I don't allow patients to lie in bed all day, they must sit in the chair most of the day.I battle with patients and their enabling families about this and I am always the winner. It is my goal to get you back home and not have you endure a lengthy stay. So yes I will take the name drill seargent any day. At ease soldier!

All comments are greatly appreciated!!!!!