Thinking about registering for the 2nd Iteration. How screwed am I?

[lilytiger72]

Reworded the issue.

[NLengr]

I don't have much advice, but your story tells a valuable lesson for residents (especially new ones).

 

Always document, including the time, when you see patients, especially when you are being called to assess someone that people are concerned about. Make sure you explain the HPI, relevant history, exams and labs/imaging. Put in your provisional diagnosis of the problem, any concerning alternative dx, and what your plan going forward is. if you talked to the staff about it, always indicate that it was discussed with staff. Nobody will ever fault you for too much documentation. If anything ever comes up legally, or academically, your documentation is the only leg you have to stand on. Unfortunately, it's easy to see from your story how not documenting things can screw you.

 

Hope things work out for you. It's a ****ty situation to be in.

[hexonu]

I'll be honest, you probably should have taken the nurses advice and called your attending right away. A nurses assessment is usually spot on and they can usually predict with good accuracy when someone is circling the drain. Your lack of documentation doesn't really help your case either. You should have documented your futile attempts to alert your attending to action, that may have helped your case.

 

As far as what to do now, I have no suggestions.

 

Hopefully things work out, goodluck.

[lilytiger72]

I'll be honest, you probably should have taken the nurses advice and called your attending right away. A nurses assessment is usually spot on and they can usually predict with good accuracy when someone is circling the drain. Your lack of documentation doesn't really help your case either. You should have documented your futile attempts to alert your attending to action, that may have helped your case.

 

As far as what to do now, I have no suggestions.

 

Hopefully things work out, goodluck.

 

I see you're a nurse. Just to make things clear, I completely agree that I should have called the staff earlier/documented everything, that's not the issue here. Hearing over and over ''you should have done this and that'' is kind of useless and redundant at this point, no offense. I realize I was at fault and I know now what should have been done. Now my question is : Any advice for the CaRMS and what's next to come. Does anyone know about a resident who resigned and was later able to get another residency spot somewhere else.

[NLengr]

I'll be honest, you probably should have taken the nurses advice and called your attending right away. A nurses assessment is usually spot on and they can usually predict with good accuracy when someone is circling the drain.

 

I think that's a bit of an overstatement. I've seen a full spectrum of nursing assessments, from "wow, great job, everything is already figured out" to "WTF are you talking about". Most fall somewhere in the middle.

 

It's appropriate to assess the patient yourself and attempt management depending on the situation, and your experience level. You don't need to call an attending because a nurse tells you. However, it should lower your threshold to say you need help and call in someone with more experience.

 

It's hard to generalize situations like this.

[bloh]

Yeah, to say that most nurses have their **** together is a wild overstatement.

 

I've seen nurses continually page for the dumbest **** ever (uhm Mr. S doesn' have any morning bloodwork, should we assess this right now at 3am) to not paging till your patient has completely decompensated to 15L from 3L.

[Rosie]

I'll be honest, you probably should have taken the nurses advice and called your attending right away. A nurses assessment is usually spot on and they can usually predict with good accuracy when someone is circling the drain. Your lack of documentation doesn't really help your case either. You should have documented your futile attempts to alert your attending to action, that may have helped your case.

 

Quality varies across all professions. Nurses are not an exception to this.

[NLengr]

Yeah, to say that most nurses have their **** together is a wild overstatement.

 

I've seen nurses continually page for the dumbest **** ever (uhm Mr. S doesn' have any morning bloodwork, should we assess this right now at 3am) to not paging till your patient has completely decompensated to 15L from 3L.

 

While we are on the topic of poor paging practices, One of my best was someone paging at 3am when I was home call because another team's patient who was covering didn't have a PM statin ordered for the next evening. I didn't order it. I just explained that it wasn't an appropriate 3 am page, and a better plan would be to leave a note on the front of the chart and address it with the team following that patient in the morning whe. They came to work.

[A-Stark]

Usually with something like that I defer the decision too and ask them to put "team to R/A in am" in the kardex. Sometimes the "team" is me, but I do find it useful to treat overnight pages as little reminder stickies for the next day.

[Alastriss]

While we are on the topic of poor paging practices, One of my best was someone paging at 3am when I was home call because another team's patient who was covering didn't have a PM statin ordered for the next evening. I didn't order it. I just explained that it wasn't an appropriate 3 am page, and a better plan would be to leave a note on the front of the chart and address it with the team following that patient in the morning whe. They came to work.

 

My best (nb: worst) page was a 3-4 AM page about how a patients potassium was 3.4 in the PM bloodwork. I told her to get him a banana and the best part is she actually wanted my last name for an order.

 

So I will say that a nurses assessment is not usually spot on and saying that it is is an overstatement, sometimes it is, sometimes completely wrong and most fall in the middle as someone else mentioned.

[rmorelan]

Nurses are likely any group in the hospital - there are good ones, bad ones and ok ones Everyone is going to have a few stories of incredibly silly things they were paged about at one time or the other. I have similar stupid consults from docs as well about absolutely non important 2am things that could be deferred. A lot of people are just still learning in the system after all.

[medicine man]

My best (nb: worst) page was a 3-4 AM page about how a patients potassium was 3.4 in the PM bloodwork. I told her to get him a banana and the best part is she actually wanted my last name for an order.

 

So I will say that a nurses assessment is not usually spot on and saying that it is is an overstatement, sometimes it is, sometimes completely wrong and most fall in the middle as someone else mentioned.

 

I find nursing assessments to also vary quite a bit, and as a rule I try to see every pt in person or at least review every chart before doing something. It takes more work but I cannot tell you how many times the context changes once i review the chart or see the patient. Many times in small ways, but many times in big ways.

 

example call for BP 210/130 and wants hydralazine order stat, i say no, examine pt, asymptomatic, cuff is way too small, get proper cuff and do manual, its actually 160s/80s, what it has been running the whole time inpatient stay or call for pt's K is 2.8, wants K replaced stat. I assess the chart, K was drawn in AM, day team replaced it all throughout day, PM re-draw not back yet.

 

Its difficult because you walk a fine line if you try to educate the nurses about issues like these, especially saying its not cool at 4AM in the morning. Some have been positive to feedback but some not so much and get defensive.