Off on the wrong foot.....

tallaght01

So, I moved from neonatal ICU to doing acute paediatrics this week. Going well so far. No dramas. Been a reasonably busy week, but not overwhelmingly so.

Started on wednesday, and by thursday I was on-call and running a clinic at the same time (most docs in here will have been in this rubbish situation before).

So, while doing the morning clinic I got 3 referrals from A+E. 3 kids who all sounded like they needed paeds input, but none of them sonuded like they were deperately ill. So, I told them I had a few punters to see in clinic, and I'd come to A+E to review the 3 kids when I was done. I also told them to call me if they were worried about an acute deterioration in the meantime. No probs.

So, 20 minutes later I get paged by the A+E. It was the charge nurse. "You have 3 kids waiting to be seen here".

"I Know".

"well, when are you coming to see them?".

"In about 40 minutes when I'm finished in clinic, like I told your SHO".

"Can you not come now, their parents are getting annoyed".

"No, I'm the only one in clinic".

*she hangs up*.

10 minutes later, my pager goes as I'm examining a baby in clinic. It says "Come to A+E...URGENT".

FCUK.

I drop everything and run to A+E. I dash into the resus area expecting a septic baby, or a diabetic ketoacidos etc.

There was no-one in the resus bay. I said out loud "who's crash-paged the paeds med-reg??".

Charge nurse comes over and says "we paged you to see those 3 kids. You were taking forever".

I lost it. I was a total hypocrite, because I'm absoloutely against anyone having the right to shout at another member of staff, or a patient, regardless of the situation.

But I asked her to follow me into a small cubicle, and tore into her. I told her if she ever paged me urgently again for a non urgent situation, I would bring the matter as high as I could, and I'd make sure she was disciplined for it.

The unfortunate thing, from a conscience point of view, is that she just apologised to me. I would have preferred if she'd argued back. Her lip was quivering a little, and she wouldn't look me in the eye. She has the reputation as being something of an angry dragon, but she seemed totally freaked out by the pasty, sunburnt wild eyed paddy shouting at her.

My conscience couldn't take it for longer than about 2 minutes. So, finally, I just said "Look, i'm really sorry. I don't mean to take it out on you. It's just i've only started in this dept, and I'm in clinic on my own, as well as being on call for A+E and its' just all a bit hellish".

In fairness, she apologised as well, as we ended up in that whole "No no, YOU were right" conversation.

Anyway, the flip side is that we're now great buddies at work, and we have a fantastic working relationship. Things just run so much more smoothly when everyone gets on.

I shouldn't have shouted, she shouldn't have crash-paged me. But we're adults, and we move on.

Hopefully that will be the last appearance that "Red" Tallaght01 will be making during my time here

Dr Galen

is she hot??

UrbanFox

You were quite right. They won't page you like that again in a hurry.

I am not a medic. In a different world from yours I had a manager who would suddenly decide that things were urgent just because it suited him and there was no urgency at all. I regarded this as abusive behaviour and bent his ear over it and the problem never recurred.

I'm afraid that "urgent" is another of those words that has suffered a loss of meaning through abusive misuse !!

Chunky Monkey

Haha if you'd ripped into my mum like that, she would have made you feel like a five year old.

I noticed that at work today. There was only one med reg on for the whole hospital and there were a couple of patients waiting for their discharge scripts. One of the CNMs bleeped her several times. In all fairness though when you're dealing with angry and bored patients, stressed out CT regs who will run back to theatre the minute you go, X-ray and cardiology departments, organising convalescence and transport, the usual no beds but a million patients have to be admitted etc, etc, etc I'd imagine it's easy to forget that the reg is busy too.

Vorsprung

Tell the to dry their eyes if they moan again. Fast bleep/crash bleeps are for urgent situations, anything else is stupid, selfish and unprofessional. Being under pressure doesn't really excuse, that's passing the buck and not on.

tallaght01

Mystik Monkey wrote: »

is she hot??

Absoloutely not. There's a desperate shortage of hot ladies where I'm working at the minute. However, I'm equally sure they'd say there's a severe drought when it comes to hot blokes too

UrbanFox wrote: »

You were quite right. They won't page you like that again in a hurry.

I am not a medic. In a different world from yours I had a manager who would suddenly decide that things were urgent just because it suited him and there was no urgency at all. I regarded this as abusive behaviour and bent his ear over it and the problem never recurred.

I'm afraid that "urgent" is another of those words that has suffered a loss of meaning through abusive misuse !!

Urgency is a very subjective term in a hospital. I constantly hear people telling other people that something is "urgent" when i know fine well that it isn't. Non clinical staff are subjected to this the most. They get told we need a set of old notes "urgently" all the time. Radiographers get it a lot, too. They aren't really in a position to judge urgency with the info they get over the phone, so they have to treat it as though they are being genuinely urgently paged. They know the piss gets taken, so we have a @Boy who cried wolf" scenario in every hospital in which I've ever worked.

I think "urgent" is one of the most over used words in any hospital and it really annoys me. I don't use it unless there's a life/death situation, or if there's a risk of significant illness/deterioration to the patient.

As far as I'm concerned, non clinical issues never make something "urgent". Doesn't always make me popular, but there ya go

Chunky Monkey wrote: »

Haha if you'd ripped into my mum like that, she would have made you feel like a five year old.

I noticed that at work today. There was only one med reg on for the whole hospital and there were a couple of patients waiting for their discharge scripts. One of the CNMs bleeped her several times. In all fairness though when you're dealing with angry and bored patients, stressed out CT regs who will run back to theatre the minute you go, X-ray and cardiology departments, organising convalescence and transport, the usual no beds but a million patients have to be admitted etc, etc, etc I'd imagine it's easy to forget that the reg is busy too.

Once you've been a doc for a few years chinky you'll realise there's pretty much no-one who'll be able to make you feel liek a 5 year old. You take so much abuse in your first year or 2, that you just get pretty thick skinned eventually. You'll also realise that no-one gives a **** how busy you are, so you'll stop caring about how busy they are.

I used to be quite meek when I was at uni, but not any more. Having said that, I really don't think what i did was particularly acceptable. There's far too much fighting in hospitals, far too many people giving each other bollockings. It's all futile in the end, and it just wastes everyone's time. I have very rarely had cross words with anyone in work. But when I have I've gone properly flipper :mad:

bigjimthefirst wrote: »

Tell the to dry their eyes if they moan again. Fast bleep/crash bleeps are for urgent situations, anything else is stupid, selfish and unprofessional. Being under pressure doesn't really excuse, that's passing the buck and not on.

This was just a pressure situation alright. Not for me though, I was sat in our nice clinic doing developmental checks

But people really do stupid things when they're under pressure. We need to look at where that pressure comes from, though. The charge nurses in most A+E departments are pretty unpopular with any of the busy on-call specialties, because they do crazy things like I've mentioned above. But the real problem is that either senior admin, or senior nursing management put shocking pressure on them to shift bodies, regardless of the actual clinical situation.

I've had them ringing my consultant at home on a sunday to tell him I was taking too long to see patients in A+E. I was in the middle of a resus where 3 people had come in really badly injured in an RTA at the time!. 2 of them went to ICU, and one died. It was horrendous, but they were more concerned that I should go and see they 25 year old with tummy pain in one of the minors cubicles. I explained this to my consultant when he rang me, and he still said "well, try and get the others seen quickly, too". Now, he was a sensible chap, and I could tell when he said it he didn't really mean it. But he was obviously under a lot of pressure too. In the UK, if the hospital doesn't either admit or discharge 97% (I think) of it's A+E patients within 4 hours, there's BIG trouble. So even our consultants were terrified of breaking the "4 hour rule" regardless of the consequences for the patient.

Your average A+E nurse didn't start out like this. They got that way somehow. And in my experience, they get that way because they're under so much pressure from above. I know my consultant wasn't like that before the 4 hour rule was introduced.

Would be interested to hear what others think? Or have others had these same experiences? Is it the same in ireland?

Chunky Monkey

tallaght01 wrote: »

Non clinical staff are subjected to this the most. They get told we need a set of old notes "urgently" all the time.

Tell me about it :mad: I was working as a ward clerk this week. At three o'clock, when I had my coat and bag in hand, someone asked me to get a chart. I asked them could I do it after my break (which should have been at half twelve and it was quiet at three so opportune moment to get away). No, they wanted to go through it now. So I go through a gazillion charts before I find it. Give it to her, then the phones start ringing constantly and people look for consults, warfarin appointments and out patient appointments which I have to do straight away as no-one seems to answer their phone bang on after four. Turns out it wasn't urgent, she just wanted to get out on time. I wound up staying almost two hours after I was supposed to be finished. Grr!!

I used to be quite meek when I was at uni, but not any more. Having said that, I really don't think what i did was particularly acceptable. There's far too much fighting in hospitals, far too many people giving each other bollockings. It's all futile in the end, and it just wastes everyone's time. I have very rarely had cross words with anyone in work. But when I have I've gone properly flipper :mad:

Got shouted at on the phone by a porter yesterday. Three wrong patients had been brought down to cardiology. There had been a lot of transfers and I hadn't had time to change it on the system. I hadn't had my nicotine fix in about five hours and was cursing every time the phone rang so I was getting ready to give some attitude when he apologised. Ah I'm a sucker for that

Your average A+E nurse didn't start out like this. They got that way somehow. And in my experience, they get that way because they're under so much pressure from above. I know my consultant wasn't like that before the 4 hour rule was introduced.

Would be interested to hear what others think? Or have others had these same experiences? Is it the same in ireland?

My mum has come home crying at times thanks to pressure from above and she is not someone who cries. We're not popular with the suits. She always lays things out bluntly to them and I'm short with them and give them the filthy eye. That's probably really unprofessional but my mum's a damn good nurse and has lasted three years as sole CNM II of this 34 bedded acute cardiac ward (I think that's its description, it's a stepdown ward) when all her predecessors have cracked in less than a year. She doesn't deserve that crap. Regarding her relationship with the doctors, she gets on with them really well, they love her.

PoleStar

Inappropriate use of a crash or emergency in my opinion is almost tantamount to negligence.

As a someone doing surgery, I could be scrubbed in a case. If I get one of these pages, I might result in me leaving the case, leaving consultant short handed and maybe struggling in a case.

Similarly, a medical reg etc may be dealing with a very sick patient and leave this patient on account of a crash or 999 page.

The only person right in this situation was the doctor. No nurse shoudl ever do this. And I am sure every doctor who reads this will know that familiar call from A&E, can you see the patient now as its busy which in reality means, we want to get rid of this patient as quickly as possible so come down, I dont care of there are 5 sick ITU patients needing urgent consults, I dont care if you arein theatre.

Rant over.

Although not really a rant, its true.

Traumadoc

Agree with you that the nurse was inappropriate, however which should get priority: emergency cases, or the outpatients?.

tallaght01

Traumadoc wrote: »

Agree with you that the nurse was inappropriate, however which should get priority: emergency cases, or the outpatients?.

Totally agree. I was extremely peed off at being assigned to be the only person doing clinic, aswell as being the only person on call.

But the reality is that all the kids had been seen, the problems had been identified. They really only needed to come in for observation (2 ingestions, where the toxicology database suggests inpatient observation for 24 hours. The other one was a kid with unusual musculoskeletal symptoms lasting 9 days who the GP had rung our consultant about. The boss had basically said to admit them and do a load of tests, so he wasn't acutely unwell. These weren't those "? sepsis" type kids that we see in A+E).

But there's no way my consultant should have put me covering both at once. I did explain that to the A+E doc, and he was fine with it. He was pretty cool about it, as I suspect he's been in the situation himself. And he knew I was coming along in an hour to scoop up all 3 kids and admit them.


plus, as any paediatrician will tell you, the stuff that comes through the door in our specialty doesn't neccesarily take preference over, say, the urgent GP referral clinic. I'd be interested in hearing the experiences of other specialties, but most of ours would go home from A+E without any treatmant. Even most of the kids who get referred to paeds (outwith a paeds A+E) would get sent home that day. Is that the same for you guys in the adult world?

PoleStar

Traumadoc wrote: »

Agree with you that the nurse was inappropriate, however which should get priority: emergency cases, or the outpatients?.

i guess it depends on what you mean as an emergency.

If it is a true emergency that requires immediate intervention then of course its obvious. But for most cases the only emergency is the nurse wanting to get rid of the patient. And in the routine case for example, RTi just requiring admission for antibioitcs and maybe nebs, or an abdominal pain for observation, when it has been decided by A&E that they are going to be admitted well then what harm if they have to wait a couple of hours. Obviosuly this aint ideal. But there isnt the option at 4pm to say in the outpatients, see ya later, ill be back in a couple of hours, this aint feasible.