Triumph: The Insult Comic Dog

I mean a lot of that title in jest, of course, but it does work on multiple levels.

I had one of the most pitiful, yet triumphant of all nursing moments at work today, when after being roundly insulted by two doctors over my refusal to pass a certain med based on a borderline lab value without valid labs being drawn first to confirm the safety of adminstering the medication. Of course, at that point, it started one of those fun, doctor-initiated "You're a stupid nurse/ I am the smart doctor so do my bidding and shut the fuck up" pissing matches I find so undignified and frankly, a waste of my time. Four hours of my time, in this case, and I had to float at 11a-3p, and then come back and pick up my assignment at 3p-7p, so you know, I really could have done without AMA SmackDown 2006 this morning.

I found it, errr, ironic that both docs insisted that I give said med and yet, when I stated I was uncomfortable due to borderline labs and no orders for further labwork to confirm the safety of administering the med, both refused to come to the floor and give the damn med. First of all, let me backtrack a bit and explain it's within the nursing scope of practice and protocol to refuse to pass a med we deem may be harmful to a patient, even if an MD insists. If we feel uncomfortable for a valid reason, it is perfectly acceptable practice to ask the MD to come and pass the med, and they may bitch and moan, but ultimately, a nurse doesn't have to give med s/he has a reason to believe may be harmful to a patient. Period. End of story. It's about patient advocacy, and double checking each other, because everybody isn't always right all the time, and we're supposedly here for the patient, not our egos. No, seriously. Can you imagine patient care being about the patient? Apparently that idea gets outmoded at some point in some peoples' lofty, mistake-free career. (Snarf).

So really, I shouldn't have to explain myself half a dozen times to two different doctors, and if they are so damn sure the med is harmless, why not come and give the goddamn thing and be done with it already? Huh? HUH?

Any way, the triumph came when a third attending was called in, a specialist, who had the labs drawn and made notes to the tune of, "Huh. Maybe we should make this an every-other-day drug, yeah?"

YEAH. MAYBE.

So you see how the title fits. Triumph: I stood my ground and didn't let doctors intimidate me into giving a med I thought would harm my patient. I was a patient advocate today. Insult: Should be obvious by now, huh? I actually had a doc say, "You've had two doctors tell you to give the med, so what do I have to do to bypass you to get the med passed?!." It was, oh, so tempting to say, "Come up to floor, lick the floor clean, write a ten page public apology to all the nurses you've insulted in your career, apologize in person to every single one on bended knee, buy us all lunch at the Four Seasons, and then maybe I'll think about passing it." It was also very tempting to say, "I don't care if two goats in rubber chicken suits told me I had to give the med, I still wouldn't do it." Comic: It was funny, kind of. In retrospect. And especially after the med was held. Dog: Well, that should be plainly obvious.

In other news, I floated to an ICU for four hours and discovered how terribly endearing a medical intern can be. Interns are my age, or younger, pretty much, and some of them actually don't get all arrogant and snotty. They actually appreciate your help and say please and thank you. It's like some kind of culture shock. Mostly, they aren't rude because some of them still don't know stuff like the standard orders for loading doses of Digoxin and have probably learned by now that nurses, even brand new ones, actually know a thing or two about medicine and are more than willing to help you out if you just ask nicely. And it flatters me just a little bit, because well, interns and new nurses start at the same time of the year (in June) and being able to help an intern with loading dig orders and clarify attending orders for them shows me just how far I've come in six months. And it's nice to hear thank you from an MD every once and awhile. It was all a warm-and-fuzzy moment, believe me.

And all my patients today were cute and sweet. Almost makes me wish I was back for tomorrow, save for the pending snow storm.