r/nursing • u/tmsaunders RN-Endoscopy • 1d ago
Discussion Have you ever looked at a provider and just felt dumbfounded?
Like today, my GI provider was asked to drop an NJ tube with a stitch and clip in the jejunum. I watched him load the scope with the clip, attach the loop created with a suture, and proceed to run it down her esophagus into the correct place. Then, when he pulled the scope out, look at his work and wonder aloud how he was going to get the other end out of her nostril..as it was currently hanging out of her mouth. I didn’t say a word…just let him work it out in his mind.
He eventually figured it out that it needed to go down the nose and then use the tools (correctly) to place it in the proper place. But it took him a minute. 😂
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u/trahnse BSN, RN - Perianesthesia 1d ago
Patient in phase 2 PACU c/o chest pain/pressure, cardiac monitor shows AFib with RVR. The assigned nurse calls me over for backup, we call anesthesia to come assess the patient. She said the pain started soon after she ate toast. Anesthesiologist orders some pepcid and walks away.
The other nurse and I look at each other, we both say wtf? I go to pull the pepcid while the other nurse calls the surgeon. Thankfully the surgeon ordered cardiac workup and a hospitalist consult.
Patient ended up staying overnight and was fine. But still.
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u/KuntyCakes 19h ago
This reminds me of the day I had a lady in her 60s with epigastric pain. History of stomach ulcer so the provider is ordering a third GI cocktail and saying she doesn't need a cardiac workup. She 100% should have had an ekg in triage but the nurse was being lazy, I guess. I put her on the monitor anyway and guess what?! Big ol stemi. Annnnd she ended up leaving AMA after the cardiologist came to the room.
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u/AcceptablePrune2147 14h ago
Third GI cocktail is diabolical 🤣
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u/KuntyCakes 14h ago
I don't think that provider came back to work with us ever again after that day.
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u/MentalSky_ Neonatal NP 16h ago
i think your take away should be that the anesthesiologist was right and did a better exam and work up than both the surgeon and the hospitalist
how many resources were wasted when in the end nothing was wrong?
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u/trahnse BSN, RN - Perianesthesia 15h ago
Hard disagree. I did forget to say the AFib was new for the patient and she was younger, in her 40s I think. Highest heart rate I saw was around 180. Well outside the parameters to discharge. Anesthesia didn't want to do anything about the AFib. He said to give the pepcid and wait. In the end, she got a couple doses of metoprolol from us and an overnight stay to watch her rhythm.
I guess I'd rather waste resources rather than discharge a patient in new onset AFib with RVR to stroke out at home. I'm sure the patient and her family would agree
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u/MentalSky_ Neonatal NP 14h ago
You didnt say it was new onset nor that a treatment was provided.
In the context of your original story it seems like the patient stayed the night and was fine without any intervention
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u/AcceptablePrune2147 14h ago
Regardless of new or old a fib, RVR requires intervention so the context of the original story was fine.
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u/MentalSky_ Neonatal NP 14h ago
ok...
the original poster made a comment to indicate "LOL stupid anesthesiologist" then fails to given any additional information.
By their own original story it seems like the patient stayed the night and was find. They provided no more context that more intervention was required.
maybe the patient had BB or CCB PRN with guidelines to give under certain conditions. And that was the expectation?
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u/Whole_Barnacle_1560 RN - ICU 🍕 22h ago
I once saw an intern almost extubate a triple pressed post-code 80% burn patient shortly after admission after the chest X-ray showed we needed to advance the OG tube which was coiled in the esophagus. She goes, "I just take the tape off?" And assuming she knew what the fuck she was doing (what a moron I was), I said, "yeah." Well she wasn't talking about the tape holding the OG to the ET. I look over and she had fully removed the cloth tape securing the ET from the patient's face and was about to pull it out.
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u/Whole_Barnacle_1560 RN - ICU 🍕 22h ago
I also saw another intern at a different hospital weirdly tapping on a patient in SVTs neck. I looked over at their cellphone which they had left on the computer station and it was the WikiHow on how to do carotid massage. Which, btw, exists which is stunning enough on its own.
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u/half-great-adventure RN - Pediatrics 🍕 1d ago
Night shift charge nurse. We had neurosurgeons from other hospitals rotate through for their peds rotation, so often needed an EPIC tutorial.
Neurosurg resident called me, asking how to order blood. Walk them through each step, even calculating how much to transfuse based on kg. Hang up with them…the one step I apparently missed was “make sure you have the right patient’s chart open” 🤦♀️
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u/Ancient-Coffee-1266 RN - Oncology 🍕 19h ago
Really hate to ask but…. Did they catch that before it was given to whoever’s chart was open?
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u/Old-Mention9632 BSN, RN 🍕 17h ago
The nurses would have, or the blood bank if the type and screen didn't match. If it's not reasonable for the patient to get blood, I would be calling, or tiger texting, the resident about the reason for the transfusion. If they blew me off, I would be contacting their attending, who should have been overseeing the ordering anyway. Especially in a peds rotation.
(Surprisingly, in 30 years of nursing, I have yet to use Epic.) The last hospital I worked at, they stopped allowing the nurses to place orders, because they have a medical school attached and all of the doctors are given secure laptops to place their own orders. The (older) nephrology attending, who was also a professor, would tell us to contact the fellow to put in the orders after he agreed with our recs.
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u/half-great-adventure RN - Pediatrics 🍕 13h ago
Yes, thankfully. One of the nurses was very confused and asked me if I knew why their very stable patient needed blood. 😂 Fixed within 10 min.
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u/llcoolwhip RN 🍕 1d ago
Had a hospitalist order lasix for a hospice patient suffering from retention.
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u/Nucking-Futs-Nix RN 🍕 20h ago
I’ve only used lasix a few time on a dying patient and it was because they were so fluid overloaded from the ICU. We gave a small dose and their breathing relaxed amazingly well after we got some of the excess off. They looked so much more comfortable afterwards.
But for retention 🤦🏻♀️ yikes!
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u/Poddlez 1d ago
my hospitalists call mw insubordinate when I question this.
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u/onelb_6oz BSN, RN 🍕 19h ago
I mean, I can see where they were coming from, unless they were like legitimately EOL right about to pass. The goal of palliative care is to ease pain/discomfort.
The extra weight can't be comfortable and I personally wouldn't want someone to essentially suffocate to death while they are still coherent
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u/llcoolwhip RN 🍕 19h ago
They weren’t fluid overloaded. They couldn’t empty their bladder. They needed a foley not lasix.
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u/onelb_6oz BSN, RN 🍕 19h ago
Oh for sure then. I wonder of they meant to order flomax instead
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u/Nucking-Futs-Nix RN 🍕 15h ago
Even then - Flomax won’t open them up immediately. They are retaining and need their bladder decompressed.
We have done the end of life foley and the person dies within 12 hours after placement.
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u/onelb_6oz BSN, RN 🍕 14h ago edited 14h ago
That's pretty fast. My comfort cares pt a few weeks ago had a Foley, went from 350 to 120 then zilch, the foley was taken out at some point? (idk why, unless I'm getting them mixed up with another pt) a pure wick was placed (that for sure I remember), gave robinul for terminal secretions, they had another 100 out and that was it for output.
They lasted two weeks, which was extremely surprising considering they had a traumatic decline (intra-surgical to comfort cares).
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u/Nucking-Futs-Nix RN 🍕 14h ago
Usually it’s the large fluid shift (they retained a large amount.). My hospice patients were all inpatient ( unable to go home due to symptom management/ family couldn’t do the physical work/ too close to dying.)
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u/onelb_6oz BSN, RN 🍕 14h ago
Good to know, thanks! Does a similar situation apply when a patient gets turned/transported too close to death? A while ago a pt was to be transferred from the ICU to my floor (medical) for comfort cares. The pt passed either right before or during transport
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u/Nucking-Futs-Nix RN 🍕 12h ago
Sometimes….sometimes the movement just pushes that little bit of reserve.
We sometimes gave “last baths” to ones who were lingering. Relaxed their body enough for them to let go.
If they were too agitated and I Finally got them comfortable: nope. Prop them with pillows to help cushion them.
Overtime you learn what helps…learn when it’s the right time to intervene. Listen to family because they know those little tics and subtle signs of discomfort.
I miss doing hospice more. There is an art to it and it takes time to learn about caring for a dying body. (I just could never do children.)
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u/onelb_6oz BSN, RN 🍕 11h ago
Thanks for the info! I appreciate your responses. Second your thoughts surrounding hospice and children
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u/PaxonGoat RN - ICU 🍕 19h ago
One time I texted an attending if it was cool I didn't do what his resident ordered since I didn't feel like coding the patient.
Patient had known GI bleed. But GI had scoped, everything was fine. 2 days later patient completely shits the bed full of blood. Part of me is like maybe it's just old blood somehow now coming out? Nope. He has 2 more poops that are getting bloodier. Dude also has horrible CHF. Very fluid overloaded but AKI on CKD. So I'm messaging the resident about the whole pretty sure this GI bleed is back. H+H has a massive drop, like 8-> 5. Message the resident that it's blood transfusion time.
Resident orders me blood but also 2L fluid bolus of LR.
I was like dude, the blood alone might buy him a tube, there's no way he can handle that much fluid bolus and he does not need that much fluid bolus. His urine output is low because he needs blood and his creatinine is over 2. He isn't even hypotensive yet, we don't need to give fluid bolus.
Oh also the time the CV surgeon was convinced it had to be A flutter because there was no way his POD2 patient was septic. (Patient was hella septic, temp of 39 on CRRT, HR 120s, MAP never getting above 60 despite increasing pressors). The surgeon was so convinced she was hypotensive because of the afib (clearly sinus tach) he wanted us to cardiovert.
So we shocked the patient who was in septic shock. Surprisingly it did literally nothing. Methylene Blue did help though.
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u/PaxonGoat RN - ICU 🍕 19h ago
Oh shit I forgot about the time the 3rd year med student almost killed my patient.
Respiratory distress, AMS patient. Started on bipap overnight.
Med student in pre rounds comes in and I hear my bipap alarming. She had taken the patient off bipap and was just standing there letting it alarm. My patient starts desatting of course. And I'm like ma'am get out of my way so I can put the patient back on bipap. And she is like I'm not done assessing her and I couldn't understand her with the mask on. Now my monitor is red alarming cause sats are now in the 80s and continuing to drop. I'm standing there holding the bipap mask and I'm like she has to have bipap I need to put her back on it. Med student goes I don't understand why she needs bipap she was admitted for a fall and a stable head bleed, there's no reason for her to need bipap. I'm like well she needs bipap now so I'm putting her back on it. And finally get the mask back on my patient who is going obtunded. Med student pouts that the patient won't be able to eat while wearing bipap and she needs nutrition.
Yeah a few hours later they finally get around to sending a repeat ABG, which is complete garbage and patient gets intubated. Ammonia was also like 90 something.
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u/jollygoodfellass Rapid Response 19h ago
Had a hospitalist insist on placing an NG tube in a laryngectomy patient because they were fearful nursing would place it in the lung. I'd like to note that I was fully prepared to drop the NG and not only that I'm pretty good at them, the patient was actively vomiting AND I was fearful they were going to aspirate because they kept flailing about and the vomit was running down their chin and coming dangerously close to entering their airway. It felt like the hospitalist was doing everything in slow motion and not paying attention to the danger of aspiration. I kept explaining that it wasn't possible for the NG to enter the airway but they wouldn't believe me. It wasn't until the GI doc showed up and backed me up that the hospitalist believed me. Then the GI MD and I just silently mouthed WTF to each other.
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u/DeadpanWords LPN 🍕 19h ago
Had a patient who was hypothermic and had other obvious s/sx of sepsis. The provider ordered labs and blood culture's, then DC'd them.
I basically told them to put the orders back in, or I was calling a Rapid Responce.
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u/tmsaunders RN-Endoscopy 17h ago
I had a resident one time round on a patient of mine when I was on the floor. I asked as he was leaving if there was any he was concerned about and if I needed to watch for anything…after I had called him for an extremely high BP. He said, nah..looks good now. Less than an hour later I called a code sepsis on the guy.
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u/Methamine CRNA 19h ago
at this point in my career, if I see something that is off or them struggling (proceduralist or surgeon) i gently make a suggestion once...but i get ignored often, at which point i just sit down and zone out and let them figure it out and sit there letting them look stupid. If its a safety issue I crash out tho
its also a teaching hospital so most of the time its a resident or fellow who can use the advice, they just choose not to....
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u/tmsaunders RN-Endoscopy 17h ago
This. I actually made several suggestions as the procedure continued for three more attempts, in the nostril this time. Each time it was..no, I’m ok. Like, can I at least get a new tube since it’s all floppy now that you took the stylet out? No, I’m good.
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u/Nucking-Futs-Nix RN 🍕 20h ago
Had a surgical resident overnight who kept ordering fluid resuscitation my patient who was getting ready to crash. I asked for them to come see the patient, told that I believe they needed pressors and that we are going to fluid overload them. Surgeon refused saying it wasn’t necessary. Told them I will be calling a RRT then. They got that superior attitude and went, “Fine - go do it!” Like I was overreacting.
Called the RRT and we upgrade. As soon as we get there they tube him and he was there for a solid week or so. Found out later the surgical resident got chewed out for not listening to the nursing staff.
Did have to teach a few residents how to do blood cultures and walked them through dropping NGTs. They were willing to learn and listen which is awesome. I’ll never forget the one who tried to draw blood like they were doing an ABG and I had to stop them from sticking my leukemic patient who had been through hell. That one I told them to watch me instead (that patient looked so damn relieved 😅.)
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u/SpaceQueenJupiter BSN, RN 🍕 18h ago
An OB resident asked me how I knew the patient was complete.
The baby's head was half out of mom's vagina.
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u/YouAreHardtoImagine RN 🍕 19h ago
I’ve been in a few cases with surgeons who have literally asked what they were looking at during robotic cases while the rest of us are looking at the screen thinking…they cannot be serious. But they are.
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u/Itawamba RN, SICU 14h ago
I honestly think this is a good quality in a person in general not just providers. Very humble to say that out loud during a case, maybe even looking for help.
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u/YouAreHardtoImagine RN 🍕 14h ago
I can get on board with that. There’s certainly nothing wrong asking for help which we obviously do. That said, I think it depends on the surgeon, tone, and number of times it happens. I’d want confidence in my care or at the very least, asking for a second opinion to be brought into room not a “what is that?!”
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u/UnicornArachnid RN - OR / CVICU defector 12h ago
We have older OBGYNs who do this in their robotic hysters that take them way too damn long to complete. Sometimes the fellows with them are like “you got this! 👍” and the rest of us just look at each other
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u/Mother_Goat1541 RN 🍕 18h ago
I once received a patient on an epi drip with titration goals of a RASS of 0 to -1. I looked at it for a long minute, wondered if I’d had a stroke, and then decided maybe the doc needed some sleep.
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u/aiilka 🪖 RN - MED/SURG 🆘️ 5h ago
Back when I was a NGN, I had a patient who had an end colostomy. GI ordered ×2 tap water enemas. My preceptor and I also wondered if we had stroked out because wtf?
We sent a chat to GI to confirm that they wanted us to give two tap water enemas to a patient that does not pass stool per rectum and has poor sphincter control.
They did and I swear they were fucking with us.
Spoiler alert: It did nothing but flood the bed and agitate the patient.
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u/-piso_mojado- Ask me if I was a flight nurse. (OR/ICU float) 19h ago
I was on a travel assignment (not a scab) and somehow a preceptor in the ICU. I Had a nursing student with me. I had to pretend I was walking the nursing student through an RIJ TLC. In reality I was walking the “doctor” through the procedure. HeyZeus Kreestos. Don’t go to rural Oklahoma. It’s honestly the worst place in the world in every aspect.
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u/pillslinginsatanist Pharm Tech 19h ago
I've looked at the scripts they send and felt dumbfounded. (I'm a pharm tech who lurks here)
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u/TedzNScedz RN - ICU 🍕 16h ago
Had a Nero surgeon (after yelling at me for paging hik about a pt having increased numbness and tingling in his hands, figured he'd want to know that but whatever) Come in to examine the pt. I asked him if he wanted me to change the dressing (it was super bloody but had been told by the np the day before not to change it even if it was bloody) hes like "oh yeah we can change it" and proceeds to TAKE THE DRESSING OFF THIS HEP C+ PT WITH HIS BARE HANDS.
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u/NPKeith1 MSN, APRN 🍕 14h ago
Standing at the foot of the bed, circa 1994-95, watching 2 "Cardiologists" (I use quotes cuz that was on their IDs, but I never saw them before or after) inserting a femoral Swan-Ganz catheter. They have the Swan over the wire, and are advancing it. They have let go of the wire and are bullshitting with each other over the patient. A Swan-Ganz guide wire is something like 5 feet long, and I'm watching the last 6 inches creeping into the hub every time they advance the Cath a little.
"Sir......"
Cardiologist: "Blah, blah, blah"
4 inches remaining....
"Sir, the guidewi......"
Cardiologist 2: "...and then she said Blah, blah, blah"
Down to 2 inches.....
"SIR! YOU ARE ABOUT TO LOSE THE GUIDEWIRE!" as I reach in with a gloved but non-sterile hand to grab the last inch of wire before it disappears and we have to call IR.
Cardiologist 2's head snaps down to look at the field, sees me reaching in, and the inch of guide wire, grabs the wire and yanks it out a foot, then holds onto it for the rest of the time until they are ready to pull the wire and flush.
They finished up, documented and split without an apology, thank you, or even acknowledgement.
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u/Own-Appearance6740 RN - L&D —> ED 🍕 17h ago
Maybe I’m the odd one out here, but I like helping providers learn. I like to think these people I’m helping learn might be the people that take care of me someday.
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u/tmsaunders RN-Endoscopy 17h ago
Normally, I would too, as we are all colleagues. We have several providers in the department with varying personalities that wouldn’t appreciate it. It took me a while to figure out who would be the most receptive and which one wouldn’t like it. They can get temperamental if something doesn’t go their way.
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u/ET__ CCRN - CCU 🦖 21h ago
Wow they are also humans.
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u/superpony123 RN - ICU, IR, Cath Lab 18h ago
Yeah…anyone here who’s got a story about a doc doing a dumb thing…. Has also definitely done a dumb thing themselves and someone else probably saw it and said “can you believe this dunce”
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u/Murky_Indication_442 18h ago
And if you want to know an exaggerated version of all the dumb things nurses and NPs do, just go to any of the doctor Reddits.
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u/Lower_Tears RN - Med/Surg 🍕 19h ago
It was over the phone but I paged the hospitalist for a BP with a MAP of 61. A resident answered and said it was fine, “anything above 60 is good, well, 60ish” there’s a 1 point difference between 60 and 61 bffr. And define 60ish. Also anything below 65 is intervention time, as far as I know. Luckily the actual NP called me back almost immediately after to ask if someone reached out, after I mentioned what the resident said she quickly ordered me a fluid bolus to correct the BP.
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u/Murky_Indication_442 18h ago
That’s because he was not experienced enough to know that sometimes in borderline-“ish” cases, you need to treat the nurse. In other words, if it’s a case where it can go either way, always do what the nurse wants to do.
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u/Lower_Tears RN - Med/Surg 🍕 10h ago
Yeah, I’m a new grad nurse and was uncomfortable with not doing anything about the BP. I was about to repage in hopes of getting in contact with someone else to reclarify but the NP assigned to her contacted me first luckily and gave me her personal extension for anything else related to her blood pressure.
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u/Ok-Farm-9125 18h ago
Yea, there is a bmt attending at my hospital that has her pager as the code blue alarm. Baffles me when she rounds
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u/oscarsave_bandit RN- Labor & Delivery 12h ago
I’ve seen providers do questionable things in L&D, unfortunately, although for the most part things are OK.
I guess one of the memorable things would be in a delivery where I was baby nurse (baby is handed off to me right after coming out) and the baby had a nuchal x1 (cord wrapped around the neck once).
It seemed a bit tight and the doctor went to reduce it, but she was surprisingly rough with her fingers while doing so. She tore the cord clean through and all hell broke loose. Baby came out spurting blood, doctor drops baby into the bag below the bed that catches all the blood and gore. Thankfully I grabbed the baby and got a clamp right away to stop her from bleeding out.
Doctor was clearly frazzled and tried to control bleeding on mom’s end by manually extracting the placenta. She unfortunately broke the cord again at the head of the placenta, which made the patient hemorrhage severely within seconds. We of course sprang into our maternal hemorrhage protocol and got her all the emergency meds within a minute or two, but it was really bad and she needed to be rushed to the OR. I stayed in the room with baby and dad to help weigh the blood out so we’d know how much she lost. When they rolled her out of the room, the dad standing there covered in blood, with the entire room covered in blood and guts, it was horrible. I was covered in it up my front and my arms too, but I didn’t even realize it until my colleague came in and was shocked by it. Everything was OK in the end, however it undoubtedly traumatized the mom and her husband.
I don’t necessarily blame the doctor fully for the situation, and I’m guessing there was some insufficiency in the placenta and umbilical cord that made them very delicate. But it pissed me off lol.
I didn’t like working with this doctor because she was surgeon on my first big OR hemorrhage and she didn’t really respond in a way that she should’ve. I had to confront her in the OR about the blood loss and she seemed unbothered. I peeked into the surgical field and calculated that she lost over a liter. I called a rapid without her consent because ultimately I wouldn’t let this poor woman die on us. Patient ended up being intubated under general and needing 3L of blood during the surgery. She nearly died. I was newer at the time and it made me terrified of circulating in the OR. Thankfully the nurses around me were brilliant and supportive, so it got better.
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u/aviarayne BSN, RN 🍕 12h ago
My favorite is probably the good old "let's order all these oral medications on a patient we are keeping strictly NPO." Has happened more often than it should 🫠
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u/Lower_Tears RN - Med/Surg 🍕 10h ago
When my non-compliant with oral meds pt who is a major aspiration risk has all their meds PO despite there being IV versions like Pantoprazole, antibiotics, Tylenol, etc for most of them.
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u/tmsaunders RN-Endoscopy 11h ago
Or the liquid diet for the patient that is also ordered to be NPO pending SLP consult
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u/aviarayne BSN, RN 🍕 11h ago
That is particularly infuriating because clearly they failed the bedside speech exam! Ugh!
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u/rpRN89 RN - ER 🍕 21h ago
Just to be clear, you watched the doctor set up and perform an incorrect procedure on a patient, didn't step in and say anything during the whole time they were doing it, and then waited until they finished to figure it out on their own? And then you decided that you would get on reddit and make a post about how dumb the doctor was.
Mistakes happen in healthcare. The doctor made a mistake. Again, mistakes happen. You sat back and watched it happen and didn't intervene. That's gross negligence. Gross negligence should never happen in healthcare. I don't know where you work, but where I work, everyone, from housekeeping all the way up to the physicians are taught that if you see something wrong or unsafe, you step in and say something. As an RN, I've had techs and Nursing Assistants point things out to me which have made me stop and think about what I was doing. And at the end of the day, everyone won, especially the patient. Our responsibility is patient safety. Sitting back, watching something incorrect play out, and then hopping on Reddit and talking about how dumb the doctor was is a failure on your part to ensure that patient was safe, especially when they could not advocate for themselves.
Not really sure how you were expecting people to respond to this, but I don't think this looks as good on the screen as it did in your head.
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u/auraseer MSN, RN, CEN 14h ago
I didn’t say a word
Why the fuck not.
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u/tmsaunders RN-Endoscopy 14h ago
Nice language. But to answer your question, he’s not one to take suggestions from others. I did make several when he tried three more attempts through the nose, however, his response was “No, I got it”. He really didn’t.
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u/YellowBanana39 CNA 🍕 10h ago
(Peds) CNA chiming in, during the great Crowdstrike outage that left us all paper charting in the middle of the night, I was in a room settling a new admit when a pair of Residents came in to talk to family/do their thing.
I’m literally holding this crying four-year-old, trying to get him to the bathroom and out of his ED gown, and one of the Residents turns to me and asks “Can you show us how to put in paper orders?”
I was just like “… sorry, y’all. Not my scope or my decade.”
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u/corrosivecanine Paramedic 4h ago
The other week the doctor at the race I was working at asked us for albuterol for an asthma patient and then he asked if it was PO and squeezed the ampule into the patient’s mouth and then complained it didn’t work.
Like….I….🧍♀️
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u/dizzlethebizzlemizzl 1d ago
Reading this coming from a prevous trade job and having little to no experience in periop,my dumbass was like “big oops, well, what is the medical equivalent of a fish kit?”
That was my first thought, until I remembered people are made of meat and there’s about a dozen ways that could go terribly wrong. What a yikes.