Have a few stories from the last couple of weeks that the students who read this blog might enjoy....or something.
Okay, first, here's a bit of advice: if you're going to be snotty, at least couch it in a sweet as honey voice that can't come back on you. For example, the other night in the middle of a CAT (critical assessment team) call (meaning someone's really going down fast) and at the same time our Baby Buggy was going out to pick up a critically premature infant from one of the small surrounding towns in the area, and we had a PRN tx call for severe respiratory distress, AND it happened to be right at shift change, got a call from a unit secretary about doing a test on a patient so they could discharge that pt.
No prob. Now, USUALLY the docs order that particular test the day before and it's completed during the day on the next shift but this was a last minute add and they wanted to let the pt go home that night. Okay. No problem. Usually there would be about a half hour to hour turn around time on that test but considering the way the shift started it was lookiing a bit longer, maybe.
I have no problem with being asked to do extra stuff but it does sometimes amaze me how respiratory can sometimes be treated like the hospital's step children for stuff like that but then we're the golden children when there's a code or CAT call or a pt's in respiratory distress.
Back to the story. Got a call from a unit secretary who said very snottily "We put through an order for (such and such) test five minutes ago and we haven't seen anyone yet to do it. This person is supposed to be discharged tonight and we can't do that until you guys get around to doing YOUR JOBS." Wow. That's a lot of attitude considering this person has been a unit secretary for a long time and she knows darn well that on a CAT call we all go running until we know what's going on and how many RT's are actually needed. Not to mention, ummmm, there's really no need for that attitude. EVER. From ANY of us. We're a team.
So I, having a congenital problem with answering to people in the same tone I'm spoken to in....did manage with that thought of "We're all a team" in mind but being a little offended, to at least wrap my tone of voice in honey and silk as I replied, "Hey, we'd love to help you send a pt home tonight but I'm having a little trouble hearing you over that CAT call and the Baby Buggy's going out right now to pick up a critically ill baby and we have a stat PRN tx on a pt with severe respiratory distress, so IF it's okay with you guys, (pause), we'll take care of the dying people FIRST and then we'll be right down to do that test. Is that okay with you?"
Ummmm. I got a few seconds of silence and then a brusque "FINE!" and hung up on.
I admit I'm not perfect when I'm offended but it was sort of two way street, if ya know what I mean.
Later that night got a call for a stat tx on a pt who was due for a tx but the therapist who had the pt hadn't quite gotten to him yet. The RN explained to me that the pt had been waiting 20 minutes and that she'd had trouble getting hold of anyone from respiratory and that the pt was irate. Okay, no prob. I went into the room with the tx and while the neb ran the gentleman got almost none, I'd say, of the tx because he spent most of the time with the neb out of his mouth berating me for it taking 20 minutes to get one of us down there to do the tx and he could hardly breathe.
Just FYI, he was talking in full sentences, great color, high sats, low heart rate, and had just been finishing up a meal when I walked in.
I was informed that he was leaving AMA and going to another hospital, somewhere where he could get what he wanted when he wanted it. I apologized and told him that I couldn't account for the specifics before I was paged but that I immediately came down to do his tx. I was told "too damn little, too damn late".
So that brings me to some thoughts about customer service, because make no mistake, medicine is also about customer service. I did what I could do to take care of the pt. I apologized and I was sincere. BUT. Sometimes there are more issues at play. The pt did end up leaving AMA to go sit in another hospital's ER for, I'm guessing, several hours before being re-admitted if he was re-admitted. I found out later from the RN that the pt told her that he'd left our hospital four times over the previous few years before that night AMA and every time had been because we hadn't given him the pills or tx's he'd wanted fast enough.
Repeat AMA walk-outs to me can signal that there are other things going on with that pt, although we still need to be polite and gracious and get the pt what he needs as fast as we can. But sometimes that's all we can do and the rest is up to the pt.
Also took care of a pt recently with the most obnoxious and volumous secretions I think I've ever seen. The pt had no cough and at the end of that NT suction session he had filled the main catheter at least FOUR FEET plus the soft catheter. But, boy howdy, his sats shot up and he breathed much better after it was all over! Wow, I loves me some snot but that's a bit generous even for me.
And my final story is about getting an ABG on a unit pt the other day who was sooooooo full of edema that I got a hub and about .25 ml of clear fluid in the needle and her pores were weeping fluid out around the injection site, AND THAT WAS BEFORE I even hit the artery. Actually, with a blood pressure in the toilet, I never did hit the artery and the RN asked me not to stick again after her eyes went wide at the site of all that fluid in the needle and weeping off the skin.
Respiratory care--even if it's not always "fun" by definition, it's at least always interesting!
