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Saturday, March 14, 2009

Docs and RT Bosses need to quit the bull crap!

Sometimes we RTs simply get tired of the bull crap. All we really want are doctors and Rt bosses to leave us alone so we can do our jobs, take care of our patients, grab our paychecks, and go home to kiss our kids good-night (or good morning in my case).

Sure we do a noble service and enjoy taking care of patients, but the bull crap that goes un-noticed are the things that make us RTs cranky and perhaps even entertaining. We are the watchdogs at the hospital; the overseers; the reality checkers.

This explains why my boss hands my coworker a list of yet another way we are supposed to chart oxygen studies on patients and he pitched it in the trash right in front of her. Now not only do we chart it in our charting, but the doctor notes and another place so the Welfare people have access to it.

This explains why my boss asked me to read and sign some sheets she placed on our desk, and I simply signed it without reading and go on about my work.

This explains why my boss called me into her office to tell me she had a nurse complain to her because she was concerned I was too tired and wasn't "pushing" the patient enough. The patient landed on a ventilator the next day, and somehow that was my fault.

"Consider this a verbal warning. The next time you will be written up."

"Did I not chart I did the treatment and CPT?" I asked while sitting in her office -- the Principal's office.

"Oh you charted excellent," she said, showing me copies of my charting. (That's another irritating fact that the bosses trust us so little they have to double check all our charting and niggle over every i that's not dotted or t that's not crossed).

"So what's the problem?"

"The problem is the patient ended up on the vent the next day."

"The patient ended up on a vent because he was a post op. It had nothing to do with how hard I did CPT anyway. CPT was useless anyway. He had phlegm stuck on the back of his throat because of the NG tube, and CPT wasn't going to help with that anyway. But I did the CPT, so what's the problem?"

"Well, the nurse thought you weren't pushing the patient hard enough," he said.

"Okay, were there other complaints from other nurses?"


"Any complaints from patients about me?"


"Any complaints from doctors about me?"

"No. But you were grumpy with me in the morning too because you were too tired."

"So I'm not allowed to be tired?" I smiled. "You're going to write me up for being tired? You'll have to write up the entire night staff."

Well, you get the idea where this is going.

Today another coworker told me he was written up because he put a post OP patient on oxygen who came back from surgery at 2:00 a.m and left a note on the chart for an order instead of waking up the doctor

He was written up for not calling for an order.

A month later the same situation, only instead of leaving a note on the chart this time he called the doctor at 2:00 a.m. "WHY DO YOU CALL ME TO WAKE ME UP FOR AN OXYGEN ORDER!" The doc bellowed.

"Well, because last month you told me I had to."


Last night I turned up a DNR emphysema patients oxygen from 2lpm to 3lpm to bring her spo2 to 92%, which is our protocol minimum. I figured we could just get an order later if need be (remember, I don't believe in the hypoxic drive theory anyway).

After I left work last night the patients code status was changed to full code (for some stupid reason), and she was put on a ventilator. The doctor made sure to tell the nurse to write me up for increasing the oxygen.

Like that's what caused her to need a vent. She was crashing the entire night I worked, her heart rate was in the 170s all night in an SVT rhythm and labored, and the doctor chose to do nothing all that night however many times he was called by me and the RN.

Yet it was the 3lpm that caused her to need a vent.

Boy oh boy, I'm telling you. I love my job, but the RT bosses and Docs need to chill a bit and let us do our jobs. I'd love my job all the more if they'd give us the autonomy we RTs should have so common sense would prevail.

I'm happy either way, yet I'd be happier (and so would all us RTs) if we could knock off the bull crap.


Matt said...

Man, it sounds like the institution you work at is NOT the place I would want to be. The part about you causing a patient to go on a ventilator would really cause me to wonder whether the people I work with (or for, either way) know what the hell is going on. A situation like that would cause me to draft my two week notice five minutes later. Seriously.

Freadom said...

Aside from the poor management style, I love where I work. But that continuous stab in the back by the people who run things has had me filling out aps from time to time.

Anonymous said...

Just curious: What state do you work in?

That, sounds like such a frustrating work environment... :(

Anonymous said...

sounds like maybe you need to do a write up on the RN for not doing proper oral care, which would have prevented the phelm from being stuck on the OG tube. turn about is fair play. And I always love it when they have to blame RT for everything, but we are the first ones they call when the patients crash

TOTWTYTR said...

Replace RT with paramedic and the stories are very similar. I was once written up because I brought a patient to a non trauma center and they died.

Which sounds bad except that they died five days after I transported from an anesthesia reaction. Which anesthesia was administered for an elective procedure not related to the original reason for transport.

The take home message was that I was supposed to know which anesthesiologists were going to suck five days after I transported a patient. Or something.

It's always easier to pass off the blame to someone who is perceived to be lower on the food chain.