[smbrn]

OK, here I go again. I'm not used to a teaching hospital and am currently at a teaching hospital in CT. Today I had a woman with extensive cancer who was in agony in the AM with severe pain. I got an order to give her 2mg of morphine IV which had absolutely no effect on her. A half an hour later I gave her two more, again with no effect. About an hour later the intern said to give her 4mg IV, a dose she has had numerous times with no ill effects and I gave it. She continued to moan in pain and was pretty much white knuckling it on the siderails of her bed. The intern ordered 0.5mg of po Ativan which I gave. She then fell asleep and was resting comfortably. A couple of hours later she was unresponsive with a blood pressure of about 70 systolic. All her other vital signs, including her respirations and 02 sat were fine. The intern and resident claimed this must be a narcotic overdose and looked at me accusingly but didn't want to order Narcan. The intern, who was nice, was in the room outside earshot of the onc fellow and I told him I thought we should give the Narcan a try since it wouldn't hurt her and at least would resolve whether this was indeed a narcotic overdose. Well, we gave her 0.4mg of Narcan and nothing happened. We repeated the dose and again, nothing. Still, the onc fellow was insistent this was sudden change in mental status and low blood pressure were due to morphine she had had, now, 4 hours previous. Then he decided it must have been the 0.5mg of po Ativan! As if! I told him I have given much higher doses of Ativan, including IV and had never seen it cause complete unresponsiveness and a patient's blood pressure going through the floor. Still, he wouldn't be deterred. Well, this joke of a situation went on and on with the residents pretending to "know", I guess magically, that in spite of the lack of response from the Narcan, this was still related to the morphine. Finally, here comes the idiot resident from the medical ICU to save the day! What a jerk. This woman has absolutely no peripheral access to be obtained and has a PICC. This dimwit decided that you couldn't bolus through a PICC and wanted a peripheral site. I told him I wasn't even going to bother since she had no access. He then proceeded to ask me if I didn't think I should have another nurse come help me. I told him no. So then the moron decides we should "hit her hard" with Narcan and barked out an order to give her 2 grams of Narcan! I repeated the dose to him and asked if he was sure he wanted 2 grams and he got all testy and said, in an extremely haughty voice, "Yes! 2grams of Narcan!" The attending chimed in, also annoyed that I dared question this ridiculous dose, that that's what they wanted. So I repeated it back yet again. I asked this moron resident if he really wanted to give 2000mg of Narcan. Then he was really exasperated and asked again if I didn't think I should get another nurse to help me! I felt like asking him if he didn't think he should buy a PDR, you know those handheld ones, and learn how to order meds, but I bit my tongue. I couldn't believe what a circus it was. Finally, with the assistance of the floor nurse practitioner and the, what used to be called an assistant head nurse, the dose was straightened out even though I had to repeat that no, 2000mg couldn't possibly be the dose. The whole thing was absurd. We gave an additonal 2mg IV and, naturally, still no response, of course. I've never seen so many people try and convince themselves of something that is so obviously untrue, ie that a narcotic overdose for some reason was not being resolved by Narcan. Then our hero, the ICU resident decides he's going to put in an IJ. So I get him a 20 jelco and a primed extension and now he wants to know what the extension is for. I asked him wasn't he going to need something to attach this IJ to once he got it, something I knew he wasn't going to be able to do anyways? Needless to say the idiot missed not once, but twice. I pointed out to the onc fellow that the woman had apparently bit her lip since it was bleeding and wasn't it a possibility she had seized and was just postictal? Well, no, of course not! Funny, after going for a stat CT of the head, which was negative, she woke up on her own, some 4hours after her last dose of Narcan. Then they decided she needed a Narcan drip! I can't tell you how absurd the whole thing was. I can understand people getting tense and curt in difficult situations, but to be expected to take abuse from such obviously incompetent residents, I think, is beyond the pale. I'll never work in a teaching hospital again; ever. Anyways, that's enough. If I don't shut my mouth there they'll probably let me go before my contract is up and I won't get my bonus. Just two more weeks, if I can make it that long. And then, after spending basically 4 hours doing a one on one with this woman, here come the oncoming witches carrying on about why I didn't do this or that. I can't wait to get out of that ****hole. One last hilarious thing. God knows where all these residents come from but they were pretty much crawling out of the woodwork trying to get in the action, so to speak and give us all their assessments of what was going on. So, here comes "Stuart", a total wimp and arrogant to boot, carring the ABG results and announces that she is not "retaining CO2". I asked him if she were a retainer, since it would have been news to me and he gets all snotty and says people who are lethargic and not breathing deeply can retain CO2 and that that would explain her lethargy! Huh? I pointed out that while, yes, hypercapnea can cause lethargy, you can't have it both ways. If hypercapnea due to poor inspiratory effort is the reason for the lethargy, fine. But to say she became lethargic in the first place because of hypercapnea makes no sense. Basically what he was saying was that she was hypercapneic because she was lethargic and that she was lethargic because she was hypercapneic. I couldn't believe it. Yet these know nothings act all haughty when you point out their utter stupidity and I see any number of nurses unwilling to challenge these idiots. Is it must me? Am I just too old? Really. I can't take it.

[maggiedanurse]

i wash my hands of it. i let them do everything to include letting them find another nurse to do it. i love teaching hospitals!!! i work as little as possible.

[faviola]

I feel for your experience...I worked in a teaching hospital for two years and had my run in from time to time with the interns...often myself tellin them what doses to order for medication, and sometimes found myself frustrated with their unsure treatments and response to medicate patients. I no longer work at that hospital needless to say..

[usnrjim]

The Narcan would have reversed the Morphine effect and you would immediately see changes. (Increases in awareness, etc.) There is not enough information here for me to may a judgement. Is this a renal patient who is not able to clear these dose with urination? PICC lines can also be used as iv access. I work in a teaching facility and go through the samething everyday.

[ResidentMD]

If you know so much, I suggest, get your MD license as well and show us how to do it. Until then, less talk more work please.

[Tiredofthesystem]

Another grand experience in the RN field. This is why some of the people in this forum get on my nerves, and try to make nursing look like a lemonade commercial. Cassio and Kimmiebear.........................you just got a 30 footer dropped in your face :::::::::::nothing but net! :: : :rolleyes:

[hsieh]

Originally Posted by ResidentMD

If you know so much, I suggest, get your MD license as well and show us how to do it. Until then, less talk more work please.

dude (or dudette) why are you on a nursing forum? don't you have a 20 hour shift to do? or is this "somebody" disguised as a "resident md"? one wonders.

[cougarnurse]

Please refrain from bashing other members, OK?

I can understand where the OP is coming from; even though I do NOT work at a teaching facility, I am lucky in that the MD's I work with listen to me and my co-workers.

Those new MD's are there to learn; we may as well train them right.....

[kimmiejs]

My experience at a teaching hospital has been limited to the OR. Call me crazy but I rather enjoyed working with both residents and interns. During a trauma case in the OR I would find an intern and make him responsible for answering all pagers in the room so I could take care of the things I needed to. i would help the residents out and they helped me. I think it all comes down to treating each other with respect

[kimmiejs]

Yo tired one.... what are you talking about. I got nothing dropped in my face. Remember we all have the right to voice our opinion, that even means you oh tired one, on this forum regardless... I for one have never had a bad experience working with an intern or resident but that doesn't mean it doesn't happen. I am sure they are sitting in their lounge complaining about some of the know-it-all bit@hy nurses they have to deal with as well. Remember it goes both ways

Trust me, I know this is not a perfect profession. Trust me, there is plenty of room for improvement. With any job it can be and is what you make of it. I simply refuse to allow miserable people to bring me down to their level of bit@hiness. Life is stressful enough when you have 5 year old twin girls at home and are in the process of moving from Georgia to Australia