Whatever, Just Put Them on the Monitor

 

I wonder why new residents love to torment tele nurses?

 

Are we that easy of a target?

Or is it that they’re too intimidated by our drive? (True story, it was relayed to my manager that many of the 1st years were afraid of one particular charge nurse, mostly due to her breadth and depth of knowledge, but also that she was doing cardiac nursing before they were conceived.)

Whatever it is,they seem to think that the only true indication for telemetry monitoring is having a heart. Yes, true. But really does every single patient you admit truly need it?

I’ve heard some truly egregious statements with regard to this. One example is the 20-something year old with pneumonia who was tachycardic. Not SVT, not atrial tach or WPW, just straight up sinus tach with a rate in the 110’s. Gee, you think maybe that they were, A.) dry or B.) febrile? Or maybe a combination of both. A couple of days later, one of the attendings realized this and took off the tele, but the poor patient got charged the higher rate for the 3 days they were monitored when they really didn’t need to be.

Or the time there was a stroke patient on our neuro floor, probably the best place in the hospital for them, remote monitored on tele as well. “But the heartbeat was irregular.” complained the nurse to the doctor, “Shouldn’t they be on the tele floor?” Of course the young impressionable intern agreed, forgetting the patient suffered from chronic atrial fib…and had a pacemaker. The patient had been on all their normal home meds until admit and heart rate was well controlled, blood pressure was acceptable and all they were dealing with was the stroke sequelea. But out of the nice private room on neuro into a shared room on tele. Family was pissed. That was a fun one trying to smooth over.

Of course there is always the bleeders, usually GI in origin that HAVE to be on tele. I’m not talking the folks having gushing blood from mouth or rectum, but the LOL admitted with tarry stools and a slightly low H&H, or the post-surgical bleeder. The relatively stable ones. And on multiple times I hear the same refrain: we want them on tele so you can see if something happens. OK, maybe you forgot basic A&P, but really by the time we see something on the monitor, the damage has been done and they’re slip-sliding back to the ICU. Like the one last month who the nurse was helping get up to use the commode who syncopeed out and shit black stool all over the bed (luckily missing her)…guess what? Nothing on the monitor, beautiful sinus rhythm with nary a bump in rate from before. Off to the Unit they went.

It seems like everyone gets tele ordered. We’ve had a couple of new hires lately, all experienced nurses, one asked me, “So, patients get taken off tele and moved to med-surg, right?” I tried not to laugh too hard. “Nope, they stay here until they leave…”. It becomes a rote thing, just a part of the routine, not actually deciding if it benefits the patient.

On the other side are the times when you go, “What, they’re not on tele? Are you kidding me?”. Unfortunately due to the over-reliance on tele, I can’t remember a recent example of this! But it’s what comes with the territory. We take the ones that need to be on tele and theses that really don’t all the same. Because I really want the DNR comfort care patient on tele, (true story). I just wish I knew why.

Stupid Questions

“Uh, hey Wanderer?  You said the super-pube would just easily come out after we deflated the balloon, right?” the nurse asked me from across the hall.

“Yeah, might have to tug a little, but should just be able to remove it and swap in the new one.”  I said.

“It seems like it’s stuck…can you come take a look?”  he said.

Gown up, glove up (isolation rooms are the best!) and head in.  The catheter is in the stoma the nurse looking at me with question marks above his head.  “You have all the saline out of the balloon?”

“Yeah, can’t pull any more back.”  he confirms.

I reach down and grab it, give it a good tug.  Nothing.  Twist it a little around.  Still no dice.  Twist and tug.  It’s not going anywhere.  Short of putting my foot on the patient’s chest and pulling, which probably is a bad idea, we’re not getting it out without expert (read: someone with an MD to take responsibilty) help.  I say as such tot he nurse and suggest he call the intern on duty.

The intern calls back and the nurse explains the situation.  She proceeds to ask, “Well, did you deflate the balloon?”

It’s a good thing it was him and not me.  He was cordial and didn’t roll his eyes too much.  Me, at that point it would have been, “Really?  Do you think I’m that stupid to not deflate the balloon?  Really?  I’m not some novice who’s never done this.  For f*cks sake, give me at least a little credit here!”  That’s why he called, not me.

Be careful of who you ask stupid questions of…