I used to think that workplace bullying was a myth or at the very least something that was conducted by someone superior. Well, guess what? I really felt like I was bullied yesterday. Except instead of getting the support from my superiors, I felt like the rug was pulled from under me even though I am very sure she did not mean to do that and that she really thought that she was helping.
Yesterday, a nurse decided to give a patient some oxycodone even though it had not been written for. She also knew that all narcotics have to be signed for by a MD. So she waited until it was time for the patient’s insulin dose to ask me to write for the Humalog dose, which I did after a conversation with the endocrinology fellow (who, despite having the justification to be frustrated at me, was a complete biatch about it). And after the nurse had overheard me being lectured by the endocrinology fellow, she came up to me (and again disrupting sign out which was the reason why I did not have the regimen for the insulin dose to begin with) to ask me to write for oxycodone. I knew from my past interaction with the GI team that narcotics are a big no-no even for pain. The most they write for is tylenol. And then they escalate to toradol (but only in extreme circumstances). But narcotics is a big no no. Ever so occassionally they will allow a one time dose of oxycodone upon admission. So I asked the nurse for the chart. I flipped to the orders. On the admission orders was written a one time dose of oxycodone to be given immediately. So I asked the nurse if the dose had already been given when the patient was admitted at 2am. She said yes. So I asked her why I was writing for it again. She said there was a second dose given at 12.15ish pm. So I flipped through the charts. There was no PRN order. I pointed this out to the nurse. At which point she starts getting antsy. She says that she knows there was no PRN order but there was another dose of oxycodone in the pyxis (that’s where the medicines sent by pharmacy are kept and accessed only by the nurses) so she gave it to the patient because the patient was in pain. So I asked the nurse if anyone had given a verbal order. She said no. She said we were nowhere to be found and the patient was “writhing in pain”. 12.15ish is during the day. There are at least 2 interns and a senior running around. She has all our page numbers. After all, she has paged me for stupid reasons such as “is the patient going home today?” when she knows that the patient is still receiving IV antibiotics. *roll eyes* So I told her that I wasn’t going to write for oxycocdone after the fact. I told the nurse that if she gave a patient narcotics without a written OR verbal order, then it will have to be written up as an incident report. Then the nurse starts accusing me of giving her attitude. WTF! And you know what? If I’m questioning you about your actions because you did something WRONG, damm right I’m giving you attitude. I don’t like writing for oxycodone without clearing it with my senior first. Who the f– are you to give a patient oxycodone WITHOUT getting an order from someone and what gives you the damm nerve to ask me to put my john hancock on it? IF you think the patient needs it and needs it so bad that you can’t wait for someone to give the go-ahead and do it yourself then YOU take the damm responsibility for it. Of course GI found out about it and was pissed. They wanted to be able to do a proper GI exam but when you give a patient narcotics its hard to elicit the where the pain is located. Thankfully this particular attending was nice. But I can imagine the amount of flak I would get if it had been another attending on service. And that’s also the reason why I did not want to sign for the oxycodone because when another attending comes on service and they wanted to find out why a proper exam wasn’t done within the first 24 hours and that it was because the patient had already received narcotics, then well, guess who they are going to yell at? Yeah. Thank you very much.
But that was part of the problem. The senior saw me crying. Partially because I was so angry about the endocrinology fellow’s mean condescending attitude towards me, and partially because I felt like the nurse was bullying me and it made me very angry to think that she thought she could get away with it. Which, to be honest, she has in the past but she crossed the line when she gave a patient with abdominal pain narcotics without at the very least running it by either the GI fellow (who was sitting there the ENTIRE TIME) or any of the residents. The senior went to talk to the nurse and then wrote for the order. After that, she said next time to just write for it. The nurse was upset that I had refused to sign it and it wasn’t a big deal anyway. I told her that it had been pointed out to me in the past by an attending that it was a medical legal issue. Plus we ALL know that GI does not like their patients getting narcotics.
But I was just so disappointed by the senior’s response to the situation. Instead of backing me up, she decided to just roll it under the carpet by signing for the order herself. I understand that she was merely trying to help..but it pretty much reinforced the feeling that the seniors see themselves above us and distinct from us interns. Which they are in a way. They are suppoed to be our educators and our leaders. But separating themselves from us and not backing us up in a situation like this makes me feel like I’m pretty much set adrift on a small dinghy by myself. This isn’t a team despite all their protestations otherwise.
Still, last night wsa perhaps my calmest call night. I actually managed to snag 2 hrs of sleep! Imagine that! Phew. And this was after I sent two kids to the PICU! (Also a first!!!) Off to the NICU. Seriously, something is wrong when someone is actually looking forward to going to the NICU.