Alwin has some very accurate and interesting things to say about bedside nursing.

I had a very very busy patient the other day; he’d gone into anaphylactic shock. When I got him in CCU, he was on 3 vasopressors and was bright red. Temperature was around the 93F range. In a phrase, he was extremely busy.

The intensivist I was working with is excellent. Very caring, very competent, easy to get along with. We were working together for the better part of a few hours, getting lines put in and medications squared away. There were other doctors on this patient’s case, and everyone was writing conflicting orders that I had to get straightened out. Add to that field trips for tests, numerous blood draws, labs to interpret and treat (and notify MD’s of) and just to make things interesting, of course the patient had numerous bodily functions to attend to. Numerous times. Not to mention all of that lovely paperwork that needed to be completed (including the ultra-important nursing care plan that I’ve been refusing to write about!)

Early on in the admission to my unit, the intensivist told me to do Something that could not have possibly been done right then. He knew that. By the time it was possible to do it, the patient was in the CT scanner. Then when the patient returned, other things (like keeping him clean, lab draws, stat medications, filling in consulting doctors on what was going on) were taking priority over this Something. By the time it was oh, about 30 minutes after I was supposed to leave for the day, the intensivist popped his head in while we were cleaning up the patient (again) and asked if the Something had been done yet. I stopped what I was doing, looked up at him, and said, “No. I haven’t had time to do that yet.”

After hours of working with this physician very closely, going out of my way to clarify and “run by” orders that other physicians had written, notifying him of labs he could have easily looked up on his own, and all the other nursing crap I have to do, he snaps at me, “Well, get it done” and walks out.

Right, then. I had been waiting to leave it for the next shift, I admit. I was exhausted and ready to go home, and it could have waited awhile longer. Heck, the physician was even contemplating leaving it until tomorrow! Maybe I’m over-sensitive, but that one comment pretty much trivialized how I prioritized the care of my patient, and I have to tell you – I am a Prioritization Goddess at the bedside. Before that point, it had felt like colleagues working together to save someone’s life. After that point, we were back to Doctor and Nurse.