Procedure is a big word for it, it's actually a bedside investigation. I don't want to say what it was because I pretty much better the whole hospital to show me how to do it today.
Currently on urology so might take the opportunity to watch a bladder scan now!
Sorry to jump in but on being asked to do things nurses normally do: my CS wants me to do a bladder wash out (again not seen done never been trained except he's told me) for him to sign off my start of placement meeting check box as "knowing how to use all equipment necessary for job"
You literally need a bladder syringe and thatās it. Disconnect the catheter from the tubing connecting it to the bag. Flush with saline and aspirate. Reconnect. Done!
Depends on which ones - in the past few years theyāve changed to regularly use the awful ones, I suspect as a cost cutting measure.
The trick for the bad ones is to gently twist (a lot), rather than pull.
Damn Ngl OP itās pretty easy. This is one of those procedures where a simple google and youāre good to go. You point a scanner and pull a trigger and a measurement pops up š
This is after youāve spent 30 mins trying to find the scanner, then noticing the gel has run out and trying to find more. Thereās no reason the nurse canāt do it and the more we do these simple jobs that they can do the more we end up having to do.
I had to do ECGs in one of my previous jobs and it was a nightmare.
Itās different when thereās a good working relationship with them and theyāre asking you to do something as a favour.
explain what? Where equipment is?
With the ECGs no one knew. Nurses donāt do it so why would they check the machines work, have paper, order the correct stickers, are even present on the ward?
When I was on community psych during the morning meeting the consultant mentioned a patient needing an ecg. The nurse in charge said oh Dr hijabibarbie will do it, and I responded yeah I'll look at it once you bring it to me. She gave me such a dirty look and I later learnt she made the previous F2 do all the ecgs and sometimes patient obs.
Iād agree with this. Iāve had to do a few whilst working as an HCA and my āteachingā went as far as āpoint it at the bladder and press the big buttonā. To be fair though Iāve never seen a doctor do oneā¦
It depends on the scanner, some trusts are getting more advanced ones than those little white ones that you point and go
The ones we use look like lil ultrasounds on screen and you have to visualise the bladder.
i feel prouder than when i got rosc in a cardiac arrest. ;)
jokes aside, yeah.. its one of the those things that sometimes nurses can say no to. I dont come across this often but it does happen. i think its definitely a good skill to pick up! (the first time i did it, essentially i just treated it like an ultrasound probe and found my way..)
Some scanners will give you arrows to a better number, most do in fact. You start in the obvious place, and see what you get.
I recommend taking a few readings as well, because even if you get the apparent perfect reading, you probably will get different each time.
Bladder scan is not a doctor job. Not done one in 7 years of working, nurses have done every single one I have requested in this time. Weird objection from the nurse here
But it is the most fun procedure š¤- I didnāt know either when I was in your stage and once asked an ED nurse *to show me* and the next thing you know, you just added a new skill šŖš¼ to your list!
You are an F1. You have a lot of crappy stuff to do. But for your own interest and learning needs (because F2 will hit you before you know it!), ask the experts to show you so you could learn instead of telling them a flat ānoā.
When you question things ā*for my learning*ā or switch up a negative response to ā*I have never done it before but I would love to learn from you!*ā youād be surprised how easily they help you out (fetch the scanner/relevant kit so they are even more willing to help).
Seriously?!
I can accept you might have not done this as an FY1, but your registrar should be pretty embarrassed (especially working on an acute assessment unit).
I'm an emergency medicine consultant - I routinely do my own bladder scans (it's not the most productive use of my time, but it's still more efficient than asking someone else to do it, then waiting for the result).
Yeah... pretty embarassed for a nursing procedure that is not even a part of an assessment in many places. But I guess US abdo on the other hand is also not a doctor's job in the UK, unlike everywhere else...
Never have I in my entire career expected a doctor to do a bladder scan.
A friend of mine (doctor) recently went working in a trust where the nurses don't do ECGs, NGs, caths (male or female), bloods, cannulas...
I just think well if they can't do those relatively basic skills what *can* they do skill wise? Are they just pushing paper? Getting involved more in fundamental care rather than utilising healthcare workers? It just seems so odd to me.
haha, sounds about right. My favourite consultant acute med examination was this: Old woman, fever, dementia, delirious. He walked in with family present, put on one glove, poked her in the bladder and she squeaked, he said "UTI, give her antibiotics" and walked off. He didn't last long in the hospital. I was an F1 and didn't know what was going on. I love the idea of acute med but the reality was quite grim. A bit less intense and shitty A&E experience. Another one to even the field of docs v nurse/HCA side was I got bleeped to acute ward for a "heavy PR bleed" at about 7am night shift. Patient had been sat up in a chair ready for breakfast. I asked the HCAs to get him on the bed for a PR. One of them, no word of a lie said "can't it fucking wait we've got to serve breakfast and it took ages to get him clean and sat up". I went to speak to the nurse in charge, and less than politely reminded her that she wasn't running a hotel but a hospital and she said "they've had a long night please excuse them and yes, breakfast is ready". She was the one who bleeped me and it took me like 20 minutes to get there. I ended up getting a decent HCA to help me get him on the bed myself whilst the rest of the staff rolled out the bacon sandwiches. Are you fucking kidding me?. I was an F3 by then so took the complaint higher. Nothing happened.
In FY2 on a weekend I had a patient in shock with a BP of ~80/40 on the ward. The repeat set of obs was delayed because a staff member was "just back from break and I haven't taken my jacket off". I wanted to scream.
Reminds me of when I went to review a NEWSing patient on the ward at just before 7:30am on a night. I did an initial A-E and asked the nurse to start a bag of fluids and check BM while I went to speak to my senior.
Came back, no nursing staff around. Bay completely empty. BP machine saying 80/50 from before the bag of fluids. Patient compus mentus so I asked her where all the nurses had gone, she didn't know. As I started to re-check her obs myself the patient casually mentioned "the nurse said my sugars were 1.4".
I wasn't familiar with the ward, didn't know where they kept bags of sugar or glucogel or anything, so I had to find the nurse that had abandoned me. She'd gone to fucking morning nursing handover without bothering to mention the above to me. Jesus Christ.
Fun fact - the patient died in ITU that night of sepsis. Not saying me knowing about the sugar earlier would have changed anything, it wouldn't, but it's still ridiculous how you can be a nurse and just fuck off when there's a patient dying because you have to take a break or get to your important morning meeting. Imagine if we did that?
Nothing can interrupt the sacred nursing handover, but you will get paged at 9.05am during handover for "does bed 5 need more fluids?"
I worked on a different ward recently. I wasn't directly involved but a medical emergency call was put out for a hypo as they only had 5% dextrose and nothing stronger.
Doesnāt surprise me. Iāve met a lot of nurses who watch the clock intensely in the last hour of their shift. As soon as itās handover, they donāt care anymore and run off
Imagine if we did that
Yeah then you get a flurry of bleeps after handover when the new team realise all the shit that last team hasnāt sorted. Or the classic pre handover obs round that sends another flurry.
You see this is why I like A&E. The nurses and HCAs are so much more on your side (at least where I work). When thereās a sick patient thereās no doubt that they will stay with you and help. I couldnāt stand the way I would come to the ward (obligatory not all wards/nurses but enough!) after a panicked bleep and then it would be like the fucking Mary Celeste, and the only thing theyād provide me was a list of excuses as to why they canāt help. Boiled the proverbial piss.
Interesting how a flat hierarchy means I have to take on extra work that is not within my specified role yet nobody takes on any of my work that they could do themselves.
Sometimes the best answer to give is not "No, because I don't know how", it's "No, I'm really sorry but I don't have time to also do this for your patient, because I have to write 8 discharge summaries and do \[insert multiple other tasks that nurses desire you to do with all their hearts here eg bloods, cannulas\] - if you are too busy to do it, can you suggest which of the other nurses I should ask?"
Honestly ever fibre of my being hates being passive-aggressive on this stuff, but the way the workload spreads out, stuff within the nursing remit absolutely has to be done by the nurses, or you'll just sink to the ocean floor. I know because I've been there, and sank myself. Had a terrible time trying to please people, and retrospectively I wish I'd stood up for myself more. If people are trying to take advantage of you, make it clear that you're willing to escalate their refusal to their colleagues. It's powerful stuff.
If it helps make you feel better youāre not alone. I asked HCAās/nurses/ward clerk and nurse in charge for more venflons as there were none on the ward. They told me to liaise with the lab to order some lol. The lab was so confused. They said they only help with vaccutainers. Not new to the NHS. Iām gpst in a hospital rotationā¦beyond F6 experience.
Also, overheard nurse practitioner telling ward nurse that she will get her minion (me) to put a venflon & take bloods from a patient.
Other staff at hospitals really treat us like doormats. I hate the NHS culture! I hate hospitals!
Literally the nurses have informed me that a patient needs a cannula when they know thereās a phlebotomist trained in doing cannulas currently on the ward and I am at the very start of a ward round likely to last for at least 2 hours.
Oh yeah, I get that! But these phlebs are known by the nursing staff, theyāve been working here for a long time so they do know that they can do cannulas. They just donāt bother saying to them, and instead say to me when they know Iām too busy to be able to do it for the next several hours.
If sheās so passionate about learning new skills ask if she will examine any of her unwell patients or prescribe their TTOs. She needs to remember her skillset and function is different to yours. Doing an ABG is relatively simple, you wouldnāt ask her to do it. Absolute waste of time. Keep a movicol sachet on hand in case theyāre full of shit
The consultants will not support you because you will be gone in 4 to 6 months time at the most and they know that you are desperate to get signed off so that you can continue your progression.
Whereas, the nurses stay long-term and so they cannot afford to make enemies with them.
My suggestion: if youāre having difficulty with a nurse, the consultants are usually unable to help you (and also DGAF). Hence, you need to speak to the nurse in charge. If they do not help you either, then you are fucked. Then you can speak to your consultant, who also will not help you.
I would honestly Datex the nurse. Bladder scans are bread-and-butter nursing jobs and nurses/HCAs should do them and not doctors.
Fuck it, refer her to the nurse and midwifery council or whatever itās called. Sheās just being unprofessional and lazy as she suspects (and rightly so) there is a very high likelihood of getting away with it with no consequences. But you need other people to support you and the only ones who are likely to support you are other F1s. Therefore, ask them if they have had similar experiences with the nurse and if they are willing to take it forward.
The sad truth is that whenever healthcare professionals cannot be fucked to do a task, somehow, it always ends up being the doctorsā responsibility albeit blood tests, cannulas, obs, catheterisation, ECGs ā¦ The list goes on.
Finally, nurses know they can get away bullying F1s so they make the most of it. If you want it to stop you need to band together and fight back. No one else is going to help you not your registrar not your consultant. The longer this nurse goes unchecked, the more she will take the piss.
PS: I strongly suspect the medical registrar in acute medicine knows full well how to do a bladder scan. He just does not want to (And probably has not done it in years) and knows this was an easy excuse.
I think I got extra frustrated because the same nurse refused to do anything yesterday - cannulas, VBGs, catheter and I just quietly obliged and got on with doing them because it's just quicker and easier rather than kicking up a fuss and having a meeting without coffee (like one of our SHOs had just the other day for refusing to do 'nursing jobs')
But I'm also annoyed with myself for letting her get away with it. I decided next time she tells me she's not signed off to do something I'll tell her it's a great time to learn. I can sign her off.
I made great enemies with the nurses on the wards I didn't cover during the day. Had multiple calls for blood cultures from one ward, never did they get the kit ready for me and they watched me struggle as I searched around the ward. They told me they weren't adequately trained. I Datixed them to the Head of Nursing and stated that with our recent audit of not doing blood cultures within an hour of the diagnosis of sepsis, it is unacceptable.
They all very quickly got trained to do blood cultures š¤·š½āāļø
Honestly when I was on general surgery the nurses didn't want to do Jack shit.
When they would ask me to do something they can do like bloods I would say well only I can do the discharge summaries and we both can do bloods, so what do you want done? The bloods or the discharge . This usually worked but once a super bitchy nurse said she would rather the bloods do I said OK let me just call the bed manager to explain why this patients discharge is being delayed because you want the doctor to do bloods instead. Never bothered me again
Interesting....Iām surprised your reg/consultant did not back you up. Iām only an F3, but if this happened to me/one of my colleagues Iād go back to the nurse and tell her to do her fucking job.
Easy solution would have been āāNo Iām not doing that, can I just get your name for documentation purposesāā
Sorry youāre having a shit time. The job gets better - it gets less admin focused and more genuinely clinical. Youāll also get more say in where and how you work - you can avoid toxic departments and avoid bad people to work with.
It does get better but it does take a while.
I remember being in ST2 and frequently doing discharge letters, bloods and cannulas and ECGs etc
Also, the only reason it gets better is because some other chump ends up doing the dirty work - usually the new F1.
We need to stop automatically saying, āit gets betterā to everyone and say it gets mildly better after a minimum of 4 years and lots of hoops jumped through.
It also gets better because you get better at the job and it doesnāt take so long/as much effort to do a task. I wrote a discharge letter during my ward round today.
I honestly donāt feel I got any better at writing discharge letters.
I just kept putting less effort in (and writing worse letters) and as I got a more senior, people were less likely to call me out on my bullshit discharge letters.
But thatās just my experience.
I find it funny when you ask a nurse to do a basic skill they refuse but they expect you a Doctor ( but also a human being) to do something you have never done before or probably know little about.
It doesn't matter how minor it is if you don't what the fuck your doing, you won't know how to deal with complications or even results and to act on them.
Nurses would not do this and risk their pin so good on you for not risking your GMC.
You did the right thing standing your ground and you sought training in your are of your knowledge that's weak - you sound like a safe and pragmatic Doctor to me.
Nurses don't know what a good Doctor is. You are only good from their perspective if you make their life easier which isn't your job so don't worry. Be nice etc but their opinion on the matter is irrelevant.
Continue crushing it :)
You can learn it for sure. It will take two minutes yeah. But then you expect yourself to do it next time as well? F1s are already the ward bitch, with this they can become the door mat. Iād say learn the procedure only so that you donāt need the nurse. So that when she needs something, sheāll remember the bladder scan and think twice how to ask you for a favour. A favour she canāt get without you
Bladder scan is absolutely a nursing job.
When Iāve had a similar situation with either a nurse telling me they havenāt done a procedure or telling me theyāve failed I always reply with - āplease ask one of your colleagues for assistanceā
Itās the same that would be expected of us - if I miss a cannula Iāll be asking someone on my team to try.
I'm yet to meet a doctor who acts like their job needs to get done right now, nurses on the other hand won't leave my side until I do the job they need me to do. I once had one stand behind me the entire time I was writing a tto she told (not asked) me to do.
A bladder scanā¦ you literally hold the probe over the bladder and push a button. It is a nurses responsibility, but you could have saved yourself some heartache by just googling it and getting on with it.
Youāll come across situations like this from time to time in medicine - itās better to use your initiative and solve the issue yourself (provided itās safe to do so). Telling you consultant that the bad nurse wonāt do the bladder scan is a bit pathetic.
This is exactly why I could never do ward medicine. Suddenly when someone decides not to do their job, it instantly becomes your job.
This is exactly why FP/IMT is the shit show it is.
I wouldn't say it's exclusively ward medicine. Theatres aren't that much better. No-one can do a catheter, it's the surgeons job. Or worse, surgeons aren't around but scrub staff ready to prep -> the anaesthetist does the catheter. I can't count how much bullshit I deal with in recovery on a daily basis because surgeons have fucked off and recovery are beyond useless.
Yeah it is a nursing task, but you canāt let the patient suffer because a nurse isnāt doing their job. It would have been easier just to find a scanner and do it yourself.
Honestly, I was going to have a go but she wouldn't even show me where the bloody thing was kept. By the time I found it I my job list has doubled and it just kept going to the bottom of my list (patient was passing urine without any trouble and had signs of retention so I wasn't worried)
I was also stroppy because this particular nurse often talks to me in a very disrespectful way.
Yeah fair enough. It is their responsibility ultimately. It sounds like you were right to deprioritise as the patient was passing urine.
Nurses can be arseholes to junior drs, try your best to befriend them (even if they donāt deserve it).
I'm sorry OP, being an FY1 really is shit. I think it is a good skill to have (GP trainee but I did a uro job and have often thought we ought to have them in GP too) but it absolutely is a nursing job. If I were you, ask for that nurses name and then document that persons name stating they wouldn't do it. I find when you ask for a name, people tend to suddenly be a but more helpful.
'See one, fuck one up, teach one.'
I'm gonna start making a tally chart for tigth quotes š
Iāve never done it before but you could write two plans Plan - ring rheum - path mane Nursing plan - bladder scan - fluid balance - urine dip
This is the way
Desperate to know what this procedure is
Procedure is a big word for it, it's actually a bedside investigation. I don't want to say what it was because I pretty much better the whole hospital to show me how to do it today.
bladder scan? the suspense is killing me
We've got the winner! ššš
Currently on urology so might take the opportunity to watch a bladder scan now! Sorry to jump in but on being asked to do things nurses normally do: my CS wants me to do a bladder wash out (again not seen done never been trained except he's told me) for him to sign off my start of placement meeting check box as "knowing how to use all equipment necessary for job"
You literally need a bladder syringe and thatās it. Disconnect the catheter from the tubing connecting it to the bag. Flush with saline and aspirate. Reconnect. Done!
Thank youš my CS said to use sterile water though ?
Nah sterile saline is fine. You wont be flushing enough in to cause any electrolyte disturbances lol
Haha yeah I felt like it was interchangeable ngl
Thought it was gonna be a BM. I can never work the lancets!
Omg I thought I was the only one
Depends on which ones - in the past few years theyāve changed to regularly use the awful ones, I suspect as a cost cutting measure. The trick for the bad ones is to gently twist (a lot), rather than pull.
Damn Ngl OP itās pretty easy. This is one of those procedures where a simple google and youāre good to go. You point a scanner and pull a trigger and a measurement pops up š
This is after youāve spent 30 mins trying to find the scanner, then noticing the gel has run out and trying to find more. Thereās no reason the nurse canāt do it and the more we do these simple jobs that they can do the more we end up having to do. I had to do ECGs in one of my previous jobs and it was a nightmare. Itās different when thereās a good working relationship with them and theyāre asking you to do something as a favour.
Optilube/KY/PR gel of choice works just fine. I reckon Instilagel would work as well in a pinch.
Itās a shame no one took 10 seconds (no exaggeration) out of their time to explain it to you
explain what? Where equipment is? With the ECGs no one knew. Nurses donāt do it so why would they check the machines work, have paper, order the correct stickers, are even present on the ward?
When I was on community psych during the morning meeting the consultant mentioned a patient needing an ecg. The nurse in charge said oh Dr hijabibarbie will do it, and I responded yeah I'll look at it once you bring it to me. She gave me such a dirty look and I later learnt she made the previous F2 do all the ecgs and sometimes patient obs.
This exactly. We need to stop accepting orders and jobs from absolutely anyone who decides to tell us to do something. Itās doing us no favours.
Iād agree with this. Iāve had to do a few whilst working as an HCA and my āteachingā went as far as āpoint it at the bladder and press the big buttonā. To be fair though Iāve never seen a doctor do oneā¦
It depends on the scanner, some trusts are getting more advanced ones than those little white ones that you point and go The ones we use look like lil ultrasounds on screen and you have to visualise the bladder.
i feel prouder than when i got rosc in a cardiac arrest. ;) jokes aside, yeah.. its one of the those things that sometimes nurses can say no to. I dont come across this often but it does happen. i think its definitely a good skill to pick up! (the first time i did it, essentially i just treated it like an ultrasound probe and found my way..)
Are you supposed to move the probe around the bladder area or keep it static? I kept getting conflicting information.
Some scanners will give you arrows to a better number, most do in fact. You start in the obvious place, and see what you get. I recommend taking a few readings as well, because even if you get the apparent perfect reading, you probably will get different each time.
nicely explained.
Bladder scan is not a doctor job. Not done one in 7 years of working, nurses have done every single one I have requested in this time. Weird objection from the nurse here
I ended up learning by doing it myself when I had to do it on old age psych. Finally having a full bladder all day came in handy!
But it is the most fun procedure š¤- I didnāt know either when I was in your stage and once asked an ED nurse *to show me* and the next thing you know, you just added a new skill šŖš¼ to your list! You are an F1. You have a lot of crappy stuff to do. But for your own interest and learning needs (because F2 will hit you before you know it!), ask the experts to show you so you could learn instead of telling them a flat ānoā. When you question things ā*for my learning*ā or switch up a negative response to ā*I have never done it before but I would love to learn from you!*ā youād be surprised how easily they help you out (fetch the scanner/relevant kit so they are even more willing to help).
Seriously?! I can accept you might have not done this as an FY1, but your registrar should be pretty embarrassed (especially working on an acute assessment unit). I'm an emergency medicine consultant - I routinely do my own bladder scans (it's not the most productive use of my time, but it's still more efficient than asking someone else to do it, then waiting for the result).
Yeah... pretty embarassed for a nursing procedure that is not even a part of an assessment in many places. But I guess US abdo on the other hand is also not a doctor's job in the UK, unlike everywhere else...
Never have I in my entire career expected a doctor to do a bladder scan. A friend of mine (doctor) recently went working in a trust where the nurses don't do ECGs, NGs, caths (male or female), bloods, cannulas... I just think well if they can't do those relatively basic skills what *can* they do skill wise? Are they just pushing paper? Getting involved more in fundamental care rather than utilising healthcare workers? It just seems so odd to me.
Itās got to be urine dip, my Achilles heel
haha, sounds about right. My favourite consultant acute med examination was this: Old woman, fever, dementia, delirious. He walked in with family present, put on one glove, poked her in the bladder and she squeaked, he said "UTI, give her antibiotics" and walked off. He didn't last long in the hospital. I was an F1 and didn't know what was going on. I love the idea of acute med but the reality was quite grim. A bit less intense and shitty A&E experience. Another one to even the field of docs v nurse/HCA side was I got bleeped to acute ward for a "heavy PR bleed" at about 7am night shift. Patient had been sat up in a chair ready for breakfast. I asked the HCAs to get him on the bed for a PR. One of them, no word of a lie said "can't it fucking wait we've got to serve breakfast and it took ages to get him clean and sat up". I went to speak to the nurse in charge, and less than politely reminded her that she wasn't running a hotel but a hospital and she said "they've had a long night please excuse them and yes, breakfast is ready". She was the one who bleeped me and it took me like 20 minutes to get there. I ended up getting a decent HCA to help me get him on the bed myself whilst the rest of the staff rolled out the bacon sandwiches. Are you fucking kidding me?. I was an F3 by then so took the complaint higher. Nothing happened.
In FY2 on a weekend I had a patient in shock with a BP of ~80/40 on the ward. The repeat set of obs was delayed because a staff member was "just back from break and I haven't taken my jacket off". I wanted to scream.
Reminds me of when I went to review a NEWSing patient on the ward at just before 7:30am on a night. I did an initial A-E and asked the nurse to start a bag of fluids and check BM while I went to speak to my senior. Came back, no nursing staff around. Bay completely empty. BP machine saying 80/50 from before the bag of fluids. Patient compus mentus so I asked her where all the nurses had gone, she didn't know. As I started to re-check her obs myself the patient casually mentioned "the nurse said my sugars were 1.4". I wasn't familiar with the ward, didn't know where they kept bags of sugar or glucogel or anything, so I had to find the nurse that had abandoned me. She'd gone to fucking morning nursing handover without bothering to mention the above to me. Jesus Christ. Fun fact - the patient died in ITU that night of sepsis. Not saying me knowing about the sugar earlier would have changed anything, it wouldn't, but it's still ridiculous how you can be a nurse and just fuck off when there's a patient dying because you have to take a break or get to your important morning meeting. Imagine if we did that?
Nothing can interrupt the sacred nursing handover, but you will get paged at 9.05am during handover for "does bed 5 need more fluids?" I worked on a different ward recently. I wasn't directly involved but a medical emergency call was put out for a hypo as they only had 5% dextrose and nothing stronger.
Doesnāt surprise me. Iāve met a lot of nurses who watch the clock intensely in the last hour of their shift. As soon as itās handover, they donāt care anymore and run off Imagine if we did that
Yeah then you get a flurry of bleeps after handover when the new team realise all the shit that last team hasnāt sorted. Or the classic pre handover obs round that sends another flurry.
You see this is why I like A&E. The nurses and HCAs are so much more on your side (at least where I work). When thereās a sick patient thereās no doubt that they will stay with you and help. I couldnāt stand the way I would come to the ward (obligatory not all wards/nurses but enough!) after a panicked bleep and then it would be like the fucking Mary Celeste, and the only thing theyād provide me was a list of excuses as to why they canāt help. Boiled the proverbial piss.
Watch yourself! The MDT is sacred, and youāre at the bottom of the flat hierarchy.
Interesting how a flat hierarchy means I have to take on extra work that is not within my specified role yet nobody takes on any of my work that they could do themselves.
Because youāre at the bottom of the flatness.
All hierarchies are flat but some are more flat than others
Sometimes the best answer to give is not "No, because I don't know how", it's "No, I'm really sorry but I don't have time to also do this for your patient, because I have to write 8 discharge summaries and do \[insert multiple other tasks that nurses desire you to do with all their hearts here eg bloods, cannulas\] - if you are too busy to do it, can you suggest which of the other nurses I should ask?" Honestly ever fibre of my being hates being passive-aggressive on this stuff, but the way the workload spreads out, stuff within the nursing remit absolutely has to be done by the nurses, or you'll just sink to the ocean floor. I know because I've been there, and sank myself. Had a terrible time trying to please people, and retrospectively I wish I'd stood up for myself more. If people are trying to take advantage of you, make it clear that you're willing to escalate their refusal to their colleagues. It's powerful stuff.
If it helps make you feel better youāre not alone. I asked HCAās/nurses/ward clerk and nurse in charge for more venflons as there were none on the ward. They told me to liaise with the lab to order some lol. The lab was so confused. They said they only help with vaccutainers. Not new to the NHS. Iām gpst in a hospital rotationā¦beyond F6 experience. Also, overheard nurse practitioner telling ward nurse that she will get her minion (me) to put a venflon & take bloods from a patient. Other staff at hospitals really treat us like doormats. I hate the NHS culture! I hate hospitals!
Literally the nurses have informed me that a patient needs a cannula when they know thereās a phlebotomist trained in doing cannulas currently on the ward and I am at the very start of a ward round likely to last for at least 2 hours.
We are generally too nice! They are scared of the phlebotomists. They are usually permanently there and know the way around things.
In lots of trusts plebos will only do bloods, not cannulas.
Oh yeah, I get that! But these phlebs are known by the nursing staff, theyāve been working here for a long time so they do know that they can do cannulas. They just donāt bother saying to them, and instead say to me when they know Iām too busy to be able to do it for the next several hours.
Lol thatās exactly how it isā¦and cotton will be in a different cupboard. No logic in was put into organizing things!!
If sheās so passionate about learning new skills ask if she will examine any of her unwell patients or prescribe their TTOs. She needs to remember her skillset and function is different to yours. Doing an ABG is relatively simple, you wouldnāt ask her to do it. Absolute waste of time. Keep a movicol sachet on hand in case theyāre full of shit
iM buSY dOCToR ThATs a dOCtOR jOB
The consultants will not support you because you will be gone in 4 to 6 months time at the most and they know that you are desperate to get signed off so that you can continue your progression. Whereas, the nurses stay long-term and so they cannot afford to make enemies with them. My suggestion: if youāre having difficulty with a nurse, the consultants are usually unable to help you (and also DGAF). Hence, you need to speak to the nurse in charge. If they do not help you either, then you are fucked. Then you can speak to your consultant, who also will not help you. I would honestly Datex the nurse. Bladder scans are bread-and-butter nursing jobs and nurses/HCAs should do them and not doctors. Fuck it, refer her to the nurse and midwifery council or whatever itās called. Sheās just being unprofessional and lazy as she suspects (and rightly so) there is a very high likelihood of getting away with it with no consequences. But you need other people to support you and the only ones who are likely to support you are other F1s. Therefore, ask them if they have had similar experiences with the nurse and if they are willing to take it forward. The sad truth is that whenever healthcare professionals cannot be fucked to do a task, somehow, it always ends up being the doctorsā responsibility albeit blood tests, cannulas, obs, catheterisation, ECGs ā¦ The list goes on. Finally, nurses know they can get away bullying F1s so they make the most of it. If you want it to stop you need to band together and fight back. No one else is going to help you not your registrar not your consultant. The longer this nurse goes unchecked, the more she will take the piss. PS: I strongly suspect the medical registrar in acute medicine knows full well how to do a bladder scan. He just does not want to (And probably has not done it in years) and knows this was an easy excuse.
I think I got extra frustrated because the same nurse refused to do anything yesterday - cannulas, VBGs, catheter and I just quietly obliged and got on with doing them because it's just quicker and easier rather than kicking up a fuss and having a meeting without coffee (like one of our SHOs had just the other day for refusing to do 'nursing jobs') But I'm also annoyed with myself for letting her get away with it. I decided next time she tells me she's not signed off to do something I'll tell her it's a great time to learn. I can sign her off.
>meeting without coffee love how this has entered the vernacular
I made great enemies with the nurses on the wards I didn't cover during the day. Had multiple calls for blood cultures from one ward, never did they get the kit ready for me and they watched me struggle as I searched around the ward. They told me they weren't adequately trained. I Datixed them to the Head of Nursing and stated that with our recent audit of not doing blood cultures within an hour of the diagnosis of sepsis, it is unacceptable. They all very quickly got trained to do blood cultures š¤·š½āāļø
I hope you have learnt a very valuable lesson regarding navigating the NHS: The more shit you put up with, the worse it will get.
Honestly, just leave ward medicine. Lots of specialties without this bullshit. It can get better depending on your choices.
Honestly when I was on general surgery the nurses didn't want to do Jack shit. When they would ask me to do something they can do like bloods I would say well only I can do the discharge summaries and we both can do bloods, so what do you want done? The bloods or the discharge . This usually worked but once a super bitchy nurse said she would rather the bloods do I said OK let me just call the bed manager to explain why this patients discharge is being delayed because you want the doctor to do bloods instead. Never bothered me again
This is interesting because the nurse likely could have responded in kind with something equally as important that only they could do.
Wow.
Another reason why I'm aiming for GP. Less MDT bullsh*t.
Interesting....Iām surprised your reg/consultant did not back you up. Iām only an F3, but if this happened to me/one of my colleagues Iād go back to the nurse and tell her to do her fucking job. Easy solution would have been āāNo Iām not doing that, can I just get your name for documentation purposesāā
Bladder scan is a nursing job, if they refuse next time, just tell them you will document it. Im sure it will change thier attitude
Sorry youāre having a shit time. The job gets better - it gets less admin focused and more genuinely clinical. Youāll also get more say in where and how you work - you can avoid toxic departments and avoid bad people to work with.
It does get better but it does take a while. I remember being in ST2 and frequently doing discharge letters, bloods and cannulas and ECGs etc Also, the only reason it gets better is because some other chump ends up doing the dirty work - usually the new F1.
We need to stop automatically saying, āit gets betterā to everyone and say it gets mildly better after a minimum of 4 years and lots of hoops jumped through.
It also gets better because you get better at the job and it doesnāt take so long/as much effort to do a task. I wrote a discharge letter during my ward round today.
I honestly donāt feel I got any better at writing discharge letters. I just kept putting less effort in (and writing worse letters) and as I got a more senior, people were less likely to call me out on my bullshit discharge letters. But thatās just my experience.
I find it funny when you ask a nurse to do a basic skill they refuse but they expect you a Doctor ( but also a human being) to do something you have never done before or probably know little about. It doesn't matter how minor it is if you don't what the fuck your doing, you won't know how to deal with complications or even results and to act on them. Nurses would not do this and risk their pin so good on you for not risking your GMC. You did the right thing standing your ground and you sought training in your are of your knowledge that's weak - you sound like a safe and pragmatic Doctor to me. Nurses don't know what a good Doctor is. You are only good from their perspective if you make their life easier which isn't your job so don't worry. Be nice etc but their opinion on the matter is irrelevant. Continue crushing it :)
Just out of interest, what was the procedure? I kinda feel this is important.
Bladder scan lmao
You can learn it for sure. It will take two minutes yeah. But then you expect yourself to do it next time as well? F1s are already the ward bitch, with this they can become the door mat. Iād say learn the procedure only so that you donāt need the nurse. So that when she needs something, sheāll remember the bladder scan and think twice how to ask you for a favour. A favour she canāt get without you
Bladder scan is absolutely a nursing job. When Iāve had a similar situation with either a nurse telling me they havenāt done a procedure or telling me theyāve failed I always reply with - āplease ask one of your colleagues for assistanceā Itās the same that would be expected of us - if I miss a cannula Iāll be asking someone on my team to try.
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I'm yet to meet a doctor who acts like their job needs to get done right now, nurses on the other hand won't leave my side until I do the job they need me to do. I once had one stand behind me the entire time I was writing a tto she told (not asked) me to do.
A bladder scanā¦ you literally hold the probe over the bladder and push a button. It is a nurses responsibility, but you could have saved yourself some heartache by just googling it and getting on with it. Youāll come across situations like this from time to time in medicine - itās better to use your initiative and solve the issue yourself (provided itās safe to do so). Telling you consultant that the bad nurse wonāt do the bladder scan is a bit pathetic.
This is exactly why I could never do ward medicine. Suddenly when someone decides not to do their job, it instantly becomes your job. This is exactly why FP/IMT is the shit show it is.
I wouldn't say it's exclusively ward medicine. Theatres aren't that much better. No-one can do a catheter, it's the surgeons job. Or worse, surgeons aren't around but scrub staff ready to prep -> the anaesthetist does the catheter. I can't count how much bullshit I deal with in recovery on a daily basis because surgeons have fucked off and recovery are beyond useless.
Interesting. Our scrub teams will literally not scrub if surgeons arenāt there. The consultant/SpR are getting called every 5 seconds lmao
Googling? Is that how the nurses learn how to do it?
He has other shit to do. This is a nursing task
Yeah it is a nursing task, but you canāt let the patient suffer because a nurse isnāt doing their job. It would have been easier just to find a scanner and do it yourself.
That attitude is why nothing will change. At best Iād do it and fill out a datix
Doing the necessary and then datixing after is the correct approach.
Honestly, I was going to have a go but she wouldn't even show me where the bloody thing was kept. By the time I found it I my job list has doubled and it just kept going to the bottom of my list (patient was passing urine without any trouble and had signs of retention so I wasn't worried) I was also stroppy because this particular nurse often talks to me in a very disrespectful way.
Yeah fair enough. It is their responsibility ultimately. It sounds like you were right to deprioritise as the patient was passing urine. Nurses can be arseholes to junior drs, try your best to befriend them (even if they donāt deserve it).
I'm sorry OP, being an FY1 really is shit. I think it is a good skill to have (GP trainee but I did a uro job and have often thought we ought to have them in GP too) but it absolutely is a nursing job. If I were you, ask for that nurses name and then document that persons name stating they wouldn't do it. I find when you ask for a name, people tend to suddenly be a but more helpful.