Hey Doc... did ya read the chart?

Reminisce back to my fundamentals nursing semester.

(Allow me to remind you I am a coffee bean grower and my medical expertise ends at the care and cultivation of my coffee beans).

Anyway..

I was caring for a ~70 year old patient. A LOL. (Little old lady).
She had a laundry list of medical problems and an immovable ankle issue.
Also, slightly demented. But sweet little old lady.

There was a big stink in the unit about this little old lady.

She needed to ambulate more, needed more independence in her ADLs (activities of daily living)..
She needed to just show that she has capability to function without total assistance.

Why?

She was a candidate for skilled nursing care but was losing her transfer because of her inability to ambulate. She did not have her walker she tells me.

So.. being the Save The Day nursing student, I set out in pursuit to get my patient her walker. Patient Advocate to Save The Day!

My adventure ended promptly when the nurse I was working with said I should do assess my patient more carefully.

Hmm....?

What's that you say?

I sat alone, read my assessment, and wondered what the hell further could I assess that has to do with this woman and her walker? Neurocheck!

I march back into my LOL's room, and tell her I want to assess her feet.

She is a little puzzled, but says okay.

She has NO sensory or motor movement in her L foot. (or R, I don't remember, irrelevant.)
I continue on... the OTHER foot as no sensory or motor movement.

Well obviously a walker will be of no service to her.

So, I amended my computer charting to include the neurocheck and that she has 0 sensory perception and no motor capability in either lower extremity. I report my findings to my nurse, her findings were congruent as well.

Now let's fast forward to the next day...

The MD is in the room with the patient when I enter to do AM vitals...

"So Mrs. NoMotorCapability, I see you walked to the nurses station all by yourself last night!"
Patient: Yes doctor.
"Great! Looks like you will be discharged soon to skilled nursing!" .. MD quickly scurries out of the room.

Me..."Mrs. NoMotorCapability, yesterday you clearly could not walk because of the condition of your feet, did you feel better last night?
Patient: No...
Me "I heard you tell the doctor "yes" when he asked if you walked to the nurses station, did you?"
Patient: No...
Me "Okay, what made you tell the doctor you did?"
Patient: The doctor said he heard I did walk to the nurses station, so I must have!"
Me "So you did not leave your bed last night?"
Patient: Well no... I can't walk remember?

See, I could have interrupted the doctor while he was in the room, but that whole pecking order thing gets to me with some of the doctors. But now... I had to do something.

I went to the dictation area and found the doc.

Me: Hey Dr. IForgetToAssessMyOwnPatients, I am fairly certain Mrs. NoMotorCapability is not able to walk.

Dr: What?

Me: The patient with ABC diagnosis that you want to transfer to skilled nursing, she can't walk. She has bilateral lower absence
of sensory perception and motor function.

Dr: That isn't right. It's nowhere in her chart!

Me: Have you gotten to reading the nurses assessments?

Dr: I don't read those, I am a doctor, not a nurse, why would I read that?

Me: The night nurse and I both charted that patient had bilateral lower absence of sensory perception and motor function.

Dr: Why isn't that in the patients chart?

Me: I don't know doctor, as a nursing student I do nurses assessments.

Dr: Well we count on the nurses assessments to know what is going on!

Me: Umm... well it's in the assessment? I'm not exactly sure where you are getting with this now, I gave you the information I needed to give you, the patient cannot ambulate even with a walker. I will tell you both of her pedal pulses are +2 (normal), normal (<3 sec) cap refill in both feet, warm to touch. She is adequately perfused, she just appears to have some nerve issues.

Dr: Who are you?

Me: I am the patient's nursing student.

Dr: Did you get that information from the progress notes? Wait, did a Dr. Dipshit send you to mess with me? Where did you get that nursing student uniform from?

Me: No... from my nursing assessment. Wait what? Excuse you? I AM a nursing student. And NO the patient cannot walk. LOOK in school, they go on and on about being a "patient advocate" and I am advocating for her that is cannot walk and is not ready for skilled nursing! She needs help!
You said you heard she walked to the nurses station. Did you know she is also demented? She thought she must have since someone told you they saw her do it! I don't know where you heard this from, does the unit have video surveillance?
I would encourage you to come assess her with me then because my neurocheck determines she cannot walk. Maybe you can teach me something.
And, the progress notes didn't offer much information on this issue.

Dr: What do we do?

Me: SILENTLY THINKING: WHAT THE FUCK!?

Me: Can you just follow me back to her room to reassess her?

Dr: Well I guess I can't finish her chart now.

::goes to room with me::

Findings? She can't feel us touch her feet and can't move them! Dr is still all like WTF? How did this happen?

BECAUSE HE RELIED ON HIS EYEBALLS, DID NOT PHYSICALLY ASSESS HIS OWN PATIENT, CLAIMED TOR RELY ON NURSING ASSESSMENTS WHICH, HAD HE READ, HE WOULD HAVE KNOWN SHE CAN'T WALK!

Was there a med error? No. (thankfully)
Was anyone injured? No. (thankfully)

Upon transfer, it would have been clearly evident that the patient can't walk. How the hell nursing knew about it but medical team didn't? Because there is NO communication!

Nurses talk to MDs when we need orders, clarification or to tell you to get your hiney's down here for something!
MDs talks to nurses when.... they need to find a chart.

Why don't nurses round with MDs? Why isn't there collaborative care? Aren't we all in HEALTH CARE?

I am probably a jaded nursing student, but seriously, doctors: read the nurses notes & assessments. We can learn from each other.