[Climbing onto soapbox]

EM is different than the rest of the house of medicine in how we approach the patient. “Regular” medicine teaches to look at a set of symptoms, decide the most likely etiology and do tests to prove that one of those common things is the diagnosis. If you can’t, come up with a bigger list and continue testing. “Regular” medicine is all about “what you have” (i.e., what is the diagnosis). Emergency physicians, on the other hand, are taught to generate a list of things that could seriously hurt or kill you based on your presenting symptoms, and test to rule those etiologies out. If they can’t be ruled out, the you will be admitted for further testing. If they can be ruled out, you will be discharged, even if a diagnosis is not yet found. Emergency medicine is not about what the patient has (the diagnosis) but rather what they do not have (the problem which could hurt or kill them). Thus, if you come to an emergency department, expect to undergo extensive testing that is designed only to really do one thing – prove if it is safe or not safe for you to go home. Often those tests are uncomfortable, and “I think it is {insert diagnosis}” without confirmatory testing is simply not good enough.

[Stepping off soapbox now]

I think the bigger issue is with your nurse. Last time I checked she wasn’t assuming responsibility for the evaluation and treatment of the patient. I hate to say this but at the end of the day they are called ORDERS for a reason. Sounds like another case of a know it all nurse with resentment towards the physician because she didn’t go to med school but surely could do the job just as well as you.

As for the nurse – she should have come up with a better argument as to why the patient didn’t need a straight cath for the urine specimen.

Thinking about a pelvic on a 15 yr old – if she is not sexually active, a first pelvic exam is going to be highly difficult and possibly traumatic for her. Perhaps a pelvic u/s would be better warranted to r/o pelvic issues.

First, the nurse was out of line in her approach and overall demeanor with the doc. But considering several factors: teen female, menstruating, embarassed and in pain, it is unreasonable to think that catheterization (during her period and after a “clean catch” was obtained) is completely necessary. Someone else suggested an ultrasound or pelvic exam. It seems to me that is far more reasonable than doing a cath on a menstruating teen already in pain.

I had a catheter done in ER when I had a kidney stone. I was 20. The catheter hurt more than the damn stone did at the time and sent my pain to levels unknown to me before.

I hated the nurse so bad that she was lucky I did not kick her in the teeth. I tried to refuse it and she was nasty with me. Refusing to give me pain meds unless I complied. Needless to say, I have to be dying to use the ER anymore. My guess is that young teen girl will end up with the same aversion.

It is interesting to read your blog. Will check back for the trial conclusion…

If the nurse has a discussion with the doctor and is like “no, that’s dumb” and doesn’t want to do the UA, then she should find someone else to do it who is able. Sometimes, really, a doc just gets on your nerves on a particular day (not that I think WC would really ever get on my nerves), and you can play trade-the-jobs. I’ll do your IVs if you do all my stupid UAs on all these chest paineurs who don’t need them. When a doc writes routine orders on the chart, they’re not really ordering a particular nurse to do anything. How nurses divide up the work is for the nurses to decide.

If she’s just refusing to do stuff because she’s layzee, that’s a performance issue (or a system issue if the place isn’t staffed appropriately, etc) and should be handled by her boss. A couple times, sure, but like all the time? WTF, chick.

Obviously, a nurse shouldn’t do anything that’s going to be patently harmful to the patient, against policy, or that’s not within her scope of practice.