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This is a discussion on fear of calling docs in First Year After Nursing Licensure, part of Nursing Career Advice ... Hi everyone. I just started my first new grad job and I find that it is so much harder than...by SimplisticRnx May 20, '12Hi everyone.
I just started my first new grad job and I find that it is so much harder than when you're in clinicals. Keeping up with others tends to be difficult since I am fairly new to everything on the floor. I just finished a month of training and am slowly picking up things. I know how to assess, give meds and work the IV pumps, but sometimes I feel that I am lacking some important things that nurses do (e.g. knowing when to/not to call doctors). I always have dreaded fears of contacting doctors even though I haven't contacted one yet. In nursing school, I got to do a lot of hands-on in clinicals, but sometimes I wish I knew how to call up doctor's or know how to stop being nervous when taking reports or receiving telephone orders. Does anyone have that similar problem as I do? What are some ways to overcome that nervousness? How do you know when to contact doctors so they won't go bonkers on you? Your advice is greatly appreciated.
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- May 20, '12 by FLArnMake sure you have all the pertinent information at hand before you call. Info such as VS, any pertinent labs, xrays, All overt symptoms and voiced complaints of patients. Have the current med profile in front of you preferably with meds for that problem noted so you know what the patient is on. Make sure you have already given any prn meds and have utilized whatever orders you already have that would help control whatever you are calling about. Take a few deep breaths while phone rings then speak loudly enough to be heard, clearly and calmly, be precise but not rushed or panicked. DO NOT apologize for calling, The doctor kept medical management and it is his job to listen and give you new orders. If you are not sure if the problem rates a call bounce it off a mentor or manager; but always listen to your gut if you feel like you need to call then you need to call. The only phone calls I've ever regretted are the ones I DIDN'T make.
- May 20, '12 by CheesePotatowelcome to the wonderful world of nursing, darling.
first of all, iím detecting some anxiety issues. enclosed please find a link to a horribly long-winded post i have already babbled regarding such things:
see? a lot of what you are feeling is terribly common and it too shall passÖlike a kidney stoneÖwith a lot of screaming, some profanity, perhaps some hyperventilation and maybe, just maybe, some blood in the urineÖ.but it will pass.
as far as the nerves when it comes to taking report and verbal orders, one way to help relieve some of that tension is to formulate your own form, if you will, as a way of making sure your information is organized and concise in a way you understand and can easily reference. i had mine all doodled out on a paper and i made copies to write on with my own cryptic short hand. granted, to anyone else it resembled the launch codes for nasa, but i understood what it meant, and thatís all that mattered.
secondly, read back, speak back, recite back! always. itís an awesome way to learn to go about any situation that involves orders or even communication in a crazy environment. mostly, it will help cement in your mind what is desired, what is needed, what is done. besidesÖ.itís just good practice.
and when it comes to calling docs, remember the following: get to the point!
itís a proven fact that nurses and doctors communicate in a vastly different manner. hell, some hospitals have done studies. seriously. no lyiní.
so what to do? well, for one, do your homework.
i mean have all the information at your finger tips before you call. donít phone a physician to say, ďmrs. potatoheadís blood pressure has been fluctuating wildly.Ē and then when he quips, ďwell what is it now?Ē have only ďuhÖ.Ē to say in response. these scenarios are terribly common mistakes for newbies and drive the docs up the wall.
know the medications they are on, what they do, when the last time each dose was taken.
have interventions attempted and responses ready to recite on command.
give plain and simple facts, facts, facts. leave opinion out of it.
and no, they donít care that the husbandís wearing a green tie or that the patient is having difficulties dealing with her separation from her prized african grey parrot.
last, but never least: what do you want?
in some scenarios, before you even get through the data, they will interrupt and start spouting orders. whoopee. write them down, read them back, carry them out, report responses as necessary and ordered.
in other cases, merely give your data and ask them for what you want to make it better. ďmrs. battlestargalactica, 183 bed a, is currently on morphine pca post total knee arthroplasty and has not had a bowel movement for two days. her normal is daily. may i have an order for colace?Ē
oh thank heaven, you just got to the point while giving the doctor enough information to know who the heck youíre talking about and what is going on. happy doc, happy nurse, happy patient. snow cones for everyone.
and in yet others, think of a phone call as having a conversation with your spouse. you know what you want done, but you need to make it seem like itís their idea. that, alone, is an art form and not to worry, it is one you will soon master if you havenít already.
iím going to be honest: there are just as many cranky, fussy doctors as there are batty, battle ax nurses. it comes with the territory. there are doctors that will tear your head off no matter what you do and as much as i would love to say something magical that will make it better, sadly, you just have to buck up and stand tall. however, having done your homework will minimize your time on the phone with them and make them a little less likely to chomp.
also, remember that some of their attitude is a matter of not knowing who you are as well. as you begin to develop rapport with your physicians, the crazies will simmer down.
last but never least, use your head.
if itís one in the morning and it can wait until a more appropriate time in the morning, let it wait. try some good old fashioned nursing interventions first. most physicians get irritated beyond belief when itís a horribly minor issue they honestly canít fix.
itís an issue that has been recognized as such for the last four hours but the nurse dragged his/her feet in calling and now itís two thirty three in the bloody morning and what the hell do you want me to do about it now the patient is going to lose their leg because of this !@#@%$ why wasnít i notified earlier?!
if you are ever in doubt as to when to call a doc, speak with your fellow nurses or your charge nurse. never be afraid to ask for help and never, ever, ever delay calling a doctor over life and limb issues because of nerves. there is a time and a place to be scared--when your patient is circling the drain is not one of them.
may i suggest you listen in to other nurses when they call doctors? this is a good way to hear and see what works, what doesnít, and to help formulate your own technique.
sorry so epically long-winded.
stuck in a call room.
the voices in my head.
a box of girl scout tagalongs.
a venti espresso.
help me. for the love of god, help me!
- May 21, '12 by dudette10I can't add a single thing to CheesePotato's wonderful post; however, I can say this: everything the previous poster wrote will become second nature as you gain more experience, and you'll be surprised how quickly that will come. You just have to make it through the growing pains of being a new nurse to reach the other side.
Good luck to you.
- May 21, '12 by SimplisticRnxThank you all for your wonderful advice. I will definitely practice speaking to docs in person and on the phone when I get the chance. Practice will eventually make things perfect . I'm sure my first few trials will be rough whether it's bugging them or just trying to get the system down. I do agree, it comes with experiences. Really love your great advice CheesePotato. It gave me a lot of confidence in just doing my best. If only my nursing school taught us how to take telephone orders.
- Jun 13, '12 by Are-En-FlaSimplistic, I, too, felt the same way about calling doctors. I still get anxiety, working on telemetry as a new grad since February. I'm finding that the more I do it, the easier it is. The more you get to know each doctor as an individual, you will know when to call, when not to call. Of course, there are certain situations that you would call no matter what. With critical lab values, we have to call within 15 minutes of receiving the value. After receiving new orders, I always ask the doc if they would like another call if the value is still critical. The doc will usually then give parameters on when to call again. If I am in doubt about when to call the doctor, I always ask my charge. It is definitely getting easier! I am learning to not take it personally when the doctor gets cranky, I am only doing my job.
- Jun 16, '12 by GinaCatI love this post because I still have the same problem!! Almost a year in, and I think one of the hardest parts is knowing the doctors' personalities. A few will say "call me anytime!" and some have specific parameters for what they consider appropriate phone calls. example- one group doesn't care about any pause w/ a-fib unless it's greater than 3 seconds.
I find myself asking my coworkers pretty frequently. but i am learning from some nurses who i highly respect- we don't have to cater these calls to them! even if they think a new little run of v-tach is no big deal at 2AM, it's our JOB to notify them whether they care or not. i also had a nurse tell me once that they get reimbursed and paid for every single phone call they receive during the night. so even though they are grumpy at times, that's payin for their boat. and that is the thought that comforts me as i waver on a decision.
I HAVE learned however, that if it's petty- don't call. i've learned to leave notes in the chart. stool softeners get notes.
thanks for the good advice in this post, im going to read it again and feel more confident w/ my future decisions to call or not