[thomask]

I am graduating in May and already have a position in a PCU with a large teaching hospital in my area. I am hired for night shift and am anticipating some uncomfortable situations with angry tired doctors. I tend to avoid confrontation, and am afraid I will be so shocked I won't be able to say anything to them. I was hoping some experienced nurses could share some tips or one liners to diffuse a tense situation and get what you want from a doctors without engaging in a screaming match. Any other tips on dealing with doctors in general is appreciated. Out of all the new things I am going to learn and all the scary things that can happen, dealing with doctors is what I am most terrified of! THANKS!!!!!

[fultzymom]

The most important thing to me is to know that you do not need to be yelled at, harassed, ect. I was the same way et thought that I could not say anything back. I have learned otherwise. One time I actually told them I was putting them on hold et I would let my supervisor deal with them. And I did!! I am not going to sit there et let someone yell at me when I am just doing my job. Thank God we have a great Medical Director now. Our old one had to return to his home country for some reason (something to do with his license). I also would not be above telling them that we are adults et we need to act like it et speak to each other like adults. Tell them that you do not appreciate being yelled at et spoken to like a child. Nothing wrong with that.

[vamedic4]

First of all, don't psyche yourself out over this. Most doctors are very easy to get along with..and if you're working at a teaching hospital then chances are you're dealing with doctors who just got that title. In this case, they don't even know what they don't know. Most interns and residents are wonderful, in my experience. And the better you get to know them, the more efficient your work becomes.

More importantly, however, they have been taught that nurses are their lifeline. Nurses spend 12 hours caring for/assessing the patients and are much quicker able to spot a problem or potential problem when it arises.

Besides, if you've got a really bad doc, you can always make it a point to call him with every q1h blood sugar/calcium/potassium or whatever other lab he may or may not absolutely need to know.

You'll be fine. Relax.

Have a great day.

[TazziRN]

If it's a doc who's cranky just because you woke him in them middle of a good dream but is usually very easy to deal with, I'd cut him some slack. If it's someone who has a rep for being cranky, I'd tell him on the phone "Dr. B, I am calling because of a change in your patient's status. I know it's the middle of the night and you were asleep and I'm sorry, but please do not yell at me." If he continues, tell him you will have the supervisor talk to him. If he hangs up before then, have the super call him back.

Cranky docs will continue to be cranky with those who let them be.

[Elvish]

Originally Posted by TazziRN

If it's a doc who's cranky just because you woke him in them middle of a good dream but is usually very easy to deal with, I'd cut him some slack.

Cranky docs will continue to be cranky with those who let them be.

Well said, Tazzi.

If it's someone that's known to be a pistol, you put on your armor before you make the phone call. If they give you heck for calling them, remind them that you're not calling them socially. You're calling for a reason. If they blow you off, keep calling back until they take you seriously. If they tell you "quit calling me!" ask them how they'd like that verbal order written! They usually start making some sense then.

There are some docs that I don't like to call at 3am because I know they're gonna be hateful, but I remind myself that it is not worth my license to not call because I didn't want to deal with a nasty doc. And those same docs would be hateful whether you called at 3am or 3pm.

Vamedic's point about residents is good too. It has been my experience that residents are usually grateful to you for catching something & thus saving their hind parts from the frying pan. If they blow me off (which is rare), I just keep calling & calling, kind of like water torture. Eventually they call me back, or I call someone higher than them, like the attending. That usually gets them right over to where you need them!! But like I said, that is rare for me. Most residents are good to nurses where I am.

Best to you!

[Roy Fokker]

I'm faaaaaaaaaaaaaaaar from an experienced nurse

But permit a fellow night shifter to share some thoughts:

1. Before you make the call - know what you are making the call about. Most MDs have standing orders on what to call for (for example: "Call if urine output < 100cc in 2 hours" or "Call if SBP > 160") etc.

2. Once you've decided - gather all pertinent data. A good collection would be:
* Description of problem
* Recent vitals
* I/O so far (have I/O of previous shift(s) handy)
* Latest/most recent labs
* Any pertinent history of patient

3. Once you have this on hand, check the board and see who is "on call" for the patient. A quick way to check is to usually call the office - most of them have voice recordings giving you directions. If not, most floors have a book that lists who is on call for whom and when. If this doesn't help, ask your fellow floor nurses. A last ditch effort would be the nursing/house supervisor or the ER - call them and ask if "Dr. so and so on call and if not, who is covering for him/her".

4. Most docs have pagers and don't like to be called. Make sure you call the numbers they list - call the home phone number only if in a dire emergency. And when you DO make the call, make sure you know the "call back number" (i.e. if I'm calling from outside the hospital, what number should I use to reach the unit?"). [I once made the dumb mistake of calling the doc at 3 am and leaving the wrong call back number. After waiting 20 minutes, I called his home phone number and well, he wasn't very happy!]

5. When MD calls back, speak slowly and clearly. Remember, that person is probably a little groggy - allow for their own perceptions to catch up. Be very sure about the orders you write down - repeat them if required so there is no confusion. (One of our orthopedic surgeons jokingly refers to me as "the Repeater" - but he appreciates the fact that his orders never get mis transcribed).

6. If you made a mistake - apologize for it right away.

7. Above all else - be confident and sure of yourself. Never fail to ask for assistance from your floor mates. Have one of your floor nurses walk you through one - or just watch and observe them make a call.


I know this post seems long and tedious - but believe me, it is not! Most of these things you know/have already.

Remember: "Excellence is a matter of habit. Form good habits, and your work will be excellent always".

cheers,


PS: There are some docs I don't bother calling at night:
1. Because they never answer pages. I have better luck and more success getting their PAs (who almost always end up being really nice, real helpful folks. Makes you wonder how they manage working for chowderheads).
2. Because they will get nasty on the phone. These docs always have the hospitalist/internist on their cases [especially our ortho docs. Unless it has something to do with their ortho-surgery, I'm better off calling the hospitalist]. A lot of these docs are rather senior (and dare I say it : "old school" and don't take kindly to "nurses bothering them at night". Management lets them get away with it time and time again - *sigh* long story).

[Mediatix8]

I have noticed that when I start off by saying "I'm sorry for calling you at this time but... blah blah blah" I don't get yelled at so much. You will get yelled at, though. But they aren't your boss. I've been yelled at for calling at midnight about a patient with a blood pressure over 200. I mean... some of the doctors are crazy. I had a lady in restraints and the order ran out at 3am. I waited until 7am to call the doctor to get an order to continue the restraints and she yelled at me. Another time I had a patient who's blood sugar orders were like every 4 hours. So one of the checks fell at 3 or 4am and her BS turned out to be over 400. Her sliding scale didn't cover over 400. I called about that and got yelled at. All of these reasons are good reasons to call the doctors and I still got yelled at. And I've made a few mistakes, too. Once I called about a blood pressure when there was a PRN order to cover the high BP and I didn't notice that. That doctor didn't yell at me, though. You have to use some discretion, though. I've never called a doctor for a sleeping pill at night. I always call for antiemetics if they've thrown up. If not, I ask them if it can wait... there's a difference between feeling really sick and just a little nausous. Same for pain... I tell the patient they don't have anything ordered. I say we usually only call the doctors at night for emergencies. I ask the patient how bad is it... is it an emergency or can it wait until morning. If they say no then I call. I don't work at a teaching hospital though, so I am not dealing with residents. You'll still be yelled at sometimes but they aren't hurting you, they're only hurting the patient. You're not asking a favor for yourself, you're asking for the patient. You could also ask other nurses if they would call about XYZ now at 3am or would they wait until 7am or so.

[thomask]

Originally Posted by Mediatix8

I have noticed that when I start off by saying "I'm sorry for calling you at this time but... blah blah blah" I don't get yelled at so much. You will get yelled at, though. But they aren't your boss. I've been yelled at for calling at midnight about a patient with a blood pressure over 200. I mean... some of the doctors are crazy. I had a lady in restraints and the order ran out at 3am. I waited until 7am to call the doctor to get an order to continue the restraints and she yelled at me. Another time I had a patient who's blood sugar orders were like every 4 hours. So one of the checks fell at 3 or 4am and her BS turned out to be over 400. Her sliding scale didn't cover over 400. I called about that and got yelled at. All of these reasons are good reasons to call the doctors and I still got yelled at. And I've made a few mistakes, too. Once I called about a blood pressure when there was a PRN order to cover the high BP and I didn't notice that. That doctor didn't yell at me, though. You have to use some discretion, though. I've never called a doctor for a sleeping pill at night. I always call for antiemetics if they've thrown up. If not, I ask them if it can wait... there's a difference between feeling really sick and just a little nausous. Same for pain... I tell the patient they don't have anything ordered. I say we usually only call the doctors at night for emergencies. I ask the patient how bad is it... is it an emergency or can it wait until morning. If they say no then I call. I don't work at a teaching hospital though, so I am not dealing with residents. You'll still be yelled at sometimes but they aren't hurting you, they're only hurting the patient. You're not asking a favor for yourself, you're asking for the patient. You could also ask other nurses if they would call about XYZ now at 3am or would they wait until 7am or so.

I am a sucker for people in pain, I am glad you addressed this. I absolutely hate to see anyone in anykind of pain. I would probably have called the doctor over a six on a ten scale pain level. I just hate pain. Better get used to it though

[Elvish]

I daresay that if that doctor were a patient in pain, he'd want the nurse to call his doctor at 3am for pain meds if none were ordered. If they want to get their shorts in a bunch, fine, but I still ask them for the pain med (or whatever it is I need).

[hogan4736]

Originally Posted by Mediatix8

I have noticed that when I start off by saying "I'm sorry for calling you at this time but... blah blah blah" I don't get yelled at so much. You will get yelled at, though. But they aren't your boss...

I disagree w/ starting your call off w/ an apology...It makes us sound sheepish and puts us at a disadvantage...It's their job to be on call 24/7...Not MY problem you decided to go to med school...Get over yourself, angrydoc...JMO

I have yet to be yelled at in 12 years...Fokker said it best...BE PREPARED...I'll take notes before the call...I'll lay out the labs in front of me...Read the H&P before calling...

If the pt is dizzy, I'll have orthos already done...Think ahead...

About them not being your boss: AMEN...We work for the pt, not them...