Doctors going over your head?

[perfectbluebuildings]

Ever had a doc call the charge nurse on you? As in, call the unit and ask for the charge nurse and complain about you to him/her, without saying anything to you first.

Happened to me this morning and I'm still frustrated and can't sleep. And happened right at change of shift, so the doc ended up speaking to the day shift charge nurse who had no idea what had gone on the previous night. I called him 3 times during the night... once around 2, once around 4, and then once between 7:15-7:30. The first 2 calls- I NEEDED to talk with him. OK the third, now I know maybe I didn't... but still think I did and the day shift nurse receiving the pts I was calling about, did too.

He stated when he calls, that he feels like I'm trying to get something from him but he doesn't know what. And that I don't have my assessment ready for him when I call. ??? Each time I told him the pt's vital signs. The first time it was a b/p that had to be reported per orders. The second time, I needed an order for nausea medicine for a pt who threw up twice, quite a bit each time, within

Maybe it's my communication skills... do you think I should practice calling doctors, like roleplay or something, with someone? That sounds kind of silly. I do try to have things written out maybe that would help. He also told her to have me talk w/the charge nurse first before calling, and I did talk w/my charge nurse at length before those first two calls- this pt I talked with her about through the night b/c was just making me nervous and not right. Maybe I talked too fast? I tend to do that when I'm nervous and this doc makes me nervous. Maybe I gave too much information each time, should have been more specific. Though this pt did have a wide range of concerns through the night.

Sorry to be long winded. This seems like what I do most of the time now. I am irritated at him going over my head, along with putting the day shift charge nurse stuck in the middle, but also want to improve for the future so this doesn't happen again. Does anyone have any advice?

[jtccedu]

For your consideration: if you have never had a physician complain about you you are either very, very new or not advocating for the patient assertively enough. A few physician, at times, feel that this type of 'telling on you' behavior will intimidate or control. It shouldn't. I am always professional but will willingly provide them the names and numbers of my supervisors or simply hand this person the phone.

[twotrees2]

So I found out the pt ended up in ICU not 2 hours after I left... and the ICU doc was livid they weren't up there earlier... pt WAS very very sick apparently and it wasn't just what they had her dx with... I wonder what I could have said or done differently so that would have happened (pt getting to ICU earlier). My charge nurse last night (different charge nurse than the previous night) said I could have called the ER and gotten a doc from there to come look at the pt if I felt I wasn't getting response from this doc. That's probably what I should have done. Anyway just wanted to update you on the whole deal.

usually when i have a resident that sick i will do a full assessment - lungs - heart - edema - neuro - blood sugar if they are diabetic - urine ( color amount etc) check with the aides any stool - whats it like - normal loose hard - vomiting - bowel sounds - ears nose any drainage? may be over kill but then i have every system assessed and can say to doc what they are an he has a more thorough assessment to make a diagnosis. i also make sure i have med sheets and history near by so can report any meds ( abx , analgesics and any prns that have been give within last 24 hours ) as well as any hx of say chf - pneumonia - etc and prior to calling i always check the nurses notes and 24 hour report book to be sure the nurse leaving did not forget to report something that i may have missed being off a few days - how had their appetite been any other fevers any other emesis - etc - our docs also have a habit of not answering our faxes to quickly - often i come in days later after being off and faxes are sitting unanswered - i will get on the line to the office right away saying hey this wasn't addressed please do do now - if there is still faxes out that they said they'd acknowledge - i will tell them that we had faxed for prn tylenol or blood work or ua and had called again that day to their primary but got no response and had they answered the on call would not have been bothered. would not be getting this call - it is often because we get very snapped at cause its not usually the doc of choice but on call and they get mad to get others stuff that should have been taken care of earlier.

[twotrees2]

oh i just love the ones who have NP's and they leave orders and then when the NP is on she gets the call in middle of night and i have been rudely told to "change the order to such and such - he isnt on call i am and i do NOT want to be called" LOL - happened just last week. couldnt believe my ears. sometimes ya just cant win ( i did fax the md about the order change by his np - shoud have puther comments in too but did not )