Doctors going over your head?

[perfectbluebuildings, BSN, RN]

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?

[UM Review RN, ASN, RN]

Nope. I think you did fine with a patient whose s/s were getting worse as the night wore on. No one could've anticipated that.

I suspect that the BP was dropping as the Temp was spiking because the patient was going septic and/or losing fluid volume. Did the Doc order blood cultures?

That's what I would've called to get.

In future, what you might do is reheorifice what you're going to say and what you're going to ask for. Like, "Hi, Dr. Oncall, I'm calling about SuzyQ--you'll recall I called earlier because of her BP dropping, as is hospital protocol. Then she began vomiting and you ordered something for that, but now her temp seems to be spiking, and it's 105.6. Would you like blood cultures, a UA C&S, and an antibiotic? Or just tylenol prn, because Pt has no order for it."

Believe me, I've had to make phone calls like that. In fact, just the other night I had to call for a patient with intractable chest pain to the primary a couple of times. But the doc didn't call the Charge. So a lot of the doc's response begins with who the doc is.

I guess what I'm trying to say is that no matter how great you are, some docs do this stuff. It's not you, it's them. So blow it off and keep calling whenever you have a patient that sick.

[perfectbluebuildings, BSN, RN]

Thanks, Angie.

The pt had had blood cx drawn the previous day, and a UA/cx on admission; was on a once daily IV antbx (which I wasn't even thinking about at the time of the call), and didn't have PRN tylenol, just motrin but we do have a standing tylenol order. So maybe, there really wasn't anything he could do, but just making him aware? Is that ever a reason to call, just to make them aware of the situation, or should you not call unless you have orders you want or etc.? I like your way of summing up the night's calls in that last call... very succinct and to the point, reading that I do think I was a little rambling sometimes. Her b/p had been low the previous day and temps high, though not so steadily low though, of course, she was sleeping much of my shift and I'm not sure if the temp spiked quite that fast the previous day? I'm not sure why they weren't a little more aggressive with her during the day actually...

Thanks very much, again... that is really helpful!!!

[CyndieRN2007]

So blow it off and keep calling whenever you have a patient that sick.

I agree. Better call than not help your pt. Good job!

[llg, PhD, RN]

I agree. Just because the doc doesn't like it ... that's no reason not to call. Sometimes people get grouchy when they don't get the sleep they. Try to keep that in mind and don't take his grouchiness personally.

llg

[UM Review RN, ASN, RN]

Yes, Rayrae, we do our "let's make doc aware" calls about an hour before the end of shift so if he wants to start new orders, we have time to get them going before leaving.

I think all those calls were relevant and I would've made them when you did, by the way. A patient whose temp is spiking that quickly despite antipyretics and despite an antibiotic is actually more alarming to me than one that hasn't been treated yet.

ETA: I might have asked for an Infectious Disease consult on the spiking temp despite treatment lady too.

[PANurseRN1]

It sounds like your calls were valid; maybe he had a bad night with other calls.

Practicing with a co-worker may not be a bad idea, though. Perhaps you think you're organized, but in fact are coming across in a disorganized manner. It certainly couldn't hurt to try it.

And I would suggest talking to him personally, as well. If you get the chance to see him, take him aside privately and say, "I understand you were upset the other day when I had to call you several times. Was there something specific that bothered you?"

I did this with a doc., and it really did help.

[perfectbluebuildings, BSN, RN]

Thanks for your continuing replies!!! They are giving me a lot of ideas.

llg... you are right!!! I don't mind the grouchiness usually... it is just irritating he called the charge nurse about me, not five minutes after I hung up from the last call I made to him... oh well, you are right, let it go!! :) :)

Infectious disease consult... good idea... Yes Angie... that is what bugged me about the temp, that it spiked so high AFTER having taken motrin!!

I am hoping the pt got a different doctor in the group rounding on her this morning, who may look at her with more open perspective.

Keep the thoughts coming... any more tips about night-time calls, etc? You all are awesome...

[UM Review RN, ASN, RN]

Yes, I have one more.

The next time you have to call this dude, please don't act on your impulse to exclaim cheerfully,

"Hi there, honey! It's your good buddy, AngieO, with yet another crashing patient that you are getting paid to treat! Yahoo! More fun! Do you want my Charge Nurse's phone number now or do you want to wait and get it in the morning?"

:devil:

[caroladybelle, BSN, RN]

Ever had the MD want to speak to the charge nurse about me?????

Heck, I don't make them call back to speak to 'em. If they have a problem, I just hand the charge the phone right away. (If I am calling the MD, a patient is crashing and s/he is right by my side/or I am the charge)

[perfectbluebuildings, BSN, RN]

Yeah... I know Caroladybelle. :) That is the smart thing to do. But, I didn't know he was having a problem with me at the time any more than his usualness... just thought he was in his typical mood while on call, usually :angryfire LOL

That is verrry tempting Angie...

[perfectbluebuildings, BSN, RN]

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.