prostituting our nurses

[Agnus]

I was just reading "I'm a florest now" thread. It reminded me of something. One hospital put on a "retreat" that was designed to foster better communications between physicians and nurses.

Guess who the nurese were that were invited to attend. You guessed it! It was not the beside nurse. Yes I said invited because you did not attend without an invite.

From this evolved a list of what nurses should do before and during a call to a physician. All common sense. However, take this handy tip for example. Have the chart when you call. That is fine except you get the answering service and you have to waite until the doc calls you. In the mean time you could be doing any of a number of things that take you away from the chart.

Not to mention that you often have to call some docs multiple times before they even return a call.

The problem I have with all this is simply. The responsibility for good communications is all put on the nurse. The nurse not the high and mighty phyusician is held responsible to communicate clearly with the doctor. The list is designed so that doctors are not called unessairly. For example one of the things was to discuss it with another nurse and if that didn't solve it discuss it with your charge nurse before calling the doctor.

I can appreciate not putting in frivilious calls but there was no guide line to doctors for them not to inconvience nurses. There were no guide lines for physicians to give clear orders, to waite for the nurse to read back what she wrote, or even to give her a chance to find the chart.

Speaking of finding charts, don't you just love it when a doc takes a chart for hours on end and having written a now or stat order which he did not communicate to you and then has a hissy fit that it was not done state. Note order written at 1310 and it is now 1500 when he finally gives up the chart. Or when he takes a chart and just leaves it anyplace.

When he writes orders and never consults with you, never lets you know he is there and never flags in anyway that orders have been written.

All the communications responsibility is put on the nurse.

Some hospitals will defend rude and othewise horrible behavior from docs because they bring in $$$ by bringing in patients. The staff has to take it. The staff is blamed if things are not going smoothly.

Some will accept it from patients and visitors because they are Customers ($$)

It reminds me of the words to an old country western song where a mother turns her daughter, Fancy, out to prostitution because they are poor. "Be nice to the gentlemen, Fancy."

[Agnus]

I was just reading "I'm a florest now" thread. It reminded me of something. One hospital put on a "retreat" that was designed to foster better communications between physicians and nurses.

Guess who the nurese were that were invited to attend. You guessed it! It was not the beside nurse. Yes I said invited because you did not attend without an invite.

From this evolved a list of what nurses should do before and during a call to a physician. All common sense. However, take this handy tip for example. Have the chart when you call. That is fine except you get the answering service and you have to waite until the doc calls you. In the mean time you could be doing any of a number of things that take you away from the chart.

Not to mention that you often have to call some docs multiple times before they even return a call.

The problem I have with all this is simply. The responsibility for good communications is all put on the nurse. The nurse not the high and mighty phyusician is held responsible to communicate clearly with the doctor. The list is designed so that doctors are not called unessairly. For example one of the things was to discuss it with another nurse and if that didn't solve it discuss it with your charge nurse before calling the doctor.

I can appreciate not putting in frivilious calls but there was no guide line to doctors for them not to inconvience nurses. There were no guide lines for physicians to give clear orders, to waite for the nurse to read back what she wrote, or even to give her a chance to find the chart.

Speaking of finding charts, don't you just love it when a doc takes a chart for hours on end and having written a now or stat order which he did not communicate to you and then has a hissy fit that it was not done state. Note order written at 1310 and it is now 1500 when he finally gives up the chart. Or when he takes a chart and just leaves it anyplace.

When he writes orders and never consults with you, never lets you know he is there and never flags in anyway that orders have been written.

All the communications responsibility is put on the nurse.

Some hospitals will defend rude and othewise horrible behavior from docs because they bring in $$$ by bringing in patients. The staff has to take it. The staff is blamed if things are not going smoothly.

Some will accept it from patients and visitors because they are Customers ($$)

It reminds me of the words to an old country western song where a mother turns her daughter, Fancy, out to prostitution because they are poor. "Be nice to the gentlemen, Fancy."

[RosesrReder, BSN, MSN, RN]

Not a nurse, but interesting thoughts.

[Tweety, BSN, RN]

Good post. It's very frustrating. I practically had to run down the hall to catch a doc who just saw a patient to give him an update of my morning with the patient.

The one and only time in 15 years I had an altercation on the phone with the doc was over him having to wait for me after I paged him. "If you're going to wake my a** up at 2AM you'd best be near the phone." It had taken him over an hour to call back, like I'm really going to be near the phone waiting with chart, and info in hand after I page a doc. NOT

My time is just as valuable and important. Why not hunt me down when you come to the floor? Why not ask me about the patient, since I'm with the patient 12 hours.

[snowfreeze, BSN, RN]

ll I can say after reading the "I guess I am a florist now" and the response to this is that.....There are a lot of unaddressed psycho/social issues running around acting like normal people and Unfortunately many people act like idiots when under stress. And that is where the social worker needs to be involved. I admire the social workers I work with and really do depend on their superb manner of dealing with issues on a daily basis.

[NRSKarenRN, BSN, RN]

Have the chart when you call. That is fine except you get the answering service and you have to wait until the doc calls you. In the mean time you could be doing any of a number of things that take you away from the chart.

Not to mention that you often have to call some docs multiple times before they even return a call.

The problem I have with all this is simply. The responsibility for good communications is all put on the nurse. The nurse not the high and mighty physician is held responsible to communicate clearly with the doctor.

I can appreciate not putting in frivilious calls but there was no guide line to doctors for them not to inconvience nurses. There were no guide lines for physicians to give clear orders, to wait for the nurse to read back what she wrote, or even to give her a chance to find the chart.

All the communications responsibility is put on the nurse.

It had taken him over an hour to call back, like I'm really going to be near the phone waiting with chart, and info in hand after I page a doc. NOT

Guess we need to send these comments to Quint Studder for inclusion in his "Got Chart" campaign. http://www.studergroup.com/newsletter/vol1_i4_sec4.htm

[RN34TX]

It reminds me of the words to an old country western song where a mother turns her daughter, Fancy, out to prostitution because they are poor. "Be nice to the gentlemen, Fancy."

Mmmm-hmmm.

That's exactly what we've become in the name of customer service.

"Yes Dr. Jones, this is nurse Ben Dover. Sorry to page you at such an inconvenient time. Have I told you how hot you sound on the phone when you yell at me like that?"

[pricklypear]

Angus - I hear you. We recently had the same kind of "guidelines" suggested to us. Most of it's pretty good advise, common sense. I work nights, so it's not hard to sit around with the chart in my lap, waiting for someone to call me back. But the day shift nurses have to deal with everybody and their Uncle milling around the unit, picking up and carrying off charts as soon as you take your eyes off it.

I would like to send around a list:

1. Please do not make rounds during shift change. Between residency and your years as a doctor, you should be able to figure out a rough estimate of when most nurses are in report. Inturrupting report, and taking the chart are not conducive to good patient care.

2. When nurses call with information, please listen to her entire description of the situation, instead of inturrupting, giving orders, and hanging up. This will avoid the 2nd page that will be placed so the nurse can explain why your orders are not possible for this patient.

3. Please do not ask me questions you know I don't have the answer for : Why did this patient not get a CXR last week in the office? Why did Dr. Idiot order this CT last week? Why didn't Dr Idiot make rounds and see this patient yesterday? I can't read this progress note, read it for me, would you?

4. When nurses page you in the middle of the night, please have the courtesy to awaken fully before calling back. We may be able to decipher poor handwriting, but mumbled and slurred orders are more difficult - especially when you hang up immediately after.

[newadventure]

I would like to add, if a doc doesn't want a second page don't write stupid orders. "What the patient takes at home" is not an order!

[nurse4theplanet, RN]

agnus....

sounds like this "communication workshop" to facilate doctor-nurse communication was actually a "let's find a way to tell the nurses to quit bothering us"

you are totally right! this is so stupid that the nurses were not involved at all being that they should have an equal voice if you want communcication to be facilitated!

[Agnus]

ll I can say after reading the "I guess I am a florist now" and the response to this is that.....There are a lot of unaddressed psycho/social issues running around acting like normal people and Unfortunately many people act like idiots when under stress. And that is where the social worker needs to be involved. I admire the social workers I work with and really do depend on their superb manner of dealing with issues on a daily basis.

Nah. You would think though.

Social workers jobs at hospitals is not to interviene between physician and nurse. "they are there for the patient." Our social workers run faster than we do from a confrontation with a physician. At least a nurse will sometimes stand up to them. Social Workers have as hard a time or harder than us with them but they are better (and in a better position to) at sidstepping having to deal with the doctors directly. They have the nurse call the doctor for them. We end up acting as intermediataries for the SW.

If you think doctors expect us to perform miracles you should see what they expect of the social worker. I would not trade places.

[Agnus]

The information on this list is pretty basic and commonsense, stuff we learned in nursing school. It is ok to have that reminder especially for the new nurse, or someone returning to nursing or someone new to a speciality etc. I even go over it occasionally.

But it puts the entire responsibility of good communication on the nurse. Having the chart is not realistic when we must call the answering service.

I'd like a list for the doctors. I'd like them to understand that they have a huge responsibility in the communication/nurse - physician relationship.

I'd like them to have a list as to what the responsibility is. Since it is clear that many do not know what it is.

Amaizingly it is the residents and hospitalist who are the WORST about returning calls. Some I page and they NEVER return calls even after several pages. Yet this is the guy or gal (doc) who is currently on duty and taking call.

Yes, nurses sometimes make mistakes and call a doc who is maby at home at 10 pm about something that could have waited. Yes I know it is irritating. Especially when this happens several times a night by different nurses from different hospitals. But if you are taking call for your group that night then this is your job. If you do not want to take call then take it up with your group.

If you are (rare breed) a rare breed of physician who works alone and chooses to take all your own call remember you made that decision.

Inerestiongly when there is such a physician who does not or rarely shares call with another and chooses to take his own call usually these are the most civilized physicians.

I remember calling such a doc in the middle of the night. He was clearly sleeping and gave some goofy order. He got a little miffed with me. However, I knew this doc well and knew he was asleep. He called back again after getting his eyes open and clarified because he then realized he had given goofy orders.

The next morning he came in early and came up to me and apologized. But then he is the exception. I did not need the apology but he gave it. I understood I had called him at home and he was not awake and what therefore incoherent. I was able to fingure out what he wanted when he called back and asked for more info we got it straighened out even further. God I am not coherent when awoke in the middle of the night. I get miffed too.

Yes, I love one othe the instructions on the list. READ the progress notes, read the nurses notes. ah ha mmm. Yes, and I am criticized because I can not read your crystal clear writing. Yep. And you (the doc) read nurses notes? Infact I am according to the list read them all for the past 24 hours. Honey, if I had 24 hours to read them I could not decipher them.

And the signatures. Who can tell who signed the order. our computer which processes the order demands a doctors name for who gave the order.

The only time I saw a doc introduce himelf to a nurse is once in the past 2 years. He saw a new super pretty one and wanted to show off for her and flirt. This particular doc is pure sleeze and will treat any nurse (with the expception of those really cute ones) like cr**. If she is cute he charms her into thinking he actually respects her for her mind and she insocently will say that she things he is just soooo wonderful. She just doesn't understand everyone's complaint about him. And don't you now the guy is married and half again and sometimes twice the cute nurses age.