Vent on noncommunication

[TonyaM73]

Why is it that the doctors, pharmacy and anyone else can't communicate with each other, but instead call the nurse to call so and so doctor? I had a day from hell yesterday. Very busy group, doctors calling me to call other doctors about a patient (not once but several times) and pharmacy calling me to call the doctors about the very same patient. I spent so much time on the phone with everyone that my pm meds were late, didn't even get to input one shift assessment until 8:30pm, and generally running like my rear end was on fire. I just don't understand why doctors can not call each other and discuss the pt condition and why pharmacy can not call the doctors directly when they have a concern about a particular med.

Can no one stop and think about the fact that the nurse is trying to medicate, assess, do wound care, admissions, discharges, orders, and deal with family members not to mention in the mean time toilet, feed and all of the other things we have to do when our PCT are very busy. You can't just tell a patient to hold it when you know your PCT is in another room bathing a 300lb pt that is a total care and you know that job is going to take at least 45 minutes. Okay, got that out of my system. Maybe tomorrow will be a better day.

[greenfiremajick]

I refuse to be the go-between. I am not a secretary for the hospital and undoubtedly one person on one side of the communication is going to have a question that i need to hang up and call the other person find out, and then go back and call 1st person again... blah.

I get sugar sweet and give them the pager or phone number for whomever they are looking to speak with! They say "I dont have time to go through that!" and I say "Well, neither do I. So if you want your question answered by X person - you can make the time to speak to them yourself!"

My question was going to be, how do we change that? Is there a way to change this behavior/practice without stirring up the pots of hell from the people calling the nurse...

Can you please tell me how the docs, pharm people, etc react and if there are any repercussions to the way in which you handle this?

[Batman25]

They will continue to do it until you put a stop to it. You can be professional and polite yet firm. Simply pass on the number and tell them it would be best if they spoke to them directly. Once they understand you aren't their secretary they will get the hint.

[Up2nogood RN, RN]

Our IV nurses esp infuriate me, it's not like they don't know how to page a doc since they done it before but they're so far removed themselves from pt care that they think that tasks like that are below them. It would be esp helpful for RT's, pharmacists, abd IV nurses to contact the MD directly to accurately describe the message they're trying to get across.

[carolmaccas66, BSN, RN]

Tonya TELL THEM ALL THIS TOMORROW that u have had several phone calls re the same patient and it is not your job to supply the info they need, or they're not talking to the right person. Many times I've found the pharmacist/PT whowever will ring the nurse cos they don't want to speak to the Dr because the Dr has either:

1) Had a go at them in the past, so they are too intimidated to speak to them,

2) The Dr told them something/gave an order for a patient and they don't quite understand, so they ring you.

TELL THEM you have a 300lbs patient waiting to go on a pan or whatever. Sometimes you can be polite but firm - you can't play piggy in the middle - you don't have time for that.

I always see my students or new RNs running around after everyone else, instead of focusing on their work - and YOUR work is just as important as anyone else's. Maybe you need to be a bit more assertive and yes, arrogant, in a professional way.

It annoys me no end when nurses get treated like **** but to be honest, sometimes we let it happen and don't take control of our work.

[carolmaccas66, BSN, RN]

Be assertive, but polite. When the MD or pharmacist calls, be matter of fact - tell them the relevant phone number(s) and hang up before a discussion can ensue. If there's a complaint, mention that it's a matter of pt safety - cutting out the middle man (you) eliminates the chances of a mis-communication and therefore a potentially dangerous medical error.

Excellent point regularRN. This is what I have been trying to drum thru my students/ENs/carers heads - the lawyers are not gonna be impressed - and the law is not going to be forgiving in anyway - when you hear an order wrong and something goes wrong, or a patient dies. And I've read about this very thing happening in my law book - pretty scary.

[nursing assit. 2010]

I hope everything gets better really soon. Sometimes it is good to vent. I had to do that the other night. You feel better afterwards. hope all goes well. :redpinkhe

[jjjoy, LPN]

It annoys me no end when nurses get treated like s**t but to be honest, sometimes we let it happen and don't take control of our work.

Sometimes, nurses do let it happen. They mistakenly give others higher priority than themselves. However, I think many times, nurses are *expected* to be a go between. It's one thing if a particularly unassertive person lets others walk all over them. But there are MANY forces that DISCOURAGE nurses from saying "If you want it done, you'll need to do it yourself or ask someone else. I have other responsibilities." Co-workers and managers need to model, encourage and support this, and often don't.

[meandragonbrett]

While we ARE the air traffic controller of the hospital.....I don't do all of that tracking people down.

Pharmacy calls me for an order clarification? I tell the pharmacist that they need to call to get the clarification.

Respiratory gives me alert gasses? They've already called the pulmonologist and are just letting me know what the plan is.

Surgery resident wants me to call the GI service to come and consult on a patient? I give them the pager number and they can call.

I don't have time to do everybody else's communicating and I am NOT going to do it unless it's something that I really do need to handle.

[tyloo]

I would say something like, "I don't know the doctors number did you try the operator to contact him regarding YOUR question?"

[highlandlass1592, BSN, RN]

That is what I don't get. If they have time to call you and then have you call them back several times concerning the same issue because you have to clarify for the person they have had you call.....why can't they make the 5 minute call themselves and save you the 30 minutes of being the go between when you have 7 patients right there that need tending to? I have only been on this floor for a few months, so I have tried to do everything that everyone asks of me until I get the feel for how it is done there, but next time this senerio plays out I think that I will just give them the phone number. The pharacist had the gall to tell me that I am the one who has to call when I mentioned that I think that she should call the doc on this. I clarified later with the other nurses and everyone said that NO it was the pharmacy's duty to call the doc. GRRRRR

Ah yes, the phone game. I agree with the other poster. If pharmacy has a problem with an order, they can call the doc directly. Be polite, professional but most of all be firm: "you will need to speak with that doctor directly to clarify that order". If they say they want you to do it, you tell them you are unavailable as you are directing patient care. That's it..don't waffle, don't get passive.

As for docs wanting you to call other docs, that can be a bit sticky. If your hospital allows that to go on (and I"ve been at many that do), you may not have much room to change. However, you can always try. Again, be professional and state you will be unable to contact that MD due to current patient care issues. I would advise you speak with your manager/supervisor to get clarification on policy as the MD may get a bit stinky and might threaten to report you.

Honestly, my years of being a "girl Friday" for docs is over. Having said that, where I'm at currently this rarely if ever happens. When it does happen, it usually involves our surgeon having to go to the OR emergently...in those cases, I don't mind calling those consults/requests. Again, that's because it happens so rarely.

You sound as if you are new...remember, staff like to walk all over the new person. Assertiveness is your best friend..stand up for yourself. Your job is stressful enough without others expecting you to do their job too.

[carolmaccas66, BSN, RN]

You also have to remember you need to get YOUR job done. Everybody is busy in hospitals - hospitals are insanely frantic places as it is 24 hour non-stop care - but your work is just as important as theirs. If you let people walk all over you, they will dump whatever work they can into your lap, and if you accept it, well, as they say more fool you. And they will keep coming back for more!

I KNOW it's hard standing up to people, but you can do it if you just take a deep breath, really listen to the order and then make a suggestion. If they actually say 'Why can't you do this?' tell them why is it your job, and the patient load you have plus all their other care involved, then refuse. If any manager has a bone to pick with it, I'd be asking them as well why THEY also think this is your job. Also ask your NM for support when this happens.

RNs run hospitals - everyone else goes home on the weekends. Even most of the doctors go home when they are on call, or hang near the hospital. That is probably why everyone defers to us all the time. But if you do not set limits, and act and talk in an authoritative tone, no-one will get this after a while.

I'll tell you a story (oh no everyone says!) when I was a student RN, I worked as a Unit Coordinator, (amongst many other duties) coordinating elective patients and organising surgeons, anaesthetists, etc for theatre (but I was not the 'big' boss so to speak). It was the most hectic job I've done apart from nursing. Anyway, I think because some of the nurses and doctors knew I was studying for my Ba of Nsg, they used to call me up and ask re medical and nursing questions, I even had the head of anaesthetics ringing me one day to complain re some of my doctors - I said what on earth has that got to do with me? One RMO even rang and asked me what sort of anaesthetic a patient should have for certain procedures I was familiar with! Unbelievable but true. I used to say legally I can't comment re that and I'm not a doctor or nurse, you will have to call _____ on extension _____. How on earth would I know what anaesthetic a patient should have - I didn't even know the patient's history and only an anaesthetist (in the end) can decide re anaesthetics to use.

I know this is long, but the point I'm TRYING to get through everyone's heads is that whatever job you do in a hospital, you are still legally responsible, not just nurses and doctors. Imagine if I'd said yeh just put this patient down for a GA when a local could do, the nurses would be on the warpath cos that's what they would set up OT for and everyone would be annoyed, and then the anaesthetist would be hollering at me over the phone later!

You have to really think about what you are saying yes to when someone calls you, and what ur legally responsible for as well. Like I said if ur not comfortable with some of these calls, write down the gist of them and ask your NM re them later or grab ur NM when these people call all the time.

It's your license, and your patients as I keep telling my students, and no-one else will be responsible for it but you. And if you take on too much extra work, ur putting your license and patients at risk.

OK I'll shut up now cos I gotta go have some lunch! :)

[TonyaM73, ASN, RN]

Thank you all for your comments. Being new, I didn't know how things were run at this hospital and on this floor. After talking with some of the other nurses at work, they all agree with you that MD to MD consults should have nothing to do with me and Pharm to MD consults are the same. I will just chalk this one up to a learning experience and put my foot down next time. I will however clarify with my nurse manager so that she is aware and if I need to put my foot down in the future, she will stand with me. (and I have no doubt that she would, she is awsome!) Thank you all for your comments and advise. Sometimes it feels easier to make that one phone call, but after the way that it snowballed on Saturday....I will not be making that mistake again.