Is this common with nurses and doctors?

[usetimewisely]

Ok, so I've been with my current employer now for a while. There is still lots for me to learn, but I'm really trying to hold my weight even though I've been working for less than a year. I think I'm doing ok, but one thing I have noticed: when I collect info and call to update a doctor about a patient, and expect some intervention, the general answer is "what do you want?"

I don't always have an answer for this. Sometimes I'll ask for things that may point me in a better direction with what's going on with the patient. An ABG, or an EKG, for example. But there are times when I don't know what to do/expect/anticipate. But more times than not, I'll get whatever order I ask for.

For example, a patient whose lung sounds have changed, have increased respiratory effort, becoming confused, I would call to report. More crackles were noted, no change in maintenance fluid rate, and blood pressure steadily climbing up. So in my call, I explain lasix helped them on the previous shift, maybe she needs more. The answer..."ok, sure." Then they give me specifics for the order. About 30 minutes later, respiratory comes to get an ABG (because they suggested it) and it was all outta whack. I felt I had asked for the wrong order.

Different day, different patient. Bit of blood loss from somewhere in the gi tract. Heart rate suddenly goes up and stays around 130s. So I look at full set if vitals, fluids running, and last H and H (over 12 hours ago). Inform the GI MD, and ask if maybe the pt needs fluids (he only had a protonix drip), or to get another CBC. He orders fluids thinking the pt is depleted. 2 hours go by, and the admitting MD asks why his heart rate is 120's to130's. Informed him that last MD started fluids to correct this, and it's now trending down. Since he was already scheduled CBC in am, he didn't want another. Well, he ordered one to be done anyway, so I called lab. It had dropped....not quire low enough to infuse yet, so I report this....to now a THIRD MD. He seems to not. Be worried about this..."we'll just watch it for now." Morning lab H and H was loooooow! And guess which doctor asked about it...the one who ordered the CBC. So, again, I was left feeling like I should have pushed harder the first time I asked for it, or pushed harder to infuse when the initial drop was noted.

Anyway, what I'm tryna say is I feel like I'm a good advocate until I see I've asked for the wrong thing. Then i feel bad, and a little peeved that i find myself in this position. I still feel that my job is to paint the picture for them, and THEY decide what should be done for the patient. But being an advocate kinda blurs the lines for me in that regard. Sometimes, I can't tell what is best to be ordered. Shoot, I'm still new!! But sometimes the impression I'm left to deal from the doctors is...."well, what do you want me to do about that?" *sigh*

Where do you draw the line? Is this just because I'm new?

[BostonFNP, APRN]

I thought I would post from experience on the other side of the phone:

I appreciate getting a call/update from the attending RN for a patient, and I respect the fact they have had eyes and ears on that patient, and have normally spent a good deal of time with that patient. If a provider is asking what you want it is a sign of that respect.

I can say a few things:

1. It's absolutely ok to say you aren't sure what needs to be done!

2. It is always the providers call: they have the responsibility to decide if the order is appropriate or not and make it, the blame doesn't fall on your shoulders. You are doing your best for the patient with the information you have.

3. Occasionally you will have a provider say no to your request and that is absolutely ok as well. I hope most good providers would say "why don't we do this instead"...

4. Sometimes it is just a professional courtesy, which sounds strange to say, but I mention it because a few weeks ago during rounds I was planning on discharging a patient and I said to the patient in front of the attending RN that "we will get you out of here today as long as (insert name here) gives me the final ok"; she got very flustered and asked to speak outside where she told me she wasn't able to make that decision and I needed to make it. I then was stuck trying to explain I was really just asking her out of courtesy and was going to discharge him regardless unless there was some major problem.

[usetimewisely]

I thought I would post from experience on the other side of the phone:

I appreciate getting a call/update from the attending RN for a patient, and I respect the fact they have had eyes and ears on that patient, and have normally spent a good deal of time with that patient. If a provider is asking what you want it is a sign of that respect.

I can say a few things:

1. It's absolutely ok to say you aren't sure what needs to be done!

2. It is always the providers call: they have the responsibility to decide if the order is appropriate or not and make it, the blame doesn't fall on your shoulders. You are doing your best for the patient with the information you have.

3. Occasionally you will have a provider say no to your request and that is absolutely ok as well. I hope most good providers would say "why don't we do this instead"...

4. Sometimes it is just a professional courtesy, which sounds strange to say, but I mention it because a few weeks ago during rounds I was planning on discharging a patient and I said to the patient in front of the attending RN that "we will get you out of here today as long as (insert name here) gives me the final ok"; she got very flustered and asked to speak outside where she told me she wasn't able to make that decision and I needed to make it. I then was stuck trying to explain I was really just asking her out of courtesy and was going to discharge him regardless unless there was some major problem.

This does give a different perspective. I hadn't considered that they could possibly be respecting my input. That's actually kinda nice. I can think of a few right of the top of my head that always say thank you when I call them, after my (sometimes lengthy) report. Makes sense.

[ICURN3020]

I agree with BostonFNP.....I have found that many physicians, after getting to know you and learning that they can trust your assessments/judgement, truly do respect your input and take that into consideration when giving orders.

Recently, I had a patient who was extubated earlier that day and (I work nights) it was pretty obvious by about 8pm that he was struggling and would likely need reintubated at some point in the near future. Instead of waiting until the middle of the night and the situation became emergent, I called the pulmonologist and notified him of the patient's condition. He asked me what I thought (as far as needing to reintubate) and I told him that I felt that if we didn't intervene now, I would most surely be calling him back later that night/early morning.

My orders: Reintubate!

It made me feel good that this physician trusted my judgement and we avoided an emergent situation later on.

[misstrinad]

When I call a Dr I always think ahead and along with my notes of what I plan to tell them I jot down what I might want from the Dr. I had a Dr ask once "what do you want me to do" and I was new and not prepared for that question. I stated "honestly I am a new nurse and I'm not 100% sure what the correct course of action should be...I was thinking at least we should get some labs"

I remember another time being asked and I wasn't sure what should be done even though I had thought about it ahead of time so I simply stated

"im not really sure where to go from here as I have not encountered this issue before, what would you like me to do right now?"

I always appreciate when the Dr or np asks my opinion.