Charge nurse hears me but doesn't listen

Daisy4RN · Aug 17, 2019

I would just bypass the Charge and call the MD directly with your concerns. Why are you even asking the Charge if you have 8 yrs experience and already know what s/he will say. Call MD, see what they say, if they say just watch and you think they need RRT, explain to MD why you feel that way and they will probably agree, then call RRT. I would not involve the manager unless more is going on here than you state.

Sour Lemon · Aug 17, 2019

I usually agree with the charge's suggestions, but on the occasions that I do not, I bypass her and call the MD.
I do try to be diplomatic about it. I might say the patient starting looking worse than she did earlier (when we looked at her together) ...or something similar to that.

JBMmom, MSN, NP · Aug 17, 2019

Our charge is not the gatekeeper to the docs, every nurse can call independently. We usually just consult charge to consolidate MD calls, and let them know about changes for report/assignment. I don't think you should be dissuaded from calling when you think it's appropriate. If someone else thinks you've overstepped and called unnecessarily, you'll find out.

Snatchedwig, BSN, CNA, LPN, RN · Aug 19, 2019

My license is mine only and not shared with someone with a billion years of experience. I wouldn't hesitate to call directly. That and if shxx hits the fan, whose going to the board?? Surely not Ms. Billion years of experience. You are.

Serhilda, ADN, RN · Aug 19, 2019

I wouldn't work somewhere that required me to have the approval of the charge nurse before calling a doctor. If she turns down a necessary page, the BON doesn't care if you told your charge. The physician was "deprived of the opportunity to respond" and that would be on you.

JKL33 · Aug 19, 2019

On 8/17/2019 at 1:22 PM, painmeds said:
How do you deal with your charge nurse who tells you to “watch the patient” when you should be speaking with the doctor to report changes?

Since the charge nurse is not the medical team responsible for the patient, I wouldn't know (care) what the charge nurse thinks.

There is a big difference between having a charge nurse who is able to consult with newer nurses or provide additional nursing expertise to help them assess/care for their patient, and a situation where all staff nurses are supposed to have some kind of unofficial charge nurse permission to call a physician. The latter is unacceptable.

15 minutes ago, Serhilda said:
I wouldn't work somewhere that required me to have the approval of the charge nurse before calling a doctor.

Period.

JKL33 · Aug 19, 2019

On 8/17/2019 at 1:22 PM, painmeds said:
I need some advice on how to approach this. I don't think she is real receptive to anything I have to say because she's got more experience than I do. And that ego is out of control. Should I tell my manager?

To answer your actual question, the way to approach it is to learn pleasant assertiveness.

You are part of the underlying problem if you are an RN who knows or feels strongly that you need to communicate with the medical team about something but then instead of taking care of the patient gets involved in trying to plead your case to a peer.

Simply make the call the next time something arises where you know you need to contact the medical team. Take care of your patient. In general, keep your charge nurse in the loop...like this: "A little update: [Rm 84] has been [having x, y, z, difficulty]. I contacted [Dr. So-and-so] and we're going to [do whatever intervention or keep watching]. I'll keep you posted."

Alternatively, you could give the update beforehand: "I'm going to be contacting Dr. So-and-So....." If s/he argues or tells you some other plan, just say something like, "I hear what you're saying but I'm going to call anyway. If they don't think my call is appropriate I'm sure they will let me know."

Note: During these interactions, you're not pulling up a chair or standing there passively waiting to get bogged down by the CN's objections; approach with your "I'm-busy-but-wanted-to-keep-you-in-the-loop" demeanor...give your update succinctly and get back to your patient.

allnurses Guide · Aug 19, 2019

I know in my facility noc nurses will go out of their way to not call physicians at night. Of course I work Psych so that's a horse of a different color. Still when I worked Med/Surg I never had to check with the charge nurse before I called the Physician and I had way less than 8 years experience.

Unless there is a specific policy that you must notify the charge before calling the physician or you have a history of jumping the gun on non-emergency/non-urgent matters, go with your gut.

Hppy

hawaiicarl, BSN, RN · Aug 19, 2019

We joke about this all the time in ICU. Admitting a patient on room air with a heplock to ICU, when I question the NOC, he says I want you to "watch the patient". Pt has uncontrolled SVT in the 180s, call the NOC what does he say? "Watch the pt" ….. Even though we joke about it all the time, I make sure we call the NOC, and then document "physician aware" even though in my heart I know when we call we will get the same answer "watch the pt". I want to make a watch the pt meme with like some 80s rap background music "wu-wu-wu-wu-watch the pt" is sort of catchy when I think about it. Then the backup singers could do the nurse part "covvvvverrrrr your asssssss".

Cheers

Snatchedwig, BSN, CNA, LPN, RN · Aug 19, 2019

8 hours ago, JKL33 said:
To answer your actual question, the way to approach it is to learn pleasant assertiveness.
You are part of the underlying problem if you are an RN who knows or feels strongly that you need to communicate with the medical team about something but then instead of taking care of the patient gets involved in trying to plead your case to a peer.
Simply make the call the next time something arises where you know you need to contact the medical team. Take care of your patient. In general, keep your charge nurse in the loop...like this: "A little update: [Rm 84] has been [having x, y, z, difficulty]. I contacted [Dr. So-and-so] and we're going to [do whatever intervention or keep watching]. I'll keep you posted."
Alternatively, you could give the update beforehand: "I'm going to be contacting Dr. So-and-So....." If s/he argues or tells you some other plan, just say something like, "I hear what you're saying but I'm going to call anyway. If they don't think my call is appropriate I'm sure they will let me know."
Note: During these interactions, you're not pulling up a chair or standing there passively waiting to get bogged down by the CN's objections; approach with your "I'm-busy-but-wanted-to-keep-you-in-the-loop" demeanor...give your update succinctly and get back to your patient.

Yes!

NurseSpeedy, ADN, LPN, RN · Aug 20, 2019

On 8/17/2019 at 1:22 PM, painmeds said:
How do you deal with your charge nurse who tells you to “watch the patient” when you should be speaking with the doctor to report changes?
My charge has more experience than I (me 8 years, her 20+) . But I believe she has forgotten that a part of our jobs is to monitor and report changes in patients. I know some issues could wait until morning/next shift, but some should be addressed, immediately. The oncoming nurses ask me, "why didn't you call the MD or does the MD know?" I've also posted situations here in the past and the census was to RRT the patient or call the MD.
I need some advice on how to approach this. I don't think she is real receptive to anything I have to say because she's got more experience than I do. And that ego is out of control. Should I tell my manager? She's new and seems to be receptive to discussion. Though I know when I DO NEED HELP, she'll hang me out to dry if I bring this to my managers attention.

You are assigned to the patient-you do what you need to do-never mind Ms. I Got 20 Years Experience (and don’t want to be bothered with an emergency) Charge Nurse. As a courtesy I would let her know what I am about to do so she is not blind sighted, but if she thinks the patient ‘should just be monitored’, well, then maybe she should be the nurse assigned to that patient-because I think she’s more likely to react when it’s put directly on her.

I had one a few years back that I HATED working with. She wanted to know everything that was going on with everyone-and then she would just tell you to delegate it to so and so. Um, no. I’m calling you to tell you I am calling a rapid on this patient that was just dropped off on the floor unstable from the ER and doesn’t match a single thing from the faxed report/chart/...and what the hell is this medication free flowing from the IV line-oops, IV site wasn’t even still in patient-guess they medicated the stretcher with whatever it was at some point....You want more info, come joint the fun in room ****.

If it’s my patient and I think the doc or more needs to be notified. I am doing so. As a curtesy, I am keeping charge informed of what I’m doing because I am the one assigned to the patient.