Communicating with Doctors on 3rd shift

ButterflyBreath · Mar 31, 2015

Oh sorry. This should be under private duty nursing

meanmaryjean, DNP, RN · Mar 31, 2015

In my PDN agency- if there's not a day nurse, the clinical supervisor or case manager takes care of this kind of stuff. NO WAY are you responsible, nor should the call-back number be your cell! That's just wrong.

TheCommuter, BSN, RN · Mar 31, 2015

Oh sorry. This should be under private duty nursing

No problem. Your thread has been moved to the Private Duty Nursing forum to attract replies from our other private duty nurses. Good luck to you.

caliotter3 · Apr 1, 2015

This has happened to me often when I work on night shift. Almost every time, I go along with the inconvenience of unpaid work during the time that I should be sleeping. I have never been paid for this extra work. Many times I have been told by supervisors that I have to follow up on things, but they never tell me that they are going to pay me. You have found the answer. Call the office early in the morning before you go to sleep and provide them with the agency supervisor's call back number. If you get jumped for doing this, remind them that you called the doctor's office on unpaid work time. It is typical for agencies to take advantage of night shift primary nurses in this manner.

Gooselady, BSN, RN · Apr 2, 2015

I've only been working PD since January, and the way orders are handled still has me confused. Mainly I'm 'confused' because I'm just not used to having someone else get my orders for me! It's like . . . my brain just won't GO that way . . .

I found some minor discrepancies between one child's neuro doc and his primary care doc, so I wrote it all out and took it into the office so I could do my first order clarification 'correctly'. The nurse supervisor just took the papers and said "Thanks!" and then had to explain to me why I didn't have to do it, she would. I work nights, too.

So not only do I not obtain my own orders, I also had better check with the parents before I get too excited. So many middle men in between me and the orders. The home environment is a whole different ball game, and I see how it works fine this way.

But if someone in the office messes up the whole MAR goes sliding into wrongland. Our office has . . . some difficulty keeping nurse managers. I handed off 'resume' orders and new med orders to the clinical manager to take to the office on what was apparently her last day. They never saw them. Come to find an order for an OTC bedtime medication to titrate upward was on those orders she carried off, and two months later, the doctor writes orders for 3x the current order, which baffled us.

The mom was very upset, the nurse who works on my nights off threw the mother under the bus, and wrote me a nasty note (which the mother confiscated lol, rats, that could have been interesting!) and the office called me three or four times during the DAY while I was asleep to, I assume, continue the drama.

Heck, in the hospital, I'd only have myself to blame (or maybe the doctor . . . ) but in private duty, we have two or three middle men between us and our orders. A lot more potential for calamity or at least the Telephone Game.

caliotter3 · Apr 2, 2015

I've only been working PD since January, and the way orders are handled still has me confused. Mainly I'm 'confused' because I'm just not used to having someone else get my orders for me! It's like . . . my brain just won't GO that way . . .
I found some minor discrepancies between one child's neuro doc and his primary care doc, so I wrote it all out and took it into the office so I could do my first order clarification 'correctly'. The nurse supervisor just took the papers and said "Thanks!" and then had to explain to me why I didn't have to do it, she would. I work nights, too.
So not only do I not obtain my own orders, I also had better check with the parents before I get too excited. So many middle men in between me and the orders. The home environment is a whole different ball game, and I see how it works fine this way.
But if someone in the office messes up the whole MAR goes sliding into wrongland. Our office has . . . some difficulty keeping nurse managers. I handed off 'resume' orders and new med orders to the clinical manager to take to the office on what was apparently her last day. They never saw them. Come to find an order for an OTC bedtime medication to titrate upward was on those orders she carried off, and two months later, the doctor writes orders for 3x the current order, which baffled us.
The mom was very upset, the nurse who works on my nights off threw the mother under the bus, and wrote me a nasty note (which the mother confiscated lol, rats, that could have been interesting!) and the office called me three or four times during the DAY while I was asleep to, I assume, continue the drama.
Heck, in the hospital, I'd only have myself to blame (or maybe the doctor . . . ) but in private duty, we have two or three middle men between us and our orders. A lot more potential for calamity or at least the Telephone Game.

Carve this post in bronze, silver, gold, or platinum and mount it on a plaque and you will have one reason why extended care home health can be so frustrating. It is pretty bad when orders and other documentation disappears into the ozone so often when submitted to the office that the DPCS complains to the external employee about how the internal employees aren't doing their job. I hesitate to say, but yes, they are doing their jobs. Their job is to make certain that their work disappears.

brillohead, ADN, RN · Apr 4, 2015

Order clarifications all go through my agency office, unless it's an urgent/immediate need that I have to do over the phone in the middle of the night.

If I fax something in to the doc's office myself, all the followup goes through the agency (which also gets a copy of what I sent to the doc's office) -- but mainly I just send stuff to the agency and it's their responsibility to follow up on everything / make sure the doc signs off on something / incorporate it into the 485/Plan of Care.

If I do get phone orders in the middle of the night directly from the doctor, I write it up as a phone order and send it to my office for them to get the doc to sign it. We have specific forms with carbonless copies explicitly for this purpose -- we write up the order and leave a copy in the field chart, the original and another copy goes to the office for them to send the original to the doc's office with the copy to remain at the office for them to ensure that they receive the original back -- when the signed copy is received back in the office, the unsigned "pending" copy is shredded and the new order is put in the office chart with a copy sent for the home chart (the old unsigned copy is removed at that time) and later incorporated into the updated 485/PoC. Those "pending" orders are checked on a regular basis in the office so they can follow up if they don't get the signed copy back.

Sounds like I'm lucky to work for an agency that has a procedure in place for circumstances like these. IMO, even if we're the "primary" nurse on a case, it's still not our responsibility to be communicating with doctors if we're not actively on-duty with the patient. That's what the office nurse's job is all about -- coordinating care with the other members of the healthcare team, keeping the chart/485/PoC updated, etc.

smartnurse1982 · Apr 4, 2015

My agencies also follow up for me if i need clarification,as i work nights only.

What type of clinical nursing manager would say its your job to follow up?

Does your clinical Rn manager for this case have a supervisor?

My agency has 1 nursing supervisor who manages the clinical Rn managers.

caliotter3 · Apr 4, 2015

People like to pass the buck and change the "rules" depending upon their 'reasoning' for their current gripe, up to and including the DPCS, in some circumstances. I sometimes find this to be quite demeaning in my case since I am known for taking care of things even when it wasn't my responsibility to begin with. It seems they never want to talk to the people that need to be talked to when it is time for constructive criticism.

Nibbles1 · Apr 4, 2015

One time and one time ONLY did I take a verbal order from a parent who had spoken to the doctor. The order i took from the mother was so jacked up and wrong. The kiddos surgery had to be postponed for a week. The doctor wanted certain meds to be held prior to the surgery. I got wrote up over it. I will gladly take a phone call when I am sleeping from a doctor. Yes i also work graveyard. Now, yesterday the mother got new orders from the doctor. I made the call to the doctors office. It's closed because of Good Friday. I will let the mother handle the new orders until i can get them verified by the doctor. But like I said I will not EVER take orders from a parent again.

caliotter3 · Apr 7, 2015

You have to use your knowledge of the parent's credibility when you take an order from them. That was the rule with the agencies that allowed this policy. Dingbat parent, no. Speak to the doctor.