Communicating with Doctors

[Stephrnpitt]

I have been having an issue communicating with doctors at my inner city community hospital MICU, that is also a teaching hospital. With our patient population, I am just getting over how patients expect me to care about them when most do not seem to care about themselves. My issue now if with the interns and residents. They talk to staff like they don't know anything and feel like RNs are 'playing doctor' when they question the MDs plan of care. How do I improve my communication skills (I get easily frustrated with them and their lack of action for critical issues and over reaction for noncritical pts)? How can I express myself more clearly and not get as frustrated? I really am at a loss and am really not enjoying being a nurse as much anymore. Thanks in advance.

[mariebailey, MSN, RN]

There is an ANA CNE called Nurse-Physician Workplace Collaboration you may like. I read the article, & here are some tips I got from it re: communicating with physicians:

-Be confident & assertive while remaining flexible & open-minded.

-Be concise in your communication, sticking to pertinent details only.

-Striving for dominance can be counter-productive; recognize the chain of command.

-Demonstrate emotional maturity.

-Disagree respectfully.

http://ananursece.healthstream.com/default.aspx

[KZincus]

You might want to read "The First Year: Conversations with a New ICU Nurse" by Kay Zincus (at Amazon.com). Has some descriptions about how a new RN handled some of the communications issues you're talking about.

[Esme12, ASN, BSN, RN]

Remind the interns and residents they are still students.

I have found that this is a cultural thing that varies from facility to facility. I have worked at teaching facilities that this is NOT allowed and the attendings make sure that the residents and interns behave themselves. I have worked at teaching facilities that this is propagated by the by the medical staff.

If I had a dime for every time a MD has asked me where did I get my medical degree I'd make Warren Buffet look like a pauper.

mariebailey is right

-Be confident & assertive while remaining flexible & open-minded.

-Be concise in your communication, sticking to pertinent details only.

-Striving for dominance can be counter-productive; recognize the chain of command.

-Demonstrate emotional maturity.

-Disagree respectfully.

and I add..... consider the source.

A very smart nurse once told me a story. She said that she responds to that question with.....

"Harvard. I went to medical school at Harvard..... but I decided to further my medical career so I went on to be a nurse." Laura Gasparis Vonfriolio.

[Chisca, RN]

Do you have shared rounds? If not, why not? I have rarely found any attending that didn't respect me and my opinion when I was on solid ground and had all my facts correct. If you present a situation in which you are trying to do what's best for a patient and some dumb intern or resident is hindering you I can't imagine the attending wouldn't ream them a new !@#*&. That's been my experience.

[Good Morning, Gil]

Yep, things you mention are things any nurse has experienced at one time or another. Don't know what to tell you. You just can't get frustrated with them, can't show it, even if you are. If you're trying to convince them to do something, be concise, but give them the necessary information, and then your suggestion. If they agree, great. If they decide to do nothing, and something needs to be done, then you have to go above their head (I'm talking critical situations here). Just ask who their attending is in that case. You really shouldn't have to do that too often, though; I haven't had to do that yet. I just bother them until I get what the patient needs if I keep getting small order after small order.

Usually, though, I don't have a problem. I ask for what I want, and they say, "sounds good." I ask for levophed, I get the order. I ask for a palliative care consult, I get it. I work with good residents, though.

It's part of working at a teaching hospital. Culture may vary among hospitals, but new physicians are still new physicians and not all are created equal, some more competent than others. And, brand new interns, I really do feel for them.

[Good Morning, Gil]

Oh, and what you're describing is also the impetus for many nurses to go onto advanced practice. Just something to consider :).

[Chisca, RN]

I've witnessed an attending dress down a surgical resident at the nursing station because he refused to listen to a nurse who was concerned about swelling in a patient's arm after PICC placement. The resident kept insisting the line was fine and to use it. I quote: " If you EVER refuse to listen to this nurse again I will personally see you out of the program". I knew he was making an example out of him and we never had a problem again. Interns and residents come and go but attendings are a nurses best friend.

[Creamsoda, ASN, RN]

"Be confident & assertive while remaining flexible & open-minded."

I often word things like, " Hey doc, labs are this, bla bla, vitals are this bla bla, would you like to try this or just watch/monitor for now? Your still asking for what you want yet keep it open and not "demanding" anything. although there are times where you do have to assertively demand

[Saylind]

I have not had to go over their heads before but some of my co-workers have and we usually get what we need. We have good residents too, but sometimes they don't see the problem at hand.