Communication Chaos!

It was my second night as charge nurse for the evening shift on the oncology unit in the hospital where I worked. There were three major problems: one, I was charge nurse on the oncology unit; two, it was the evening shift; and three, I had no oncology experience. Nurses Announcements Archive Article

Communication Chaos!

I had been assured by my colleagues who had recruited me to the unit as well as the head nurse on our unit that the fact that I had no oncology experience and that I was not chemotherapy certified were only minor issues...unless I had the unfortunate opportunity of coming into contact with one of two primary oncologists who had reputations for being extremely demanding to the point of being able to throw some fairly impressive fits when they wanted something. These 'fits' were generally a result of them wanting their patients to have the best care, but also because they were 'typical' oncologists and wanted what they wanted when they wanted, where they wanted. I was reassured that it was extremely unlikely that either of these physicians would be causing me any issues on the evening shift because they rounded early in the mornings and again in the afternoon. My head nurse further reassured me that she had spoken with both physicians to let them know I was coming on board and that while I was not yet chemo certified, we had our IV therapy team that could provide the chemo until I was up and running. With all of these words of encouragement and phone numbers for every single person I knew (both home and beepers...I'm dating myself!), I felt like I was armed with enough knowledge and tools to handle whatever situation might arise in these first few evenings of uncertainty.

While I had never met either oncologist that I was incessantly being warned about, I was certain that between my nursing courses and minor in psychology with my English degree, that I could no doubt handle whatever issues might come my way. Until that second night.

Life had been going so well. Things were flowing smoothly. Then our unit secretary called me to the nurse's station to take a call from Dr. B (one of the notorious oncologists). As I approached the nurse's station, the unit secretary grabbed my hand before I could pick up the phone. Her words cut through me like a knife "he's admitting a patient to the floor. Tonight. And she needs chemotherapy." This wasn't supposed to happen--I didn't want to do this--I was just kidding when I said I would--I want my Momma!! Wait a minute. I could do this. Even if there was no empty bed on the floor.

I picked up the phone and in my sweet, naive voice, said, "Good evening, Dr. B, how can I help you?" At that moment my brain went into one of those modes where it's trying to process something that's being thrown at it but it just can't process it and it can't figure out why until it hits you that perhaps someone neglected to tell you that one of those oncologists that demands perfection is from Pakistan and might have a thick Pakistani accent which might make it extremely difficult for you to understand over the phone especially if he's barking orders one after the other at you. Breathe!

Oops! The physician had just rattled off a list of orders that I had not even begun to understand (although I was writing furiously). With every ounce of courage in my body, I finally said, "Excuse me, Dr. B. Could you please repeat what you just said?" Again the physician began to rattle off the admission and chemotherapy orders (which I had no clue about, although he would never know it!!). Still, I couldn't understand him. I was trying. And praying...hard, extremely hard. But it wasn't happening to me. Again I stopped the physician in mid-sentence, "Dr. B, I am so very sorry. Could you please repeat what you just said?" My brain was trying so hard to process the orders being thrown at me like darts through the phone. I contemplated either handing the phone to the unit secretary or just hanging up and leaving the unit--it was obvious my career here was over, but then I realized I couldn't do either. One more time I squeaked, "I am so sorry, Dr. B. I just do not understand what it is you are saying to me. I cannot tell you how sorry I am." Then it happened. Without warning, Dr. B began speaking loudly and so fast that I could only understand about every third word he said. Unfortunately this time, I did understand, "I can't believe you cannot understand what I'm saying! I don't know why you cannot understand me, no one else has a problem understanding me..." He continued. For an eternity. In a time that would have put an Olympic trial to shame, my ego had been deflated, my feelings had been annihilated and I had most certainly lost my job. I stood with the phone in my hand but away from the ear, although not far enough from my ear that I couldn't hear the laughter that began permeating through the phone line. There was a language I could understand! I put the phone to my ear in time for Dr. B to say, "It's ok. You'll learn how to understand me in time. But don't think I'll let you off the hook for very long!" At that point, he began to slowly repeat the orders to me. We then discussed the fact that I didn't have any empty beds on the unit, but I assured him I would work that out, even if I had to single-handedly build a room on myself!

A couple of hours later Dr. B appeared on the floor to see the patient we had discussed...she was in her room, her IV accessed and her chemotherapy being administered by the IV therapist (I'm still paying all off all those people who helped make that happen, and it's been 20 years ago!). Dr. B and I had a great talk that was the beginning of a long, strong relationship. He was right, it didn't take long at all for me to learn to understand him and what he wanted for his patients. And I delivered every time!

19 year(s) of experience in Hospice. Also, home health and oncology. I am currently working on my legal nurse consulting cert and have just re-entered school to work on my DNP.

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