Ever had a doc call the charge nurse on you? As in, call the unit and ask for the charge nurse and complain about you to him/her, without saying anything to you first.
Happened to me this morning and I'm still frustrated and can't sleep. And happened right at change of shift, so the doc ended up speaking to the day shift charge nurse who had no idea what had gone on the previous night. I called him 3 times during the night... once around 2, once around 4, and then once between 7:15-7:30. The first 2 calls- I NEEDED to talk with him. OK the third, now I know maybe I didn't... but still think I did and the day shift nurse receiving the pts I was calling about, did too.
He stated when he calls, that he feels like I'm trying to get something from him but he doesn't know what. And that I don't have my assessment ready for him when I call. ??? Each time I told him the pt's vital signs. The first time it was a b/p that had to be reported per orders. The second time, I needed an order for nausea medicine for a pt who threw up twice, quite a bit each time, within
Maybe it's my communication skills... do you think I should practice calling doctors, like roleplay or something, with someone? That sounds kind of silly. I do try to have things written out maybe that would help. He also told her to have me talk w/the charge nurse first before calling, and I did talk w/my charge nurse at length before those first two calls- this pt I talked with her about through the night b/c was just making me nervous and not right. Maybe I talked too fast? I tend to do that when I'm nervous and this doc makes me nervous. Maybe I gave too much information each time, should have been more specific. Though this pt did have a wide range of concerns through the night.
Sorry to be long winded. This seems like what I do most of the time now. I am irritated at him going over my head, along with putting the day shift charge nurse stuck in the middle, but also want to improve for the future so this doesn't happen again. Does anyone have any advice?
Specializes in ICU/CCU, Home Health/Hospice, Cath Lab,.
One thing our hospital has is a medical response team (if you have a clincial practice meeting that you can suggest this at might be a way of starting it). What happens is if the pt meets a list of certain requirements - unusual hypotensive, spike temp, increased RR, new cp, or (this is the best one) the nurse is concerned - a clincial nurse specialist (icu trained) and respiratory therapist show up. We can order most labs, start different tx, and transfer the pt to ccu if necessary. Mosthospitals that have implemented a structure like this have seen a decrease in codes due to the use of this resource.
AS for the doctor talking to your charge, just remember your clinical judgement was correct - something was wrong with the patient. Hopefully the doctor will remember that next time you call with a concern (yeah right, who am I kidding?)
It sounds like you did the right thing, especially knowing the pt went to the ICU. It can be really difficult to learn how to communicate with MDs, especially over the phone or with docs you don't work with all the time. You can try to SBAR technique. I personally don't use it with my docs bc I work ER and we all get along pretty well, but have used it with floor docs when I have campers, and it works like a charm.
S: situation; Hi Dr S, this is Nancy Nurse from 5b. Your pt, Susie X has developed a fever of 103*
B: background; She was admitted yesterday evening for abd pain, hx of UTIs, MI, and PE; no allergies.
A: assessment; Current VS are xxxxx. She c/o feeling nauseated, her skin is flushed.
R: recommendations; May I have an order for Tylenol and Zofran please? Would you like me to draw cultures and a UA?
I like the R part best - it lets me tell the doc what I want, and gives him a chance to think of other things. Plus, if you're calling and waking him up at night, it gives all the pertinent info and lets you be the hero (by not making him remember pt x and by giving him an out with possible interventions).
This is actually the way we're supposed to be reporting off to everyone now (transport, xray, CT, etc) per joint commission; but I like it for MD communication too.
You did the right thing; the doc probably was just ticked that he was called multiple times....not like you can schedule when ppl crash :)
Jahra's story reminded me of a certain ortho MD we have at our hospital....he is so difficult to work with! I had a trauma one day who had numerous ortho injuries, and he was in consulting for the trauma doc. I had a full pod (3 pts in rooms plus one in the hallway) and he comes barrelling out of the room waving his arms and yelling that I hadn't consented him for surgery (how do you consent someone who's intubated and sedated and family isn't there), hadn't gotten the EKG (I had, he just hadn't looked in the right place), didn't have him in hare traction (again, yes....how do you miss that thing?), and why isn't he ready to go to the OR (it literally takes me 5 minutes to get a pt ready to go to the OR, even when intubated....pt would have been in the room before he was done scrubbing!) I tried to calmly explain all of the above, but he kept going off and saying that I was "incompetent." Really didn't sit well with me. I told him I had to get the pt packed up, and I had 3 other pts to care for, told him the above comment was inappropriate and directed him to my charge. He still had not nice words to say now that I've stood up to him.
BUT the funniest part is that later that evening, my hallway pt needed an ortho consult, and (since that ortho doc was on call) we gave her his referral card. She looked at it, looked at me, and said "isn't this the @sshole who was completely out of bounds and inappropriate with you earlier?" I couldn't help it, just started to laugh!!! I got her another referral.
Next time you call him, use the script that an earlier poster suggested. I would be a little careful about suggesting or asking for a specific med until you know the MD better. There are some MDs I can call and ask for a specfic med no problem and others that will go out of their way to do anything but what I have suggested or asked for - just to prove something.
For docs that are turds, I have been know to notify them of absolutely everything that they 'order' - ie notify if BP under 100/60, and pt. normally healthy with lowish BP (I'm a labor nurse, so most pts are pretty healthy) - pt sound asleep with a BP of 99/58 - "Hi Dr TurdBurd, this is Heather calling from the BC. I'm so sorry to wake you up for this, but Mary Marathon-Runner's BP is 99/58. She's got an epidural and is sound asleep, baby looks great. I hate to call, but you have standing orders that say I have to notify you." Once they get to know me and know that I am a pretty good nurse with good assessment skills and judgement, they back off and quit being turds.
Action (Calling the Doc) and Proper Documentation of that Action is your defense against Malpractice and anyone in general complaining about your abilities as an RN. You were advocating yfor your patient with deteriorating conditions. This is what an RN is suppose to do.
BUT the funniest part is that later that evening, my hallway pt needed an ortho consult, and (since that ortho doc was on call) we gave her his referral card. She looked at it, looked at me, and said "isn't this the @sshole who was completely out of bounds and inappropriate with you earlier?" I couldn't help it, just started to laugh!!! I got her another referral.
Those hallway pts pick up everything :)
Bless their little hearts those hallway pts., and they tell
others "I loved my nurse, but there was this Doctor"...........................
This is why being respectful and elegant pays off..............
A tip of my nursing cap to you NurseErica!!!!!!!!!!!:balloons::balloons:
Your stories are both hilarious!!!! I can just picture a patient doing that... hahaha.
And I know the thread is going a different direction now... but just wanted to let ya know I just got to vent about the whole stinking mess at work, over the phone with my college roommate and best friend. She was wonderfully sympathetic and wonderfully mad at the doctor as well. So, that helped. And convinced me more that maybe her getting so very sick, was not my fault. Just as you all had done :) Thanks.
Next time you call him, use the script that an earlier poster suggested. I would be a little careful about suggesting or asking for a specific med until you know the MD better. There are some MDs I can call and ask for a specfic med no problem and others that will go out of their way to do anything but what I have suggested or asked for - just to prove something.
For docs that are turds, I have been know to notify them of absolutely everything that they 'order' - ie notify if BP under 100/60, and pt. normally healthy with lowish BP (I'm a labor nurse, so most pts are pretty healthy) - pt sound asleep with a BP of 99/58 - "Hi Dr TurdBurd, this is Heather calling from the BC. I'm so sorry to wake you up for this, but Mary Marathon-Runner's BP is 99/58. She's got an epidural and is sound asleep, baby looks great. I hate to call, but you have standing orders that say I have to notify you." Once they get to know me and know that I am a pretty good nurse with good assessment skills and judgement, they back off and quit being turds.
haha... yeah... i think of doing that kinda thing but haven't yet. Right now I'm just hoping this doctor's not on call again any time soon...
I think sometimes, especially at night when you get whoever is just covering, the dr. (especially residents) want you just to tell them what you want, like you tell what is wrong and say "do you want to get blood cx" or do you "want to give the compazine". But I think you did the right thing, if you hadn't have called if your patient coded then they would have been saying why didn't you call. I know what you mean about being nervous, but you did good, and you should be commended on calling back even after you had called before and this doc was kinda rude. Cause when it all comes down your first priority is your pts well being. Also you have to follow policy cause if it comes to it, you following protocol could be what saves your job, or your license.
Lots of good ideas here, bottom line is...you are there for the patient! Sounds like you did what you should have. Don't second guess yourself. If it is only one doctor that you are having the problem with, you can also have your charge nurse or the supervisor right there with you when you call. Make sure everything is documented. You have to protect the patient and your license! Personally, if these docs don't like being called at night...should have went into dermatology or something!! LOL:smackingf
I need it!!!
to wake you up for this, but Mary Marathon-Runner's BP is 99/58. She's got an epidural and is sound asleep, baby looks great. I hate to call, but you have standing orders that say I have to notify you." Once they get to know me and know that I am a pretty good nurse with good assessment skills and judgement, they back off and quit being turds. 
patwil73
261 Posts
One thing our hospital has is a medical response team (if you have a clincial practice meeting that you can suggest this at might be a way of starting it). What happens is if the pt meets a list of certain requirements - unusual hypotensive, spike temp, increased RR, new cp, or (this is the best one) the nurse is concerned - a clincial nurse specialist (icu trained) and respiratory therapist show up. We can order most labs, start different tx, and transfer the pt to ccu if necessary. Mosthospitals that have implemented a structure like this have seen a decrease in codes due to the use of this resource.
AS for the doctor talking to your charge, just remember your clinical judgement was correct - something was wrong with the patient. Hopefully the doctor will remember that next time you call with a concern (yeah right, who am I kidding?)
Pat