Doctors not talking to nurses

[AlphaPig]

Where I work, doctors never speak to the nurses unless A. the nurse calls/physically hunts them down or B. the MD has a verbal order and doesn't feel like logging onto a computer.

I was just thinking yesterday, as I kept missing the doctors as they came to see the patients (at least I assumed they saw the patients because hours later I would see progress notes pop up), that there are probably not many other jobs where different people working on the same "project/goal" (getting the patient better/discharged) never actually speak to each other about "project".

There are a few doctors who come to me and ask about the patient and verbalize their plan and ask me what I think and I share my nursing opinion and we have a nice discussion (maybe 5 MINUTES LONG) and the patient care is better for it.

I just don't get it. A 5 minute conversation would also minimize later phone calls/issues/missed things. . .

Are nurses that awful to speak to??

ALSO, my biggest pet peeve is when the MD writes "discussed with RN" in his progress notes when he/she NEVER SAID A WORD TO ME. That happened 3 times yesterday with 3 different physicians.

Sigh.

[emtb2rn, BSN, RN, EMT-B]

Not that way where I work. Sounds like a miserable environment. Can you leave?

[AlphaPig]

I think that most of the doctors where I work are pretty unhappy - my hospital has been making a lot of changes and some of the MDs I am friendly with have told me things that make me feel bad for them. Many have been leaving.

I just wish there was more. . .teamwork/camaraderie between nursing and medical teams. I try to be in the room when the MD is there to listen, but that is not always possible.

I have worked in a teaching hospital before and it was a completely different story! However, in this area the good hospitals all require BSNs. Overall, I like my hospital and I work with really good people. . .just this gulf between nursing and medical always amazes me.

[classicdame, MSN, EdD]

certainly does not occur here. Small community (

[caliotter3]

I accompanied a patient to doctor visits, where the doctor would talk to mom exclusively and ignore the fact that I was present in the room. I would address an issue with him and he would not look at me. Finally, one visit, I was somewhat vindicated when he went into a tizzy over the child's blood pressure. Well, I will be, I had only addressed the elevated blood pressure, IN WRITING, to the doctor three or four times in the past year, and the child had only had elevated BP's at three or four previous visits. When the clinic director, the MD's boss, entered the room and rechecked the BP, I just sat there, shocked, and wondering why all of a sudden, there was interest. I now make it a point to avoid any case where that particular doctor is the PCP.

[SleeepyRN]

Not that this would ever actually happen, or any benefit would even come from it, but sometimes I fantasize about a group of nurses going to the medical students' classrooms each semester and being kind of like guest lecturers on doctors and nurses working as a team. Or even occasional meetings with physicians and nurses where issues with things such as communication can be addressed. A meeting where we can share our side and they can share theirs. Where we can say what works best for us and how they can help reduce our workload and vice versa. In the perfect world, doctors and nurses should work together and make each other's work days easier. Something as simple as "hey doc, how about you put that chart back where it belongs after you're done with it so im not wasting time running around looking for it later." Ok, lame example, but point is I'd like more of a dialog with the doctors and get on the same page.

[HouTx, BSN, MSN, EdD]

Wow. There is a HUGE amount of evidence that the leading cause of clinical errors & poor care is lack of communication among caregivers. A good first step would be just to address the physician(s) --but since OP can't catch them, this may not work.

Any changes in physician behavior need to be initiated/led via their own structures, so the med staff leaders need to informed & become involved in fixing this problem. Is there any way to turn this into a PI initiative?

[krisiepoo]

That's really sad :/ As a nursing student I've had doctors come up and ask me my opinion, what I've seen with the pt and we discuss the options. However, the medical director at this particular hospital has spoken to our class and he is a huge proponent of team work and when I thanked him for encouraging this atmosphere and shared my experiences his reply was "of course he would discuss with you, you were caring for him all day"...

[DoeRN]

The hospital I worked at with my first job the doctors there would always talk to us. Many of them would find us first to see how the patient is doing. But with that said it was a top 10 hospital and team work was encouraged and I felt respected by the doctors. Where I'm at now humph I don't even know how half of them look like. On occasion one will find me. But for the most part I don't talk to them unless I page them.

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[monkeybug]

I suppose L&D is a very different world, but in most of the hospitals I've worked, the OBs and RNs had great rapport. They HAVE to talk to us, they leave laboring women in our hands and totally rely on us to let them know if something is up. There's no way they could do all the monitoring and still see clinic patients and do surgeries. I had a pregnant woman in ICU once. I sat in the ICU with her to monitor baby while the ICU nurse handled everything else. She went into labor on my shift, so I was checking her cervix and calling the OB regularly. When he got to the unit, we discussed the plan, he checked her and concurred with my assessment, and we carried on as we usually, sarcasm and humor were rampant. I knew we were being watched by several of the ICU nurses, and when he left the unit they swarmed me asking if he were always this nice and did he treat all the nurses so well. Yes, actually he was one of our more surly docs, the rest were much more personable, but it illustrated for me what a great unit I worked on.

[nurseprnRN, BSN, RN]

Some of you have heard me tell this story before.

Years ago, I worked at Stanford University Hospital in the cardiac surg ICU. The Chief of the service was Norman Shumway of blessed memory, he who did the first work enabling human heart transplantation (though California law at the time made it impossible for him to be the first to have a donor heart to use), and we had a great unit with one of the very best nursing managers I ever worked for. The first of July he would come into the unit for rounds with the new house staff, and took them around. While pouring his coffee from one cup to the other to cool it, he would say, "You see these nurses? These are the best nurses in the world. If one of them ever tells you to do something, you do it. And if I ever hear of any of you abusing one of them, you are out of here." He repeated the same thing in the OR, minus the coffee.

And that is why I never knew that cardiac surgeons were supposed to be egotistical jerks until I left there. Nary a tantrum or a thrown instrument or an unkind word to a patient, either. It can be done, but it starts at the top. The chief residents out of that program went all over the country to run programs of their own and they carried that culture with them-- if the programs at Johns Hopkins, or Minnesota, or San Diego are peaceful, thank Norman. The only one of his residents that I ever knew that was a jerk is in private practice-- I had occasion to contact him to ask him a clinical question a few years ago and he's still a jerk.

Communication is a two-way street, and behavior modification can be done. In my first job after school I worked in a PACU where one (but only one) anesthesiologist in particular was a joy to work with. We got a box of gold notarial seals-- those stick-on gold foil sunbursts with about a hundred points-- and whenever he did something really neat regarding pt care or collegial relations we said "Gold star!" and stuck one on his scrub shirt. Then the other docs asked him what that was about...and they started getting them once in a while, then more often. In about four months the whole culture was changed. We knew we had it licked with them when one of the OR nurses told us one of the docs saved and wore his scrub shirt from the previous day because it had a star on it. :) But it started with the nurses making the first move. You can do that too.

[RED1984, BSN, RN, EMT-P]

That's really sad :/ As a nursing student I've had doctors come up and ask me my opinion what I've seen with the pt and we discuss the options. However, the medical director at this particular hospital has spoken to our class and he is a huge proponent of team work and when I thanked him for encouraging this atmosphere and shared my experiences his reply was "of course he would discuss with you, you were caring for him all day"...[/quote']

I'm a nursing student as well. The doctors at the hospitals I've done rotations at have also spoken with me regarding the patients I was assigned. I suppose it really comes down to where you're at.