Fear of physicians and taking telephone orders

[Joni's Mom]

How do you get over the fear of talking to the physician, and taking down telephone orders. Writing down the order as fast as the physician is talking. Knowing the right spellings for the drugs and such?

Thanks

[nightmare, RN]

Have all the answers to hand he/she is likely to ask.As for taking down orders.take them down so that you know what it says then rewrite them for others to read.

[ohmeowzer RN, RN]

i always read the order back to the dr, no i don't have a fear of it because i double check what the dr says when i read it back to them... then i check the spelling of a med if i need to ... i can understand your fear , thats why i started reading the orders back to them...

[Super_RN, BSN, RN]

Working night shift really helped me! If you can call the doc in the middle of the night and wake them up, you can call anytime

ALways, always, always read back what the doctor ordered so you can ensure you got everything. Once you call a couple times, you'll be fine. Of course, there will always be that doctor that makes your hair stand on end

At my old hospital (I'm in a school now) we had to write VORB (Verbal Order Read Back) Dr. Who / J. Nurse RN.

Hope that helps!

[Luv2BAnurse]

Have all the answers to hand he/she is likely to ask.As for taking down orders.take them down so that you know what it says then rewrite them for others to read.

That or ask the MD to clarify, or spell the med...I've done that before and the MD spelled it incorrectly! They are human too. :)

Just remember that you and the MD are both there for the better of the patient.

[racing-mom4, BSN, RN]

Before I ever call:

I write out the most recent labs.

I have written out the problem I am having ex: pain-sob-etc etc and have down in front of me what I have done so far to assist with the problem.

I also have written out in front of me my goal of the phone call ex: pain meds and what kind, diuretics and what kind, and I write to the side of that the std doses so if he prescribes a low dose I can say the standard is 0.5mg q4 or something along those lines.

When they 1st call in I always thank them for getting back with me so soon, even if they didnt get back as soon as I would have liked.

Then I state I am taking care of so and so, she was admited with XYZ she is complaining of ABC--so far I have done ABC and the result, I will then state any pertinent labs to him. And I will then make my suggestion " I was hoping to get an order of ABC"

I then always repeat back what he says "Ok so we are going to go with 5mg of Haldol IM every 6 hours as needed" he says yes and I will then tell him thanks and I will leave you a note in the progress notes of how well that worked.

PS I work 3rds so I agree calling in the night is tough. I think they appreciate when I do call that I have already done something to try and rectify the problem before calling them.

Another thing we have a nurse who I over heard calling the Dr at 2am for a diet order!~!!! Eeekss So think before you call, and only call if it is something you totally need now.

[Guitar_Heroine]

I know it sounds silly and people tease me about it, but I work nights and when I have to call one of the nasty doctors, I STAND up while talking on the phone. It makes me feel more assertive!

Some people I work with are really into the SBAR tool. I just try to be as prepared as possible. If I'm calling a critical lab value, I look at the last few to see how it's trending, what meds the pt is on (don't forget IV fluid!), I&O, relevant assessment info, etc.

It really just takes time to get over the fear and feel confident in your own judgement. Hopefully you have coworkers you can run it by before you call to help you think through what you want to say and what orders you anticipate. I know some drs who if you lay out the problem (Mr. X sounds really wet, he has a CHF history, his oxygen requirements are increasing and his edema is getting worse. And his weight is up 16 kg since admit..) will say "what do you want me to do about it?" Waiting for you to ask for Lasix and maybe some KCL. Then other drs get mad if you make a suggestion and don't make it out to be their idea.

Just remember your job is to protect your patients, not make friends with the docs!

[Blee O'Myacin, BSN, RN]

How do you get over the fear of talking to the physician, and taking down telephone orders. Writing down the order as fast as the physician is talking. Knowing the right spellings for the drugs and such?

Thanks

For the sake of your license, read back and verify. "OK, Dr. X, that's 50mg of lopressor P.O. first dose now, then q12 hours." Or "Dr. X, do you want the lopressor held if the SBP is less than 100 and/or HR less than 60?"

You can always draw a line through what you initially wrote if you need to reword. Just at the end of the order, read back what you have to the doc. You want to get it right because the last thing you want is the doc coming in the next day to sign said orders and saying "I didn't say THAT!!" and then not sign the order.

But remember this if nothing else. Docs are people too, treat this as if you are calling in a diet order - calm and professional. Behave professionally and no one will hold that against you. "The nerve of that nurse, repeating and verifing orders so the patient gets proper treatment... sheesh..." is not something I've ever heard a doctor say.

It does get easier. I had hives from nerves all over my hands the first time I took a phone order.

Blee

[hrobrnc]

Hi all,

I can remember how scary it was to have to take telephone orders from docs. it takes a little wile to get over. the read back format is very helpful and is part of the JCAHO patient safety guidelines. Most docs are understanding but there can be a few that are just not team players.

Be patient and the scary feeling will go away, esp when you mature as a nurse. jan:nurse:

[RobLPN]

Comes with time and experience. Sound like you know what your doing makes it easier.

Side note: I believe male nurses are recieved different then females. This includes getting orders.

[GrumpyRN63, ADN, RN]

Everything comes with experience, pretty soon you will be calling them, telling them what YOU want/need for the patient, kinda role reversal

[Dolce, RN]

It helps to remember that it is THEIR JOB. If they don't want to be on call they can quit.