Getting doctors to listen to me

Every doctor is different. In many ways, the attending doctors set the tone of doctor-nurse interactions. If the docs at the top are open and responsive to nursing, the junior doctors tend to follow their lead. In my department, I don't see much inflated ego problems at all. In a teaching hospital, the residents are well-informed on the latest research.

That said, there is the matter of not only what you say, but how you say it. Communication is an art and timing is everything. Nobody likes to be told how to do their job; you meet resistance if you try that angle.

When you bring up patient issues, are they not giving appropriate orders?

I've found that once you've proved yourself, they tend to listen. Of course, there's always that one that's got to be a jerk no matter the situation, but usually they want the best for the patients. And it helps if your presentation is good. Sometimes ask it in the form of a question. "Hey, what would mag sulfate do in a case like this? Would it help, or would it not do any good at all?" Totally non-threatening and non-judgmental and likely to get them thinking. I tend to ask a lot of questions like that even when I'm not trying to lead them somewhere, so it's not something that sounds out of place for me. With some of the docs I've had the best relationships with, the frequent response to my call for orders was "What do you want me to order?"

Maybe you work with a particularly bad group. It definitely happens. We had a private group of OBs that were angels who respected the nurses, and then we had the medical school. The attendings--and thus, the residents, since they followed their lead--were difficult and rarely listened to us or even acknowledged our existence. Maybe it's how you present yourself. Maybe they just need to see that you know what you're talking about.

Majority of the docs I work with will listen to and respect my suggestions. There are some that do not, but we are still able to have a professional relationship. There is one doc in particular I work with that can have a bit of an ego, but once you prove yourself to him as a good nurse he is more inclined to listen.

I would choose "often" if that were an option.

Yes, a lot of the time, until they've gotten to know and trust you, doctors may we wary or hesitant to listen to what you are saying. Phrasing things as a question as someone else said can definitely help -- there are many nurses who DO try to tell the docs what to do, so sometimes that impression is all it takes for them to stop listening. A question asked appeals to their medical knowledge and often it'll open things up.

I also am a huge promoter of generally getting the doctors to know and recognize you. You have to know who they are but not vice versa. Say hello to them even if you don't need them, make an effort to be remembered. A physician is more likely to listen to (and trust) a nurse they know over just some nurse.

The poll is skewed:sarcastic:

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.

My floor has a lot of residents, and I'm not sure I've ever seen the attendings before or spoken to them. The residents run the show, and are mostly helpful and respectful.

I like SBAR if I'm giving report, or if I'm calling a doc on the phone that isn't very familiar with the patient (if at all). But in my face to face interactions with docs, SBAR would be very stilted and completely inappropriate. Fortunately for me, now that I work in a small ED, I work with only one doc at a time (other than the hospitalists or specialists that sometimes get involved), and so we have an opportunity to develop a relationship and get to know one another's communication styles and thought processes.

Yes, doctors listen to me and other nurses. On my second day out of orientation, after calling about a troublesome NG tube, a doctor asked me - "What do you think we should do?" with genuine sincerity. When I call doctors they often ask "What would you like/need/recommend?" and they will also ask my opinion. I actively seek them out to clarify the plan of care. I think we've got awesome rapport with our doctors at my hospital. They often know us by name. Now, some of the surgeons, I'll tell you a different story ....