How comfortable would you be...

demylenated, BSN, RN · Oct 5, 2011

We are advocates for our patient first. I've found doctors I work with willing to listen and order things a nurse recommends.

All he can do is say no, what is everyone afraid of?? Yikes. ADVOCATE for your patient... that is our job!

DizzyLizzyNurse · Oct 5, 2011

I just started a new job and we are instructed to suggest tests/meds for our patients when we call the dr to report something. They said the dr's are being trained to take the nurses' advice in consideration. At my last job if we had a suggestion the dr almost always told us to go ahead.

Boog'sCRRN246, RN · Oct 5, 2011

I'm quite comfortable asking for whatever I think the patient needs. We have one physician who listens to input and even says "Just tell me what you want." But then there are other physicians who are just so gawd-awfully unapproachable that the "anonymous love note on the chart" is the best way to go.

shortscrubbs108 · Oct 5, 2011

I think it depends on your position, I've never worked in the hospital as a nurse, but I have worked in the same clinic for 2 years now and I am constantly doing this. I get calls from nurses at the hospital asking if I can talk to dr. so-and-so about this or that and I think, they're just a person! And like dem said the worst that can happen is they say No (or no way wth are you thinking who is the dr. here?) But in that case so what? You were trying to help your patient and the doctor will either forget it get over it.

mrmedical, ASN, BSN · Oct 5, 2011

I find you can suggest in a form of a question, such as "Hey Doc, for pt X, why not run labs/rads/test so-and-so..."

Comes off as non-hostile and impinging, and if there was a reason they decided not to do it, a lot of times they go over why they wouldn't preform it.

OCNRN63, RN · Oct 5, 2011

How comfortable are you suggesting additional diagnostic testing to a doctor? We recently had a patient undiagnosed with multiple issues and were discussing some of his symptoms. I suggested a possible diagnosis to a co-worker of when I had seen similar symptoms before (rare condition). The charge nurse wanted the other nurse to suggest a diagnostic test to confirm/rule out the condition (lab test) and the other nurse didn't feel comfortable doing it. Had I been in that situation I think I would have left an anonymous dear doctor note suggesting the lab test and why I feel it was appropriate.
While I know it is not our job to diagnose our patients we have seen a lot. This patient currently was working with no diagnosis and the doctor on the case was new. Just wondering how comfortable you would be suggesting diagnostic testing to confirm rule out a diagnosis the doctor may not have thought of.

I would and have done so in the past. The first time was as a new grad. Not only was I right, but the patient required transfer to another facility because we were not equipped to care for her.

JulieCVICURN, BSN, RN · Oct 5, 2011

I would be completely comfortable doing this. I would just ask the doctor, "I've seen symptoms like these before and I was just wondering what your thoughts are about the possibility of XYZ..." Depending on the physician, you just have to tailor your approach. We have a couple of physicians who will reject an idea from anyone else, whether it be nurse or other physician, because they want to own the entire case. These are not our good doctors! Most of the others are more than willing to have this discussion with a nurse.

xtxrn, ASN, RN · Oct 5, 2011

BTDT..... some docs are very receptive- and then there are the distal GI outlet that refuse to listen to anybody's suggestion that isn't an MD.....but most are open if there's good rationale :)

LouisVRN, RN · Oct 5, 2011

Thanks for all the responses. I am very comfortable suggesting procedures/meds/tests to doctors on a normal basis when it is currently in line with their current plan of care. Just wasn't sure if it was completely off base to suggest something from way out in left field that would only confirm/rule out one diagnosis. But this specific patient has had an extensive work up done with several consults and still no diagnosis.

BTW it makes it a little more difficult that we work nights and rarely see a doctor and the on-call doctors are usually not familiar with the patients.

The last time I suggested something similarly off-base based on clinical symptoms I had seen before the doctor (known distal GI outlet doctor) shot me down, only to later come in and order everything I had suggested, which ended up leading to a correct diagnosis and she was able to be treated without any adverse outcomes and she was able to be discharged home.

Elvish, BSN, DNP, RN, NP · Oct 5, 2011

I'd suggest it as mrmedical did earlier....nonthreatening and no smartassery involved. Just the rationale. The worst they can do is say no.

kool-aide, RN · Oct 5, 2011

SBAR, Situation, Background, Assessment, RECOMMENDATION! I say go for it!