How to deal with physicians effectively

Sun0408, ASN, RN · Jul 12, 2012

Why did you call the other times?? I would not have call for a non critical lab value unless the pt was having issues.. Its hard to give advice when I am not sure what the actual problem is.. Maybe you can check the progress notes, this will let you know who has rounded on your pt thus far and what they wrote, if he was aware of the lab value, etc.. Also, until you are more comfortable about what to call to a MD, maybe run it by your charge nurse beforehand.

Don't fear any MD/PCP. You have a job to do just as much as they do.

SonorityGenius · Jul 12, 2012

Cr 1.8 on a pt with prior hx of renal failure medication is not a critical call to MD.. at least he didnt write you up for incompetence. (yeah I have had MDs that did this to some nurses who called at odd times of the night!!)

Born_2BRN · Jul 12, 2012

First several calls were regarding pt's med requests and another pt's who didn't have acetaminophen order ready. He had fever so I called to get order written. This last call was about lab. I felt stupid after call him about the lab. However, others were legit. He was annoy because he had to call back several times. I work day so all calls are during the day time.

VANurse2010 · Jul 12, 2012

It sounds like he didn't get mad until the last call - which as much as it pains me to do so, I have to take his side on that one. Now, if the creatinine had gone from like 0.6 to 1.8, I can maybe see that but 1.8 is barely elevated and in a renal patient.... yeah. The Tylenol thing - that's on him for not writing appropriate PRNs. I hate when MDs don't write appropriate PRNs for common complaints then get po'd about getting called.

Anyway, don't worry about it and chalk up to lesson learned. MDs are pretty oblivious, so he probably won't even remember next week.

psu_213, BSN, RN · Jul 12, 2012

Yeah, I agree that the call on the Cr was really not necessary, but that is water under the bridge in the long term.

As for calls in general, when the physician gets upset with you, you just have to let it go. Unless he is truly abusive, you are going to get nowhere trying to take on a physician (particularly if he brings in a lot of revenue for the hospital). If he wants to be mean on the phone that is on him. You are calling to help the pt, and it will be your butt on the line if you don't call the doc when it is necessary.

dirtyhippiegirl, BSN, RN · Jul 12, 2012

Cluster what you can, even if you don't feel like you should. How high was the patient's fever? Were the medication demands emergent or something that could have waited? (Or something that you have to put your nurse balls/ovaries on and tell the patient "this can wait.")

You'll figure out which docs want to be paged for everything and which only want to hear from you if the patient is actively coding. As a nurse who works nights and also works with docs on both ends of this spectrum, I've learned to consider calling judiciously and, frankly, to let feelings slide when I do have to call the latter doc over something that he's going to yell at me for but is important. (Pt's potassium was 2.9.)

Also, not certain how your floor works exactly, but try to clump your calls with your coworker's calls.

Born_2BRN · Jul 12, 2012

I don't want to take him on. He's one of those who would have careless his patient coded if you know what I mean. The patient fever was 100.2 and he asked for the medication. I didn't have it so I called. Another patient wanted his home med that he takes four times a day divided equally so he doesn't have to ask every-time. I don't think I have developed that thick skin yet. How did you get yours? Will this be on a regular basis? Something I will have to deal with every working day?

xoemmylouox, ASN, RN · Jul 12, 2012

I would agree that if you aren't sure if the doctor should be paged or not.. Ask your charge nurse. They can be a great resource. Also understand some docs will always be upset. It doesn't matter if they are paged once or 100 times in a day.

Sun0408, ASN, RN · Jul 12, 2012

What is your policy on fevers.. We do not treat a fever until it reaches greater than 101.2. Without knowing all the pt info, I can't say i would or would not have called.. For non- emergent issues, we leave a communication note in the progress section for the MD's to address on rounds.. Of course, each issue, request, is handled individually. Yes, some docs dont care how many times you call, while others only want to be called for emergent issues. You will learn as you go. You will have to deal with MD's every day but most will not be rude.

Pat2012 · Jul 12, 2012

Do you use the SBAR method when you're calling these Dr? I find that it helps me organize my facts so I'm not forgetting something important. It is also concise and to the point...

studentdrtobe · Jul 13, 2012

A tip for the future:

Please have all issues regarding a patient ready when you call us instead of making multiple calls. It really does make things so much easier and, for residents who're on call and maybe trying to catch an hour nap when things quiet down, it really is a blessing when a nurse pages you only once instead of interrupting your sleep by paging you multiple times regarding the same patient. This is especially true when we're on night float or on-call since the intern or resident is easily cross-covering 70+ patients. Depending on specialty, interns can easily be covering more than 100 patients on any given night. So that's a lot of people we're trying to keep alive till the day team shows up and any help/cooperation from the nurses goes a loooooong way in helping things out.