I feel dumb. re: talking to doctors and patient's family.

patwil73 · Jul 6, 2008

Talking with doctor's and families can always be stressful. To help with this always be truthful in what you know - don't try to make things up (or stall as you look them up).

If the doctor asks about a patient you haven't seen yet, truthfully say "I just got on and haven't seen the patient yet, however the report I got was the patient was improving."

If the doctor presses for more information tell him you can look that information up or call him back after you have had a chance to assess your patient.

Families are essentially the same way, however there is a need (because of the vulnerability and trust when people are sick) to not appear that you don't know what is going on. If they ask for information at the start of your shift again you can say (providing they have the right to such information) that the report you got was "x", but you would like to do your own assessment and you would be glad to update them once you have had a chance to see the patient yourself.

If it is in the middle of the shift and they are asking things you just don't know (haven't had the chance to read doctor's notes, etc) ask them to give you their questions and you will check on them and call them/talk with them later when you have all the answers. (You do have to be careful and set limits depending on how much they ask).

There will be times that you just feel like an idiot because every question they ask you have to look up, but remember we all have those days. It will get easier.

One thing I tend to do is talk in generalities then move to specifics: Vitals have mostly been within normal limits the last shift (frantically loading the page with vitals) - HR 76, BP "x", etc.

or: Family - "What did the test yesterday show?" Me - "Which test were you referring to, we ran a few?" Family answers and I am quickly opening the page for results. Depending on the test say bleeding "I haven't noted any bleeding during my assessment. His color is also good which is usually a good sign and, see his Hct is steady from yesterday. Things are looking pretty good."

I hope this helps

Pat

CABG patch kid, BSN, RN · Jul 7, 2008

And just a quick reminder to ask the pt if you have their permission to discuss their condition with so and so family member. It might save you a few explanatory sessions if you don't have their permission, plus its HIPAA, so we don't really have a choice.

I'm a new grad so I know how it feels to be put sooooo on the spot, but just be honest and try to roll with the punches. We can't be expected to know everything; just show the family you are confident and trustworthy and they should be forgiving if you don't know how much granny had for dinner last night.

As far as doctors go, some will be more lenient than others when dealing with nurses, so don't take anything that goes down personally, unless it is a direct attack on you, lol. I work night shift, so I have a few unhappy calls to docs at night, but hey, they get paid the big bucks, and if they are on-call, then they can expect to be getting a few calls. I make it a habit to talk with other more experienced nurses to see if the situation warrants a 3 am call or if it can wait until rounds if I'm unsure. If the pt is going south, don't hesitate to call, in fact, a good doc will be p.o.'d if you DO put it off.

Good luck at work, hang in there, you will always have good days and bad days no matter how much experience you get! Just take the good with the bad, try to have fun at work when you can and keep caring!

JRD2002 · Jul 8, 2008

Don't be afraid of saying "I don't know"...just follow it up with "but I will be glad to check on it for you." Totally agree with everything Pat said. When family members are asking how a patient is doing and you are not very familiar with the patient, you have to realize that they probably are wondering about something in particular with the patient. When I get asked that question I usually say "Is there anything in particular that is concerning to you." That way I don't have to babble on and on and we can get down to the root of the concern and the family can feel better.

al7139, ASN, RN · Jul 8, 2008

Hi,

Don't worry! It is the norm, and you will get used to it! I hate that right when I get report, lots of our hospitalists are doing rounds, and some have bad tempers...I have learned to deal with this in my own way... If I get asked a question by a doctor, I tell them straight out "I just got here, and have not seen your patient yet. I can tell you what was reported to me, or you can see the patient yourself." This may sound disrespectful ( and mabye it is), but I can only do so much as a nurse. I don't know, I just got report. Deal with it, and quit coming during shift change.

As for family, unless you are on our need to know list (i.e. pt is confused and you are POA), do not get upset when I say to you I cannot tell you anything about this persons condition, you will need to ask the POA for details, and they or the patient will have to give me authorization to discuss their health with you. The law is the law, and I'm NOT breaking it. Tough noogies.

As for questions from the proper channels (pt, or POA), please realize I am not the one to give out test results, prognosis, etc. And NO, I have no idea what time the Doctor will be in to see them. If you need to know, they will call (I hope) you based on the large note I put on the chart last night.

FYI: Never give out test results without talking to the Dr. first. If it's negative, they want to be discharged, and if it's abnormal, they want immediate answers. Tell them the tests are still pending.

Amy

sofaraway04 · Jul 8, 2008

I have got used to talking to the doctors pretty much now, one of the things I do before ringign them for anything is to check that I know as much about the patient as possible. have read the most recent doctors entry in the notes and have a recent set of observations. I also have the chart and drug chart in front of me.

for familes, i still hate it, I hate havign to answer questiosn because I always feel like i don't know what I'm talking about. usually I will say to the family, "I wasn't here when the doctors were on their rounds, but I'll check what they wrote in the notes". when pateints or their families ask for test/scan results etc, I never tell them the results. i will say that the report will be avalible for the doctors to see on the computer shortly and they will be able to discuss it with the patient when they do their ward round.

had a nightmare family yesterday, spoke to several members on the phone about their dad. then one son visited and had a talk with ward sister about the progess and plans for the pateint. about an hour later the son asked me if there was any news and what was happening with his dad. I had to tell him that there was nothing new sinc ethe discussion he had had with the sister. really what did he expect? in the time he had been sat with his dad, no doctor had come, pateint hadn't been for any tests etc.

If family members keep asking questions or want information that i can't give, i will usually see if the doctor can come down and speak to them. I've only occasionally had a doctor say they can't they are too busy.

1910anna · Jul 11, 2008

I was wondering if their is a book or web site to help with practicing telephone orders from doctors. This is my biggest fear. I have just gotten back into nursing after almost 10 years. Ten years ago i never had much contact with doctors . This is what i am most jittery about is talking to doctors. They really intimidate me. :eek:

Babs0512 · Jul 11, 2008

1910anna: Just prioritize your phone call to the doc. Think about it - should go something like this: Dr. Jone, my name is Babs on 2 north, I'm calling regarding your patient Mrs. Zee. She has been complaining of urinary frequency and burning. She is afebrile, and her VS are stable. Can I get an order for a straight cath UA & C&S please? Dr. Jones: "Sure, UA c&S is fine, you may straight cath." You repeat what Dr. Jones said "Okay, I will get a UA, C&S via straight cath", would it be possible to get something for her discomfort?" Dr. JOnes - "lets just start her on Macrobid **mg, po bid" YOu repeat, "Macrobid, **mg, po bid." Thank you Dr. Jones, is there any thing else. Dr. Jones" "Yes, get a CBC and Card 1 (BMP) in the a.m."

You repeat so we're going to get a straight cath UA,C&S, start Macrobid **mg po bid, and get a CBC, and Card1 (BMP) in the a.m." Dr. JOnes states, yes. You say, "Thank you, have a good night"

If Dr. Jones had wanted specific data on her VS, you would have had them ready, just 1. let the doc know who you are and why you are calling, 2. give pertenent data regarding the complant, 3. ask for what you want, 4. always repeat back the orders to the MD. 5. Say thank you.

That's pretty much it. I write the orders as I'm talking with the physician, and repeat them back after each order is given, and then at the end, I repeat everything once more.

:twocents:

mandykal, ADN, RN · Jul 11, 2008

Don't feel "dumb" as you stated. You will be put on the spot all the time as a nurse. Remember that saying "It's not what you say," but rather "how you say it."

I have 3 per diem jobs. Places I'm rarely there, units I've haven't worked in months. Today I was assigned to a unit that I haven't worked in over a year. As a nurse, I try to stay away from the words "I don't know." Of course we can't know everything, but we're trained in that basic way, that we should know where to find the information needed. I've had Dr.'s ask me how a certain wound it doing in terms of healing progress, I was straight forwarded and told him I couldn't give him the right answer because I don't know the base line of this wound, but don't leave it as that. Show your interest in answering any questions as I told that Dr. let me check the treatment record for measurements or notes. Honesty is the key. I even once told a family member that I just got onto shift, let me gather my thoughts and information you need, please call me back at......keeping in mine that whatever information you give them may potentially lead to more questioning. Give them clear answers that they would understand. Whenever I update family on new drug orders, I should know the information on the drug, likewise, with lab results. Be professional at all times. Make sure your answers make sense. Alway follow through.....You're attitude makes a difference, don't rush, if you don't think you have time, make the time....Pt's family (those who are allowed right to information) is just as important as your patients. And only through repetition interacting with Md's and family, in time, you will get better. When you feel down, ask yourself what could you have done or say that would have a better outcome. Learn from your mistakes and mistakes of others.... The feeling you feel is a natural for new nurses.