independent or not

[Sterlink]

I am new to HH nursing, actually new to nursing with just now 2 yrs since school. It's a second career. I was told that I lack confidence. I am having trouble knowing when to call the MDs...it's tough to get MD offices to be on the same team...I don't get call backs, or they sound like they are half listening. I feel like they don't have time for me. So I think I must not be calling for the right reasons or with good info...and then I feel inexperienced and of no use to my patients. I had one patient with redness around an ostomy stoma. I recommended a topical steroid...but the office nurse came back with an order for silvadene...that would not work under a skin barrier for an appliance and was not really what the patient needed...maybe I went to HH nursing too soon.

[caliotter3]

Well, I've seen plenty of orders for corticosteroid cream for the GT site, but have yet to see one for silvadene. I don't think you are the one that is off base on that one. Just keep plugging away at it. At least you are making the calls and trying. There are many who try to get away with not lifting a finger if they can help it.

[ProBeeRN, BSN, RN]

Keep your communication with the MD office short and to the point, give clinical to back up your reasoning, eg: "Mrs Smith has a reddened area around her stoma 3:00-6:00, directly under the wafer site, no breakdown, no drainage, blah blah blah". Request exactly what you want- if you need scripts, tell them, give product names, etc.

In the case of the silvadene, if you need to call back and tell them why it may not be appropriate (will interfere with adehesion of wafer, etc). If you really aren't sure or the doc will not bend-- then go ahead and try what the doc prescribed, monitor effectiveness and call back if no improvement.

I try to remember that I am the patient advocate, and if I'm going to call the doctor 16 times until the patient gets what they need, then so be it!

[Sterlink]

Thank you...it sounds easy enough....I will be more short and specific.