I just want to vent for a minute. My hospital has a policy that new critical lab values have to be reported within 90 minutes. I work night shift, 7p-7a and have gotten cussed at (by one doctor) and ripped a new one by a few others for following this protocol.
I work in a busy CVICU and always try and wait to see if anyone else needs the critical care doc before paging, but sometimes I just have to bite the bullet and page. The biggest lab value that seems to prompt this is always the critical procalcitonin. The patient is septic and we know that? Of course! They’re on antibiotics? They are! But for some reason the docs keep putting in the FIRST procalcitonin as an EAM lab draw!
If I don’t call, I’m in violation. If I do call, I’m on the *** list. There’s no winning. If I didn’t have to call, I most definitely wouldn’t.
This is an issue within all of the critical care units of my hospital, and if the docs have a problem with it I wish they’d take it up with administration who is writing the policy and not take it out on those of us who have to make the unsavory call in the first place.
The other sore topic is the generic order to call for urine output of less than 30 mL/hr for two consecutive hours. Dayshift will go all day with borderline urines and not address the issues, and it’s understandable because the doctors are right there and not being woken up. Night shift then roles around and my outputs are 30, 25, 15, 10. I always try to fix the issue myself (flush the foley, bladder scan, flow track, check the creatinine and BUN, PRN albumin) but I call and get berated because “this has been happening all day and it couldn’t be addressed earlier?” For CV patients this is something we HAVE to call about. It’s all just so frustrating. I wish I could tell the docs that I don’t want to call them any more than they want to hear from me.
I wish I could tell the docs that I don’t want to call them any more than they want to hear from me.
You pretty much can.
"Hello, Dr. So and So. Due to the hospital's policy about reporting critical labs, I am required to let you know that Mr. X's _____ is ____."
And if it is something that could have been addressed on a different shift and the provider asks why it couldn't have been taken care of earlier >> " I was not here earlier. I'm here taking care of this patient now."
Just stay calm. Abusive language is obviously inappropriate, but a little huffing and puffing about something idiotic is different in my book. It doesn't rattle me and I feel nothing. I probably agree with them about how stupid it is that they are being called.
Oh, and I DO feel sorry about having to engage in stupidity. I know sorry isn't the perfect word but everyone knows what's being conveyed; it's less apologizing and more commiserating. I've said it many times, "sorry to have to bother you with this [idiotic thing]." I think it's a great way to let them know that I didn't come up with this brilliant idea on my own and please don't associate it with me or my intelligence. Hasn't really failed me as far as developing rapports with people and making sure my patients get taken care of.
The problem is believing some thinly-veiled narrative from nursing school about how practically everything is nurse-vs-doctor. Just relate human being to human being and you'll have much less frustration. ??
Oh, and I DO feel sorry about having to engage in stupidity. I know sorry isn't the perfect word but everyone knows what's being conveyed; it's less apologizing and more commiserating. I've said it many times, "sorry to have to bother you with this [idiotic thing]." I think it's a great way to let them know that I didn't come up with this brilliant idea on my own and please don't associate it with me or my intelligence. Hasn't really failed me as far as developing rapports with people and making sure my patients get taken care of.
The problem is believing some thinly-veiled narrative from nursing school about how practically everything is nurse-vs-doctor. Just relate human being to human being and you'll have much less frustration. ??
I've been in facilities where there was a lot more commiserating with one another versus taking pot shots. That's nice, it's great to have collegial relationship with our providers and I think it makes for excellent care.
On the flip side, I've been called everything but a child of God by physicians for calling something that has to be called, and I'm sorry but I have no patience or sympathy it is a part of the job, not to mention having that kind of toxic response to calls discourages nurses to report things that need to be reported and little issues become big issues become rapid responses and code blues which in my opinion are more troublesome than a phone call that can last maybe 30 seconds.
On the flip side, I've been called everything but a child of God by physicians for calling something that has to be called, and I'm sorry but I have no patience or sympathy it is a part of the job
I understand, but my only context/experience would suggest that I've encountered this so very little not because there are no rude or frustrated people around me but because of the way I view and approach the situation. The example dialog I posted above isn't pandering, it's very neutral and straightforward, but it serves my purpose of immediately letting them know this wasn't my idea. So they might as well save their comments because it's no use telling them to me.
If there was a offender who insisted on insulting me despite knowing that none of this was my idea, I would state one of two things, either: 1) Please let your chain of command know that you disagree with this process or 2) "I will let my supervisor know that you are very displeased with these kinds of calls." Then I would fill out an incident report.
1 hour ago, TheMoonisMyLantern said:
not to mention having that kind of toxic response to calls discourages nurses to report things that need to be reported and little issues become big issues become rapid responses and code blues which in my opinion are more troublesome than a phone call that can last maybe 30 seconds.
You are correct there. And yet administration is going to require what they require, for their own reasons, regardless of the unnecessary angst and chaos it introduces to patient care. This situation we are discussing (the unnecessary phone calls) interrupts and detracts from good patient care even if no one gets all jacked up about all the phone calls. Even if they just pleasantly say, "thank you for letting me know" it still detracts from appropriate patient care. That's how it can be judged that people's responses to it aren't *the* main problem. The wrong thing that is happening in the first place is the main problem.
Administration, too, should be held accountable for distracting from good patient care. Everything shouldn't be a matter of forcing the little people into more and more stupidity and then spiting and criticizing them when they don't enjoy it. And in case there's any question, providers are included in the "little people" group these days.
I understand, but my only context/experience would suggest that I've encountered this so very little not because there are no rude or frustrated people around me but because of the way I view and approach the situation. The example dialog I posted above isn't pandering, it's very neutral and straightforward, but it serves my purpose of immediately letting them know this wasn't my idea. So they might as well save their comments because it's no use telling them to me.
If there was a offender who insisted on insulting me despite knowing that none of this was my idea, I would state one of two things, either: 1) Please let your chain of command know that you disagree with this process or 2) "I will let my supervisor know that you are very displeased with these kinds of calls." Then I would fill out an incident report.
You are correct there. And yet administration is going to require what they require, for their own reasons, regardless of the unnecessary angst and chaos it introduces to patient care. This situation we are discussing (the unnecessary phone calls) interrupts and detracts from good patient care even if no one gets all jacked up about all the phone calls. Even if they just pleasantly say, "thank you for letting me know" it still detracts from appropriate patient care. That's how it can be judged that people's responses to it aren't *the* main problem. The wrong thing that is happening in the first place is the main problem.
Administration, too, should be held accountable for distracting from good patient care. Everything shouldn't be a matter of forcing the little people into more and more stupidity and then spiting and criticizing them when they don't enjoy it. And in case there's any question, providers are included in the "little people" group these days.
As always, you are of course right. Most of my interactions with providers are actually quite collegial, collaborative, and positive. And I do recognize that many times physicians are being worked just as ragged a we are by our corporate overlords. I do get VERY bent out of shape when an on call treats me like I'm a criminal for daring to disturb his sleep because a patient had the gall to have a critical lab, change of condition, etc.
I wouldn’t let anyone talk to me like that, not even a physician. I would kindly interject and state, “it seems as though you are frustrated, do you need a minute and I can call you back?” Nobody should be cussed at, and you do not need to be verbally abused in the work place. If reasoning with them doesn’t work, I would report it. Talk to your charge or the supervisor.
have gotten cussed at (by one doctor) and ripped a new one by a few others for following this protocol.
Do not tolerate this behavior. Plain and simple.
Take notes as you speak, quote accurately, and bump it up the chain. If it is somebody you need to work with in the future, you might give one free pass, and explain that next go around will be reported. If anything he/she says could be construed as a verbal order put document it exactly verbatim.
Also- don't start by apologizing for doing your job. Replacing "sorry to call you in the middle of the night...." with "Policy requires me to report this."
There are all sorts of ways docs can mitigate this with standing orders, PRNs, etc. But nothing nurses can do. Take no responsibility for their unwillingness to do their jobs right, and keep doing yours.
There are all sorts of ways docs can mitigate this with standing orders, PRNs, etc. But nothing nurses can do. Take no responsibility for their unwillingness to do their jobs right, and keep doing yours.
This ^ I have had this talk with docs on during the weekend multiple times, "If you don't want to be called for orders, you need to leave enough standing orders for me to where I don't have to call you." I wasn't nasty or mean, and actually a couple docs received this well and greatly expanded the amount of standing orders they wrote before taking off for the weekend. That was really nice.
One psychiatrist would call me before going to bed and give me standing orders for admissions, anxiety, insomnia, agitation, and it was great! It saved me time and a phone call, it gave the doc a full night sleep, and allowed the patient's need to be swiftly addressed.
JKL33
7,043 Posts
You pretty much can.
"Hello, Dr. So and So. Due to the hospital's policy about reporting critical labs, I am required to let you know that Mr. X's _____ is ____."
And if it is something that could have been addressed on a different shift and the provider asks why it couldn't have been taken care of earlier >> " I was not here earlier. I'm here taking care of this patient now."
Just stay calm. Abusive language is obviously inappropriate, but a little huffing and puffing about something idiotic is different in my book. It doesn't rattle me and I feel nothing. I probably agree with them about how stupid it is that they are being called.