New nurse scared to talk to doctors!!

Hospice RNCM · Sep 25, 2005

I am posting this thread because I thought someone might be able to help me get over my nervousness about talking to doctors. I graduated in May 05 and am working at a hospital about 50 miles from my home and I really don't know anyone there. I get so nervous about having to call a doctor or talk to them when they make rounds. Is this normal? I am just afraid I am going to say something totally stupid or they will ask me something that I don't know and they will think I am stupid! I have a great preceptor and he knows that this bothers me, and he is trying to make me face my fears by making me call them and talk to them. So far, it hasn't been that bad, but I am just waiting for one to go off on me and I don't know how to handle that. Sometimes I just want to wear a sign that reads "I am a new nurse"!!

I am a new nurse myself, and have been working at a local nursing home for about a month, and I can tell you that calling the doctors is one of the hardest things I have had to do. A couple are real "anal sphincters" but I have found that the nest way to deal with them is to call and say "here is the problem, I don't have any orders for this problem, and I want your permission to give this patient this treatment and this medication" and as long as I have a solutiuon to the problem I am calling to discuss, and I am certain that it is in the patient's best interest, and all I ned is his say-so, then he is ok......the other night, I called to ask if I could give a resident an albuterol treatment and cough medicine, and the doc I had to call was the worst one to call, and I very quickly explained what was going on, that I have no PRN for this problem, and I want an order for these things, and he said "Yes, that is a good idea, and also go ahead and order a stat chest X-Ray, let's make damn sure he does not have pneumonia."

I have also found that whenever the doctors are in the facility, and they are on my floor, it's a good thing to make a point to introduce myself as the new fulltime RN, and I was the one he talked to on the phone the other night. I've found that in person they are much more amenable to being just a little friendly, and they will also more freely discuss our common patients one-on-one, and they also see up close that I am fully competent to take care of their patients. Try doing that and I can guarantee that the next time you call the doc he will remember you as the competent nurse who knows that if you're calling, it must be a big problem, and he had better listen real close.

eezee · Sep 25, 2005

Sometimes I just want to wear a sign that reads "I am a new nurse"!!

I can relate on that. I also felt that during my training in my hospital a couple of months ago. & actually I am feeling that until now, I was just transferred to the OR almost 3 months ago. Hope we could adjust well as new nurses...adjust to the environment & most esp. to our workmates.

justmanda · Sep 25, 2005

I am posting this thread because I thought someone might be able to help me get over my nervousness about talking to doctors. I graduated in May 05 and am working at a hospital about 50 miles from my home and I really don't know anyone there. I get so nervous about having to call a doctor or talk to them when they make rounds. Is this normal? I am just afraid I am going to say something totally stupid or they will ask me something that I don't know and they will think I am stupid! I have a great preceptor and he knows that this bothers me, and he is trying to make me face my fears by making me call them and talk to them. So far, it hasn't been that bad, but I am just waiting for one to go off on me and I don't know how to handle that. Sometimes I just want to wear a sign that reads "I am a new nurse"!!

Some doctors will be grumpy no matter what. I live for these types. They make my job very entertaining. For some reason, it just makes me laugh to see someone blow their top. Here's an actual call I made one time:

The patient was a new admit and had not received any of her home BP meds. The doctor didn't re-order them. It was 2am.

Me: Patient's blood pressure is 205/105.

Doctor: This isn't a emergency!

Me: (thinking he didn't hear me right) The patient's BP is 205/105

Doctor: I said this isn't an emergency!

Me: I didn't call 911 Doc. Why don't we try to avoid an emergency and give her her home meds.

Doctor: Don't you dare call me at 2am for something like this again!

Me: Okay, I'll call you later after she strokes.

Doctor: and he didn't restart her meds

I called a consult on the case who hadn't even seen the patient and told him her primary refused to address the BP. When the consultant asked WHY NOT, I told him that the Doctor didn't think it was an emergency and hung up on me. The consultant ordered the BP meds, reported the primary doc and signed off the case.

Don't be afraid of them. Most of them appreciate a call if they care about the welfare of their patients. Those who don't, will give you a hard time...and you can chalk it up as a funny story to tell to your co-workers.

justmanda · Sep 25, 2005

One more thing....I don't think there is anything wrong with saying..."Forgive me Doctor so and so, I'm a new nurse" whenever you get flustered while you are trying to give them the required info. I did this a few times as a newbie and the doctor actually gave me reasons why he was ordering this and that. In fact, I called a doctor in the wee hours of the morning for a myoglobin that was VERY HIGH on an established renal patient. He really could have reemed me. But, he said.."Oh, we can expect that in renal failure. Don't worry about it." And that was it. They aren't all monsters.

Daytonite, BSN, RN · Sep 25, 2005

Some doctors will be grumpy no matter what. I live for these types. They make my job very entertaining. For some reason, it just makes me laugh to see someone blow their top. Here's an actual call I made one time. . .Don't be afraid of them. Most of them appreciate a call if they care about the welfare of their patients. Those who don't, will give you a hard time...and you can chalk it up as a funny story to tell to your co-workers.

Loved this! While the B/P was a serious situation I loved the way you handled it! I was thinking how the whole call would look with Sarah Silverman doing your voice and a couple of cute puppets acting it out on Crankyankers! :lol2: We ought to write Jimmy Kimmel and ask him to do a special block of calls nurses makes to doctors. They probably couldn't be real calls because of patient confidentiality. But, boy would some of the doctors be made to look like the boobs they are when they get calls about something serious.

shablee · Jan 9, 2006

I can definitely empathize with you. I was a shy self-conscious gal when I started nursing. Over the years, I've grown and learned. You will too. You will go through times when you will be think "why did I....?" It is part of the learning process. I used to despise talking with doctors. (Actually, I really don't even like doctors.) There are only a chosen few who have made it to my "like" list. It's a skill, learning what to say and what they might ask. After almost 30 years in nursing, there are STILL some doctors I don't like to call and talk to. But I do. And my patients appreciate it.

I too am very self concious and shy around "authority figures" & anyone who I think is smart..........So much so that I am only 7 months out of RN grad and I am thinking I should find something else to do!!!!! I am 38 and have worked in a hospital for 17 years as an aide and ward clerk. So I do have a certain amount of burnout even though I am a new RN. Last night I sortof froze up during a trauma & my co-worker told me--the more you do traumas the more you will know what you're doing..but what she don't realize is that I've seen tons of traumas as the aide & "scriber" & If I don't know what to do by now -I'll never know!!!

I truly think I am in the wrong profession for my personality. I am petrified that a doctor will get mad at me. Last night I hadn't started an antibiotic on a patient that was ordered 3 hours ago ( The patient s tarted gong down) & the doctor was a little upset--& I coudln't even tell him that I was the only RN over 13 patients & had 2 brand new aide's and was doing the best I could!

I am going to start another post about my anxiety giving report too .....I have very hard time!!! Please offer any advice!!!! :confused:

pugmum · Jan 11, 2006

someone mentioned sbar earlier. our new grads (and some "old" ones) have found it helpful to organize the info you want to present. we keep the forms by the phones on the units.

this part is the actual worksheet:

sbar report to physician about a critical situation

s situation

i am calling about .

the patient's code status is

the problem i am calling about is ____________________________.

i am afraid the patient is going to arrest.

i have just assessed the patient personally:

vital signs are: blood pressure _____/_____, pulse ______, respiration_____ and temperature ______

i am concerned about the:

blood pressure because it is over 200 or less than 100 or 30 mmhg below usual

pulse because it is over 140 or less than 50

respiration because it is less than 5 or over 40.

temperature because it is less than 96 or over 104.

b background

the patient's mental status is:

alert and oriented to person place and time.

confused and cooperative or non-cooperative

agitated or combative

lethargic but conversant and able to swallow

stuporous and not talking clearly and possibly not able to swallow

comatose. eyes closed. not responding to stimulation.

the skin is:

warm and dry

pale

mottled

diaphoretic

extremities are cold

extremities are warm

the patient is not or is on oxygen.

the patient has been on ________ (l/min) or (%) oxygen for ______ minutes (hours)

the oximeter is reading _______%

the oximeter does not detect a good pulse and is giving erratic readings.

a assessment

this is what i think the problem is:

the problem seems to be cardiac infection neurologic respiratory _____

i am not sure what the problem is but the patient is deteriorating.

the patient seems to be unstable and may get worse, we need to do something.

r recommendation

i suggest or request that you .

transfer the patient to critical care

come to see the patient at this time.

talk to the patient or family about code status.

ask the on-call family practice resident to see the patient now.

ask for a consultant to see the patient now.

are any tests needed:

do you need any tests like cxr, abg, ekg, cbc, or bmp?

others?

if a change in treatment is ordered then ask:

how often do you want vital signs?

how long to you expect this problem will last?

if the patient does not get better when would you want us to call again?

___________________________________________________________________________

guidelines for communicating with physicians using the sbar process

1. use the following modalities according to physician preference, if known. wait no

longer than five minutes between attempts.

direct page (if known)

physician's call service

during weekdays, the physician's office directly

on weekends and after hours during the week, physician's home phone

cell phone

before assuming that the physician you are attempting to reach is not responding,

utilize all modalities. for emergent situations, use appropriate resident service as

needed to ensure safe patient care.

2. prior to calling the physician, follow these steps:

* have i seen and assessed the patient myself before calling?

* has the situation been discussed with resource nurse or preceptor?

* review the chart for appropriate physician to call.

* know the admitting diagnosis and date of admission.

* have i read the most recent md progress notes and notes from the nurse who

worked the shift ahead of me?

* have available the following when speaking with the physician:

* patient's chart

* list of current medications, allergies, iv fluids, and labs

* most recent vital signs

* reporting lab results: provide the date and time test was done and results of

previous tests for comparison

* code status

3. when calling the physician, follow the sbar process:

(s) situation: what is the situation you are calling about?

* identify self, unit, patient, room number.

* briefly state the problem, what is it, when it happened or started, and how severe.

(b) background: pertinent background information related to the situation could

include the following:

* the admitting diagnosis and date of admission

* list of current medications, allergies, iv fluids, and labs

* most recent vital signs

* lab results: provide the date and time test was done and results of previous tests

for comparison

* other clinical information

* code status

(a) assessment: what is the nurse's assessment of the situation?

® recommendation: what is the nurse's recommendation or what does he/she

want?

examples:

* notification that patient has been admitted

* patient needs to be seen now

* order change

4. document the change in the patient's condition and physician notification.

i found this link on google.

www.ihi.org/.../patientsafety/safetygeneral/tools/sbartechniqueforcommunicationasituationalbriefingm odel.htm

hope this is helpful for some. :wink2:

dawn1rhino · Jan 11, 2006

thank you sickandtired!!!

of course there is a sbar on our floor but it isn't near a cool as yours!!

i wish there was a system for emailing through the answering service so if the md doesn't wish to respond i haven't spent valuable time away from my 6 or 7 patients other patients -

time looking for phone numbers

time calling the answering service

time waiting for the call with out "tied-up time" (blood/decubitus ulcers/ivs/admissions/pegs, etc..

wasted time if the md does not respond.

it's not the attitude for me it's that you wasted my patient's care time - that ticks me off

for that matter why can't the doctor write the order and email it back to be attached to the sbar, seems like that would be efficient - no language barrier either...imagine the time saved.... :chuckle

any woo.......thanks for sharing

Daytonite, BSN, RN · Jan 12, 2006

Actually, the nursing homes I've worked in over at least the past 10 years have nailed this down, but good. They almost exclusively use faxes to communicate with doctors. The last one I worked in had a specific fax form for the nurses to use to send a fax message to a doctor's office. They even had specific ones for specific kinds of lab test notifications. As I recall it included the patient's name, diagnosis, why they were calling the doctor, what they wanted from the doctor, and a space for the doctor to write his reply. We would fax this to the doctor's office, mark the date and time it was faxed on the form and put it into a special tray. We were all responsible to check for follow up answer faxes from the doctor's. If the doctor faxed an answer back that included an order, a telephone order was written and the fax was filed in the patient's chart as documentation of notification. The fax machine had most of the doctor's office fax numbers programmed into it, or else there was a list of doctor's office fax numbers by the fax machine. It was a system that worked quite nicely for routine orders which are very commonly sought in nursing homes. I figured it would just be a matter of time before the system encompassed the use of e-mails.

When I worked in the hospital I kept a list of most frequently called MD's on my report sheet with their office numbers since we often had the same doctors admitting patients to our particular unit. I learned years ago to talk to the doctor's nurses and ask them what their backline number was at the office where I could reach them rapidly. They almost all have them in order to bypass the answering service and patients who call. They will usually give these numbers out to other professionals. I also learned that just because it was Wednesday (or some other designated day of the week) and the office was closed, that wasn't necessaily true. Often, the staff is still in the office and working even though they weren't seeing patients or taking calls on their published office phone. The doctors were usually in contact with their offices on their days off to find out what was happening that they needed to know about. Also, we could have the hospital operator place calls to MD's and then have them transfer the call to our unit once the doctor was online. That helped save time. Sometimes there are already time-saving routines in place that you may not know about because you were never told about them. Sometimes you have to take the initiative to ask or set an idea in motion to get something put in place to help you out.

dawn1rhino · Jan 12, 2006

Thanks Daytonite that is helpful to know. Primary problem with faxes in my situation is I work the 7p to 7a shift so the offices really are closed.... I am trying to piece together how to present a workable idea to my institution - I have found that my unit manager is not really open to discussion and being new (7 months) I feel that I should work within the established system but at the same time think that in this age of communication we don't take advantage of the tools available - like emails, blackberries, etc.. Our institution is quite forward in some ways with computerized documentation and computers at the bedside with access to the internet through the institutions website but for some reason there is no communication through that system between nurses and doctors - perhaps there are security issues I am unaware of?? Anyway thank you for telling me about the fax system.

thatoneguy · Jan 13, 2006

humm i have read through most of this and although i am new i have no problem talking to any doc. i look at it this way; i am working for the patient not the doctor. just like if i was running a job site "construction" say, if the owner wants black tint on the windows instead of the clear and i see no problem with it, i call the tint guys and tell them the issue. so if i see no reason why my patient is NPO and he/she wants to eat i call the doc. if he/she "the doc." gets mad, o well it's not like it was not in the brochure i am sure they all heard about the calls long before they actually became a doc or even entered med school. and besides, at least the patient knows who i am looking out for. i just always think before talking to them this is for my patient not that i am calling asking for a favor for me. if the doctor gets really mad just tell them to write a order to not call them for this or that.

Indy, LPN, LVN · Jan 14, 2006

i'm a new nurse (3 months) i am working 7p-7a on a med-surg and i was at first very hestitant to call a md. i have quickly adjusted my attitude to "oh well" - as in oh well if the md is asleep, oh well if the md is mean, rude, patronizing, etc... my patient's health relies on me making that call. so, this is the scenario that i have become comfortable with:
"dr xx, my name is xx, i'm calling from xx hospital about xx patient in room ##, are you familiar with this patient?"
what i've come to find is more than 50% of the time the answer is no. for some reason that makes me feel better to know that i actually know more than the md does about the pt in question making my input very valuable. now i feel much more like a part of the patient care team and not just a new, dumb nurse waking up the md. :)
hope this helps with you as well.
my grace is sufficient for thee: for my strength is made perfect in weakness... - ii corinthians 12:9

just to let you know, i have adopted that opening line as well. it makes me sound professional, and feel professional (for a bit anyway). the grumpiest doc on our unit was pleasant when i used this format to talk to him about a really sick patient one evening. anyhow, thanks for the suggestion. it's a really good one!