New nurse scared to talk to doctors!!

cjblu · Jan 16, 2006

The doctor phone call is intimidating for me as well, but like others have said, remember that they are just another part of the team. My parents are both MD's and I have a lot of friends who are now completing their residency. Remember that nursing and medicine are two different professions, and we rely on each other. The docs are grateful for our eyes and ears and critical thinking skills as we watch over their patients...and from what I have heard...they are thankful when a nurse is smart enough to know when to call. Just speak to them with confidence, or if you don't have confidence yet (like me)...just fake it 'till you make it....

nethmateo · Jan 20, 2006

I think almost everybody felt the same way as you are, but as we grew more in experience we develop confidence to our job and interacting with people, bear in mind that they are also like us who can be happy,upset and anxious at times. Just try to smile and it can change everything around you. Good Luck!:wink2:

LauraLou · Jan 22, 2006

I just finished my first week of new nurse orientation and we actually had a session on nurse-doctor communication. They gave us forms that detail what information you should have ready before calling the MD and list the chain of command if you don't get the orders you need. They showed us some sample conversations, both good and bad as examples. It was really helpful as a new nurse to get this information.

We use a system called SAFE, S-situation A-assessment F-findings & figures E-express & expect.

S- (situation)

Verify that the MD know this pt, if not, provide brief history

What events prompted you to call, be specific

Get directly to the point

If the situation is urgent, say so

A- (assessment)

What do you think the problem is

State your primary concern

What is your assessment of the current situation, be specific

F- (findings & figures)

Give findings specific to the problem (ex. lung sounds, pain, LOC, meds given)

Give figures specific to the problem (ex. v/s, lab values, I&O, infusion rates)

E- (express & expect)

Express what you think the pt needs to address the situation

Request orders for tests, meds or treatments

As the MD to come see the pt if needed

Clarify the MD's plan of care if the orders you receive aren't clear or you feel they don't address the pt's need

RN007 · Jan 27, 2006

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!!!!

The great thing about nursing is there are so many different ways to practice the art. Is moving to another discipline, like say working in a doctor's office or home health, an option for you?

carolinapooh, BSN, RN · Jan 27, 2006

I agree, some MDs can be intimidating. Just be confident in your abilities, if you dont know something make note of it and guarenteed next time you will know! A girl in my clincial had a great idea. she carries around a little tiny note book and everytime she has a question or learns something new she jots it down...then when she gets home she looks it up on and researches it...i think i may have to try that:)

I used to do that when I was a pharmacy tech. I actually learned a lot that way. Invariably looking up what I jotted down led me to seeing another unfamiliar term, so I'd look that up, and then see something else....I'd end up reading whatever book it was for an hour.

Actually, I do it when I'm on this board, too!

irish_std/n · Jan 30, 2006

With regard to calling docs in the middle of the night...the best perspective I've ever had on this was from a senior doc, an intern asked him if dr X wud mind her calling him and the senior doc replied what do you mean wud he mind...its his job to be on call!

VickyRN, MSN, DNP, RN · Feb 7, 2006

I have attached an excellent tool for giving report to a physician or to other staff nurses: Situation Background Assessment Recommendation (SBAR). :nurse:

skittlebear · Feb 10, 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

all of these comments are great! i especially like what dawn1rhino's advice...i will definitely use that! thanks

loryces · Mar 5, 2006

i'm so glad we have this thread! i, too, am a new RN. i started working just last month and like most of new RNs, i'm having a hard time talking to physicians especially when taking phone orders. one time, i had to actually hand the phone over to my preceptor because i was just too scared to listen and remember what the doctor was saying.

ladybird1292 · Mar 5, 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.

i found this link on google.
www.ihi.org/.../patientsafety/safetygeneral/tools/sbartechniqueforcommunicationasituationalbriefingm odel.htm

hope this is helpful for some. :wink2:

hi i'm a new grad rn and i also have difficulty framing my words..... so thanks for this tool, i'll be using it at work. this is a great thread thanks to all who have contributed

MARIAN202 · Jan 7, 2007

SBAR

HAVE ALL INFORMATION AVAILABLE WHEN REPORTING

CHART
ALLERGIES
MEDICATION LIST
PERTINENT LAB RESULTS
DNAR STATUS WITH DATE
PRIMARY PHYSICIAN'S NAME

SITUATION

STATE YOUR NAME AND UNIT
“I AM CALLING ABOUT (PATIENT NAME AND OTHER IDENTIFYING INFORMATION)…

“THE PROBLEM I AM CALLING ABOUT IS…”

BACKGROUND

STATE THE ADMISSION DIAGNOSIS AND DATE OF ADMISSION
STATE ANY OTHER PERTINENT DIAGNOSIS
STATE THE PERTIENT MEDICAL HISTORY
GIVE A BRIEF SYNOPSIS OF THE TREATMENT TO DATE

ASSESSMENT

ANY CHANGES FROM PRIOR ASSESSMENTS:

MENTAL STATUS
VITALS
HEART RHYTHM CHANGES
SKIN COLOR
NEURO CHANGES
PAIN LEVEL AND WHERE
WOUND CHANGES/DRAINAGE
MUSCULOSSKELETAL CHANGES
GI/GU CHANGES
IS THE PATIENT ON O2?

RECOMMENDATION

SUGGESTIONS YOU MAY HAVE:

TRANSFER TO ICU
NEEDS MEDICAL ASSESSMENT
TALK TO PATIENT AND FAMILY ABOUT CODE STATUS OR OTHER PERTINENT INFORMATION
ASK FOR A CONSULT, TEST TO BE DONE, LABS TO BE DRAWN

IF YOU BELIEVE A TEST IS NEEDED, WHAT IS IT?

CHEST X-RAY
ABG
ECG
BLOOD TEST (WHICH)

IF A CHANGE IN TREATMENT IS ORDERED, THEN ASK:

HOW OFTEN DO YOU WANT THE VITALS?
IF PATIENT DOES NOT IMPROVE, THEN WHAT IS NEXT STEP?
DOCUMENT THE CHANGE IN CONDITION, PHYSICIAN NOTIFICATION, AND ANY ADDITIONAL INTERVENTIONS IN THE PATIENT’S MEDICAL RECORD.