Nurses- medical provider needs your opinion!

[Buckeyeqt]

My SO is a medical provider at a hospital (internist). He does a call shift to answer questions from nurses. He has NPs in his group as well. He was venting the other day and mentioned how he wasn't so short with the nurses when he first started, but now the phone has a bad connotation as he knows when it rings it's due to a problem he has to help with. It's silly when it's his job to answer, but he says he gets annoyed but he said he likes nurses who think critically and he said the ones who usually call tend to call for mundane reasons and he admitted his med group has started to see a pattern in the nurses who do keep calling because they choose not to figure out a problem themselves. They have NPs with their group as well. He also mentioned the NPs have started to get cranky with phone calls too even though some were the floor nurses at one point. Is it common when you call for help, to deal with the providers who are moody and what's a good way to remind them you call because it's their job to answer and they should try to be more understanding? NPs---can you relate to this? He said he's trying to remember it's his job to help and he wasn't always like this, but I guess when he feels the answer is right infront of your face and you still call for help-he feels it's a waste of his time. I informed him id get feedback from here-what would you guys want him and his colleagues to know regarding your position when you do call for advice? ..He's trying to work on getting past being short. It's not all the time just when he thinks phone call is unnecessary.

[Adele_Michal7, ASN, RN]

I've had to make phone calls I considered ridiculous. Sadly I have seen nurses fired for letting things wait till the AM. Or failing to notify the MD at all. So I just think of that during an awkward call. It comes down to facility policy. I think it's ridiculous to have to notify the doctor over one loose BM and request a c diff sample (when said loose BM is most likely a result of patient going out to eat when out on pass and has a hx of doing so) But I don't want to anger my higher ups. And thus have no choice.

[Dranger]

When I page, "Paging per protocol" it helps them understand I don't want to page but I have too. Many don't call back and that's fine I know they got it.

[nicolemy0215]

Reiterating the majority of comments...most of the time, we (nurses) are just as annoyed to have to stop what we are doing to make the call as he is to receive the call...but it's pretty much drilled into us from nursing school on, that any change in condition, any clarification, etc, we must notify the doc....trust me, there are many many times I have made a call notifying a doc and heard their irritation and had the urge to say "OF COURSE I KNOW WHAT TO DO, I've spent the last 8 hours with this patient!!!!! BUT ITS MY JOB TO TELL YOU!" We do understand the simplicity in some of our calls, we do get why they would get annoyed, we do know what to do without their advice a lot of the time....but we also have to cover our own butts by passing along all info to them. It's just a matter of understanding the requirements of each other's jobs so that we can be more patient.

[NursesRmofun, ASN, RN]

I find that I can reduce the bad mood of the provider if I am apologetic and make it quick. I call because I have to...not because I can't figure it out myself-- but I have to have a doctor's or provider's okay and write it up that way.

[meanmaryjean, DNP, RN]

Used to work with a crusty old surgeon who did NOT like to talk on the phone. Called him one night and started with "Sorry to bother you Dr. Smith..." He immediately cut me off and said "Young lady- I work for the patient, not the other way around. If you as a professional feel there is a reason to call me, do NOT apologize- just cut to the chase." How I loved that man!

[Karou]

I never WANT to page a doctor on night shift, especially after midnight. I try to address any patient concerns at the start of shift (do you take a sleeping pill? Is your pain well controlled?) and call early for those things.

There are some things that I literally cringe at paging over. One is Tylenol. But when a patient has a severe headache, and has zilch ordered for pain, I have to call for something. Also, sleep aids. I try to ask ahead of time but sometimes it's not until after midnight that the patient realizes they can't sleep. They ask me to get them "something to help them sleep" and since I can't prescribe meds, I have to call. I NEVER want to, but I am my patients advocate and if they want a specific medication or intervention that requires an order, and it's reasonable, then I am obligated to call.

With this customer driven healthcare, patient satisfaction is more valued than patient outcomes. So if a patient throws a fit and is demanding that I call over something stupid, I am in a loose loose situation. I will get my head bit off for calling the doctor, but the patient will complain and I will be in hot water with my manager if I didn't call the doctor after the patient asks.

Many stupid calls could be avoided by providers being proactive in their order sets. Tylenol, sleep aids, antiemetics, Benadryl, pain medicine, parameters on BP meds, routine labs, ect... No one wants to call in the middle of the night for any of those things.

[No Stars In My Eyes]

Have a New-Agey, Positive Thinking friend who would approach a challenge like your hubs' like this: "Oh, what a wonderful opportunity to practice patience!" You can't just magically reach a state of equanimity, ESPECIALLY as you are feeling irritated and aggravated. But, you can only practice it when you ARE irritated and aggravated, so......

OR, if you are of a Christian persuasion you can polish up your Golden Rule real good.

Tell you what though, we have a Scope of Practice and facility policies, rules, regs, and the law surrounding everything we do. Sometimes WE don't want to call you just as much as YOU don't want us to call you.

I take care of a very dear 98 y.o. lady who is verrrrry forgetful and whose retention span is like 10 seconds sometimes. I know I am going to be answering many of the same questions over and over and over, for 12 hrs. Now, I will admit that I do have my moments of the big (inner) sigh and the (inner) eye rolling. But here's the thing.....she can't help it. If she had her druthers, she wouldn't be doing it. She'a trying really hard to nail down the details but can't do it without help, and even when she does, there are going to be more questions and other questions to come.

If your hubby is the Go-To-Guy sometimes, well, better make some kind of peace with it somehow, or be resigned to wallow in misery.

[kbrn2002, ADN, RN]

The best advice I got from a mentor when I was first starting out was never feel bad about phoning the on-call if you feel it's necessary. Even if you don't feel it's necessary but some silly facility policy demands you call still don't feel bad about it. Her reasoning...that MD is making more to be sleeping between calls than you are while busting your behind working and still needing to take the time away from what you are doing to make the call and you sure better be waiting close by the phone when the return call comes. Not much aggravates the on-call more than having to wait for you on hold when they call back.

[Jules A, MSN]

The best advice I got from a mentor when I was first starting out was never feel bad about phoning the on-call if you feel it's necessary. Even if you don't feel it's necessary but some silly facility policy demands you call still don't feel bad about it. Her reasoning...that MD is making more to be sleeping between calls than you are while busting your behind working and still needing to take the time away from what you are doing to make the call and you sure better be waiting close by the phone when the return call comes. Not much aggravates the on-call more than having to wait for you on hold when they call back.

So while I get the gist her message this sounds like the us against them mentality.

FWIW and not that this is really relevant but depending on the contract for call requirements the overnight reimbursement might not be more than nurses' hourly rate.

[OCNRN63, RN]

Used to work with a crusty old surgeon who did NOT like to talk on the phone. Called him one night and started with "Sorry to bother you Dr. Smith..." He immediately cut me off and said "Young lady- I work for the patient, not the other way around. If you as a professional feel there is a reason to call me, do NOT apologize- just cut to the chase." How I loved that man!

I also had someone tell me not to apologize, but it was a nurse. She said that the docs are getting paid to take call, and if the patient needs their attention there's no reason to apologize.

After that, I stopped with the "Sorry to bother you..." spiel. Truth was, I wasn't sorry to call; I just wanted to get it over with.

[KatieMI, BSN, MSN, RN]

The SO of the OP needs to be informed about one thing we nurses cherish. It is named AUTONOMY and taken for granted by the majority of doctors.

Not only providers need to be more proactive and use those "admission sets" of Tylenol, Dulcolax and such. They need to take responsibility of the tests, labs, histories and such THEY do and order, and either let nurses take care of the results and TRUST the said nurses, or do it all themselves or through third parties usually named "specialty services".

A guy admitted a week ago with marginal liver functions, ammonia is up, he is having fevers... and I got yelled for calling and asking doctor to please d/c that protein supplement, change tubefeed to low protein and not giving 650 mg of Tylenol at once? Either you do it, or delegate the responsibility to RD and me, as you just saw, we know what we are doing.

Another one has three "specialty services" on board, all hand cherry-picked by YOU, all prescribing what they consider to be first line meds, all these meds are blood thinners... oops, you are upset that I called you at 7 AM Sunday and let you know that the patient is heading in ICU with retroperitoneal hematoma? I told you just that three times last week. Next time, do not brush your nurse off but listen, think, see the picture she sees because you see the patient for 10 min. and the nurse for the rest of 11 hours 50 min. Find good nurses, trust them, teach them, let them decide, and your life will become easier.

[nicolemy0215]

So while I get the gist her message this sounds like the us against them mentality.

FWIW and not that this is really relevant but depending on the contract for call requirements the overnight reimbursement might not be more than nurses' hourly rate.

Just a thought on that "mentality", although it's common to see the us vs them between nurses and doctors, I've never understood it...we are part of a team. And maybe that thought process could help your SO with his frustrations....we are a team, I definitely do not want to be in their shoes: to make a new diagnosis, to decide which meds are the right mixture for a pt with a long medical history, to answer any call when I've had a long frustrating day just as I've curled up in bed...but I'm quite sure they don't want to be in our position either, to have to spend a solid 8-12 hours physically busting a**, counsel, take blame for every possible complaint ("I'm so sorry you had to wait 5 minutes for your 3rd blanket while I was doing chest compressions") , having to page the on-call (and wait) for a Phenergan order while you are watching your sweet little 80 year old patient violently vomit...maybe it could help your SO to take the outlook of "well I'd rather get a call than have to go do what that nurse is dealing with" and as nurses, we can take the outlook of "well I'd rather brush off that Dr. So-and-So just berated me than be woken up 27 times in one night".

It all has to start with an understanding of each other's positions.