terrified of taking doctors orders

becembrie · Jul 11, 2008

I don't think you will find any help from a book or website. Once you do it a few times, you won't have any problems. Like everything else in nursing, experience will give you confidence.

SharonH, RN · Jul 11, 2008

Just curious: what are you afraid of? Are you scared you'll get the orders wrong or are you just intimidated by physicians in general. There's an acronym that the hospitals have been forcing on nurses in order to allow them to communicate effectively with them......what is it....oh it's SBAR! I don't remember what it stands for. It might be pretty helpful for someone in your situation. My beef with it was that it put all the responsibility for effective communication on the nurse but it was a good tool nonetheless. Google it, I'm sure you'll find some info on it.

ohmeowzer RN, RN · Jul 11, 2008

it won't be a scary as you think... just be sure to read back the orders he told you on the phone so you know you got it right. then i always write .. "read back" under the orders... you'll be fine.. keep us posted

racing-mom4, BSN, RN · Jul 11, 2008

I was kind of freaked out at that at 1st too. Very normal feeling. Just write everything down they say on a scrap peice of paper. Read it back to them ver batum.

If I have them paged, just to start the conversation out nice. I always thank them for calling me back so soon, even if they took longer than I had wanted. I then tell them I am calling about Suzy Smith, the 62 year old CVA that came in yesterday.

Before I make any call, I write down:

1) what I want out of the conversation--is it pain meds? something for breathing? fast heart rate??...

2) then I have all that days recent labs and test in front of me.

3) I write down the most recent vital signs and compare them to the ones earlier.

and if I know I want a certain drug, I look that drug up in the drug book and have that page open with the std dose highlighted. Many times that Dr has asked me "what is the std dose"

I then thank them and tell them I will update them in the morning in the progress notes on what ever new orders I recieved.

pattycakeRN · Jul 11, 2008

Situation

Background

Assessment

Recommendation

For instance, I'm calling about 3209, 74 yo admitted today for chest pain, her BP was in the 140s/80s and was just retaken at 190/110, rechecked manually at 192/90, she's had blah blah blah meds tonight, c/o HA and has hx of uncontrolled HTN... how about some hydralazine or lopressor IVP?

Puhhhlease and thank you!

That's just sort of how I work out what I'm going to say to the physician before I call. It helps organize your thoughts. I like to be in front of the chart and the computer with all the pt's info pulled up as well.

Dalzac, LPN, LVN, RN · Jul 11, 2008

The best thing that helped me was imagining them doing something the same as I do. grilling hamburgers or going to the kids ball game or falling asleep in the recliner plus of course having all the info about your patient in front of you. I have to tell you once I overheard a doc wife complaining about her hubby and the fact she wouldn't let him use the downstairs bathroom since she put suede wallpaper in it because she didn't want him to stink it up. I never ever had a problem calling him again.

Scrubby · Jul 11, 2008

I regard doctors as just another coworker. Yes they can give orders etc and sometimes they are arrogant and i want to scream at them, but at the end of the day they are still human beings, they eat and poo the same as anyone else.

RNperdiem, RN · Jul 11, 2008

Racing-mom4 has it right.

Look at calling doctors for orders as another skill you must get back. I'm sure there are other skills you need to get strong on again.

Calling docs has never come easily to me.

If your hospital has text paging, consider using it for the nonurgent but still important issues.

SoundofMusic · Jul 11, 2008

For some reason, even as a new grad, this has become easy for me. I guess it's because I do it ALL DAY LONG and it's just become 2nd nature.

Some get rude, but I'd have to say 95% of them are fine, even friendly. (especially the younger docs -- just love their voices . ... but I digresss.)

Just do the SBAR thing and try to know your stuff. I've had a few hang up on me because I didn't know what I was talking about -- and I don't blame them! I don't over-thank them, though -- sorry, it's their job and I'm taking care of THEIR patient. I'm important, too -- I'm doing MY job to call them. If I didn't call, I'd be questioned on it.

I think the harder thing is being the advocate for the patient w/ the docs. I always love it when a doc takes the time to actually SEE the patient, and see what I'm talking about. Even then, the advocacy thing will come in to play.

I think it's also important to document things you hear, see, objectively. Write it all down and let the docs sort it all out. It's amazing how much they trust our eyes and ears. Sometimes I can't believe the trust they put in us.

Penguin67 · Jul 11, 2008

It will all get easier with practice. Here are a few things to remember:

1. Avoid verbal orders if they are standing there and could just as easily write on the chart as you. The rationale for that is to reduce possible errors in the transaction. Be nice, and hand them the chart and ask them to write it down before they leave the floor. This is a common practice for error reduction strategies.

2. During phone orders, write down exactly what they say, and then before hanging up, take an extra moment to "r/v", aka "repeat and verify" the order back to them for clarification. And then when you document the order, in addition to documenting "phone order" document "repeated and verified" as well. That way, the MD cannot come back and say "I never said that" or "You got the order wrong". This is another common strategy being implemented all over the place toward error reduction.

3. Most importantly, remember that MD's put their shoes on just like we do...one at at time. They are human, too, and they are not deities. Sometimes we tend to forget this. We are a team and ned to respect each other in order to best care for the patients.

Good luck! It's not all that bad. Just give yourself the time to get used to it.

metfan · Aug 3, 2008

Ok. I am bringing this thread up again because I also have questions about taking doctors orders. I am still on orientation and have not had a chance to do too many orders. The situation is this...the doctors do rounds once a week and many new orders are written. Sometimes about 20 per unit. It is a LTC facility by the way. The doctor sits and writes many orders usually with a nurse watching him. However, many (and I am talking 50% of them) orders have to be clarified with a call later to the doctor. The doctor either is not clear or has simply not written the order properly. I guess I was just wondering what I, as a new nurse, can do to prevent this from happening. Can you give me a run down on what should be on an order. Obviously, a treatment or medication, the dosage, time etc. For example, the doctor wrote an order for a treatment to be done every 2 or 3 days. It had to be clarified if he wanted every 2 or 3 days. I guess an order has to be specific. Can an order be written simply to change the dressing every day or does he have to state what kind of dressing change? If he wants to change the dose of a medication that the patient is already on, does he have to D/C the previous order first? Any good web sites for me to check out? I will be oriented properly on doctors orders ( I hope) and I have done a few. I just see the other nurses struggling and I want to be prepared. Sometimes the nurses seem to get the blame. They get asked "why didn't you tell the doctor to include this"? I really thought doctors would know how to write an order the right way. Thank you. Colleen