Throw some tips and tricks at me.

locolorenzo22, BSN, RN · Aug 27, 2008

When it comes to care, I usually just think in my head...

i.e. ok, I've got 8AM meds for this guy, he had knee sx, I need to take a dressing/iodine in to change that, give him a antibiotic for after surgery, I need unhook his IV fluids, he wanted pain meds, etc....it depends on what you need to do. comes with time.

The docs go like this...if I need something and they've already been in...I don't care about sounding stupid...I tell him what's going on, and what I need.

a patient had itching unrelived by benedryl....so I called the doc, got a order for decadron 1 time, and that was that.

Just know what you want to tell the doc and what you need...just to make sure. short and sweet.

Mary C, MSN, RN, APRN, CNM · Aug 27, 2008

Wold this be an appropirate mini doctor script:

This is Mary C, the nurse for Mr. _____ in room ____, are you familiar with him?

He ______ (spiked a temp, split a stitch, is complaining of severe pain, is bleeding out his rectum).

Now should I ask him to put in orders for what I want him to do (order a pain med, blood cultures & tylenol, come view/pack his wound) or should I just state that information and see what he says.

blondy2061h, MSN, RN · Aug 27, 2008

One thing you can do is make a chart with the hours of your shift going down the side and your patients' names going across the top. Write in everything you need to do for each patient in the appropriate hour slot- meds, drsg changes, blood draws, assessments, I&Os, vital signs, blood transfusions, when they're going to be off the floor, etc, etc, etc. That way you'll have an established sheet to look at at a glance and know what you need to be doing.

This works for me, but I'm in a setting where I may only have 3 patients but have things due every hour on them, so it may not work as well in a more med-surgy type setting.

RedhairedNurse, BSN, RN · Aug 27, 2008

after 9 weeks orienting on my floor, the time has come to fly solo. i was just wondering the pertient info you all relayed during report (i've obviously given it with my preceptor there, but i wouldn't mind seeing how others do it in black and white).
what i am terrible at is a) clustering care. i always feel like i am running back and forth because i forgot things. i have a little brain i created that is pretty amazing, but do you have any other recoomendations for clustering/organizing care? b) calling drs. i sound unsure and i babble on. i was critiqued pretty strongly on this. i get so nervous to call drs and my brain shuts down and i never know how to say or what to say. any advice from other new nurses?
anyways, maybe it would be a benefit if we could discuss the stuff that makes us nervous and give advice on things we've seen or done that have worked? :typing

at my job we use sbar for communicating with md's.

s - situation

b - background

a - assessment

r - recommendation

dr. jones, this is deb mcdonald

rn

, i am calling from abc hospital about your patient jane smith.

situation

: here's the situation: mrs. smith is having increasing dyspnea and is complaining of chest pain.

background

: the supporting background information is that she had a total knee replacement two days ago. about two hours ago she began complaining of chest pain. her pulse is 120 and her blood pressure is 128/54. she is restless and short of breath.

assessment

: my assessment of the situation is that she may be having a cardiac event or a pulmonary embolism.

recommendation

: i recommend that you see her immediately and that we start her on 02 stat.

this is an expample i obtained off the internet.....of course, i would want more in my background s/s such as o2 sats, pts description of chest pain, etc. always write down what you want to say before you call the doc, and always know your labs! hope this helps! :clown:

Dolce, RN · Aug 27, 2008

Many hospitals have the SBAR forms right next to the phones and in the report room. It is the best way of discussing a situation with a doctor. Never assume that the physician remembers the patient or their history. They see many patients and get them mixed up just like anyone else would if they were woken up at 2 a.m.

Mary C, MSN, RN, APRN, CNM · Aug 27, 2008

One thing you can do is make a chart with the hours of your shift going down the side and your patients' names going across the top. Write in everything you need to do for each patient in the appropriate hour slot- meds, drsg changes, blood draws, assessments, I&Os, vital signs, blood transfusions, when they're going to be off the floor, etc, etc, etc. That way you'll have an established sheet to look at at a glance and know what you need to be doing.
This works for me, but I'm in a setting where I may only have 3 patients but have things due every hour on them, so it may not work as well in a more med-surgy type setting.

Thanks, that's actuallywhat i meant by brain... I made one. It sounds infantile, but i also add stuff like drs who stopped in & leave a blank for i&os!

Mary C, MSN, RN, APRN, CNM · Aug 27, 2008

at my job we use sbar for communicating with md's.
s - situation
b - background
a - assessment
r - recommendation
dr. jones, this is deb mcdonald
rn
, i am calling from abc hospital about your patient jane smith.
situation
: here's the situation: mrs. smith is having increasing dyspnea and is complaining of chest pain.
background
: the supporting background information is that she had a total knee replacement two days ago. about two hours ago she began complaining of chest pain. her pulse is 120 and her blood pressure is 128/54. she is restless and short of breath.
assessment
: my assessment of the situation is that she may be having a cardiac event or a pulmonary embolism.
recommendation
: i recommend that you see her immediately and that we start her on 02 stat.
this is an expample i obtained off the internet.....of course, i would want more in my background s/s such as o2 sats, pts description of chest pain, etc. always write down what you want to say before you call the doc, and always know your labs! hope this helps!

many hospitals have the sbar forms right next to the phones and in the report room. it is the best way of discussing a situation with a doctor. never assume that the physician remembers the patient or their history. they see many patients and get them mixed up just like anyone else would if they were woken up at 2 a.m.

that totally helps! i always blank when i call a dr and stutter. even if i sound monotone reading, i at least won't have to worry about screwing it up. thanks so much!