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Discussion

Was this an appropriate order?

I had a doctor leave something like this on one of my patient's charts during the night shift (I'm on days):

Please have Dr. ________ call me after he makes rounds in the morning.

I'm a new grad, and I don't even know all the doctors yet. Also, we don't necessarily make rounds with the physicians (only one or two will actually seek out the nurse to talk with them).

I knew the odds of me recognizing this physician AND being in the nurses station when he came in were very slim. Trying to increase the liklihood that this message would be delivered, I put a sticky note in the patient's chart drawing attention to the message. Also, the previous night's nurse felt this was more appropriately handled by the ward clerk, who sits in the nursing station all day, so she left a copy of the order with her.

The obvious happened, and the physician came in to make rounds. I was predictably tied up with another patient in another room, and didn't see him until he was heading out of the hospital (another nurse called his name, or I wouldn't have even known it wa him) and I forgot about the message. Who knows if he saw my note? There was no indication that he did - or did not - return the call.

The ward clerk came to me in the afternoon up in arms with the charge nurse in tow. I ended up getting publically chewed out by my charge nurse for not passing the message along. The ward clerk, looking to cover her own butt, was really accusatory in the process. "YOU should have done this! How am I supposed to be able to do extra things like this? I am way too busy!!" (Yeah, no one else is busy. :icon_roll )

I don't place any blame on the ward clerk for not informing the doctor; it was (in my opinion) a stupid order the doctor should never have left. We aren't secretaries, and if the doctors want to talk to each other, they should call each other directly. I guess I was just hoping that instead of everyone standing around pointing fingers at me, someone might have said "Well, it's too bad the doctor may not have seen this order. They should really be better about calling each other. Try to remember to relay the message next time." Even better, I would have loved to see the charge nurse say "well, that's what happens when the doctors try to use us to relay messages".

I guess I am pretty disappointed in the lack of support.

So what do you guys think?

BTW - I have learned my lesson: when I get another dumb order like this one, I will call the doctor's office and leave a message as soon as I see it.

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i find it hard to believe that in this day and age of technical innovations that the doctors have no way of getting a message like that to one another other than leave an "order" on the chart and have the nursing staff take care of it. The more logical thing to do would be for Dr. A to leave a phone message or a text message for Dr. B. I mean what if a code was going on at the time? Passing along that message would have definitely fallen by the way side.

Why not just page the doc and tell him that Dr. so and so would like to speak to him regarding patient X? We do that type of stuff all the time... annoying? YES. Necessary? YES.

Some of the older docs are seriously technology inefficient, and can't seem to page someone on their own, so yeah, I have called someone to tell them to call someone else on more than one occasion.

MDs read previous orders and the Progress Notes in the chart. Leaving a message physically in the Progress Notes and a sticky in the orders are the best you can do sometimes. RNs have more to do, and more important things to do, than to be a messenger service between MDs. It is also not my responsibility as to whether Dr. B. forgot to call Dr. A after seeing the message left to him/her. I can write a note, call Dr. B's answering service, or if I'm very lucky, I can tell Dr. B personally. After any of those three, communication between MDs is out of my hands. MDs have cell phones, answering services, receptionists, and email. Communication between MDs should not be a problem. It also should not be a function of nursing. YMMV

Actually most of the older doctors I know, call another physcian themselves as this is what they have always been accustomed to. It is the new doctors who see themselves as to busy to pick up the phone to speak to another doctor..

Our unit secretary would have taken care of this type of order by putting in a call to the office.

  • Author

Thank you for your responses.

FirefightingRN - that is pretty much my position. Thanks for confirming that I am not completely off in my thinking, even if it didn't serve me well at the time.

Contageon - I agree that is how I will handle it next time, but really, I don't think a doc needs to be especially tech-saavy to phone a doctor's office and leave a message. If they can make it through medical school, I think they are probably smart enough to figure it out.

But yeah, I guess I never expected to be responsible for such orders during nursing school, and since I've been working only a couple of months, I hadn't seen anything like this come up before.

I'm just about to graduate and I've been doing my nursing practicum.... I've learned this.....

Everything that goes wrong is the nurse's fault.... I've already gotten used to that idea....

We do the best we can in situations like these....

Usually the unit secretary can take care of these little requests and courtesies. You can also leave a sticky on the progress notes and an extra cue. I don't see anything wrong with the doctor asking for this help.

I would have been miffed about it too... I didn't go through nsg school to be a secretary. I probably would have handled it by leaving a post-it in the front of the progress notes saying "Dr. B: Dr. A has requested you call him after seeing this patient. His # is _____. Thanks, nsg."

Why would you all be miffed? I can't for the life of me imagine what's wrong with helping the communication process between doctors.

The doctor obviously realizes that the nursing unit will be aware of when this other doctor will be seeing the patient. He would like that doctor to call him after seeing the patient. He's in a hurry, so he includes it in the orders. A unit secretary worth her salt will take care of these things.

  • Author
I would have been miffed about it too... I didn't go through nsg school to be a secretary. I probably would have handled it by leaving a post-it in the front of the progress notes saying "Dr. B: Dr. A has requested you call him after seeing this patient. His # is _____. Thanks, nsg."

Yes, that's exactly what I did, with the extra step taken by the night nurse to give a copy of the order to the ward clerk in case she saw him. The ward clerk was the one who made a big deal out of it.

  • Author
A unit secretary worth her salt will take care of these things.

Is the unit secretary the same thing as a ward clerk? We don't have a unit secretary; the ward clerk is the person who is supposed to input doctor's orders, answer phones, and call consults that the doctor has ordered. She is the person that said she was "too busy" to take care of this.

Yes a unit secretary and ward clerk are the same.

There's not much to do in this case. When the doctor comes through, let him know verbally, and also leave a sticky on the progress notes just in case he slips in without you noticing. You can chart that you left a note on the chart, that should cover you.

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