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.
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.
All the input about leaving notes in the chart, etc. are good and valid, but the bottom line is this order did not require a license, but rather was a secretarial duty. Im also missing the charge nurse's solution or instructions on how to handle this, or is she a chew nurse only.
I would have to talk to the unit manager about the charge nurse's behavior.
It is not a nursing responsibility to make sure one doc calls another doc (unless the patient is having some sort of crisis.) Furthermore, the charge nurse handled the situation badly by not talking to you privately and asking you what happened, rather than going on the ward clerk's info. I would talk to the UM because it IS a secretarial task, since she has the easiest access to all the docs' telephone numbers. If the w.c. was "too busy," she should've asked you to help. Instead, she waited till there was a confrontation and neatly skipped out on her responsibility by throwing you under the bus.
I would have to talk to the unit manager about the charge nurse's behavior.
It is not a nursing responsibility to make sure one doc calls another doc (unless the patient is having some sort of crisis.) Furthermore, the charge nurse handled the situation badly by not talking to you privately and asking you what happened, rather than going on the ward clerk's info. I would talk to the UM because it IS a secretarial task, since she has the easiest access to all the docs' telephone numbers. If the w.c. was "too busy," she should've asked you to help. Instead, she waited till there was a confrontation and neatly skipped out on her responsibility by throwing you under the bus.
Nice. :angryfire
Thanks for your input. The thing is, I don't really know how the nursing heirarchy works. Will I be putting myself in a position to be continually harrassed if I complain about being admonished publicly? Will the charge nurse be able to negatively affect my performance evaluations if I make her mad by going over her head?
The thing is, I would like some clarification about how to handle future orders like this, especially since the majority have so far agreed that this was not a nursing responsibility, but I really wish to avoid getting involved in workplace drama/politics. I don't want anyone taking the blame for this - I really feel it was simply an inappropriate request that I did my best to try to meet.
Sometimes I think it would just be smarter to nod my head publically, and roll my eyes privately. I'm a big fan of choosing my battles, and I'm not sure this is the ship I'd want to sink with, ya know?
It was never a professional order. Indeed, we are not secretaries, having to be told by the doctors what to do out of work context. If it was necessary that DR. A need to know if Dr. B made his/her rounds then Dr. A should've put in more effort than what's expected, much more than what has been done. It's passing the "burden" on you so he would've MORE enough time to doze off..lol
Thanks for your input. The thing is, I don't really know how the nursing heirarchy works. Will I be putting myself in a position to be continually harrassed if I complain about being admonished publicly? Will the charge nurse be able to negatively affect my performance evaluations if I make her mad by going over her head?
The thing is, I would like some clarification about how to handle future orders like this, especially since the majority have so far agreed that this was not a nursing responsibility, but I really wish to avoid getting involved in workplace drama/politics. I don't want anyone taking the blame for this - I really feel it was simply an inappropriate request that I did my best to try to meet.
Sometimes I think it would just be smarter to nod my head publically, and roll my eyes privately. I'm a big fan of choosing my battles, and I'm not sure this is the ship I'd want to sink with, ya know?
Next time, don't ask the secretary to pass on the message, but tell the secretary it is critical that she alert you the minute Dr. x steps on the floor and then chart that you did.
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.
If the unit secretary signed off on the order, it should have been done by her/him calling the doctor's office, if they signed off on the order and didn't do it.. that is a problem with the unit secretary. I have worked at places the charge rounds with the doctors, and she/he will tell them along with the office being notified. You might find out what is typically done where you work by asking others also.
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.
Because we are not personal secretaries! If a doctor wants to talk to another doctor, then pick up the phone and call him.
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.
I wouldn't be miffed but the problem isn't that the doctor coming to the realization the nursing unit would be aware of when this other doctor will be seeing the patient. It's when he expects the one nurse assigned to his patient who has other patients as well, that she will be able to alert the doctor before exiting the building.
Can a doctor leave an order to follow for a whole nursing unit pertaining to one patient?
This isn't the nurse's job. If the doctor needs to talk to another doctor they can page or call them directly. The docs where I work would never have done this because they know its lazy and inappropriate.
I agree with Angie that I would take this up the chain of command. You need to have this addressed and rectified to avoid a problem in the future.
Thanks for your input. The thing is, I don't really know how the nursing heirarchy works. Will I be putting myself in a position to be continually harrassed if I complain about being admonished publicly? Will the charge nurse be able to negatively affect my performance evaluations if I make her mad by going over her head?
The thing is, I would like some clarification about how to handle future orders like this, especially since the majority have so far agreed that this was not a nursing responsibility, but I really wish to avoid getting involved in workplace drama/politics. I don't want anyone taking the blame for this - I really feel it was simply an inappropriate request that I did my best to try to meet.
I would request a meeting with your CN and her superior and discuss the situation in a calm manner. You don't need to be confrontational but stay firm and polite. Say you don't ever expect to be treated so disrespectfull again. If your CN has a problem it should be handled in private. Period.
Also explain you want a clearer understanding of how orders like this work. Ask why the doctor can't page or call the doctor himself. Ask why passing on messages would be a nursing duty versus unit secretarty or the doctor's own responsibility. Let them flat out know you aren't comfortable with this order as you are there to provide patient care and can't be held accountable for tracking down doctors when you might be in a room with a patient addressing a patient issue or concern and your patient is your top priority.
It sounds like your CN is spineless and buckled when the doctor complained. The unit secretary got scared and went on the attack to protect themselves. You were 100% right here.
.thumb.jpg.6eeb2c01c27cfd151d706238b7f6d6b7.jpg){kind=small}
FireStarterRN, BSN, RN
3,824 Posts
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.