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.
Thanks again for all your responses. To clarify, no physician has complained (that I know about). For all we know, the doctor saw my sticky-note on the chart and made the phone call. I'm not really even that upset with the doctor who wrote the order - he probably isn't even aware that many nurses would consider this to be an inappropriate request to make of nursing staff.
The bigger issue (IMO) was the ward clerk trying to cover her butt by aggressively insisting it was MY responsibility, when I felt that it was really neither of ours.
Also of course, being chewed out by the charge nurse in public is humiliating.
Also, not even having the time to properly defend myself in such cases because I am so swamped at work, but I suppose that is a topic for another thread.
Specializes in Acute Care Cardiac, Education, Prof Practice.
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.
I would also drag that mouthy secretary in there as well.
I misunderstood. I thought this was a dcotor complaint when it seems like the unit secretary was behind the whole hoopla. If she saw him she should have alerted the doc and if she knew you missed him she could have just told you and in this instance you could have just called the doctor until you got better clarification on this situation.
The unit secretary was worried that they screwed it up and went in a panic. They then went on the offensive to cover their own butt. I take great issue however with your CN not taking the side of the nurse here and setting the unit secretary straight. Furthermore having this discussion in public is unprofessional and uncalled for.
I would still meet up with CN and superior to get clarification on how you expect this situation to be handled in the future regarding it being handled privately and whose responsibility this is because it surely shouldn't be on the nurses.
Because we are not personal secretaries! If a doctor wants to talk to another doctor, then pick up the phone and call him.
We're there to help coordinate care and help facilitate good communication between patients, families, doctors, and other members of the healthcare team.
We're there to help coordinate care and help facilitate good communication between patients, families, doctors, and other members of the healthcare team.
We can't be held responsible to have one doctor call another. This doctor should have paged or called the doctor himself and frankly, by the time he wrote the note asking someone else to do it he could have done it himself. This is the epitomy of laziness.
I think the order was inappropriate and showed laziness on the part of the MD. They should handle their own communications.
Doctors are extremely busy people. I think the doctor was trying to make good use of other members of the healthcare team. I, also, make requests of unit secretaries, techs, the charge nurse, social service, etc. We are supposed to collaborate for a common goal.
We can't be held responsible to have one doctor call another. This doctor should have paged or called the doctor himself and frankly, by the time he wrote the note asking someone else to do it he could have done it himself. This is the epitomy of laziness.
I disagree. We don't know what was going on with this doctor. Maybe he is shortstaffed at the moment and has a fuller schedule than usual.
As example, our cardiac surgeon's nurse practitioner was on vacation recently. She is awesome and is practically his right arm, he totally relies on her. So, while she was gone he, as a time saver, was writing a progress note, quickly going it over with us on his rounds, and having us write the changes as a verbal order. It was unconventional and actually not quite kosher. But, he had a very, very busy schedule, he is a very courteous and conscientious man, is respectful and wonderful to work with, in my opinion. We all do our best to be supportive of him as he has a very demanding job, being the only surgeon who does open hearts in this region. He's a darned good doctor!
I understand the physicians are busy. I am busy, too. So is the ward clerk, and so are the CNAs. In fact, I have yet to see anyone involved in healthcare who isn't busy. If everyone weren't busy, this would have been a non-issue, but since everyone IS busy, it is important to understand who is actually responsible for odd-ball orders like this, especially since we are often short-staffed, too. In fact on the day this hapened, I didn't even have a CNA to help me out. As a new grad who is still trying to find my groove, I don't have time to pick up the slack for someone else. I am still overwhelmed by the ordinary things.
Not a smart thing for that Charge to do. I would've lost any respect for her right there. I've noticed a type of nurse that is amazed at anything with "MD" on the jacket -- and will do any silly thing asked of him/her. There are other nurses who are professionals, and their focus is actual patient care. To me this situation is like getting coffee. I'll get you one if I am going to get myself one... If I see that Doc, I will for sure pass on your message. I am hoping as the old guard in nursing goes out, and the new comes in, some of this silly stuff /expectations will too pass.
Having said that... I ran a Doc's office while taking my prereqs... and I did do all the things I needed to do to keep my Doc's nose pointed in the right direction, and made sure I had him cross all his T's and dot all his I's. I would have tracked down that other doc for him.
Specializes in Telemetry, ICU, Resource Pool, Dialysis.
I apologize, I admit I did not read all of the previous posts.
Dr __________ can call Dr _____________ him/herself. You have enough to do, YOU ARE NOT A SECRETARY, a PERSONAL ASSISTANT, or an I-POD.
This order is about as inappropriate as an order I found on a pile of papers that was formerly a chart:
"Put chart back together"
A Resident had dropped a chart, scooped up the mess, placed it on the nurse's station counter, written that order on a random order sheet, balanced it precariously on the pile, and walked away.
We're there to help coordinate care and help facilitate good communication between patients, families, doctors, and other members of the healthcare team.
I would do that by showing the good doctor where the unit phone book was and reminding him that adding a third or fourth party to the communication increases the chance that the whole thing will get bunged up.
It was the doctor's responsibility to do his own communicating. I would do whatever was needed if there were unusual circumstances, like he was late for a meeting, or forgot his glasses, whatever. When a physician needs to consult with anyone on the health care team the accountability for doing that rests right back on the doctor. He can't pass that accountability off to you EVEN IF he writes an order. Same as you are accountable to see that patients get fed EVEN IF you delegate the task to a tech. Of course you would help the tech if he/she was busy, or not feeling well. Of course you would help the doc too...so long as it doesn't interfere with the work YOU have to get done.
You passed delegation on to a secretary, and she missed him because she was busy too. No biggie- the ultimate responsibility rests with the doc. Once he's written the order it would be nice to let him know you were unsuccessful, and why orders like that are more likely to cause confusion than facilitate communication. If he understands the situation he'll probably agree.
Since you're a new grad, and since this has blown up into a big issue it would be PC to talk to your manager about it, and ask her to clarify the responsibilities of everyone involved.
(About the resident that let the order to fix the messed up chart...the best response to thaat would be to put the whole thing back on his desk...but I suppose you needed the chart...some people are just grease spots on the world.)
I would do that by showing the good doctor where the unit phone book was and reminding him that adding a third or fourth party to the communication increases the chance that the whole thing will get bunged up.
He had probably already left the unit when the order was written.
What I would have done was, as I was signing off the order, I would have written a sticky note and put it where the rounding doc could not have missed it. If the charge nurse signs off the orders, then she should have made sure it was done.
Since the doctor's request was that the other doctor call him after rounding on the patient, then putting a note on the chart would be a surefired and easy way to facilitate this.
vashtee, RN
1,065 Posts
Thanks again for all your responses. To clarify, no physician has complained (that I know about). For all we know, the doctor saw my sticky-note on the chart and made the phone call. I'm not really even that upset with the doctor who wrote the order - he probably isn't even aware that many nurses would consider this to be an inappropriate request to make of nursing staff.
The bigger issue (IMO) was the ward clerk trying to cover her butt by aggressively insisting it was MY responsibility, when I felt that it was really neither of ours.
Also of course, being chewed out by the charge nurse in public is humiliating.
Also, not even having the time to properly defend myself in such cases because I am so swamped at work, but I suppose that is a topic for another thread.