Why can only nurses call the MD?

dudette10, MSN, RN · Feb 1, 2012

Or even better, when MDs refuse to call each other. "Dr. x wants this." Dr. Y: "Why?" Me: I don't know. Dr. Y: Well call Dr. x and then call me back.

My biggest pet peeve of all. "Dude, pick up the effin' phone yourself! You probably have the other doc on speed dial cuz you request the consult on every damn patient!"

prinsessa · Feb 1, 2012

Pharmacists are pretty good at my hospital with calling the MD for clarification. Sometimes they will call us first to see if we know the answer but they will actually page the MD themselves. If a MD is sitting at the nurses station and asks me to ask another MD something I will ask "would you like me to page so-and-so for you?" That works most of the time. RDs will also page the doctor instead of asking us to do it.

babyNP., APRN · Feb 1, 2012

That's so annoying; our services are usually very good about calling each other. In fact, many times they will ask me, "Who is the resident of patient X?" so that they can be the one to page the docs.

turnforthenurse, MSN, NP · Feb 1, 2012

Or even better, when MDs refuse to call each other. "Dr. x wants this." Dr. Y: "Why?" Me: I don't know. Dr. Y: Well call Dr. x and then call me back.

This happened to me. I had a patient who went into non-sustained v-tach, first event. Patient was asymptomatic and vitals were stable. Told the on-call doc, told me to consult cardiology. I asked him who he wanted me to put in for the order and he said "anyone." I asked him again and finally he mentioned a doctor, then he said for me to call him. I'm still new but I was "newer" at the time and I went ahead and called the cardiologist at 0000 and explained what happened. He wasn't very happy. I apologized and explained and then the cardiologist was okay with it but reminded me not to call a discipline unless the doctor has already been consulted by the primary physician and not to call at night unless it is an emergency. Hung up. Cardiologist called me back again saying he reviewed the chart, didn't know the patient had a bleed, blah blah blah, then told me to tell the on-call primary to call him (the cardiologist) regarding that. Then he said, "actually, I'll just call him myself." UGH.

Some of the RT's are good about getting neb treatment orders from the doc, but I'm usually the one that has to call about that kind of stuff. And call about things related to other disciplines. Very annoying.

P_RN, ADN, RN · Feb 1, 2012

I have always found that saying OK, "Doctor _____ 's telephone number is 000-0000." Please let me know what he says.

Repeated once then imply or outright say let me speak with my director or if you would like to her beeper is 000-0000.

Having a lot of grey hair does give some oomph to this.

RachRN66 · Feb 1, 2012

I don't call for other disiplines or other doctors. If they need information relayed then they need to relay it. I work in home health and do a lot of MD calls, but a week or two ago I was called by my manager in the office to say that OT wanted me to call the MD because patient had a heart rate of 42. That's all the info that was relayed to me. Because my manager told me to call, I did call the md. Then the nurse at the MD office started asking questions, was this patient taking meds correctly, what meds had the patient taken that day, was the HR at rest or upon exertion? Was the patient symptomatic? Was this an apical pulse or a palpated pulse from an extremity? I had NO clue, all I knew is that my manager told me to report the HR of 42. The doctor got on the phone and chewed me out for not having proper information. I charted all of this, and then reported to my manager that if the OT could not call the MD, then SHE needed to triage the call. Subsiquently, I called the OT and asked questions that the MD needed answers for and told her that she needed to relay the info to the MD because it was HER assessment. Every disipline has their own license to protect. I protect mine, and the OT and my manger need to protect theirs. I'm not a secretary, further more, if I didn't assess it, or don't have the documentation to support it (OT had not transferred her laptop yet, so I had no notes from the OT to go on) then I don't have correct info to report.

IF the RT didn't get the dosage s/he wanted then they should have called the MD themselves. You can't relay all the pertinent info to the MD if you don't have all the facts, and relaying "hearsay" can get lost in translation. These are all professional people that you work with, they all have their very own license to protect. It's not your job to do the talking for them. If you do it, and you don't get the facts straight, then YOU become liable! Protect yourself..

GilaRRT · Feb 1, 2012

In my area of the world RT's make respiratory related calls to providers. Nurses can as well, but we are often on the phone changing and clarifying orders or discussing pulmonary related issues. We often notify the patient's nurse of changes or issues but typically deal with respiratory related issues. Sometimes, there is a break in communication and the nurse is aware of something we are not and vice versa.

northbynorthwest · Feb 2, 2012

Sounds like a frustrating experience, and I share your pain. After 30 years of nursing experience, glad to help you out. You NEVER want an RT to get an MD order if they don't have one already. Techs that present to the floor are ultimately responsible for the delivery of the order, but not getting it. I always used to check with the RT to make sure the order they have is the one in the chart. You did the right thing. This comes down to who is actually going to be responsible for the order. RTs do the procedure, they are not legally responsible for obtaining the order. Sounds like on this one, the RT spoke out of turn. RTs fault. The MD is responsible for the order itself, and you are responsible only to make sure the MD order is there for the RT to follow as ordered. If an RT gives you a hassle about it, always go back to your own license, and if needed, call the MD for the order, then pass to the RT. Just always remember that no matter who passes through your floor for procedures, you can see those orders, and compare what they have to the orders in the chart. It is easy to let support personnel pass through your shift without talking to them, but your responsibility before they do anything is to check with them to make sure they have an order, first. All about due diligence. Watch everybody that touches your patients. Trust absolutely nothing until you have personally spoken with them. In this age of medical errors, your RT was committing one. You are the one responsible. Just make sure YOU get an order if needed. It's CYA, CYA, CYA. In the end, you want your patient to be receiving the right order, and only an RN can really know that. OK?

tokmom, BSN, RN · Feb 2, 2012

You know if a pharmacist, etc... calls the MD, they don't get yelled at like we do.

Our pharmacist will call us and want us to talk to the MD. Why put someone in the middle? Isn't that were errors occur?

Drives me nutty

GilaRRT · Feb 2, 2012

Sounds like a frustrating experience, and I share your pain. After 30 years of nursing experience, glad to help you out. You NEVER want an RT to get an MD order if they don't have one already. Techs that present to the floor are ultimately responsible for the delivery of the order, but not getting it. I always used to check with the RT to make sure the order they have is the one in the chart. You did the right thing. This comes down to who is actually going to be responsible for the order. RTs do the procedure, they are not legally responsible for obtaining the order. Sounds like on this one, the RT spoke out of turn. RTs fault. The MD is responsible for the order itself, and you are responsible only to make sure the MD order is there for the RT to follow as ordered. If an RT gives you a hassle about it, always go back to your own license, and if needed, call the MD for the order, then pass to the RT. Just always remember that no matter who passes through your floor for procedures, you can see those orders, and compare what they have to the orders in the chart. It is easy to let support personnel pass through your shift without talking to them, but your responsibility before they do anything is to check with them to make sure they have an order, first. All about due diligence. Watch everybody that touches your patients. Trust absolutely nothing until you have personally spoken with them. In this age of medical errors, your RT was committing one. You are the one responsible. Just make sure YOU get an order if needed. It's CYA, CYA, CYA. In the end, you want your patient to be receiving the right order, and only an RN can really know that. OK?

Actually, in my area of the country a registered respiratory therapist is a licensed provider with a minimum of an associate degree just like a nurse. The RRT is in fact well within their scope to obtain orders from the physician. Also, the RT is ultimately responsible for the delivery of respiratory interventions and the cardiopulmonary departments bill these interventions as such. Your situation may be different but thoughout my area of the sand box, a RRT is a licensed respiratory care practitioner with a well developed scope of practice. Mileage may vary according to facility policy as always.

wooh, BSN, RN · Feb 2, 2012

I'm going to agree with above. There are "levels" of RT (which I only sort of understand, probably about as well as an RT would understand the differences between an RN, LPN, CNA and PCT.) I know RT students can work as a sort of respiratory tech. They'll get the easy peasy patients with a breathing treatment and not much else. They cannot take orders, and they're under the direction of a licensed RT. But RTs are responsible for their own practice.

wooh, BSN, RN · Feb 2, 2012

And I know I should have just MADE her call herself in the first place. But I really like her, and was trying not to be too obstinate. I only came back to nights about 6 months ago, and I'm still getting used to all the RTs at night. During the day, the RTs generally would call for their own orders unless it was one of those, "When they came through, you mind asking for x?" sort of things. But if a call was necessary, they'd generally call. Or if I needed orders too, we'd call together. But at night, I barely know who's a new RT, who's a tech that can't call for their own orders, etc, and I was trying to be nice. But after the, "That's too much!" I did make her call to clarify it herself. :)

I think everybody likes to have nurses as the middlemen just to have someone to throw under the bus when a mistake was made. "But the nurse made the phone call/took the order/whatever." I ain't doing it anymore!