Why do doctors ask the nurse?

[NotMyProblem MSN, ASN, BSN, MSN, LPN, RN]

I'm busy trying to be in 3 places at once so that the patients will stay happy. It is the middle of the night, not one of the patients are asleep because they might actually sleep through the next dose of Dilaudid. People are falling out of the bed because we are too short-staffed for a sitter, families are refusing to stay with the patients and are threatening lawsuits if their loved ones are physically restrained, etc. Now the hospital cell phone rings with Dr. X on the other end. This is the conversation: "Hi, this is Dr. X and I was calling to see what the surgical consultation report says that was written at 0910am because I can't read Dr. Y's handwriting." My thoughts: REALLY???? ARE YOU SERIOUS??? This is so annoying! Ummmm, have you tried calling HIM instead of ME? After all, you're the one who consulted him. Maybe in your conversation with HIM instead of me, you might want to mention the computerized system that allows for such consultations to be entered.

Another one is when the consulted physician writes a med order, we give it, then the primary comes along and d/c the order, only to have the consulting physician to come and REORDER it. And you ask me why Dr. B ordered this for your patient. Why not just discuss the pros and cons of a plan to medicate, physician to physician, and come to a conclusion BEFORE making it an order?

At my job, the change of shift chaos can last for hours because of 'stuff'. It could be a long time before I even get to open up a 'paper chart' to see who said what, that the off-going nurse forgot to mention or didn't even have time to check herself, given the right set of patients.

I really miss working at a facility where physicians had to call their own consults and come to a conclusion before fighting it out on the charts or misinterpreting what was written due to poor handwriting. I honestly don't have the time to run interference between the doctors.

[Nurse_]

Most of the doctors in where I work call their own consults. However, I still follow-up with it. When the patient is admitted on night shift, even if the night nurse told me she paged/left/called the doctor, I still follow it up just to make sure and chart it.

I don't mind getting yelled at for doing my job. My job is to ensure the care of my patient. What I hate is getting yelled at for being blindsided and being accused of not doing my job because I forget to follow up and assumed someone did it.

Also, if I see a doctor, I make sure to inform him of what had happen that day and who've seen the patient. Call me irritating, but I'd rather the message gets across than falling into the spaces. That's what we are, nurses are the bridge for these disciplines.

[SaoirseRN]

As for the doctor who called you to ask what Dr. X wrote, two reasons I could see for this...

1) you implied it was a night shift. Chances are, the doctor knew the nurses would be awake where perhaps Dr. X would not be.

2) nurses have a lot of experience reading doctors' handwriting. I often interpret certain doctors' writing for others because I've been looking at that scrawl for years and have learned to read it, while another doctor may not be as familiar with it.

[NotMyProblem MSN, ASN, BSN, MSN, LPN, RN]

As for the doctor who called you to ask what Dr. X wrote, two reasons I could see for this...

1) you implied it was a night shift. Chances are, the doctor knew the nurses would be awake where perhaps Dr. X would not be.

2) nurses have a lot of experience reading doctors' handwriting. I often interpret certain doctors' writing for others because I've been looking at that scrawl for years and have learned to read it, while another doctor may not be as familiar with it.

I agree with you. However, although we may be proficient in deciphering the jargon they call handwriting, isn't the 'correct' way to do things if there is a question about something written is to call the person that wrote it? I once had a member from another unit to call me about what she thought an order said. I disagreed and said that this is what the doctor ordered (based on what he said) but since the patient/chart was on her unit for a procedure, I couldn't double check. And we all know how a doctor can say one thing to a patient AND to us and turn around and order something totally different. However, I did call the doctor and ask what he wanted. And of course, he said something entirely different from each of our understandings. So, since what the doctor ordered in no way resembled what was on the chart, I had to write a clarification order and take it down to the other unit. No big deal but when other nurses are drowning, my patients are left unattended while I'm away even for a couple of minutes.

Since I'm a float nurse, I work days as well. Can you imagine the other scenario that I gave? Dayshift can be a nightmare most days. And when the physicians cannot agree, yet refuses to talk with each other, patients and nurses get aggravated. Case in point is the repeated medication orders. I was shoving a pill down a patient's mouth every hour because of a physician wanting this and the other saying no, he wants that. I did that all day until the patient finally REFUSED to take another pill.... all because the doctors would not talk to each other. That same patient also demanded to see a patient representative because she had had enough of those doctors doing that and was not about to allow another physician in her room until they came together on one accord. I, too, was sick of it because I couldn't do anything but transcribe orders and administer meds repeatedly to the same patient. The frustration that day could not be measured.

[Rhi007]

We have a doctor that covers all floors when on nightshift he basically sees the new admits up on the ward for himself and rings the on call specialist (they really don't like being woken up)

[brithoover]

Or some docs:

Me: Pt X has bad mouth sores. Can I get some nystatin ordered please?

Doc: Sure. What's the dose?

[Rhi007]

Apparently we went to both med school and nursing school and have to solve first world problems as well

[SoldierNurse22, BSN, RN]

Or some docs:

Me: Pt X has bad mouth sores. Can I get some nystatin ordered please?

Doc: Sure. What's the dose?

I used to see this a LOT. Interns would come up to our floor, get cut loose by their attendings/fellows/residents and we'd ask them for X,Y and Z. Being new to medicine in general and completely unfamiliar with oncology, they'd ask us often what we needed & how much of it. Those were the days!

[gcupid]

I'm busy trying to be in 3 places at once so that the patients will stay happy. It is the middle of the night, not one of the patients are asleep because they might actually sleep through the next dose of Dilaudid. People are falling out of the bed because we are too short-staffed for a sitter, families are refusing to stay with the patients and are threatening lawsuits if their loved ones are physically restrained, etc. Now the hospital cell phone rings with Dr. X on the other end. This is the conversation: "Hi, this is Dr. X and I was calling to see what the surgical consultation report says that was written at 0910am because I can't read Dr. Y's handwriting." My thoughts: REALLY???? ARE YOU SERIOUS??? This is so annoying! Ummmm, have you tried calling HIM instead of ME? After all, you're the one who consulted him. Maybe in your conversation with HIM instead of me, you might want to mention the computerized system that allows for such consultations to be entered. Another one is when the consulted physician writes a med order, we give it, then the primary comes along and d/c the order, only to have the consulting physician to come and REORDER it. And you ask me why Dr. B ordered this for your patient. Why not just discuss the pros and cons of a plan to medicate, physician to physician, and come to a conclusion BEFORE making it an order? At my job, the change of shift chaos can last for hours because of 'stuff'. It could be a long time before I even get to open up a 'paper chart' to see who said what, that the off-going nurse forgot to mention or didn't even have time to check herself, given the right set of patients. I really miss working at a facility where physicians had to call their own consults and come to a conclusion before fighting it out on the charts or misinterpreting what was written due to poor handwriting. I honestly don't have the time to run interference between the doctors.

One of the reasons why being a nurse sucks! If it were any other discipline they would not have to deal with these type of situations. I really wish I could respond with Dr. Call the consulted Dr. His/her number can be found in the CPU program that you have access to look it up easily.

[ninjago]

I was just thinking about what OP said, one doctor orders a med and another doctor d/c it only to have the other doctor order it again.

so here's the scenario:

nurse: Mr X, here is the new medicine doctor A order for you. (gives med to pt to take)

patient: ok.....(leaning to his table to get some water). Putting the pill in his tongue and about to take a gulp of water when....

nurse realized in the computer the order has been changed to d/c.

nurse: ooops, sorry MrX but doctor B does not want you to take the pill. Spit it out, please.

Patient: are you sure?

nurse: yes, there is a new order here to discontinue it. so please spit it out.

patient: okay(spits out the pill)

nurse: Thank you. Let me just review in my computer if I have given you all the meds you're supposed to take this morning.

(reviewing....reviewing....) seems okay.......hey wait a minute! New order to give the pill. Mr X, seems like there is another new order to give the pill you just spat earlier.

Patient: well, nurse make up your mind! do I take the pill or not?

[KelRN215, BSN, RN]

Or some docs:

Me: Pt X has bad mouth sores. Can I get some nystatin ordered please?

Doc: Sure. What's the dose?

Once had a neurosurgery patient who started seizing. The code light went off and the Neurosurgery Resident was the one overseeing the patient... he called for ativan and we said "how much?" The response was "the usual dose." Fortunately the Neurology resident was right behind him and gave the appropriate order.

[KelRN215, BSN, RN]

I was just thinking about what OP said, one doctor orders a med and another doctor d/c it only to have the other doctor order it again.

so here's the scenario:

nurse: Mr X, here is the new medicine doctor A order for you. (gives med to pt to take)

patient: ok.....(leaning to his table to get some water). Putting the pill in his tongue and about to take a gulp of water when....

nurse realized in the computer the order has been changed to d/c.

nurse: ooops, sorry MrX but doctor B does not want you to take the pill. Spit it out, please.

Patient: are you sure?

nurse: yes, there is a new order here to discontinue it. so please spit it out.

patient: okay(spits out the pill)

nurse: Thank you. Let me just review in my computer if I have given you all the meds you're supposed to take this morning.

(reviewing....reviewing....) seems okay.......hey wait a minute! New order to give the pill. Mr X, seems like there is another new order to give the pill you just spat earlier.

Patient: well, nurse make up your mind! do I take the pill or not?

When I worked in the hospital, usually only the MD's covering the patient's service were allowed to write orders. There were some exceptions (like only Oncology could write chemo orders, so if the patient was in the ICU or on the surgical service, Onc would still be writing/overseeing those orders) but overall, if a consulting physician wanted to order something, he had to speak with the MD covering the patient who would then enter the order. It made it easier in some ways... so you didn't doctors competing with orders and dc'ing each others... but also made it more complicated with the nurse being the go-between... Endocrine wants to give more ddAVP to this patient so now I need to make sure Neurosurgery actually orders it...