Everyone gets nervous in a big way or a small way whenever dealing with the physician or nurse practitioner. Nurses are geared to deliver information to one another; we are used to saying half sentences and waiting for the other nurses to jump right in there. We are comfortable around other nurses, we know that, well, for the most part, they have our backs.
This is not true whenever you must deliver succinct, complete, pertinent information to the physician. And we don't even want to talk about trying to get the physician on call to follow our line of reasoning!
Hopefully the following guidelines will help cure you silent groans of "OH God, it’s the doctor" the next time you must pick up that telephone!
First of all, if it is an emergency do NOT bother calling the doctor. Use your best nursing judgment! Send them to the hospital; call for back up, call the code or whatever you have to do according to where you and your patient are at that time. Just get that patient taken care of pronto!
You knew that! :)
Now, if you are in a hospital setting, find out what time your doctor is coming in, if you are in a nursing home, find out if your doctor is coming in. If you are in home health, all bets are off...call that doctors office and talk to that nurse then write it all down on your scratch paper.
Documentation is still the key to all of this! If you must, scribble it on whatever is handy but remember it MUST be in that patients chart to be of any use to you in the future! I agree, I hope you never need it in the future either!
Starting with the hospital: if the MD hasn't made rounds yet, great, make a list, give it to the charge nurse. If you are in a nursing home, make a list. If you end up with only the one patient to discuss, fine, call the MD before 11:00 in the morning.
If you have labs that need to be reported get as much of the other patients needs down on paper as you can but call those labs in first thing! Even if the lab work states MD office notified, you are responsible!
Why do you need to notify the MD of anything before 11:00 o'clock in the morning? Because, unlike you and I, the MD office gets to eat lunch, not only that but they get to eat their lunch in peace and quiet! Sometimes for as long as 90 minutes! I know, it isn't to be believed...
If you wait until after their lunch, chances are you will not get a call back until the next day. Most physicians take care of all their "outside" calls after their office closes. That means the physician or his nurse or both will start calling with the answer to your routine questions after 5:30 in the afternoon or even later.
What, you ask with a yawn, does this have to do with your talking to the physician phobia?
Everything.
Because my point is this: Make every call as if you are already speaking with the physician. Never mind if the doctors nurse is an old friend and you were in nursing school together or even if the MD nurse is an in law!
Stay professional.
The thing that helped me was when I started writing out a "script" of everything I wanted to tell that doctor. In the script I started at the head (figuratively speaking) and went through the body systems one by one. Just as if I were completing a physical. Except the script contained only the pertinent information.
For example; a patient fell on the previous shift, struck the back of his head and sustained a laceration of approximately 4 x 0.5 x 1cm behind left ear. Nursing called the family, MD on call and patient was transported by non emergency ambulance to the emergency room where patient received seven sutures. Sutures are clean, dry, intact, emergency room MD orders received but requests patient be seen by primary physician within next 3 days and requests patient return to emergency room for suture removal.
The 'usual' report to the physician the next day may be the following: so and so had a fall on the previous shift, was taken to ER, treated and returned, no problems noted.
Your "written" script to deliver to the physician may include the following:
Nursing has nearly completed the neuro checklist, no signs of complications due to recent fall noted. Patient remains awake and alert, does complain of slight headache. (Has or has not received as needed pain medication). Resident is (or is not) on Coumadin for (plug in diagnosis used for use of Coumadin. Proceed with patients vitals starting with most recent, even better is to give an average over the last six to eight hours.(or however long you have been doing neuro checks) For example: patient systolic averages 100-130 and diastolic averages 70-80mm/Hg,heart rate 70-86, no skips noted, no chest pan noted, skin cool and dry, patient with history of seizure activity taking depakote, last level drawn (give date) with level of (give level) and last known seizure was on (give date) and consisted of (give type) seizure lasting (give minutes).
May nursing remove sutures in ten days or do you wish patient to return to ER for suture removal?
May this nurse put a note in your MD book to remind you to check this patient on your next rounds?
Would you like any labs or other orders for this patient?
Then of course you document all of the above verbatim along with the physicians’ response in the patient chart.
Why should you give all this information? Better yet, why should you write it down then read it to the physician?
1. What if that patient has a seizure two hours after you go home? The next nurse calls and the physician could say they had no knowledge of this patient having a history of seizures nor were they informed of it when "you" gave them report! The physician may go so far as to question other information from the neurochecklist, the last known lab work, is this seizure the same as previous seizures and if so when was the last known seizure...Can you see what your next shift report will feel like? It will be a bit frosty! Worse yet, it may be very public!
2. No one likes to suffer through a verbal report filled with uncomfortable silences, repeated uh's, I'm sorry just minute and let me look that up for you. Imagine yourself as the physician or the nurse practitioner and you will realize they are depending on you for the correct information! You are an important member of their team! You will realize when you start doing this that you are powerful! You will discover that your time is as valuable as theirs and you will then find that you are on a level playing field with your physicians an your nurse practitioners.
The most important and self changing benefit of delivering all the information the physician and or the nurse practitioner needs is that you will get better and better at the critical thinking part that comes with going deeper than just the one or two sentence report!
Your report will be the one the physician will look forward to hearing, your work will be what the nurse practitioner will be proud of, your presence at the patient’s bedside will be the calming, and professional atmosphere that patient needs to improve.
Thinking about all the aspects of whatever you are giving report on will open your mind to all the different levels of care that are impacting that patient! You will be amazed at the difference you see and feel in your own work when you start this one small change. One change, how you give report, will cure your fear of speaking to the physician ad or the nurse practitioner and it will enrich your professional life on a daily basis, only getting better as time goes on.
Give it a try! You will pleased you did!
barbara bethard
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