I remember in nursing school the doctors were referred to as this all-powerful being that we must serve and who knows best for the patient. I remember some old-school nurses in clinical giving up their chairs for the doctors. Apparently that was the way back then: nurses would rise and give up their seats for the doctors.
However, my clinical instructors taught me about collaboration with the doctors; we work together as a TEAM: nurses, doctors, respiratory therapists, physical therapists, social workers, etc. We work together for the health and well being of our patients.
Why do we need to contact doctors?
There are several conditions that are necessary to call the doctor: status change, unstable vital signs, order discrepancy/clarification, and the most common, pain medication. Also if your nursing gut feeling says you need to call the doctor, do it after you've assessed the patient. There is nothing wrong with informing the doctor about the patient's clinical outlook with the right reason. As nurses, we are the eyes and ears of the patient because we are with them throughout the day in constant contact.
Occasionally we have surgical and obstetric patients that come to our medical floor. The doctors handling their care are not usually around our floor. On night shift prior to report I make sure I page the doctors to give them an update on how their patients did through the night. It lets me express any concerns that happened and gives the doctors a heads up before making rounds in the morning.
What information do I give the docs?
SBAR has been an effective tool for me to use in giving doctors information:
- Situation - what is going on with the patient
- Background - what is the patient here for, any important medical history/procedures
- Assessment - report any significant findings
- Recommendations - give suggestions or ask "what can we do for my patient?"
A sample telephone conversation can go like this:
"Dr. Smith, this is LT Awesome. I have Mrs. White who has admitted here today for pyelonephritis. Her heart rate is 103, her blood pressure is 150/90, and is complaining of 10/10 constant sharp pain to her right flank. No pain medications are ordered. She is allergic to morphine. What can I give her for pain?" Or,
"Dr. Cosby, this is LT Cool. Mr. Bradley is here for fever unknown origin. His vitals last night were stable, but has spiked a temperature of 101.5 in the last hour with a pulse of 110. He is sweating and has chills. No blood cultures were done since his admission. Do you want any blood cultures before I give him Tylenol?"
After communicating with the doctor I make the effort to make a nurses note about when I paged the doctor, the time the doctor called back, and a brief description of the plan of action. I found it a good practice to keep a running note throughout the night. It helps me and it helps the next nurse coming on shift to have an idea of what happened the shift before.
Contacting the doctor
Working at WAMC I have found three methods of obtaining access to a doctor:
- Face to face
- Telephone paging system
- Online-paging system
Face to face
Doctors are easiest to get physical contact with in the morning and throughout the majority of day. The residents and attending are making rounds on the floor. This makes for easy access to give information to them.
Telephone paging system
Each team of doctors have their own dedicated pager as well as their own personal ones. When a doctor of a particular team is unavailable on the floor, the telephone paging system is available. Just be sure to be nearby the phone and ask your co-workers if they need to speak to the doctor about their patients too.
Online paging system
This was new to me at WAMC. The pagers here can be sent text messages of 150 characters via the WAMC home page. Type in the pager number/pick provider name on drop down menu, type in message, and press send. If I have something non-urgent I tend to use this method.
The recommended format is as follows:
- RE: Patient last, first intial - DX: ~~~. Message to be sent. Person making page. Contact extention
- Example: "RE: Smith, J - DX: GI bleed. Request diet order post-endoscopy. LT Bold 1345"
All these things are tools to help disseminate information to the health care providers. Be sure to utilize them.
Tips:
- Get as much background/assessment information needed
- Get to the point, don't ramble or point blame
- Document attempts and call backs
- Respect each other
