You know that feeling. Something’s not right. You’ve done a thorough patient assessment, and checked and rechecked the vitals and the labs. Maybe you even have a “hunch.” But you need orders. You have to go through the steps of preparing yourself and ultimately paging a doctor.
Sooner or later, your nursing judgment will tell you that your patient has a need beyond your scope of practice. That’s when you need to be a patient advocate and call the doctor – even if it’s the middle of the night! Remember: The physician also has a vested interest in the patient receiving good care and will want to be updated on any important changes… but that doesn’t mean they’re happy to hear from you!
Did you know that communication failures are among the most common root causes leading to patient deaths as reported by the Joint Commission? That call could be the most important nursing intervention you make! Experienced nurses, as well as new grads, know the pain of dealing with a snippy doctor, but as a nurse, it’s your job to report changes in the status of your patient. Don’t let intimidation stop you.
Being a new nurse doesn’t mean you have to make rookie mistakes. Here are some hints for making that call to help you communicate competently and confidently.
- Perform a focused assessment relating to the specific concern, and use a tool such as SBAR to focus communication. Make sure you have relevant information and be prepared for logical follow-up questions. Having notes on hand of diagnostic tests, labs, and medications given can help you stay focused and answer questions quickly.
- Try to think ahead and anticipate obvious suggestions the doctor may make. Will the doctor order a urinalysis? Blood work? Depending on your facility, you may be able to get those samples started before you call, and then ask if there are any other orders.
- Additionally, while it’s important to get to the point and ask for what you need, be careful not to “recommend” a plan of care because many physicians will view this as a challenge to their status and it is a common source of conflict in nurse-physician relationships.
- Remember to repeat back any verbal orders and remind the physician, if necessary, that they will need to be cosigned later.
What if the call doesn’t go well? Sadly, the reality is that physicians are not always receptive, especially in the middle of the night. While you must learn to not take this personally, you do have a responsibility to advocate for the care your patient deserves.
- If the physician responds abruptly, acknowledge it, but don’t engage. You could try something like this: “I understand it’s frustrating to be called at 3 am, but I’ve summarized the information about Mr. Smith, and I need to know what you want to do regarding ____.”
- You should also document the time you called and the length of time required for a response. If the call was terminated before you could relay all the information, document that and inform your charge nurse. Your facility may have a policy regarding what to do if a physician does not respond in a timely or appropriate manner when called about the need for intervention or assessment.
One of the most important skills you will develop as a nurse is the ability to communicate effectively with other members of the health care team. Don’t let intimidation be a factor, and don’t hesitate to ask for advice or support from your nurse manager, who is responsible for equipping you with the skills necessary to do well as you learn the ropes on your unit.
Remember: you are your patient’s best advocate!
About the Author: