Don’t be intimidated! Follow these tips for working with physicians and banish your nursing anxiety for good.
Something I was super nervous about and didn’t have much experience with in school was working with physicians. I always heard horror stories about nurses getting screamed at for no reason and just assumed that would happen to me with every interaction with each and every physician.
I made it into a much bigger deal and source of stress than it needed to be. Yes, I have been yelled at before. However, that is few and far between.. and there are many, many fantastic nice, patient, informative, and amazing physicians.
A Note For Physicians
This note is for all of you doctors out there that are calm and patient with new nurses who are utterly overwhelmed. Thank you. You have no idea how much easier it makes our entire day/life to know that you’re on our side and want us to learn and grow. (And as soon as you leave the unit, we tell everyone how great you are BTW.)
Tips For Working With Physicians
There are a few things we need to realize as nurses, and these tips will make your life a whole lot easier during your shift!
#1 Remember that physicians are very busy as well
Doctors are very, very busy. Do you think you’re busy as a nurse? So are docs, but in a different way.
We get to clock out and completely forget about the patient’s we just took care of because we’ll be getting brand new ones tomorrow! They are often take call overnight and still expected to come in the next morning, even if they were in surgery for hours or had to come in for a consult overnight, then come in the next day to round on all of their patients.
They carry significant responsibility on their shoulders in being the one who ultimately calls the shot (ha!) on their patients, and have to see often a very large amount of patients each day. They have to evaluate the patient, write a note, change/update/add orders, and write admit/transfer/discharge orders as well.
That patient is their responsibility for their entire admission and all decisions (good or bad, obvious or not) rest on the physician’s shoulders.
#2 Don’t immediately page with every need
I know we were told in school to notify the physician, but we also need to use our critical thinking skills to figure out when and who.
Don’t you hate 10 calls/questions when you’re trying to assess, document, and medicate your patient? It’s the same thing with doctors. If we’re constantly interrupting them with every non-urgent need that comes up, it is very difficult to stay focused on a task and simply feels like their time is not being considered or respected.
If it’s not an emergent/immediate need, wait for rounds if possible, and then if they haven’t rounded by a certain time, then page. If it is, ask all of your fellow RN’s if they need to talk to the same doc. I also utilize text pages or if the computer charting has the capability to send provider messages. (Then I documented that I did so!)
#3 Reach out to the Advanced Practice Provider (APP) first
A lot of medical teams work with advanced practice providers like nurse practitioners or physician assistants. They can field many questions on order clarification, new needs, questions, etc. They may occasionally request you actually call the physician directly if it’s not a question they can answer.
(Please know, that’s not them trying to pass off work or make you call a bunch of people, but if you’re the person at the bedside with the question or need, it’s much better for you to speak with the physician directly rather than the APP be the middleman.)
#4 Be ready to field their clarifying questions
When you page or speak to them in person, they will probably ask you twice as many questions as you ask them. Have the patient’s chart readily available. Make sure you have a fresh set of vitals and know some of their labs or can quickly get to them on the chart.
They ask about meds, labs, and vitals frequently. Rarely do they just say “yes” and that’s it. I’ve overheard nurses call physicians without having any of that information readily available, or saw a change and immediately called without thinking to gather more information first and couldn’t field any questions the physician said. Rather than wait on the phone for the nurse to ask the patient questions, get vitals, open the chart, etc. the provider will just tell the nurse to call him or her back when they’re prepared.
Example: Your patient is now tachycardic. Maybe they were in the 70-90’s before, but now the has a heart rate of 135. You immediately page the physician.
Nurse: Hi Dr. Smith. Calling to let you know the patient in 8763, Mark Cuban, has a heart rate of 135.
Physician: Ok, what’s the blood pressure?
Nurse: I don’t know.
Physician: What’s he doing? Is he in pain? Is he working with therapy? What’s going on right now?
Nurse: I’m not sure, I’m at the nurses station and he’s in his room.
Physician: Ok, now MY heart rate is 135. Please get a fresh set a vitals and physically assess the patient and call me back when you’re prepared.
Is it understandable why that would be frustrating? They are trying to make a clinical decision based off of the new information you’re providing. If you’re not sure what kind of other info you need to know off hand when calling with your specific need, ask your nursing preceptor or charge nurse first.
#5 Provide background info as appropriate
Just because a doctor is covering for your patient doesn’t mean they know them. Don’t immediately start spewing out questions if who you’re speaking with is the on-call doctor and not the doctor who routinely care for your patient. If it’s an on-call doctor, you’ll probably have to give them a little background before you go over your list.
Ask, “are you familiar with _____?” If they’re not, then tell them a SHORT version of their story.
Example: I’m calling about Mark Cuban in 8673. Are you familiar with that patient? [No] He came in yesterday evening with chest pain. Cardiology consult tomorrow, probably a cath. NPO, on a heparin drip. Vitals have been stable and normal the entire night, HR 70-90’s. Then while sleeping about 20 min ago his HR jumped up to 135. It’s sinus tach, his blood pressure before was 135/90, and the pressure I just got was 114/77. Asymptomatic, no chest pain right now.
#6 Make sure you’ve got what you need
Sometimes, physicians may call the unit beforehand to give you a heads up that they need to come to the room to complete a procedure. As the primary nurse, whenever that happens, it is your responsibility to ensure you’ve got what they need readily available.
If what they need won’t be there for some reason (so maybe they need a specific dressing or tool that you don’t have on the unit), call and let them know. They may want to switch up their time management.
If you wait until they show up to say, “Hey we actually don’t have any ABD pads. I ordered some, but it won’t be here for another hour or so,” that’s not respectful of someone else’s time. Call and let them know so they can see other patients in the meantime.
Before you page with concerns, make sure you’ve bounced your concerns off of others and have done all the troubleshooting you can.
I’ve seen nurses page doctors about high blood pressure when there were already medications ordered (as needed, or PRN) available for the patient. (Boy, that makes people frustrated… when you call and wake someone up when you’ve already got the orders you need and can take care of the issue yourself.)
I’ve also seen nurses call the doctor when all they needed to do was call respiratory therapy and they were able to deal with the problem appropriately.
One thing I love about nursing is that we can be pretty autonomous. There are a lot of nurse-driven protocols (like glucose management, electrolyte replacement, etc.) that enable the nurse to deal with the situation themselves without having to call the physician. It feels pretty awesome when you can handle something pretty complex solo, and then notify the physician during rounds… and then they’re impressed and happy you took care of it yourself.
(Of course, make sure that when you are working autonomously, it’s all covered by policy and permitted for you to do! Don’t practice outside of your license and scope of practice!)
#8 Call the correct person
Know when it switches to the on-call doctor/APPs. (It’s usually 1700-0800). It is ideal that you get most questions/concerns addressed with that patient’s primary physicians rather than the on-call staff.
So if it’s 1645 and you’re just noticing the primary team hasn’t rounded yet, call them. See if they’re going to make rounds and if not and ask them your questions then.
It’s really frustrating for on-call providers to get calls just after 1700 that could have easily been addressed by their primary physician earlier in the day. And really, you want that doctor calling the shots.. not the on-call doctor. They are there for needs as they arise, not for routine things.
More Help For New Nurse Grads
I know how intimidating it feels to be that new nurse grad! I hope these tips helped you. If they did, check these out next.