Tips: Approaching/Calling Providers

Originally published at http://onlinelpntorn.org/2014/tips-approachingcalling-providers/

Talking to physicians can be one of the scarier parts of being a new nurse. I vaguely remember from my clinicals that when my instructor said "I don't know why that order is there; ask the doctor before you do it" for the first time, I thought, "well, I'd rather stick a needle in my eye." Some providers are intimidating. Some are not. However, of course nurses fear the ones who are likely to bristle at what they see as having their judgment questioned—particularly when sometimes we are in fact questioning their judgment. That is a sticky part of a nurse's job.

Worse, many new nurses work night shift, and providers like to sleep at night. What they don't like is nurses calling them in the middle of the night, and they like it even less if the call is unnecessary or takes longer than necessary. My first job was in a cardiac ICU, so I cut my nursing teeth on waking up cardiovascular surgeons in the middle of the night. I can recommend this strategy for nurses who wish to develop a thicker skin.

The odds will never be totally in a nurse's favor. Physicians are human, and thus they are prone to snappishness and exhaustion and all other human ailments that lead to unfruitful interactions. However, nurses can stack the deck a bit by following these tips.

  • Call the right person. Seem obvious? Patients nowadays typically see a half-dozen doctors in a hospital stay if they're sick enough, which, we know, they generally are. Even less-sick patients probably see two. Hell hath no fury like a physician woken up to a question about someone else's order. I mean, I've heard.
  • Know what you want from the interaction. State it. This sounds pushy and requires some finesse, but physicians don't want a bedtime story. They want to know what you want from them and then why you want it so they can make a decision, give the order, and get back to what they were doing.
  • Do your research. You may get a provider who knows your patient's life story, or you may get someone on call for her who doesn't know your patient from Adam's housecat. Assume the latter. Scan the basics (chief complaint, allergies, recent tests/results, labs, current medications, most recent set of vital signs—I italicized that because it's important), and be ready to look stuff up. If your provider wants to know the patient's mother's maiden name, or whatever arcane thing they need, you will look a lot smarter if you have the chart in front of you to look it up.  What you don't want is to be left saying, "ummmm...I didn't get that" or "hang on a second while I get a set of vitals." You will return to a dial tone.
  • Have a current set of vital signs. I know I already said this, but for some reason if you report these it makes providers happier. I don't care if you're calling to ask if you can remove the sutures from someone's little finger. Have a current set of vital signs.
  • Use SBAR: Situation, Background, Assessment, Recommendation. "I'm calling about Mr. Jones. He complains of chest pain every 30 minutes. His vital signs have been within normal limits since this morning, last set 75, 120/80, 99%, and his EKG is available for you to view. He has no abnormal heart tones, his lungs are clear, his bowel sounds are active times four, he has no nausea or vomiting, and his skin is pink and dry. He does state he is very anxious. I wonder if we could try giving him some [Ativan, hydroxyzine, magic medicine X]." You have wrapped up the situation and stated what you want from the discussion. Now you can answer other questions because you have done your research (above).

Finally, if you work with certain providers consistently, you will know what they are going to ask. You can even ask what information they want when you call. Most will happily tell you and thank you for asking.

Happy dialing!

Photo credit: https://flic.kr/p/N8rfH