Talking to physicians can be one of the scariest parts of the job for a new nurse. For the rookie RN, a 3 a.m. call to the doctor can be fraught with terror that they’ll say something stupid, get yelled at, or even have the physician hang up on them. Without the cushion of experience, many new nurses stress over what sort of situations even warrant a call to the doctor, and which ones don’t.
“It was intimidating. It can still be intimidating and I’ve been doing this for 20-some years,” says Jodi Wendel, RN, an oncology nurse in Muncie, Indiana.
In her early days, Wendel says she remembers her fellow nurses warning her about doctors with reputations for being rude or difficult. “They’d warn me, ‘doctors A, B, and C aren’t going to give you any trouble… and doctors D, E, and F are going to give you trouble, question you, or get mad at you.’”
In time, Wendel says, she gained confidence in her interactions with physicians and learned how to handle those with more difficult personalities. With the right mindset, and by following these tips from Wendel and other seasoned nurses, the new nurse graduate can speak to doctors with poise, rather than a pit in the bottom of their stomach.
Doctors are busy people, so before dialing the MD, make sure to have all your ducks in a row. Know the patient’s diagnosis, have their latest labs and vitals on hand, know what medications they’re taking, and be aware of any allergies. “Know what you’re calling for and what you’re hoping to get. That way it’s just cut and dry and you’re not doing the ‘let me check, let me check, let me check,’” advises Wendel.
Try to anticipate what other questions the doctor might have. If you’re calling about a patient with a low O2 sat, make sure you’ve got the respiratory rate. If the patient’s blood pressure has plummeted, know the patient’s heart rate and have other vital stats available. Be sure to keep the patient’s chart open so you’re not fumbling for an answer—and document the communication.
Alana Aghassi, RN, a staff nurse on a busy neuroscience unit in a St. Petersburg hospital, urges nurses to follow the SBAR (Situation, Background, Assessment, and Recommendation) technique to relay information efficiently. Following this rubric, the nurse: identifies the patient and the problem (situation); provides a brief explanation of the patient’s admission and pertinent medical history (background); presents any concerning findings, including symptoms and vital signs (assessment); and then asks the physician what they need (recommendation).
While the recommendation step can be difficult for new nurses, it’s a key part of the call—and the nurse should know what he or she wants from the doctor. “They’re asking for your professional opinion, so you need to have one,” says Tina Stevenson Reed, RN, a longtime hospice nurse in Tampa. “If your patient has been on two antiemetic medications, and is still vomiting, have an alternative in mind. “You might say, ‘we tried Compazine, and it didn’t work. We tried Reglan and that didn’t work. I’m thinking Zofran, what do you think?’”
Be Confident, Not Apologetic
Kathleen Bartholomew, RN, MN, a nurse leader, consultant, and speaker based in the Seattle area, recalls an encounter during her first nursing job with an “egotistical” doctor who made poor eye contact with nurses and was known for hanging up on them. One day, when that physician finally decided to speak with Bartholomew, she jumped on a chair, locked eyes with the six-foot-four physician and asked him what he needed. Stunned, the doctor walked away—but Bartholomew says she earned his respect. The next time she talked to the same doctor, he was more attentive and they soon developed a good working relationship.
While not all new nurses may have that panache on day one, learning to be assertive is essential—and don’t be afraid to “fake it” till you make it. “You can’t let people walk all over you,” says Aghassi. “You approach respectfully, but confidently, even if you are not feeling the most confident.”
And by all means, never apologize for calling a doctor, says Bartholomew, author of the book Speak Your Truth: Proven Strategies for Effective Nurse-Physician Communication. “When it’s 2 o’clock or 4 o’clock in the morning, we have a tendency to say ‘I’m sorry to bother you.’” Chances are, the doctor doesn’t apologize when he calls the nurse—and nurses simply perpetuate a power imbalance when they apologize for doing their job, Bartholomew says.
If possible, cultivate friendships with the physicians, advises Bartholomew: “You can talk about what to do, and skills and tactics, but what matters is the relationships. Until you feel like you can ask a physician out for a cup of coffee and they say yes, you have work to do—because sharing a cup of coffee means collegiality in this culture.”
Be Your Patient’s Advocate
Poor communication can have a big impact on patient safety. In fact, communication breakdowns have been implicated as the root cause in nearly two-thirds of serious medical errors.
Paula Bungay, an RN who has worked in Canada and Florida, says she learned early on in her career that the stakes are too high not to speak up. “I was a student and I had a patient go very, very bad first thing in the morning in the middle of report, and she ended up dying. Nobody would listen to me because I was a student. They just kept blowing me off. From that point on, I swore I would never let that happen again.”
For the new nurse struggling to decide whether a situation is urgent enough to call the doctor immediately, or wait till rounds, Bartholomew prescribes this litmus test: imagine the patient you’re concerned about is your own daughter, mother, or father. In that situation, Bartholomew says, you’d do anything. “If you’re afraid to speak up, then your patient is at risk, and we have not met our ethical obligation.”
Report Bad Behavior
While doctors’ behavior has improved over the past couple of decades, “you still have physicians who are rather intimidating and use intimidating tactics,” says Bartholomew. Those tactics can be subtle, such as not knowing a nurse’s name, even though she’s been working the floor for six months, looking at a nurse with a “hurry up” or “get-it-over-with” look on their face, or making no eye contact at all.
In a 2013 survey on workplace intimidation by the Institute for Safe Medication Practices, 87% of nurses reported a “reluctance or refusal” by physicians to answer questions or return phone calls or pages, and 74% said doctors had used “condescending language” or made demeaning comments.
Nurses need to remember that if a physician is really acting like a jerk, they can and should report them. “Hospitals have a lot more standards and policies about this stuff than they used to and that’s important for new nurses to know,” says Aghassi. “Know your chain of command and what to do to report abusive physician behavior because a lot of physicians have really toned it down—because a lot of these hospitals really go after these nasty doctors. The culture is changing; it’s no longer acceptable.”