FAO Nurses: How to get on/work with doctors
Aha! As promised, after doing my version for doctors here is a version for nurses.
So I am going to break this down into bullet points on what I think nurses should do to get along with the doctors and work with them so that there is no animosity. Often times I see doctors acting like nurses are below them and often times I will see nursing staff acting rude and not helping doctors out - HOWEVER, when both get along its a wonderful thing and most importantly it is great for patients.
1. Call doctors by their names - Now, the reason for this is the same reason I would suggest doctors call nurses by name too; it breaks down that formal barrier and promotes a better relationship. A question a few nurses raise though is whether to use a doctor's first name or call them Dr. so and so. I would suggest that anyone who is less than consultant grade you call by their first name. Anyone who is a consultant you should call Dr. or Mr. so and so (in the UK we call surgeons Mr.- google to find out why, it's pretty interesting). If they themselves want you to use their first name then they will tell you. And yes, you should even try to remember the name of that weird microbiologist that you occasionally see out of his normal laboratory habitat hahaha.
2. Avoid "Bay Syndrome" - "What's that?" I hear you say? It's what I diagnose a nurse with who will not understand that a doctor is taking care of several wards and has many ill patients to care of and thinks her bay needs some kind of priority. This manifests in nurses bleeping/paging doctors with jobs such as prescribing drugs or fluids that are not needed by the patient for several hours just so that they can tick a box on their list of jobs to do. The job does need to be done, but can it not wait until the ward round or when the doctor comes to the ward? My most favourite nurses are the ones that will let jobs like these accumulate and then bleep the doctor once for all of them saying "Hi doctorphantom, just have a few things on my ward for you to do. Nothing urgent but just come down when you get the chance. Grab me and I'll tell you what needs to be done/I'll leave the drug charts at the front with notes on what I need". BTW, I wonder how many of you thought of a nurse that was particularly fond of causing Michael Bay-esque explosions when I mentioned "Bay Syndrome"? Hah!
3. Don't know why I asked you to do something? ASK! - Often I see nurses when they are doing their handovers pass on a piece of information to another nurse and when that nurse asks why that is the case you get the "NO idea, but the doctor wanted it" response. Do please ask us if there is something you are unclear about. This helps in 2 major ways. First of all it makes the handovers better and if you need to call a doctor at night or over the weekend for an ill patient the nurse can quickly and succinctly get the attending doctor up to speed - a patient has a story and not just a list of jobs to do so do please become acquainted with the story during handover. Secondly, the family and friends will be speaking to you and if you can answer their questions without having to bleep a doctor to speak to them then you will save us a lot of time to get on with our jobs and we will really appreciate it.
4. Never, ever, ever, ever think that just because you tried to bleep/page a doctor but got no reply you are free from the responsibility of looking after the patient - Sorry to get a bit serious but this is a VERY important point. If a nurse fails this test then all I see a nurse who has failed at her profession - I WILL raise the issue to your seniors. There are countless reasons why a doctor may not reply to a bleep - could be doing a procedure, breaking bad news, had poor signal coverage or you misdialled and so the doctor didn't get the bleep. That doesn't mean that if you bleeped them once or even twice you can then write in the notes "doctor bleeped - no response" and call it a day. The patient needs a doctor. Keep bleeping or find out the number for another doctor! You still have responsibility of the patient's health. When you call a doctor you aren't transferring responsibility - you are asking for another member of the team to come and assist in the patient's care. I once had to attend a peri arrest where a patient had become hypovolaemic from loss of blood after an amputation of a toe. Looking in the notes I saw "bleeped doctor on XXXX - no reply" as the last entry around 5 hours earlier....... Needless to say, the nurse who wrote that got a mauling from the head sister.
5. Do those training modules to become a better nurse - So in the UK there are certain core procedures that nurses have to be able to do but there are MANY procedures that are "optional" (they really shouldn't be to be honest.....). Amongst these are canulation, phlebotomy, male catherisation, NG tube insertion, wound cleaning and semi advanced life support. All of these are basically "see one, do one". They aren't hard. If you can do one of these study modules online and get certified (takes minimal effort) even in ONE of these skills it will help the doctors (and your fellow nurse in the other bay who is trained in this stuff who you keep asking for a hand) out A LOT. Asking a doctor up to his neck in sick patients to take a gentamicin level could result in........
6. Be social - Asking a doc how their weekend was, how their day has been, bribing them with sweeties is always a great way to break that formal barrier. When I walk around on the various wards where I work all the nurses will say hi to me, ask me how things are, if I've been getting up to mischief, what new chocolate stashes they have got for me etc. Makes me feel awesome and when they in return need a hand I feel like I am helping out a friend rather than a work colleague. We just get on so much better and it makes for a pleasant work environment. Don't be that nurse that actively hates joy of any kind........
7. Join the doctors when they come for a ward round or patient review - It is easy to think "oh, I'll just take a look in the notes when they finish seeing the patient" but being there during the consultation will allow us to explain why we want things done and give our impression of the patient better. It will also allow you to ask any questions you may have or to calm a fearful patient in a strange environment since it is your face the he/she will be be most accustomed to. You may think it will take up time but I think in the end it will save you having to trawl through notes and maybe chasing up doctors for clarification.
8. Recognising the ill patient and referring appropriately - This is one of those things that you get with experience if you are doing all of the above. Experience is noticing that a patient's blood pressure has been lower than normal after a general anaesthetic/epidural but not calling the doctors knowing this is expected and currently at an acceptable level and stable. Or not calling down the doctors for a urine output of 0 after an entire day of 60mls plus U/O hourly BEFORE washing out the catheter to make sure it isn't blocked. Or calling a doctor down since you noticed that the patient's temperature is just starting to climb in tandem with a rise in heart rate and the patient looking a little clammy a few days after an operation. You may think you won't get any recognition from doctors for this but I PROMISE you that we keep tabs on this. When certain nurses call me as soon as I hear "Oh heya doctorphantom! It's XXXXX, just wanted you to come and review a patient for me" I will know that this nurse always refers patients correctly and I will need to review this patient so I just ask for the minimum details and come down and get the rest from the nurse in person. Although with a few nurses.........
That about sums it up I think. Doctors have duties that vary from completing discharge letters and prescribing regular meds to attending acutely unwell patients. The latter will always get priority. As a nurse you can help us be much more efficient by referring appropriately and by dealing with as much of the non urgent stuff as you can. You have a huge role in the patient's care and we really do need your help to provide our patients the best care possible. Like I said earlier, when doctors and nurses get on it's a beautiful thing and only good things come of it.
Doctors, any further suggestions? Reblog and add them or PM me.
I hope to do an update of this and the last blog with the suggestions of the nurses and doctors who do have further suggestions.
