Tuesday, August 28, 2012

Paging Dr. Grumpy

 "Page the Doctor." 

  The three words that seems to strike fear into the heart of every new nurse. In nursing school I cannot tell you the number of time that when the teacher said;
  "You'll need to call the Doc if this happens."
  "But what if he yells at you?" someone in the class would pipe up and ask every time.

  Why is this the gut reaction of every new nurse? Are doctors really terrifying creatures that put on a human skin when they come out of the lounge but in reality are snarling beasts when there are no prying eyes to see? Or is it that every doctor has an inner ear condition that is painfully exacerbated by only the exact pitch of the cell phone or pager ringer that sends them into a fit of pain induced rage when ever a nurse calls?

  All kidding aside, as a new nurse I have found it daunting to call a doctor, especially in the middle of the night. I don't like talking to some disembodied voice, that I have no face to attach to. In the end I did have to get over this irrational fear of talking to doctors, what helped me through this phase was to have a formula when I called the Doc.

  Remember SBAR? Yes it felt like I was pulling that one from the depths of my brain, but I guess they taught it to us for a reason. A charge nurse suggested that every time I contacted the Dr I should write my report down in SBAR fashion so that it was organized and I had all my information in front of me. OK for those of you who have forgotten lets review.

  SBAR stands for SITUATION, BACKGROUND, ASSESSMENT and RECOMMENDATION. This format is often used in giving report to help the nurse give a full picture of the patients status in a short, concise manner to someone who would not be familiar with them. Let's face it, Dr's see hundreds of patients everyday, if you just call them about Mrs Smith it might be the eighth Mrs Smith they have seen, you need to give them enough to jog their memory about the patient so they can make the right call. SBAR report may be awkward in the beginning but with enough practice it will become second nature.Here's a little taste of how it often goes.

 "Dr. Grumpy, I'm calling about Mrs Smith. She is a 57 yr old female who came to us with sepsis, since 8pm her BP has been going down and now I notice she has inadequate urine output. (That is your situation) She has a history of CHF and hypertension. (This is the pt's background, don't give a life story just what is relevant) Right now her BP is 80/45 and she is tachycardic at 110, with only 50mL urine output in the last 2 hours. (Your assessment) Would you like me to give a bolus of normal saline and start a pressor of some sort?(Your recommendation)" 

  If you read that aloud you'll notice it took under 5 minutes and gives the Doc a nice picture of whats going on in your neck of the woods. Not only have you clearly stated the problem that you are calling about but you have given the Doc enough info to make an informed decision. Here are some other tips:

  • Keep the patients chart open near by, the Doc may want to know the most recent labs. This way you are prepared, not fumbling around, they appreciate that.
  • Take five minutes and write your SBAR down so you have everything you want to say in front of you. I have blanked a couple of times when the Doc got on the phone, it saved my butt!

  • Don't take is personally if you do get a cranky Doc, they are people too and like us nurses can have bad days. Just be polite, get what you need and hang up, then vent to your fellow nurses, no point getting too upset over it we have more important stuff to attend to!
  When a patient starts to take a turn for the worse it can often be pretty scary especially for a newbie. The best advice I ever got was from my charge who reminded me that a patient rarely goes downhill so fast that you can't take a minute to organize yourself. Taking a second to clear your mind and focus on all the important things not only improves your patient care but will also make communicating with those Doctors even easier.


  1. Just reading about calling the doctor made me shudder just a little. I guess all the practice with SBAR we're doing during clinical comes in handy :)

  2. SBAR is so great and I think the docs appreciate concise, relevant notification...the will respect you more and be more receptive to working with you as an RN. My hospital is a teaching facility, so we have a new (inexperienced) resident every month, so it helps to page them with info that jogs their memory, remind them of pertinent facts about the patient, and by you giving a recommendation or REQUEST for what needs to be done for the patient (as an experienced RN, you already know what needs to be done, you just need the doc to order it!)...helps put a set of legitimate orders into motion much faster. Sometimes the power of "suggestion" via a recommendation/request allows for a much smoother shift on the RN's part. You know what to expect because you put the idea in the doc's head! Haha and if you aren't sure if any intervention is emergent, an "FYI check on next rounds" text page will cover you.

    1. I do love text paging! Our Doc's all carry Blackberries so if it's not an emergent item I often email a short SBAR and request. The Doc's love it because they can literally call back and say yes or at least have a nice picture of the patient when they get to the unit

  3. oh, yes.
    SBAR is most definitely stressed right now.
    the last time i called a Dr. {resident} i was nervous as all get out!
    she was super nice - not sure if that is the norm.

    1. I think most Doc's remember what it was like being brand new. Generally if I have screwed up I apologize and let them know I'm kind of new to the scene and they are pretty cool. I've really only run into a couple of situations when one of the Doc's was snarly.

  4. I once had an on call doctor yell at me for interrupting his ball game *rolling eyes*, I wish I could have said sorry buddy, you're on call and I'm just doing my job so deal with it.


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