Hi Guys question about paging

[IM-an-MD]

HI, I have a question, I am an intern resident, and have problems with a particular nurse calling me about nothing and nonstop. Yes I know I will probably get flamed here, but this is the issue, she pages me about nothing, and keeps me on the phone I do not understand what is her problem, I am close to reporting her. For instance, she called me regarding a particular patient that I admitted, and called me and said exactly the following "she doesnt look so good" now I do not understand this :eek: could it possibly be that maybe I already know this because I have rounded on her three times - including with my upper level residents and staff physicians - that particular day and she is in a bit of discomfort????? what exactly should I do about it over the phone - such a vague statement, no fever or elevated white count what the heck are you saying to me???? and then I had multiple patients on the same floor, and unfortunately the same nurse answered the phone because another nurse paged me about another really sick patient, and as usual I was doing 5 things at the same time, and that particular patient was really sick! so I fixed that particular problem, and then there she went again, the last thing that she said before I hung up the phone, "so what should you do about the other patient?" now this is highly inappropriate abuse of the paging system in my opinion, the patient is fine now and ready to be discharged, but how can there be allowance of this type of behavior??? When I am managing multiple very sick patients with very little help at times, how can I put up with this type of behavior... and then get this, I was just mentioning that a patient's appetite was better, and she said the following, "how can the patient's appetite be better when they are NPO?" What the ..... no explicatives there....but this is the by far and large the most annoying nurse on the planet, what should I do about it????????? I love it when nurses are actively involved in patient care and welfare - it really does help my job, but this is going way way way beyond the borders here and I need to do something about it besides keeping it bottled up..... she is extremely inappropriate....and it can affect my clinical judgement at times... if you guys wanna kick me off of here than please go right ahead and do so I totally do understand, but I am lost and clueless on what to do...

[NEURO_QUEENCST/CSA]

sounds like somebody likes the sound of your voice! hhahaha. joking aside.
i work in the operating room and have for 23 years. so, what i think i would do if i were you; is document each time she calls, a brief summery of the call, and then write her up and give it to her supervisor.
you didn't say if this nurse is a new grad or a seasoned nurse. that could make a difference. is her supervisor available for her to consult before calling you. maybe she needs additional orientation.
and no i dont think we will kick you off here!! even though medical students, residents and interns can be a large pain in the rear.....SOMETIMES.
best wishes!

neuro queen cst/csa :cool:

[IM-an-MD]

Queen let me first off say that you are awesome! No I have no clue what is the level of this nurse, but I am bound to find out and will surely make that internal effort to find out...... and I dont want to get anyone in trouble though, would it be a waste of my time and efforts if I asked her about it first? I mean definitely she is out of line contacting me about meaningless issues when I am extremely busy with this rotation, and so many patients with COMPLETELY different issues to all deal with at the same time...so its tough and yes we can be a major pain too....I myself need to learn how to be more assertive, but you know what, when there is that chemistry that goes down and things work out well for the patient most importantly, nothing better than that chemistry, all working together... and successfully, you know it is terrible that she is bugging me like this, and you put a great perspective on it, making me think that she wants me lol... smileys dont work here did anyone here know or realize that? now thats a nice way to put it and I will think of that in my head next time that she pages me unnecessarily - that she likes my voice, hopefully that will somehow numb the pain and agitation slightly, which will be tomorrow probably...but goodness gracious please please please please please anyone reading this please learn to respect others as well, like if you are paging me for one thing, then STICK to only that, and dont divert my attention to other issues which are not at all whatsoever serious, its really unfair, and if it gets out of hand then yes I am going to report her, she bugs me so many times, and then when I go up there to sign an order after like twenty minutes, I find out that she didnt even write the order, ugh... painful nurse very very painful... thanks for reading. I totally agree with you one of my colleagues a fellow intern unfortunately is so rude to everyone, and lazy and incompetent at times, wholeheartedly will agree with you on that one.

[cassioo]

is there a charge nurse on the unit where this nurse works (or by chance is she it?). Maybe she needs much more direction then other nurses. When she says doesn't look right ...say tell me what doesn't look right leave it open to explain. This might be a really good nurse that just knows something isn't right but not what. When I was on peds that's all you had to say to one doc to have him over your shoulder in a minute that was all the information he needed you'd get hung up on then think oh great but here he'd come and we'd end up with a really sick kid....we have a bit of the same problem on our unit have interns and residents and new to the area doc and the senior nurse on night shift is a caller that says their temp is 100 can I give tylenol? Or they haven't been able to pee for 8 hours and the bladder scanner says there's 500 cc's in there can we cath her just common sense things but the policy says have an "order" where most would write the order anyway she wants to talk to the doc... you could also say what do you think needs to be done? see if she has some big idea.

[IM-an-MD]

good advice there, nothing in peculiar that she says, just that she always contacts me about trivial things , like how hungry patients are which is another ridiculous thing because they are NPO because of various tests so why should I get paged about it??? She should sometimes think about it and read up a bit on the patient and ask her colleagues what to do much before paging me, thats what I always do to my higher ups, order all of the labs, totally exhaust each and everything that I can possibly do, and THEN call the upper levels or higher ups, You know you guys are like my group therapy, you guys are priceless here and I mean that 110%.. I mean you have the best perspectives on these types of issues..... you can bill me too I dont care because you guys are totally and completely worth it.., but you know what I really do admire the perseverence that you talked about the Peds stuff and the docs there, because I admire that thats just great dedication, and the type of person that I want to model myself after, not someone worrying about when a nurse is going to page me about how much the patient likes a particular type of food, no I am for sure that she is not the charge nurse, I know most of the charge nurses on the various floors, and although I am relatively new, I think that she is new also.

[medi]

She pages you just to tell you some patient's who is NPO is hungry?? Omigawd... either Queen's right and she's got a thing for you hon... or she's a world class dingbat! *LOL*

I know you're tired beyond belief, at your wits end already just trying your best to keep up with an impossible load, those toothpicks that are propping your eyelids open and attendings on your case day & night are mind numbing enough, and you probably pray just to make it through the rotation without killing anybody as it is.... and the last thing you need is someone paging you frequently for nonsense!

Ok. Take close your eyes for one solid minute and take a deep breath. Now let it out.... slowly... then repeat as necessary. A little better? Ok, how do we deal with this?

You've had some really good suggestions so far, but I'll add a few thoughts as well.

Number one-- you don't have the time to stop whatever you're doing to jot a note about each time she pages you. It's engrained well enough in your head anyway so if you need to have a talk with her charge nurse or department manager you can give them the gist of it just fine I'm sure.

Let's suppose that she's a brand new grad and afraid of her own shadow so she calls a doc everytime someone blinks because of lack of experience. Let's start with trying to train her then....

Situation: She pages you to tell you patient x "doesn't look good".

You: "That's not very nice Nurse X.... we can't all be beauty queens after all.... (long pause then).... or are you calling me to tell me there's been a clinical change I need to know of?

Nurse: Here she needs to get more specific obviously.

You: Use interrogetories to quickly get to the specifics.

If there's nothing at all specific in her call- no change in BP, outputs, clinical changes of any kind, then order her to do all sorts of things if you feel it warranted---- give her some work in other words. The assessment or tests you order will either confirm some clinical reason behind her call OR will eventually teach her to call you only when there's an actual change in a patient that you need to know about.

Situation B: She's dumber than dirt. Have a talk to the nursing supervisor of her department about the frequent nonsensical calls and question the nurse's competence.

I wouldn't tolerate failure to write orders you gave her over the phone though. If you get to the floor to sign off orders and find she failed to write them I'd tell the unit sec to get the charge nurse and when he or she arrived I would have a stern talk with the nurse in question in the presence of the charge nurse on the spot. There's no acceptable excuse for that. It may not seem like a big deal for a routine med change but what if your patient needed to start on the med, or have the test done, or whatever immediately? Failue to write an order & get it started endangers patient's lives. Don't tolerate it and don't let it slip away in silence.

Some suggestions about how to handle things like that though....
When necessary to chastise or complain about performance always call the nurse, or whoever, and their immediate supervisor aside -- away from onlookers and other staff. Criticize in private. The goal is to improve performance-- not to demean and humiliate the individual.

On the flip side of that- always praise in public.