[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 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...

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[cassioo]

I answered a bit in the other forum...did you ask the nurse what is "a bit of discomfort" what does the pt rate the pain what have you done about it? when did you do it? how much med has she had? have you turned her? when's the next med due? was she asking you to do something about it or up dating on the pt "while she had you on the phone" put the ball back in her field for more information she's the one at the bedside.

[IM-an-MD]

Originally Posted by cassioo

I answered a bit in the other forum...did you ask the nurse what is "a bit of discomfort" what does the pt rate the pain what have you done about it? when did you do it? how much med has she had? have you turned her? when's the next med due? was she asking you to do something about it or up dating on the pt "while she had you on the phone" put the ball back in her field for more information she's the one at the bedside.

you answered more than a bit thank you wholeheartedly for it, and this too... no I didnt ask, it was so vague, and like I said I rounded on that patient three times that day, so I knew that she was in discomfort, exactly those types of questions you know what those are so good that I am about to write it down, I am positive and for sure that she didnt ask or inquire about those things, because I asked her about other things, like a test that she was to have the next day and thats why she was NPO, as I figured she did not even read any of my progress notes or any of the other consulting physicians, unfortunately nurses do not document notes in our charts in the hospitals, I think that would be good not only for others, but esp the nurses so that they can follow up on whats going on with the patients, no I strongly believe that this nurse was paging me blindly, she knew nothing about the patient, AMAZING... in my history and physical note, I explained each and everything in GREAT detail as I usually do, and she questioned and asked me about so many things that were in my notes... I was just so disappointed.... I dont know what to do about this poor miscommunication, but like it or not she is gonna hear about it one way or another, she is not going to continue doing this.... I literally cringe when that number comes up from that particular floor, because I know that its probably going to be another - I dont want to say how I really feel here but its pretty obvious what should be said and you guys sound like you agree - unnecessary call that will interfere with my work. Yeah what you are describing is something that an excellent nurse would do, that sounds like some great communication there, but like I said she didnt know anything about the patient, and it was totally obvious. My mother has been a nurse for the past twenty years, and she is shocked and disappointed by some of this stuff thats going on with me sometimes... sigh... thanks a million for the advice...

[cassioo]

ask her also is it different then what I've written in the progress note? We have door charts where we chart but the "big" chart is there we can always look back at. Usually it's the residents, interns and new docs that really do chart the old attending writes good day, stable, doing well that about covers their note...except one really old fellow who writes 2 pages (he also writes obtain consent for cesearan section, possible hysterectomy, possible leg amputation, possible hangnail he covers everypossible)...how about an inservice on calling the doc when to. Maybe she's worked with the one that likes to be called about everything maybe she needs that face to face and tell her what you expect she may not be secure with her own assessments but she should go to the charge nurse, a senior nurse or her supervisor about concerns maybe some CEUs on delegation and decision making. Maybe she'll never change but hopefully your rotation through there will go quickly

[kimmiejs]

Sorry this is a bit late. Right now I am suffering from a bout of insomnia so I am going through a lot of the posts on this forum. Let me try to look at this from a nursing perspective and see if there is anything that I can come up with.

1. To start with I would talk to her unit manager and the nurse in charge of inservice/education at the hospital. I have seen forms that new graduates have been given as a guideline so they will know what information they need when they call a physician regarding a patient. I will be the first to admit that many times trying to read a physician's handwriting in the progress notes can be downright difficult if sometimes impossible at times. Many physicians will ask one of the nurses to try and interpret another physicians handwriting.

2. Many of the physicians at my hospital will ask to speak to the nurse caring for the patient either before or after they have made rounds. I try to make rounds with my patient's physicians so I can help to clarify any miscommunication between the patient and the physician.

3. As far as the NPO status I have learned that sometimes it is best if the physician takes the extra step to write an order like this: NPO after MN for CT of Abdomen/Pelvis with contrast. Resume previous diet after CT completed or MD to call with diet after results of CT called to physician by radiology. By doing this there is no mistake regarding the diet. I have seen patients that were kept NPO unnecessarily and were discharged before they ever resumed any PO intake. To me this is quite shocking and poor nursing care.

4. Since I do not know you or what type of physician you are I am curious how you deal with pain control. As a RN I feel that many patients are under-medicated for pain by their physicians. It has taken quite a bit of work but we have now convinced several doctors that PCA pumps with basal rates are very effective and safe. Patient's pain is better controlled since they receive enough pain medication while they are sleeping so they do not wake up in immense pain. In my experience they use far less pain medication with a basal rate than they would have without one.

5. Unfortunately the medical profession is not free from idiots. Plan and simple. I have run across so many nurses and physicians alike that can not walk and chew gum at the same time. If you continue to have problem with this one particular nurse I would suggest that you keep a record of when she called, why she called and what basic information that she should have at hand that she did not. Sometimes I think I have every bit of information a doctor would need after paging him or her for a problem and sometimes I am thrown a curve ball. Sometimes a bit of education for this nurse is all that is needed.

I really emphasize you for the situation that you are in. When I hear the conversations that doctors at my hospital have on the phone after they have been paged just makes me cringe. As I said before documentation and education are needed. Good luck I hope this helps. Years ago I worked around residents and I actually found it to be an enjoyable experience. The residents looked after me and I did the dame for them.

Cheers mate Good luck in your practice. Thank you for posting your problem on our forum. Now if there was something you can do to solve my insomnia problems

[nurse1stik]

I think cassio hit on the point. People get miserable when they are in pain or discomfort. They will call the nurse over and over about pain and treatment issues. As an advocate the nurse has to do something so we call you. Sometimes a many times if our problem is not solved. I hope it wasn't ME you were dealing with.. just kidding.... Ask the nurse lots of questions and you will get the relief you need. :luck: