Many of the confidential comments from the VHA study concerning disruptive behavior concerned nurses who were afraid to call physicians at home because they knew the doctor would be angry. But that’s not always because the doctor is a jerk, researchers say.
In many cases, the doctor is understandably angry because the nurse calls in the middle of the night without any of the information the doctor needs to provide orders. Michelle O’Daniel, director of member relations for VHA in Irving, TX, says physicians report that they commonly receive calls from nurses who don’t even know the patient’s name or vital statistics, yet they expect the doctor to cheerfully approve the nurse’s suggested order. "It’s not an excuse for the physician to be disruptive, but it shows that there’s more to this than just a mean doctor and an innocent nurse," she says.
Train nurses in good phone etiquette
O’Daniel suggests training nurses in specifically how to call a physician, even though they may think they know already. When trying to get physicians to respond in a more pleasant way, ask them for suggestions on what they would like to hear when a nurse calls. Then use that information to train the nurses. The VHA researchers suggest that, at a minimum, the nurse should be ready with this information: patient name, vital signs, diagnosis, and the type of surgery the patient had or is scheduled to have. Also, the nurse should identify herself or himself clearly — by name and position. This basic information especially is important when a physician is covering another doctor’s patients.
Some hospitals even post reminders by the phone or on cards the nurses can carry and consult before calling the doctor. These are common reminders to post:
- Have I reviewed any standing orders?
- Have I seen and assessed the patient before calling?
- Do I have the patient’s chart in hand with the most recent meds?
- Have I read the progress notes?
- Have I discussed this with my charge nurse?
How to wake up a physician
O’Daniel provides these examples of bad and good phone etiquette when waking the physician at 3 a.m.:
The Wrong Way to Call the Physician:
Doctor: Hello . . .
Nurse: Can I give Mr. Jones some morphine?
Doctor: Who is this?
Nurse: Jean. He needs some morphine.
Doctor: Are you a nurse?
Nurse: Yeah, I was thinking 2 milligrams.
Doctor: Who is Mr. Jones?
Nurse: The guy with the hand thingy.
Doctor: Is he scheduled for surgery?
Nurse: Yeah. He’s not breathing too well, by the way.
Doctor: Can you present the patient to me?
Doctor: Is he healthy? Does he have any heart or lung problems?
Nurse: I don’t know. I’m only covering for Christine.
The Right Way to Call the Physician:
Doctor: Hello . . .
Nurse: Sorry to bother you. This is Jean, the nurse in the ICU. I’m taking care of Mr. Jones, the patient in Room 212. He has asthma but is otherwise healthy and is scheduled for open reduction of the wrist later. He is currently 5 out of 10 on the pain scale. Can I have an order for pain medication?
Doctor: Yes, you can give 2 milligrams of morphine.