You chart, check for medications, and then prepare for your nursing care. Suddenly, the buzzer sounded loudly and you check the room number on the monitor.It is your post-surgery patient at the room at the far side of the hall. You immediately rush to the room and as you opened the door, you see everyone in shock and in fear. You see your patient shivering and when you touched his skin, you found it to be cold and clammy. The patient looks weak and you notice significant pallor. You take vitals signs and you note the ff. parameters: T: 37.1, HR: 128, RR: 32, BP: 80/50. You need to refer this patient, and you noted that his Attending Physician is one of those “difficult doctors”. Fear has gripped you. What do you do?
A lot of us nurses deal with different people everyday. As they say, there are difficult patients…and there are difficult doctors as well. There are those doctors who would embarrass a nurse in front of patients, making the nurse feel so little and as if he did not study anything. There are also those doctors who will still find fault in what you do, even if you managed a situation based on what standards of practice allow you to do. I am sure all of us have experienced these doctors. In line with this, here are some tips to ensure that we are not degraded by these unscrupulous people.
1. Make a thorough patient assessment.
Never call an Attending Physician (even a resident) for referral unless you have taken a thorough assessment of the situation. Make sure that when you dial that number, you have all the data that is required and that you have the patient’s chart with you. Make sure to make a fast, but complete assessment in relation to what you are referring for. Do not be like other nurses who refer without even taking important parameters such as HR and Blood Pressure. Show you are professional enough in assessment.
2. Make sure that what you are referring is worthy of referral.
Always be 100% sure that what you are referring is worthy of immediate attention. Remember that you are going to call a person at a specific time, and on the spot, and regardless of what he does. Make sure that what you are reporting is indeed important. If you can do something within the cope of nursing practice to address the problem, do something about it. Ask your charge nurse if you have any doubts.
3. Ensure that you did something to manage the situation.
Before referring, make sure that you did everything that a prudent nurse would do and could do in a situation based on Nursing Standards and Scope of Practice. We have independent nursing functions that we could perform without the need for physician’s orders. Be courageous enough and have the confidence to manage. If you have doubts, ask your senior or your charge nurse. There is always something you could do in any given situation. Use critical thinking.
4. Have laboratory results ready.
Many times have we called physicians without having laboratory results in hand. Even if tests were done a day ago, or even 2 days ago, some physicians will still ask for laboratory result parameters. Keep in mind that you must have them with you always.
5. Be confident.
You are a nurse and you have been trained to use triage even if you are not on duty at the emergency room. Do not ever think that you are lower than a doctor. We are under different departments and we are members of one medical team. Management cannot be possible without the other so we must work as a team. Whenever you refer, be confident to speak to a doctor, even if he is a fellow or a consultant. You are his patient’s nurse and you are entrusted his patient’s care in his absence.
We cannot please everyone. There would always be those patients and doctors that will not see the best in what we do. In these cases, we can only do so much by exerting our best efforts while exuding confidence. We are nurses and we are professionals. We were trained and we were educated to perform our functions within the Scope of Professional Nursing Practice. Be confident in your professional knowledge and skills and do your best. Trust me, these people will respect you. Just show them the best you got, always. We are a team; remember that.