"The single biggest problem with communication is the illusion that it has taken place"
If nursing school taught me anything, it is the importance of communication. In school we talked about therapeutic communication, communication within the multi-disciplinary team, and formats like SBAR. While we talked a lot about communication and even tried to ‘practice’ by calling our instructors and acting out scenarios, nothing really prepares you for your first call to a provider.
I believe consistency and practice are key when it comes to communication. Every new nurse is scared to death of calling the physician and every physician is different. Some physicians are all for cell phones and constant updates, while others want to be paged, or generally not contacted unless the patient is on their last breath and all standing orders have been exhausted. The scary part for me and most other new nurses, is finding out what each physician prefers, and how best to serve your patients, without getting yelled at.
I tend to stand up for myself, but like to avoid conflict. I understand that the amount of experience and knowledge my physicians have far exceeds my own. What I have learned is that nurses are the middlemen when it comes to communication. That is a hard place to be in. I once had a sticky situation where a provider wasn’t in-house but we needed a consult. Of course, this was at midnight and the on-call physician was not happy to receive my call. I was automatically set up to fail with this exchange. I was not the patient’s primary nurse, the provider wasn’t in-house to answer the call, and the call center that forwarded me to the consulting physician put in the incorrect number.
So what did I do? I tried to explain the situation as best I could to the consulting physician and even offered to connect her to my provider. I can still quote the consulting physician, “No, just tell me. I don’t want to be dealing with this all night long!” Four calls and four very unhappy individuals later, that situation was handled and I learned a good lesson. Be prepared! I should have insisted my provider be present prior to making any consult requests. If that wasn’t possible I should have had the primary nurse explain the situation first-hand, not through me who was basically acting as secretary, and lastly I should have wrote things down before that call so that I was fully prepared.
During our webinar this month I shared with the group that since this situation (described above) I started writing things down as a way to prepare prior to calling the provider. That way nerves can’t get the best of me and I can stay focused when the questions start rolling in. While there were a few in the group that stated they did the same thing, there were others in the group that didn’t have this as part of their current practice, but were struggling when it came to calling their physicians. Sometimes as new nurses we look at how the experienced nurses function and we don’t see them writing things down so we think we don’t need to or shouldn’t either. I think it was helpful for my peers to hear that I and some of the others in the group write things down before we make the call and know that if that is what we need to do to prepare, make sure we have out ducks in a row, and not completely freak out and go blank when we get that grumpy physician asking questions, then that is okay! As our facilitator said in the webinar, when we are new we sometimes have to force ourselves to do that sort of thing until it becomes a natural part of our practice. The more we do it, the more comfortable we will get, and eventually it will become second nature.
Thankfully, I have had more good calls than bad now that I have been in my position almost a year. I know my providers. I know the facility policies and standing orders. Proficiency comes with time and practice, and while I still don’t jump at the chance to call a provider in the middle of the night, I am no longer petrified of the thought and know how to prepare myself thoroughly. My practice has changed, thanks in part to the bad calls but also the good calls, in that I have confidence and know that when prepared, I can answer most questions the provider throws at me.
The modules and discussion provided through the IONRP have helped reinforce the need to be prepared and use of formal communication tools when communicating with all members of the healthcare team. While this is definitely not the first time I have heard this, now that I am out there practicing, it was good to really think about it in the context of my recent experiences. It was good to hear that my peers have the grumpy physician they dread calling and that they too struggle with communicating clearly at all times. It was good to hear that some of them write things out before they call as a way to prepare, just like I do. It was good to have this brought up again and really think about how I am applying these things to my practice. It gave me a little confidence boost knowing that I am indeed using ‘best practice’ with my communication and that I have advanced in the last few months with my communication. I really have grown from where I was on day one.
This program might not always be about learning something new, but an opportunity to evaluate strengths, reinforce correct actions, and perhaps help other people who aren’t quite there yet.
Abby Schubert, BS, RN
RN-MSN (in-progress), Clarkson College
Montgomery County Memorial Hospital
Emergency Room and ACU Nurse
Click Here for more information about Abby