What do you do if you get physician push-back?

Hi, everyone! This week we are going to discuss a little bit of conflict you might run into on the floor:

Physician Push-back

By this, we mean that something has changed with your patient and despite having paged the doctor, you are given no response. You may have even contacted them multiple times with your concerns to no avail. The physician refuses to give you what seems clinically indicated or may even refuse to see the patient to make their own call.

Situations you might be calling about could include:

  • You need to restart a home med.
    • This is not just any home med, but their pain meds, anxiolytics or other anti-psychotics
  • The family has a question that you can't answer
    • This also needs to be addressed as soon as possible rather than waiting until they round the next day.
  • They were NPO and they don't have orders to eat
    • If you are a primary care provider please just give me orders for food, so we don't have to call you for this. We hate doing that as much as you had getting the call.
  • Your patient is crashing or you're trying to keep your patient from crashing.

Luckily, at the facility we work, our doctors have build trust with the nursing staff and we rarely have an issue with an MD not hearing the nurses. This takes time though to develop. If you don't have that luxury of familiarity with your care providers, you need to present the information as objectively as possible. If you start saying things like, "I think..." or "The patient thinks..." or any variation thereof the doctor might stop listening.

Use phrases like:

  • Patient states...
  • Vitals are...
  • Lab work says...

Very concrete, very objective.
However, don't be afraid to tell the doctor how you feel. Many a patient has been helped by the nurse saying they have a bad feeling. Work in the medical field long enough and you will develop nurse's intuition.

If that doesn't seem to be working, get your management involved. Sara and I are both charge nurses and sometimes we are not told what is going on. We are there to help and can sometimes intervene long before the patient's condition begins to deteriorate. Let your charge nurse know what is happening on the floor. We can't tell you how many times we have walked out of a room and found out someone was moved to the unit. We didn't even know they were crashing to begin with!

Many facilities have teams of critical care staff, management, and possibly MD who will come look at your patient. They just have to be called overhead and they will be at your bedside to help you look at the patient! It's really that easy. There is no penalty, maybe some paperwork, and your patient gets some extra attention. When in doubt, call your Critical Assessment Team or Rapid Response Team.

If you have exhausted your communications with the MD, you can go up the chain of command. Your charge nurse can help you get this started if the patient is struggling and you are not getting the help required from the care provider. Don't be afraid or intimidated to do this. You are not there for the primary care provider to like you. You are there to take excellent care of the patient, be their advocate, and make sure they are safe.

No matter what you having going on with your patient, we can't act without orders. That is unless they have a standing hospital protocol you can act on, but this is facility specific and you should consult your policies and procedures.

So to recap:

  • Present the information as objectively as possible.
  • Get your leadership involved, including your charge nurse.
  • Call your CAT, if you feel it necessary. 
  • Go up your chain of command.

Side note to nursing students and new nurses, we have all been there and you WILL get through this! If you find yourself in a position where you’re getting push-back from a physician be sure to follow the chain of command…We’ll be sure to cover that topic later on! In the meantime, have no fear, we are nurses! We’re going to therapeutically and safely provide excellent care to our patients!

Mama Flo (Florence Nightingale. Google her; do it!) would be proud of how far we’ve come! Okay…now back to your patient and continue to monitor...

Top 10 Things We Are Thankful For As Nurses

We are so thankful for these top 10 things during this Thanksgiving holiday season. Nurses, nursing students, and other staff really help to make the healthcare industry go round and we couldn't be more thrilled to be a part of it.
Hello, friends!

Tomorrow is Thanksgiving, so we asked our coworkers what they were thankful for. What really made their job easier as a nurse?

Here’s what we got:

  • Gloves

Let's be real, who isn’t thankful for gloves?! Best idea in healthcare, hands down we are pretty much unstoppable if we have: comfy shoes, an empty bladder, coffee and GLOVES. Just saying.

  • Thank yous

Gratitude is always a nice surprise. Nursing, for the most part, is a thankless profession. We’re expected to just handle it. Whether or not we get those gestures, we aim to provide the very best care that our patients deserve! It’s always a treat to be thanked from a family member, the patient, management, or even a colleague. Remember to sprinkle “please" and "thank you” around, it’ll make everyone feel appreciated.

  • Available and working equipment

Who else dreams about beeping IV pumps that malfunction? Feeding pumps that are possessed? The Posey alarm that you thought was working...but wasn’t and you find a patient half way out of bed and looking at the floor like it's real comfy? Our days go so much smoother when we’re able to perform our duties with  available and functioning equipment!

  • Environmental services

They are superheroes! They always do a great job keeping our work environment clean. Now they can’t exactly make it smell pretty (#cdiff), but EVS staff members are excellent at keeping our patients’ rooms picture perfect and ready for our patients. I mean, don’t we all just feel better overall in a clean space?

  • Wine

Another way to list this one is just something to relax us. Especially after those days where you don’t remember how you got home after working a 12+ hour shift. But hey, your patients were cared for, charting was up to par, and hand off was organized...we’d say you’ve earned yourself a glass or three of wine. ADPIE supports responsible drinking, just to be clear.

  • Our Hospitalists

THE REAL MVP's!! We LOVE our hospitalists. Talk about the best working relationship between nursing staff and physicians. A lot of nurses feel that hospitalists are more approachable than specialists. One reason may be because they are readily available. Not to disregard specialists, as floor nurses, we just hold a special place for our phenomenal hospitalists.

  • Knowledgeable and involved family members

Yes! Yes! Yes! Family members who are present are such wealth of knowledge to nursing staff. They know their loved ones more than we do, so if they mention any advice on how to care for their demented parent, stubborn uncle, or even their sneaky sibling...listen! Our clinical pearls only get us so far, but remember, always think critically to provide safe care for our patients. Just because Mama likes ice cream with her medications does not mean it’s okay to disregard the NPO except for meds order.

  • Nursing friends

Here at ADPIE, we’re so lucky to have amazing nursing friends. We get to work together and hang out outside of work, because nursing friends are truly the best friends! We support, encourage, and vent to one another. While each of us nurses may have a trusted friend that may not be a nurse, we believe nursing friends empathize because they’ve been there!

  • Team players

It’s always so nice to work with team players! Those who really go out of their way and ask how you’re doing, if you need help with anything. That whole cliché “team work makes the dream work” totally applies when you’ve got a great staff. Those individuals who take the time to check on their fellow nurses are gems and should always be recognized. Wherever you work, if you get the chance to recognize them, please do. Those individuals deserve all the recognition for their amazing attitude.

  • Working in a job we love

Not many people get to say they do what they enjoy. Nursing, while hard, brings so much meaning to people in the profession. We find joy in helping others and standing up for those who are not always at their best and able to speak for themselves. Yes, it's difficult to deal with family and patients who won't let you do your best work, but it all helps you grow and learn as a nurse.

We would like to add to this list what we’re thankful for, and that’s you, our dear followers! We thank you for being part of ADPIE and truly appreciate your support. We hope you all enjoy our posts and take away something after each week! We’d love to hear what you’re thankful for, so comment below. Have a safe holiday everyone! Please continue to monitor...

World Diabetes Day 2018

2018 World Diabetes Day, awareness, education, nursing, nurses, nursing student, students, public health, community health

Today is World Diabetes Day!

It was started in 1991 by the WHO and the International Diabetes Federation to help raise awareness about diabetes. 2006 marked the first year this awareness day was recognized as an official United Nations Day and is annually on Nov. 14th. This is also the birthday of Sir Frederick Banting who helped discover insulin in 1922. The aim of World Diabetes Day is to promote the International Diabetes Federation platform, coordinating actions against diabetes as a global health issue.

The theme for 2018 is Family and Diabetes!

This year’s theme brings attention to the impact of diabetes not only on the individuals struggling with this debilitating disease but on the families and friends who support them. It also encourages engagement in the management, care, prevention, and education in regards to diabetes.

Greater than 400 million people live with diabetes. To put this more in perspective, that's 1 in 11 people. Type 2 diabetes is the most common. There are several risk factors:

  • Being Overweight or Obese 
  • Unhealthy Diet
  • Not Exercising
  • Family History
  • High Blood Pressure

Many of these are preventable! We have to impress that upon our patients. It is not easy, but if they want to get off their medications and avoid the complications of diabetes, it’s something they need to do. Your hospital or clinic should have some information you can give to your patient for them to take home and implement into their daily lifestyle.

Fifty percent of individuals suffering from diabetes are not diagnosed. This is related to lack of public education regarding diabetes and its warning signs. Symptoms of diabetes are:

  • Excessive Thirst
  • Frequent Urination
  • Lack of Energy
  • Blurred Vision
  • Slow Healing Wounds
  • Numbness in Feet and Hands

These are especially true for Type 1 diabetics. Symptoms are sometimes hard to identify due to their mild nature or they may not present in this classic way at all.

Once someone is diagnosed, it can be expensive for the diabetic and their family. People can live healthy and productive lives with diabetes, but about 1 in 4 families don't have access to any kind of education program for support. Some basic needs that every family requires are:

  • Daily Treatment
  • Regular Monitoring
  • Healthy Diet and Lifestyle
  • Ongoing Education

You might be surprised by how many people you know that have pre-diabetes or outright diabetes. Tag your social media with #WDD2018 in support and help raise awareness. Please continue to monitor for next week’s post...

National Stress Awareness Day

National Stress Awareness Day is the first Wednesday in November. Today, you are encouraged to look for and reduce stress factors in your daily life. It was founded by Carole Spiers who was the Chair of the International Stress Management Association. This year's theme is "Does Hi-tech Cause Hi-stress?" This seems very relevant as most healthcare entities are moving to EMR for their documentation and patient care management. We also live in a very technology oriented society in most developed countries.

Stress can be a physical or psychological response to an event or series of events that someone has been put through. This includes the workplace! We work in a profession that gives us many reasons to stress:

Mrs. Jones can't remember that you already gave her this morning's Namenda; Mr. Brown is literally yelling at you and you're not sure why; Mr. Cox is having active chest pain and wants a sandwich...

How we respond to these situations has an impact on how we internalize and react to them. Many of us who work in healthcare are very empathetic to our patients. To some, that means we also take on our patient's emotions and have to deal with them ourselves after we leave. If we don't care for these emotions properly, they can begin to envelop us. This affects our patient care and how we interact with our family and friends outside of work. Give yourself some grace when you need to take some time for yourself. It can sometimes leave you with a guilty feeling when you spend time or money just on yourself, but it is vital that you do this for your own mental health and your patients' well being.

If a friend or family member says you seem stressed, don't get offended or testy. Take it as a reminder to evaluate your situation and find moments that could be best spent in more healthy constructive ways.

To celebrate this day you are encouraged to lessen your tension. We post examples of how to de-stress yourself every Sunday. Check out our suggestions on our Facebook or Instagram. Enjoy yourself and tag your ideas or activities with #StressAwarensessDay.

Continue to monitor for next week's post...

What's My Day Like Nursing?

This post may contain affiliate links and advertising. We make a small commission if you make any purchases through any of these links, at...