Roger That

I was asked by a medical student last evening over a beer to describe from my nurse’s perspective what our single greatest “pet peeve.” I indicated to him the interactions between physicians and nurses are always multifactorial and the singular view I could offer may limit some of the overall answer’s effect. I described to him the example of a nurse engaging a physician regarding a patient concern. When a nurse pages a physician to report a change in clinical status, especially when it may warrant physician intervention, often the nurse is frustrated when there is no follow-up response to their inquiry. If there is no immediate intervention assigned, often the response is something like, “Let me take a look at the labs and I’ll call you back with some orders.” Sometimes, what occurs is that orders are placed but the individual responsible to execute them is never made aware by the ordering provider and the orders are often discovered late. An adequate course of action is as follows: Orders are/are not placed, the physician calls the nurse back to let him/her know of changes in the care plan, if any, and the communication loop is closed. Both parties are aware of the care plan and have a short forum within which to discuss concerns or questions or the need for additional follow-up, particularly patients who demonstrate a declining clinical trajectory. It is incumbent on the nurse to understand the task saturation and rigors of a professional physician, especially residents who may be carrying significant volumes on their service to see. However, much like a critical lab value or image that requires follow-up review when resulted, the physician must understand that changes to care plans and communication with the nurse are also actionable items. Closure of communication loops between nurses and physicians is probably one of the strongest initial interventions we could foster together in order to bridge some of the distance between our professions.

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