I know the very title of this post put some of you on edge. I can hear you now, “How does a physician know what makes a good nurse??”
The truth? Healthcare is a team effort.
Solid communication and mutual respect creates the best outcome for your patient. So out of curiosity and desire to improve, I asked the physicians of Reddit “What are some uncommon things nurses do that make them stand out in a positive way?” the following are the most common responses.
1. Take Initiative.
This was mentioned so many times I had to address it first. You are not an automaton that just takes in orders and dispenses medications. You are a highly trained professional.
Physicians count on you to see what they can’t. This is reinforced several times throughout this article in concrete steps you can take.
There are plenty of nurse-driven interventions that directly help your patient and make life a bit easier for your physician.
Know your PRNs. I can’t tell you how many times early in my career I paged a physician for hypertension or pain only for them to ask if the PRN meds helped.
This was followed by a long pause and profuse apology for wasting their time. Check your PRNs at the beginning of your shift. These are your first line tools for treating your patient.
And for the love of God wean your oxygen! A patient on 5L stable, with no saturations under 96% for the last four days is endlessly frustrating for your physician who is dealing with a thousand more important things.
2. Read the Progress Notes.
Many physicians use the progress notes to answer potential questions from the family or from medical staff. Don’t be that nurse that calls at 3am when the answer is in the progress note. Even if it’s the same, generic, copy-and-pasted progress note from a week ago, check for a small blurb at the bottom that could save you valuable time.
3. Know Your Patients.
This should go without saying, but you are the main source of information on this patient. You are the expert. Physicians rely on you to fill in the cracks between the labs, imaging and assessments.
They need you for a complete picture of the patient. Why did they come in? What has changed recently? What is the family dynamic?
4. Overnight Paging Etiquette.
Oh boy, This was repeated so many times. So let’s talk about overnight paging etiquette. Have you ever been aroused from a deep sleep and immediately asked a question? Even a simple question can take a minute to answer because you are still trying to decide if you are actually at home in bed and if you are even really awake.
Imagine doing this, except your answer could possibly maim or kill someone. So please remember your SBAR format and give a brief introduction to the patient, not just a room number or last name.
Be sure that you have read all of the most recent progress notes, physicians often cover common questions in these. ALWAYS have a full set of vitals and most recent labs when you are paging.
It is just common courtesy to have information available for a physician you just woke up in the middle of the night.
If you are gravely concerned about the patient, lead with that! Set the tone of the call because it will change how your physician processes the following information.
You are a trained professional and any good physician will respect your concern.
Pro-Tip! When you are paging a doc at night, ask around if anyone else needs him. A simple “Hey i’m paging Dr. So-and-So, Does anybody else have anything urgent for them?” can save your physician from being woken up multiple times per night.
5. BONUS for ED Nurses.
Help your physician discern why your patient came in TODAY. Most ED patients have chronic health issues, but something changed that made them turn the TV off and drive themselves to the hospital. I understand it can be difficult when they want to start the story of why they came in somewhere in June of 1998, but help your physician cut through that and find out what changed in the past 24 hours that made them come in.
6. A Free Text Shift Summary.
If your hospital policy and EMR allows, please include a shift summary of any major changes or adverse events. It is extremely time consuming to pour through the chart and look up bowel movements, emesis, med refusals, and EKG changes on 40 patients. Even two lines in a progress note can be extremely helpful.
7. Anticipate Complications
When you get that albumin and 500 mL bolus order for hypotension, ask the physician how much bolus they are comfortable giving. Ask what presser they would like if the situation calls for it. What second-line presser do they prefer? This saves you multiple overnight calls and increases your autonomy as well as your physician’s REM cycle.
8. “I Have To Protect My License”
“I have to protect my license” is not an excuse to remove critical thinking from your job. This one really irks me. Giving your 95/55 patient all of his anti-hypertensives because “it’s on the MAR” and then calling the doc because BP is crashing is completely inexcusable.
You have a brain and are meant to use it. If you feel uneasy with these types of meds, ask for parameters. These are generally expected with vasoactive medications, but often not included. Is the physician asking you to push a giant syringe of propofol? Or give enough benzo’s to kill a small horse?
Of course, protect your license. Just please don’t use this tired excuse to be intellectually lazy.
9. Give a Good Report.
We have all had the aimless, vague, swiss-cheese report that leaves you learning about your sick patient all shift. A thorough handoff is vital not only for you as a nurse, but for your physicians who count on continuity of care in the nursing staff who is their main support.
Several complained about coming through shortly after shift change to find that their nurse knows almost nothing about the patient through no fault of their own.
10. Be Curious.
Even I was a bit shocked at how many physicians said they enjoy teaching nurses who want to learn. I know what you are thinking, you have been burned by a rude doc who blew you off and said to just carry out his orders. These are the exception to the rule.
In my experience, most physicians are excited to share their knowledge in the appropriate setting with somebody willing to learn. Don’t understand the disease process? Do some research and if you have lingering questions and some base knowledge, most physicians would be happy to get you up to speed.