PAGING THE DOCTOR - MOST INTERNATIONAL RNs' HEADACHE.

The method of contacting or paging the doctor varies from hospital to hospital, and from unit to unit. Good communication among health care team members means a lot to RN practice.

In most countries, all physicians are employees of the hospital and may even be living on the facility’s property.

But the opposite prevails in USA. MDs are usually not employees of the hospitals, but have contracts with the hospitals.

These MDs are in groups, according to specialty, and have their group offices that you will have to call first. You then tell the clerk your needs and he/she goes ahead to page the patient’s doctor or the MD on call for the group. In few cases,you can page the physician directly.

You will learn of interesting protocols/policies as you move from unit to unit and from hospital to hospital. In some units for example, no one pages the doctor except your charge nurse. All that you need to do is notify your charge nurse about your assessments/observations.

And in some hospitals, you contact and take orders from MD via the intranet.

SBAR (situation, background, assessment, recommendation) is a useful tool that is used in communication with the physician.

It is particularly useful when placing a call to an on-call MD who does not know much about your patient.

This is how it works:

S-SITUATION: Identify yourself, the patient’s name and current situation. Describe what is going on with the patient.

B-BACGROUND: Give relevant history, physical & allergies. Also, you should state data pertinent to the problem, the treatment and clinical course summary.

A-ASSESSMENT: Now, summarize your observations on present situations.

R-RECOMMENDATION: Offer your suggestions or what you think the patient needs now.

In the course of paging the doctor, many RNs have complained of gross arrogance and rudeness from some MDs.

Indeed, few physicians have distasteful individual depositions and very rude. But RNs can minimize or prevent this kind of treatment from the MDs.

There is no bigger insult to you and your RN profession than paging the doctor without having a SBAR about your patient.

Was your observation a new change or one that was there on admission, and that the MD might know about it?

Of course, the MD will be mad at you when you call him at 01:00 am to report an asymptomatic heart rate of 120 when this patient has a history of a-fib; and ,may be, has a PRN medication you did not see.

And whenever the doctor asks for a result (be it lab results,vital signs or a diagnostic tests) please give him the figures or report.Nothing will irritate an already tired MD than telling him the results are "normal" or "abnormal". Where normal/abnormal means what?

Patients with multiple system diagnosis will certainly have multiple doctors with each taking care of his specialty. Try and have an idea about who is taking care of what.

Imagine a situation where an RN places a call to a gynecologist to report a heart rate of 36 on a known cardiac patient who undergone hysterectomy in the previous shift. The gynecologist will be mad and tell you he does not “know” where the heart is, so go back and read the chart.

When you are new to a unit, first seek help from experienced RN colleagues/friends by discussing your observations before paging the doctor. In most cases, you may not need to call a doctor.

The next issue about paging the doctor is international RNs with strong assents. Communication, as you know, is meaningful only when the other party can understand you.

Many RNs fail their job placement interview because of their relatively strong and almost incomprehensible assents.

A couple of MDs also complain about the issue of strong assents any time some international RNs are paging the doctor.

Many of us international RNs had this problem initially, and our thick native assent still lingers in our conversations. You may not be able to do away with your native assent completely; even if you mean to. But just a little effort on your part can make a great difference.

There are lots of products on the market that can help improve your ascent, and some RN agencies have measures in place to help their nurses.

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