Tips for doctors

19 Hi all, I'm a med student doing clinical rotations and have seen a pretty big gap in knowledge from doctors regarding the nursing workflow and the best ways to get things done efficiently.

So I figured I'd try to get some tips from you guys about things you wish doctors would do/not do to make things go smoothly in the hospital. For example, some doctors told me to always call/talk to nurses after I make orders to let them know the plan but I had one nurse tell me that she sees the orders in the computer so there's no need to waste time doing that. On the other hand, there are times when we put in orders for daily weights, I/O's, etc and they just don't get done, so I wonder if I should have let the nurses know directly in those cases.

So, any tips in general to make the doctor-nurse interaction go smoothly (other than the obvious don't be rude, etc) would be much appreciated. Also, any tips on what things to order/not to order based on your guys' experience would also be great (e.g. when I see KCL oral powder and oral liquid I have no clue if one tastes much worse than the other but you guys probably do).
I work with psychiatrists, so the only general tip I can offer is if you order an unconventional dose of a medication, talk to the nurse, unless you want to get a call to confirm the dose.

Quote from RNdhI work with psychiatrists, so the only general tip I can offer is if you order an unconventional dose of a medication, talk to the nurse, unless you want to get a call to confirm the dose.

If a pt is NPO for any length of time, consider ordering IV hydration. Our docs often overlook this fact.

Consider only putting orders in for patients who actually need them. Like, you're talking about how I&O sometimes doesn't get done. That MAY (I'm speculating because I don't know what your hospital is like) be because EVERYONE gets ordered for strict I&O, including patients who don't really need it which causes people to expect to see and ignore that order. I mean, I saw patients admitted for elective seizure monitoring ordered for strict I&O at times when I worked in the hospital when it was completely unnecessary. Same for cardiac/respiratory monitoring when I worked in the hospital- it was part of the admission orderset, everyone got ordered for continuous monitoring when the truth is almost no one on the floor warranted continuous/never come off the monitor monitoring. A kid admitted for a headache alone (no hydrocephalus/brain tumor, etc) doesn't need to be on the monitor and woken up by it beeping when we finally got him to sleep. Half the kids who you'd see riding trikes around the floor in a pediatric hospital might be ordered for continuous monitoring and continuous pulse ox just because the MD didn't uncheck the box.

Please look at what orders the other docs have placed for the pt. This prevents the duplicates & conflicts & resulting phone calls from us to you to resolve.

Im a new graduate RN and have worked for about 2 months on a stepdown unit.YES try to tell the nurse any new orders that are not to be expected (chest xray / consult / new and uncommon meds]. It's nice to have the Doc briefly discuss with you the plan of care.I do understand that the docs are also swamped with more patients / more documentation than ever before, so often times this doesn't happen.

I'm also a new nurse (6months in) but I would say that it depends on the computer system. For me, any new orders entered by the MD automatically pop up on my screen & I have to acknowledge them. So calling me to tell me a new med has been ordered or chest xray is just having each of us double do our work. But, if there's something specific and very important of a test result that you're thinking of, let the nurse know your thoughts. I look at lab results and radiology reports when rhey result, but I can get busy and not have the time. But, if there's a serious concern that should be reported to u that I need to look for, it would be nice to have a heads up. And I would say that it helps, too, that if a patient is NPO to please state of they're allowed ice chips and/or their meds. I don't hold certain meds by a general rule..but to know I'm allowed to give them w/o necessarily questioning that fact...that would be a help. And patients have a way of thinking they're going to die of dehydration or starvation if they're NPO..so allowing ice chips (when possible) helps to make them less agitated. And 1 more suggestion that I noticed as a new RN..docs don't tend to put in parameters of when to hold BP meds. In some cases, it's obvious, but in others..Idk if that's what the MD might want for a particular patient. So having it state "hold X if SBP is under 110" would save a potential phone call. Just some suggestions. But I must say that I like that you ask & are interested in improving the relationship. We could use that in my hospital lol.

OMG, are you single OP??HPRN

If you put a patient on a PO diet, please take out the NPO order. Also, please answer your pages in a timely manner. We are with the patient asking for hours for a laxative or pain medication. Telling them over and over again that we've paged the doctor isn't very satisfying to them or us.For patient's who have unstable blood pressures, consider ordering a PRN dose of hydralazine if BP goes high enough. Save the secretarial work for the secretaries, or better yet, do it yourself. Learn where consent forms are kept instead of asking us for one.

Please listen to us. if we ask for something, it is not because we get a wild hair-we think it is important. If we ask you to come assess a pt b/c we have a feeling that something is not right-come. Now. Otherwise you will probably going to get a page for an RRT or a code. We don't do/ask/suggest things just "because". We have plenty other things to do- we ask because we think it is important. Do not throw us under the bus. we can make life very difficult Also, back us up when someone makes a run at us. we don't forget that either

Nasty tasting meds - anything with potassium that is not a capsule, liquid tylenol is quite nasty, as is lactulose (unless they need it for elevated ammonia levels, order something else for constipation), liquid vancomycin is also nasty (unless they have c-diff or MRSA there are other options).Another thing I just thought of: If a patient gets an NG tube and meds are to go down there, make sure to change the route of the meds to NG. And don't order any extended release or enteric coated meds and expect us to crush it and put it down there. Protonix comes IV.If a patient is agitated, don't be afraid of ordering a PRN sedative (over-sedation), a sitter (cost), or restraints (liability and stigma). IV potassium is very painful and irritates veins and messes up IV access. If potassium is 3.4 or even 3.2 please order PO replacement if possible. Don't give out IV narcotics, especially IV push narcotics, freely. Don't give into drug seekers. We want them out. Many times if you DC the IV narcotics, they will leave AMA and save us all a headache.Don't order non-critical/routine labs or labs that are not sendouts during day shift. Save them for the next AM lab draw. Patients hate being stuck more than once a shift and we don't have time!Consider central IV access early! Assess need for PICC lines or central lines on admission. Does the patient require lab draws multiple times a day? Do they require a new IV every day, or even more than once a day? Are they an especially "hard stick" and it takes 4-5 sticks each morning to draw their labs? Then they need a central line. All surgical patients need the following on the floor before surgery. Type and screen, CBC, BMP, Coags, EKG, NPO order, IV fluids, and order to hold specific meds before surgery.

[QUOTE=Lev And if the patient can tolerate additional fluid please order IV potassium in a liter bag, the patients appreciate it being diluted!