May 2, 2019

Why Are You Calling Me? | Provider-Nurse Disconnection

Okay, I'm a new nurse practitioner. I'm fresh and brand new to the scene. As a new provider, I've noticed a trend in the local provider community. It might not be new to everyone else but it's new to me. Whether its a physician, physician assistant or nurse practitioner, there is a trend in the inability for these individuals to understand bedside nursing objectives and expectations. I didn't quite understand the nurse-provider disconnection until I was on the other end. When I was a bedside nurse (which was about 5 seconds ago), I'd call a provider regarding an urgent matter. He or she would then usually say something along the lines of, "why are you calling me about this?"

Umm, because I'm required to call you! I know that response might seem dramatic, but seriously? The heart rate is 150, expect a call. I don't get to assume it's fever-related and chart abnormal vital signs my entire shift. As a registered nurse, I have a nursing license (that I must protect). As an employee, I have a specific scope of practice I must work within (with no gray zones). There are required actions with certain vital signs. Now, you'd think nurse practitioners would definitely understand the nurses' perspective in this matter. But oddly, no. Not all nurse practitioners have inpatient experience. Hell, some nurse practitioner schools don't even require bedside nursing experience in general. It's as if we are all fighting on the same side, but the left hand doesn't know what the right hand is doing. We are all in the vicinity of the patient, but we are all on different tracks and unaware of the required actions of the others involved. Listen, I'm a nurse practitioner. Calling internal medicine (for me) has taken up to 2 hours to get ahold of someone. I might see someone in the hallway while rounding, but to get them on the phone is another matter. Communication can be tough, and the disconnection definitely doesn't help the situation.

As a new provider, I made it a note to speak to the charge nurse about what vital signs require my attention (based on hospital policy), and what situations needed provider notification. I can't get upset about a phone call if that is the protocol in the institution. How are you upset at someone for doing their job?! Listen, I'm new. Some might say I have more patience due to the newness of the experience, I can see their point of view. But also, you have to understand the dynamic you are working within and what each team member is contributing to the situation. I need more providers to understand the nursing staff and understand they have parameters they must work within. I'm new, I'm not jaded yet, haha. But I don't ever see myself losing the passion to understand the role each professional has in direct patient care.

When I was a bedside nurse experiencing this level of disconnection at what my actual job objectives were, my response was something like, "this is hospital policy. Inaction or action, I must notify you. What would you like me to do?" Nurses, understand you are dealing with people who might have no hospital experience prior to the interaction. Understand you might be dealing with someone new to the hospital setting all together or a resident who just started their clinical rotation. Do not assume the person you are talking to knows what you do and what you must communicate. Some providers visit two to four hospitals per day, rounding on 20-35 patients. It's not you, it is the relationship disconnection. Don't allow someone's title to determine your practice or lead your decision-making process. You work at the hospital, that provider could be working in three different hospitals (with three varying policies). Remind us, teach us but don't allow us to discredit you because of our titles. Protect that license, keep advocating and keep being awesome.

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