As a new nurse, or even a nurse on a new unit, communicating with doctors can be daunting. In most institutions, an unspoken hierarchical culture still exists, which makes it very intimidating to communicate. Derived from the military, the “SBAR” method was developed to facilitate better communication and has been adopted in healthcare settings. The SBAR method encourages the explanation of the Situation, a succinct description of the Background of the problem, the Assessment of the issue (abnormal lab values, vital signs, etc.), and your Recommendation to solve the issue. If you have not been taught this in nursing school yet, gear up, because it’s coming.
Okay, so this is a nice, structured, idea, with some research to back it up, but it really did nothing for me. I believe the upstream issue is the hierarchical culture, so SBAR is really just a Band-Aid to a larger problem. I suppose in a roundabout way, I do use aspects of it, but since it was another acronym I was forced to memorize, SBAR is still a serious turn-off. So, the following are some tips to communicate with doctors, nurse practitioners, and all upper level providers that have really helped me over the years. I hope they help you too.
Don’t forget, they are just people
I’m starting off with the most important tip – doctors are people. The doctor you are calling was new once too. Like any person, he or she has been nervous to talk to an attending before, and newsflash, medical students are terrified of ICU nurses. Doctors have experienced all of the same emotions you have – fear, nervousness, and insecurity. They just have the social glory of being called “doctor,” to buffer these emotions. When you speak to a doctor, talk to them like you would any other colleague, because when it comes down to it, they are just humans. Oh, and most of the time, they are really nice and will teach you something too.
Remind yourself it’s for the patient
As mentioned above, in healthcare there is no longer room for a hierarchical model of communication. It creates intimidation leading to poor patient care. We are nurses and the prime advocate for the patient. Sometimes, even after I have followed all of my own advice and am still particularly anxious about communicating with a doctor, I remind myself, I am doing it for the patient. Our job is to speak for the patient, so we have to set our fears aside for the sake of another, and just do it.
Practice makes perfect
Do not underestimate the difficulty of communication. Heck, I have an entire degree in it and frequently do not express myself well. Communication is sometimes perceived as “easy” or an afterthought, this is not the case. It is an art and the skill must be developed, so if you have to practice, then write scripts and practice. In the beginning, I was determined to overcome my fears, so I would envision scenarios of communication. I would also reflect after ones I performed and consider how I could be better. I still do this. I also try to get to know my teammates – doctors, nurse practitioners, physician’s assistants, other nurses, nursing assistants, secretaries, and housekeeping, just everyone. The more people you know, the more you talk, the more comforting the environment becomes.
Perhaps the most beautiful part about nursing and nurses in general, is how raw and real we can be. In general, our main priority is the patient. We are typically selfless, have dark senses of humor, emotional intensity, and wear our hearts on our sleeves. Good communication is derived from authenticity. I always say, “Whatever you fake, someone will feel.” The more you try to act like something you’re not, the more it becomes about you and the less it becomes about the message. Consequently, this breakdown in communication, once again, leads to bad patient care. If you always consider the patient and practice patient-centered care, you simply cannot go wrong.
Identify your fears
Identify your fears, so you can figure out how you would react if they came true. I’ll tell you mine.
Fear 1: I worry I will look stupid.
Worst case scenario: I look stupid.
How I would solve this: Realize I need to do better and ask for help. Lesson learned.
Fear 2: The doctor will be mean to me.
Worst case scenario: The doctor is mean and it hurts my feelings.
How I would solve this: I would make sure I didn’t evoke the meanness somehow. Then, I would lecture the doctor on how his or her reaction was unwarranted and how treating each other poorly decreases the quality of patient care. I would reaffirm how I know we work in a stressful environment, but I would appreciate a better response. This is quick, mature, and works almost every time.
These are my main fears, if you have others, make a chart like this, it really helps to plan a response.
Get yourself together before you call
Here is the tough love portion of this post – get your shit together before you make the phone call. As a nurse practitioner student who is almost done and has experienced both sides, I can gather why providers get so frustrated sometimes. I hear an overarching theme from providers when they complain about calls – “Nurses are not trained to critically think anymore.” I do agree with this to an extent, but I also understand that nurses are so overworked, especially on med-surg floors, they do not have time to critically think. Also, everyone is so worried about being blamed these days, many nurses call for absolutely everything just to document “MD notified” in the patient’s chart. But with all of that being said – get your shit together. Before you call, know the patient’s name and room number. Give the provider the date of admission and diagnosis on admission to jog their memory. If you think you saw blood in their stool, send it to the lab if you need confirmation. Then look at their hemoglobin and see what the last one was if you don’t know it already. Also, look at the prior hemoglobin to trend. Some labs are worthless without trending. Then, consider if the patient is on blood thinners, what could be making the patient bleed? Are there any other signs and symptoms of bleeding? After you have all of this info, then call the doctor. If you do not know how to obtain this info, ask a more experienced nurse to guide you.
So that’s that. We are all a team. Try not to feel intimidated because the bottom line is, we are here to provide the best patient care and communication is an imperative part of that.
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