Out of control paging behavior

[epsilonprodigy]

I have been thinking a lot about how to make the incoming interns' lives more bearable. Covering the trauma floor for a friend today, I realized there's one thing I never quite squared away this year: establishing some semblance of control over the barrage of meaningless pages. I am talking about some really bad ****. I used to be a nurse, so I really don't think I'm out of line here.

"Gee, Dr. EP, I saw that you ordered duonebs on this actively wheezing patient getting 10 on their ISS. Did you really want duonebs?"

"Gee Dr. EP, Mr. Smith's potassium is undetectable and he consumes more Lasix than he does food. Did Dr. So and So from Team Not Yours really want to give that K?"

"Hey doc, even though this patient is not now, and never was on your service, this patient's primary team says they "can't" write wound care orders. She has to leave for SNF within a be next 3 minutes or lose the bed, will you help us?"

I like our nurses. Really, I do. I don't have any problem helping people out who are having a hard time understanding what's going on, but not at the expense of real patient care. I try to be nice and understanding even when it's really bad, but often have a difficult time getting people to wrap it up on the phone. It's the oddest thing- almost like part of it is just wanting a piece of our attention. Having been in their shoes, I get that we all have our to-do list, but some of the crap we get belongs on SNL.

I suspect that because I make a point to be polite in a specialty with a bad rap for hot tempers, I have inadvertently become the go-to girl. Kinda nice I guess, until you have 3 chest tubes and 10 discharges to deal with. So do I need to invest in a Wrap it Up box?


Sent from my iPhone using SDN mobile

---

Members don't see this ad.

 

[operaman]

I am a big fan of using free text nursing orders for some of these things. It's faster and surprisingly more preferred by nursing as well - they have their concerns both answered and documented clearly in the chart. I've actually found myself using free text nursing orders more and more to avoid stupid pages. Intentionally not restarting a home med? I put in a nursing order saying xyz mess will be restarted at follow up.

The wound care sort of stuff is more tricky. If it's something like that where our service is/was directing said wound care, it really should have been taken care of far in advance and I deal with it and say something to whoever on our service dropped the ball. When I get those last minute poor planning things, if I'm truly too busy with legit issues I just offer them the choice of giving it to them verbally or they can wait until later and lose the dispo if they want me to type it for them. It's amazing what people can do with a little motivation.

Obviously one of the keys is generally being a very kind and easy going person so you can play the douche card occasionally without suffering the consequences.

From a preventative standpoint, I find tremendous value in solo rounding when able and ensuring nursing has an accurate understanding of our plan and the active medical issues. Often some of these key points get lost in signout.

Something else I've posted about here before is the value of getting your patient admitted to the correct unit. I find a get stupid pages if my patient goes to a unit that doesn't typically get our patients. I'm fairly proactive about this and it really pays off.

 

[Crayola227]

my program used yellow sticky notes in Epic for the sort of nursing communications described above

it can be EHR/hospital/culture specific on how to deal
I talked to a senior and got lots of good tips on how to end these convos faster
as you might have guessed, I tend to be the chatty type and I needed to learn what they called,
"transactional communication" - look into it

ironically, taking the time to really "teach" (ie yak someone to death), discouraged others from paging me without taking the time to read the notes or use their brain, or else waste their own time on the phone with me. I was still considered accessible and nice going this route of discouraging pages. It was an investment of time initially, but paid off with some nurses while backfiring with others.

ditto adding in all kinds of protocol driven comfort care type orders, all kinds of order sets for eye drops for dry eye, heat/ice packs, bowel regimen, itchy cream, etc (where appropriate)

ditto that where you can put in an indication for orders, or rationale for why you're NOT doing things you're getting bugged about, in the notes, you can cut pages

with the nurses that loved to yak and yak, I had to learn to shut things down

 

[Dejavu]

Just say " Oh, my page just went off, sorry, got to go. "

 

[akwho]

The only one that really gets me is the meaningless double pages within 3 minutes of each other. It's gotten to the point that double pages mean less than single pages because the person double paging doesn't know what the hell they are doing. I always answer those the same way,
"Is a patient dying or in serious trouble?"
"No doctor."
"Because right now this double page is interrupting a procedure on an anesthetized patient. Please don't double page me unless it's an emergency. I will return it as soon as I am able to. Goodbye."

 

[TraumaLlamaMD]

The only one that really gets me is the meaningless double pages within 3 minutes of each other. It's gotten to the point that double pages mean less than single pages because the person double paging doesn't know what the hell they are doing. I always answer those the same way,
"Is a patient dying or in serious trouble?"
"No doctor."
"Because right now this double page is interrupting a procedure on an anesthetized patient. Please don't double page me unless it's an emergency. I will return it as soon as I am able to. Goodbye."

Had an intern once page me 12 TIMES in 20 minutes before he realized the number he was sending me didn't work. And no, the consult was not dying.

 

[WheezyBaby]

The only one that really gets me is the meaningless double pages within 3 minutes of each other. It's gotten to the point that double pages mean less than single pages because the person double paging doesn't know what the hell they are doing. I always answer those the same way,
"Is a patient dying or in serious trouble?"
"No doctor."
"Because right now this double page is interrupting a procedure on an anesthetized patient. Please don't double page me unless it's an emergency. I will return it as soon as I am able to. Goodbye."

Double page spaced over 5 minutes. "oh hey can this patients vitals be q8". Nope, *click*

 

[axiomofchoice]

This will get worse as nursing education continues to preach everyone is equal on the team (there is no hierarchy)

I find that new nurses think less and page more... the justification being some nonsense about "losing my my nursing license"

 

[bannie22]

The only one that really gets me is the meaningless double pages within 3 minutes of each other. It's gotten to the point that double pages mean less than single pages because the person double paging doesn't know what the hell they are doing. I always answer those the same way,
"Is a patient dying or in serious trouble?"
"No doctor."
"Because right now this double page is interrupting a procedure on an anesthetized patient. Please don't double page me unless it's an emergency. I will return it as soon as I am able to. Goodbye."

you don't get fired for that?
I think that response would lead to a report and investigation which would inherently find the nurses to be "appropriate" and lead to a professionalism misdemeanor.

 

[Shikima]

I refuse to carry a pager.

 

[HooliganSnail]

Double page spaced over 5 minutes. "oh hey can this patients vitals be q8". Nope, *click*

You catch more flies with honey....

 

[dienekes88]

I have been thinking a lot about how to make the incoming interns' lives more bearable. Covering the trauma floor for a friend today, I realized there's one thing I never quite squared away this year: establishing some semblance of control over the barrage of meaningless pages. I am talking about some really bad ****. I used to be a nurse, so I really don't think I'm out of line here.

"Gee, Dr. EP, I saw that you ordered duonebs on this actively wheezing patient getting 10 on their ISS. Did you really want duonebs?"

"Gee Dr. EP, Mr. Smith's potassium is undetectable and he consumes more Lasix than he does food. Did Dr. So and So from Team Not Yours really want to give that K?"

"Hey doc, even though this patient is not now, and never was on your service, this patient's primary team says they "can't" write wound care orders. She has to leave for SNF within a be next 3 minutes or lose the bed, will you help us?"

I like our nurses. Really, I do. I don't have any problem helping people out who are having a hard time understanding what's going on, but not at the expense of real patient care. I try to be nice and understanding even when it's really bad, but often have a difficult time getting people to wrap it up on the phone. It's the oddest thing- almost like part of it is just wanting a piece of our attention. Having been in their shoes, I get that we all have our to-do list, but some of the crap we get belongs on SNL.

I suspect that because I make a point to be polite in a specialty with a bad rap for hot tempers, I have inadvertently become the go-to girl. Kinda nice I guess, until you have 3 chest tubes and 10 discharges to deal with. So do I need to invest in a Wrap it Up box?


Sent from my iPhone using SDN mobile

Hahaha. I used to get the page-rage. I actually developed a vicious temper as a junior resident and got a horrible reputation among nurses and even some other services. It has been a long process (years) to rebuild a good rep. Keep it together, because, fortunately, you will age out of this BS. In the interim, I think coming up with an easy phrase to "wrap it up" would be good.

Also, you need to learn to say "no" politely. Something like, "regrettably, I'm attending to another patient, can you tell the resident that you think a free text wound care order would suffice?" Or... "Unfortunately, I'm not really familiar with that patient's case, and I can't really comment on that." You don't want your name all over a chart for a patient who you're not really actively involved with. That can get bad, because you don't round with those guys.

Had an intern once page me 12 TIMES in 20 minutes before he realized the number he was sending me didn't work. And no, the consult was not dying.

Hahaha. Been there.

This will get worse as nursing education continues to preach everyone is equal on the team (there is no hierarchy)

I find that new nurses think less and page more... the justification being some nonsense about "losing my my nursing license"

It's the future of medicine unfortunately.

 

[WheezyBaby]

You catch more flies with honey....

I'll generally look into and consider whatever the nurses want overnight, including changing vitals frequency, but if you make me step away from an admit or a sick patient's bedside or whatever because you double page for something unimportant, I'm not going to reinforce that behavior. This isn't routine or common, I have a good rapport with our nurses.

Another enjoyable experience - "hey can so and so's vitals be q8? They're going home soon". Yea, I'll look into it. Review info, vitals trends, recent labs, etc. Everything kosher enough, although "going home soon" was more like sometime in the next few days. Go to change the order and the vitals have been q8 at night x2 days. "Oh sorry, I guess I was just too busy to look at my orders!" But not too busy to page and ask for them to be changed :|

 

[ThoracicGuy]

I'll generally look into and consider whatever the nurses want overnight, including changing vitals frequency, but if you make me step away from an admit or a sick patient's bedside or whatever because you double page for something unimportant, I'm not going to reinforce that behavior. This isn't routine or common, I have a good rapport with our nurses.

Another enjoyable experience - "hey can so and so's vitals be q8? They're going home soon". Yea, I'll look into it. Review info, vitals trends, recent labs, etc. Everything kosher enough, although "going home soon" was more like sometime in the next few days. Go to change the order and the vitals have been q8 at night x2 days. "Oh sorry, I guess I was just too busy to look at my orders!" But not too busy to page and ask for them to be changed :|

The worst pages would always start: "I was just looking through the chart and..."

 

[gutonc]

The worst pages would always start: "I was just looking through the chart and..."

And those always come around 3am when everything's tucked in, the nurses have already had "lunch" and they've already spent 2 hours on Facebook/IG/Pinterest/Tindr and basically ran out of things to do so decided to read the chart.

 

[akwho]

0200: "Dr. I noticed PT wasn't ordered."
*Internal monologue* AHHHHHHHHHHHHHHHHHGHHHHH.

 

[epsilonprodigy]

My personal favorite so far: I was on call and it was a ****show. I decided to close my eyes for 10 minutes at 3am. I got a call from a heavily accented pharmacist who decided that then would be the appropriate time to inform me that docusate now only comes in 250 mg tabs. For a good 3 minutes, I was certain that my chief, who's a known prankster, was pulling my leg. We went back and forth for a bit until the poor dude said, "madam! I assure you that this is a serious matter!" I still beg to differ.


Sent from my iPhone using SDN mobile

 

[operaman]

0200: "Dr. I noticed PT wasn't ordered."
*Internal monologue* AHHHHHHHHHHHHHHHHHGHHHHH.

In a similar situation I called back and in all polite quasi-seriousness, asked how the patient was doing, and if she would ask her charge for the number of the overnight physical therapist on call for their unit. No no, no need to page me back with the number, I've got a minute and will just stay on the line with you so we can get this squared away. Oh there isn't an on call PT overnight? Yeah I agree this could probably wait til the team rounds in the morning.

Sometimes you gotta lead the horse to water.

(Can't do this unless you can be 100% convincing that your call back is totally sincere.)

 

[mvenus929]

I'm not proud of this (well I guess I am a little bit since I'm sharing it), but one time I made a peds RN calculate the UOP for me in Mg/kg and then look up the normal range for that patients age group after she paged me on multiple different occasions for "low" urine output that wasn't actually low.

Still amazed I didn't get written up for that one. I like to think I've grown since then...

...She wasn't already reporting it to you in mL/kg? We get those pages all the time, but it's usually either 'the patient hasn't urinated in the last 6 hours', or 'the UOP for the past 12 hours is 0.5 ml/kg' as they are prepping for change of shift.

 

[LucidSplash]

I'm not proud of this (well I guess I am a little bit since I'm sharing it), but one time I made a peds RN calculate the UOP for me in Mg/kg and then look up the normal range for that patients age group after she paged me on multiple different occasions for "low" urine output that wasn't actually low.

Still amazed I didn't get written up for that one. I like to think I've grown since then...

Also surprised peds nurse wasn't already reporting it in mL/kg. But I've done something similar to this for the adult ICU with little old ladies who are like 80lbs soaking wet and putting out 25/hr average urine. Certain RNs (not all) would call repeatedly for anything below 30/hr. While that was typically low for the standard morbidly obese TN patient, obviously doesn't apply to the tea and toast LOLFDBHOC (little old lady fall down bump head on Coumadin) and was always surprised I had to explain that to seasoned ICU nurses. But I think they were just used to dealing with 250lb+.

 

[j4pac]

I refuse to carry a pager.

LOL. Isn't that the dream of every physician...to not own a pager nor stethoscope

 

[Shikima]

LOL. Isn't that the dream of every physician...to not own a pager nor stethoscope

I own a stethescope, rarely use it. Pager.... well, I have my cell phone.

 

[DD214_DOC]

LOL. Isn't that the dream of every physician...to not own a pager nor stethoscope

I don't own a pager, and my daughter broke my stethoscope (that I rarely used) several months ago, which I have yet to replace. I guess that technically means I'm living the dream.

 

[michaelrack]

Don't use a pager anymore, but I still ask if the hotel is pager-friendly when I go to Vegas (I go to vegas 2-3x per year). Never have stayed at Caesar's Palace, although I occasionally play poker there.

 

[Smurfette]

Don't use a pager anymore, but I still ask if the hotel is pager-friendly when I go to Vegas (I go to vegas 2-3x per year). Never have stayed at Caesar's Palace, although I occasionally play poker there.

Why do you ask then?

 

[Apollyon]

Why do you ask then?

I was wondering that myself.

 

[IM2GI]

Why do you ask then?

 

[dpmd]

I'm not proud of this (well I guess I am a little bit since I'm sharing it), but one time I made a peds RN calculate the UOP for me in Mg/kg and then look up the normal range for that patients age group after she paged me on multiple different occasions for "low" urine output that wasn't actually low.

Still amazed I didn't get written up for that one. I like to think I've grown since then...

One time my husband was staying with me overnight while I was on an away peds rotation. Got a call maybe 2hrs before we normally round from the nurse informing me that for the past 12 hrs the patients UOP was 0.99ml/kg which was of course under the normal 1ml/kg. I think I mumbled something about MD aware and we will be rounding on the kid in a few hours when my husband pipes up with "why don't they squeeze the kid to get a few more drops out so it will be high enough output". Either that or round the **** up. Kid was totally fine on rounds of course.