Collaboration

Every now and again it's possible to have an interaction with a MD that turns into a team effort, a collaboration of sorts, that ultimately results in the greater interest and care of the patient.
Now it is possible to have great care without this collaboration, but with it, along with open lines of communication, great things can be achieved.
This week I had a couple of these such interactions, and I just need to toot my horn a bit....
Earlier in my work week I received a patient fresh off the operating table.  From that moment a time table begins.  We want you to wake up, eat, talk, pee, and maybe even move a little.  Patients laugh at me when I say, "Okay, so I know you just got back from surgery, but now it's time for you to get up and walk!"  They don't realize it greatly improves their outcome.  In this specific situation, this gentleman was unable to pee upon returning to my floor.  I did plenty of education, telling him I may even put a catheter in to scare the pee out of him, but he was still unable to void.  Alas, I did an "in and out" catheter where I drained the bladder.  I felt bad, but the bottom line being, it was a Doctor's order, and an order is an order.
In the morning when the surgeon walked into the patients room after I had to catheterize him once again, because we had hit that 6hr mark again, we had a nice little conversation...
Dr. McSmart: "Oh did you have to 'I and O' him?"
Nurse K: "Yeah, he was unable to void, and I wanted to give him some time, but also wanted to follow your orders, so we just finished cath #2."
Dr. McSmart: "Okay, did we start him on Flomax?"
Nurse K: "Well yes, but because he is allergic to sulfa, and Flomax and Sulfa interact, we started him on Rapiflo instead, per the protocol."
Dr. McSmart looking at patient: "See these nurses, they're smarter than me."
Did you hear that!!!  What a good feeling to be caring for a patient, looking out for the great good, and I was actually rewarded for it.  Maybe not that exciting to you, but boy did it feel good.
_______________________________________________
Later in the week I worked on another floor.  I had this patient in a very precarious situation with some very high lab values that could be life-threatening.  We were monitoring those labs closely and I was instructed to call the MD for certain values and levels.  At the beginning of my shift I needed to call the MD with results, we chatted, he came up with a plan, I implemented it, and everything was hunky dory.  He called me back a couple times with further orders and we worked those out too.  Later, with the next lab draw, things were looking up.  The patients labs were improving, but not improving too fast which was really important.  Had they not, the patient's brain would swell, and I really didn't want to deal with that.  About 0430 in the morning, yet another lab draw, this time critical results...My thoughts were: I know I have to call, but this poor MD is going to bust a gaskit that I've been calling him every 2 seconds tonight, maybe I can push it back until closer to 0500, I even asked my charge nurse what she thought, and she agreed that 0500 would probably be fine.  I sat for a minute, thinking, I decided to call right away, what did I ask the charge nurse for anyway?  I knew what I wanted to do, but still felt bad.  I critical lab value needs to be dealt with and I didn't feel right about sitting on it.  So what if he yells at me for calling, it is my job to care for the patient.  So I call.  MD is so nice, he had been the night before, but at that ungodly hour I just wasn't sure.  We collaborated on this patient because things were starting to look weird.  MD SoNice wants to consult pharmacy, so I transfer call.  Ten minutes later MD SoNice calls me back.  We make plan.  I write orders. Go implement orders.  All is well.  In the morning, I'm in a patient room, when another nurse comes and tells me MD SoNice is here and wants to talk to me.  As I'm walking to the nurses station I'm wracking my brain with what I missed.  I walk in and this occurs....
MD SoNice: "Hi, I'm Dr. SoNice, you must be Kelsy.  Thank you so much for your help last night.  I'm so glad you called when you did and that we could get things figured out for this patient."
Nurse K: "Oh it's nice to meet you.  Your welcome.  I'm sorry I had to call you so much, but with those labs values, I was getting worried."
MD SoNice: "Oh I'm so glad you did.  I was worried about this patient all night.  So thanks again, you did a great job."
Nurse K: "Oh well, thanks for being so nice when I called."
MD SoNice: "Ha, for being nice?  What do you mean?"
Nurse K: "Well not all docs are as easy to talk to at 4 in the morning..."
Oh come on, he knew that.  He was just playing off how nice he is.  He knows he's one of a kind.  Anyway, it was a good week with doctors and it was an awesome feeling to know I made difference and be recognized for that.  It is true that the more approachable a doctor is, the better outcome is for the patient.  A nurse won't hesitate to call with something important to a doctor that is easy to approach.  A good nurse won't hesitate to call for something important to a doctor that is NOT easy to approach.  Unfortunately, I can only count on one hand the docs that are easy to approach.