Confidently Contacting Physicians for Orders: A Guide for Nurses

Clear communication with physicians is essential for providing quality patient care. For nurses who are new to the US healthcare system, contacting a physician for orders can feel unfamiliar or even intimidating at first. However, with preparation and practice, you can approach these conversations with confidence. This guide will walk you through the process and provide helpful tips to make these interactions effective and seamless.

The Importance of Nurse Autonomy in the US

In the United States, nurses play a vital role in patient care and are trusted with a high degree of autonomy. This includes assessing patient conditions, identifying changes, and contacting physicians to request or clarify medical orders. Understanding how to confidently communicate with physicians strengthens your role as a key decision-maker in the care team.

Effective Nurse-to-Physician Collaboration

Nurses and physicians work together to provide patient-centered care, and strong collaboration between them is linked to better patient outcomes. Research on Magnet hospitals has shown that improved nurse-physician relationships contribute to higher patient safety and satisfaction. Here are some key practices that help foster effective communication:

• Introduce yourself: When you see a physician on the unit whom you do not know, say, "I am the registered nurse taking care of [patient's name]."
• Prepare patients for exams: Let patients know the physician is on the unit so they can be ready for an examination and have time to think of concerns or questions.
• Make rounds with the physician: If possible, walk with the physician during rounds to discuss pertinent patient care issues. If you cannot attend rounds, document any concerns on a communication sheet.
• Clarify and confirm orders: Always check written orders before the physician leaves the unit and seek clarification if needed.
• Be prepared during urgent calls: If the physician is responding to an urgent situation, have up-to-date vital signs, assessment findings, and lab values available. Position the patient appropriately for examination.

Overcoming Barriers to Communication

Some nurses feel hesitant to contact physicians about patient concerns due to differences in communication styles. Physicians are trained to communicate concisely, while nurses may provide more detailed background information. This difference can sometimes lead to miscommunication or frustration.

To ensure effective communication:

• Be direct and to the point.
• Structure your communication using standardized frameworks.
• Avoid excessive details—stick to the most critical and relevant patient information.

Professionalism in Contacting Physicians

To maintain professionalism and prevent communication breakdowns, consider these best practices:

• Contact the correct physician—make sure you’re calling the right specialist. Many patients will have more than one physician on their case during the hospital stay.
• Use the physician’s preferred method of contact—some prefer text messages, others prefer calls. Always follow your unit protocol when contacting providers.
• Be available for a return call—if you leave a message, ensure you can be found quickly.
• Be succinct—get straight to the point.
• Be ready to take orders—encourage the physician to enter the order in the patient’s chart. If your facility allows verbal orders ensure that you write it down immediately, document in the patient chart (electronic, or written) and read back the order. This is a Joint Commission requirement for patient safety.

Communication Frameworks

Use the SBAR Method

The SBAR (Situation, Background, Assessment, Recommendation) method is a widely used framework in the US healthcare system that helps you provide clear, concise, and relevant information:

• Situation: What is happening with the patient?
• Background: What is the patient’s medical history or relevant background?
• Assessment: What are your clinical findings?
• Recommendation: What action or orders are needed from the physician?

📌 Example of SBAR in Action:

• S: "Mrs. Collins is complaining of severe anxiety."
• B: "She is one day post-op from a lumbar laminectomy."
• A: "She is alert and oriented, and her vital signs are stable. She has no numbness or tingling in her extremities."
• R: "She said she takes lorazepam 2 mg orally at home when anxious. Would you like to order this or something else for her?"

Read-Back Tool: Ensuring Clear Communication

To ensure the physician’s instructions were received and understood correctly, use the Read-Back tool, a closed-loop communication technique that confirms understanding.

‍📌 Example of Read-Back in Action:

• Doctor: "Give me 25 mg of Benadryl IV push."
• Nurse: "25 mg of Benadryl IV push."
• Doctor: "That’s correct."

When Patient Safety is at Risk

If you have concerns about a physician’s order or a patient’s condition, escalate concerns while maintaining professionalism.

• "I’m Concerned about [patient's condition]."
• "I’m Uncomfortable with this approach."
• "I don’t think it is Safe to continue without intervention."

A Step-by-Step Guide to Contacting a Physician for Orders

When you need to contact a physician, following a structured approach ensures clarity and efficiency. Here’s what to keep in mind:

1. Be Confident in Your Request

• Approach the conversation knowing that you are advocating for your patient’s needs.
• Physicians rely on your clinical assessment, so be professional, clear, and direct.

2. Be Prepared with All Information

Before making the call, gather key patient details, including:

• Vital signs and any recent changes.
• Known allergies.
• Recent lab results or diagnostic test findings.
• The most recent orders written for the patient.
• Relevant medical history that may impact current care.

3. Communicate Conditional Changes

• Clearly explain any significant changes in the patient’s condition that prompted your call. Be prepared with the current set of vital signs and any lab values that may need intervention.

4. Clarify and Confirm Orders

After receiving instructions from the physician, always take steps to ensure accuracy and avoid miscommunication.

• Read back the order to confirm what was stated before ending the call.
• If anything is unclear, ask for clarification immediately rather than making assumptions.

5. Document the Interaction

Accurately record the conversation in the patient’s chart, including:

• Time of the call
• Physician’s name
• Orders given
• Follow-up steps required

6. Stay Ready to Take Notes

• Have a pen and paper handy during the call to write down any additional instructions.

Final Thoughts

Contacting a physician for orders may feel daunting at first, but with preparation and structured communication, you can handle it with confidence. You are a vital part of the healthcare team, and your observations and recommendations directly impact patient care.

By practicing these steps and using communication techniques like SBAR and Read-Back, you’ll feel comfortable advocating for your patients and ensuring their needs are met.