I was walking out of work the other morning and was talking with a co-
worker. She was frustrated about an incident she had with a
consulting physician. She said that she called him because her
patient's abdomen was "getting bigger" and she felt that the patient
was bleeding. The patient had a ventral hernia repair and indeed was
bleeding into her abdomen. This nurse was frustrated that the
physician didn't seem, to be concerned and didn't give her orders. I
asked her what she said to him when she called and she told me "I
said I think she's bleeding and her belly is getting bigger. He just
told me to keep and eye on it." I told her I was surprised because
this consulting physician was always responsive when I had called him
in the past. She said, "It's different when you call, you're smart
with a lot of credentials, people listen to you."

I realized then that this was not an issue of being "smarter or
having more credentials" it was a communication issue. Being able to
communicate objective information to other members of the healthcare
team is extremely important. As the nurse, you are the one at the
bedside, you are the one taking care of the patient, and you are the
one who is in charge. There were a number of things that would have
clarified the concerns of this nurse. The patient's heart rate had
gone from 98 to 110, and her systolic blood pressure was down
slightly. She had been given two units of PRBCs and her hemoglobin
was 7.2 at the start of the transfusion and was 7.9 by the end of the
second transfusion. Her abdomen was bigger but measuring abdominal
girth or intra-abdominal pressures would have provided an objective
measure.

I sat down with my co-worker and went through this case with her.
She understood after we talked how difficult it would be to make a
decision on treatment options without these objective pieces of
information. I explained my "secret" of getting people to listen to
me – that of providing a clear clinical picture with objective data.
I think that nurses don't always realize the power we have at the
bedside. We are the team leader and we need to have the knowledge to
direct the team and provide the information each member needs to make
clinical decisions about patient care. It's easy to get discouraged
and blame the physician who doesn't listen to us, but if we do who
will take care of the patient's needs?

Christine A. Varner, MSN, RN, CCRN, CEN
Implementation Specialist, Seminars4Nurses, LLC.
cvarner@...