My first thought was, “I have been incredibly jinxed with urine output lately!” It was getting to the point where I was more surprised if my patients actually peed an appropriate amount. The doctors were getting used to my frequent pages begging for boluses for my dry patients.

Yes, my patient’s urine output was only 200cc for the entire shift. I resigned myself to this fact after about ten minutes of manipulating and milking the tube, and falling short only of pushing on my patient’s bladder and begging. I had no choice, it was time to call the doctor for another bolus.

What luck! The doctor was standing by the nursing station flirting with the young nurses. Granted, he his young and devastatingly handsome, but do the girls really need to giggle like that?

I hesitantly walked over to him, taking deep breaths, attempting to overcome my absolute fear and intimidation of talking to doctors. Causing the most trepidation was having to interrupt his “professional” conferencing with the nurses.

“errr…hi….I…ahhh…have a question.” I hate the way I sound so nervous when I talk to doctors.

“What is it?” He went from flirtatious to serious, bored, and bordering on annoyed. Sometimes it just doesn’t pay to be a male nurse!

“My patient has a low urine output. Mr. Smith that is, no! Sorry! Mr. Elliott!” I’m stammering. I’m getting more nervous. Why can’t I just be confident like everyone else?

“Tell me his story.” He said, not looking at me.

This is approximately the moment I panicked. I just expected him to ask about cardiac history, and order a bolus of Normal Saline.

“Errr…well….unresectable tumor of the panc…no liver….geeze…” I point to my abdomen and the doctor gives me a look that most definitely accuses me of being a complete idiot. His eyes ask who the hell let me take care of his patients. “His pelvis, it was in his pelvis.”

“I can see you don’t know anything about this patient, just get me his chart.” He sighed. I gave him the chart and ran away embarrassed. The truth was that I had been caring for this patient for days and knew him inside and out. I had read his chart front to back and knew his entire medical history. I had assessed him numerous times and knew every wheeze and bowel sound.

The patient got his bolus, but I had completely failed at my report to his doctor. As I lay in bed at night reliving the moments of the day (we all know this is a nurse’s favorite past time, and is potentially what leads us to insanity), I asked myself, “tell yourself honestly, did you know this patient.”

The answer was a definite yes. Where I had failed was in my preparation in giving report to the doctor. I didn’t organize my thoughts and the patient’s situation/needs into an organized presentation for the doctor. I failed to use my communication skills properly, and I failed to project confidence in my patient’s needs.

My hospital has begun teaching the SBAR method of reporting a situation to a doctor. Never until this moment have I fully understood exactly why it was necessary. SBAR stands for Situation Background Assessment Recommendation.

I had a Eureka moment as I lay there in bed desperately trying to find a way to improve myself. When I need to talk to a doctor, I just need to stop, organize my thoughts using SBAR, and then proceed. If I had done this, my side of the conversation would have looked more like this:

“Mr. Elliott had an output of 200cc concentrated urine for my shift. He had a laparotomy on Wednesday for an unresectable tumor with a colostomy creation. He has had a low output for the past 72 hours and has received two 500cc Normal Saline boluses, the last one at 23:00 yesterday evening. He has a history of hypertension and a MI in 2004. His vital signs are all stable and unremarkable. I think he would benefit from another bolus.”

I couldn’t help but wish I were the type of person that could just roll words off of my tongue with no effort at all. While earning my degree, I had more than one professor tell me that I sounded very confident and intelligent in my writing, but verbally I struggled. It’s true!

The next morning during report I was told that Mr. Elliott had been causing problems overnight. His lungs sounding worse, his Sats were dipping low occasionally, and he felt short of breath.

Not a problem, I gave him some ventolin for the wheezing, lasix for the crackles, ordered a physiotherapy chest assessment, taught him breathing/coughing exercises, and kicked him out of bed for some walking. He had none of the problems night shift experienced.

During morning rounds, one of the doctors (the same one that caused me to stutter my words in nervousness) had a hunch that Mr. Elliott was having cardiac problems and ordered an ECG and Troponins.

Oh what joy! The ECG shows a block, and the Troponins were sky high!

Moments later, a severe looking women entered the room. She was definitely high on intimidation factor! She introduced herself as a cardiologist here for a consult.

“Can you tell me about your patient?” She said, in a way that told me she was completely bored with the situation. You could tell she would rather be elsewhere. And seriously, how did she get here so fast. And OH CRAP, I need to talk to a doctor again!

“84 year old male for unsuccessful laparotomy to remove abdominal tumor, diverting colostomy created. Low urine output times four days, chest has wheezes and course crackles, at 05:00 this morning he experienced episode of decreased Sats and shortness-of-breath, oxygen delivery was increased, and Lasix and Ventolin were given. All vital signs have been stable since. His ECG showed a block, and Troponis were 0.28” I rattled off with definite confidence. I liked the way it all sounded! I forgot to use SBAR, but I think my bedtime talk with myself had worked a little bit.

“OK” she said, and went to assess the patient. I didn’t receive one condescending look from her!

Nursing is a reflective practice. We learn how to do our jobs by examining our performance, and critically thinking in order to find ways to improve. In nursing school we called them “Reflective Journals,” and we all dreaded them. But I really do understand why the practice is important.

My conversation with Doctor McFlirty kept me up late at night because I knew that I could do better. I knew that I was not happy with my performance. I laid there in the dark, picking apart my performance until I discovered a method to improve the way I communicate with doctors.

Sure, my performance the next day was not perfect, but it was a vast improvement. With practice and reflection, I will develop the confidence I feel my patients deserve from me.