The orders that are written for our patients is essentially our toolbox. In the CVICU, we have autonomy to be able to titrate meds like insulin, heparin and pressors, but there will come a time when you run out of tools or you're not sure which tool to use.

Effective communication with the provider allows you to get what you need, or further understand why you're using a Phillips screwdriver instead of a flathead.

As a student nurse, I rarely interacted with providers. If a question was asked and I knew the answer, I'd respond, but as for advocating for my patient when something went wrong, I never really got a chance to experience it. We can learn about proper communication skills in school, but when it actually happens and you're a nurse needing to discuss something with your provider, it's important that you know your stuff.

When a critical lab value pops up, running to the provider with just the memorized value isn't going to be very impressive. Go through these steps before taking that plunge (if it's not emergent of course).

1. Do you believe it?

You may be asked this question as you're standing in front of your provider. You may be stunned because the next words you were expecting were a set of orders that you can implement. But do you believe it? Is that glucose value of 345 true? Did you draw it off of a line infusing TPN? Did you forget to pause the K and flush beforehand and that’s why the Potassium came back high? If the value isn't believable, first figure out why and if it was a mishap, you'll still need to let the provider know. So say it wasn't a mistake or a human error. What do you do next?

2. Why? 

Figure out possible causes for the problem. Look for trends. See if you're giving your patient fluids that can cause their lab values to be out of whack. Review the patient's history. Are they anemic? Do they have DI or SIADH? Is their LVAD working properly? If not, maybe we're hemolyzing their RBCs which is causing their Hct to gradually plummet (something I recently learned).

You may not be correct, but coming to the provider with suggestions doesn't just make you look better and shows that you took time out to think, it helps you learn and strengthen your critical thinking skills.

3. "What do you think we should do?"

Try and figure out a solution to the problem. Maybe they need orders to be on ICU protocol for their electrolytes, maybe we can slow that drip down. Maybe there isn't anything we can do. Think about it and come up with a solution! I guarantee one day a provider will ask you, "Well, what do you think we should do?" Be able to give your suggestions in a clear and concise manner. Don't let nervousness trump your confidence!

Communicating with your providers is an essential skill that you must have. Preparing yourself will make it a lot easier and will allow the conversation to become a teaching/learning moment instead of you walking away feeling incompetent. Don't ever be afraid to be your patients advocate. There will be times when your right, times when you're wrong, but the best part is knowing that you've learned something from the situation and knowing what to do when it happens again.