Calling Docs, Who's Responsible?

[lisa41rn]

I work 7-3 and have always made sure calls to the docs were made regarding issues occuring on my shift BEFORE I left work if necessary. Well yesterday the 11-7 nurse mentioned to me a lab that came in that she hadn't mentioned in report. She also mentioned the patient was on two antibiotics that covered the problem. Well, apparently she had just gotten the results, but never called the doc. When he came in, he went to the charge nurse who said something to me about it. I told her I found out from the previous nurse and that seemed to end it. Then I spoke with the doctor for further orders and he said he didn't need anything done he just felt it was protocol to call about the lab. Wouldn't you know, he's one of the docs who when you do call, he acts like you're a pain!! You just can't win.

Regardless I wonder why it is our night nurses often seem to put off making calls to docs and expect the 7-3 nurses to make the calls. I understand you don't want to bother the docs in the middle of the night if it isn't needed, but this nurse should have called before leaving (she got out at 800 am!) and I'm stuck with the attitudes. If I have an issue at change of shift, I place the call and then wait for the call and make the oncoming nurse well aware if I reach the doctor or expect her to follow-up if they don't call back soon. I guess you could always say "did you call the doc?", but if something happens within your time frame,you should take care of it, not push it off on the next shift.

How do your floors work with issues occurring at change of shift?

[lisa41rn]

Constance, you sound like a good nurse. I'm sure there will be many who wouldn't call for MOM, but hey the doctor should have this ordered. Another med is Tylenol. When I worked nights, I'd have patients with a temp who could use Tylenol and it wasn't ordered.

It seems like on our floor, they do not want to call the docs at all during the night. Another time I went to work and the night nurse said a critical lab was called to her and she didn't bother to call the doc. Her response to me was "what's he going to do about it now?!" I thought maybe give you an order!! It just seems safer to call sometimes, especially with critical labs. These nurses are scheduled to work until 0730, but the one in question stays much longer. The one in question was hanging out talking until at least 0800 when happened. I don't think calling a doc at 0700 before leaving is too drastic of a time to call!!

Bottom line is, yes this doc is a bit of a pain and I took the brunt of it!! However, it was protocol for him to be called so he was trying to make a point that we blew it. NOTHING needed to be done/changed as the patient was already on antibiotics. Fortunately the majority of docs are much easier going....thank God for that!! They'd at least come to us to discuss it instead of running to the charge nurse and report it the way this doc did. When I then spoke to him about further orders, he completely blew it off as it wasn't a big deal he just should have been called. Gosh, nursing can be so exhausting!!!!!!!

[Constance7]

Thank you Lisa. I know that there are a lot of other nurses that will disagree with us but let's keep doing what we are doing. There is very little recognition given to Nurses from upper management. Our patients are where we get 99% of our gratification. We and all other nurses that share this opinion will be the nurses that the patients remember as the ones who took the time to care. When we choose our profession we knew that there would be moments that would prove to be "annoying". Some Doctors forget this and assume that they are above midnight calls. I have total respect for the majority of doctors that I work with and they all know I care about their patients even when they may be too tired. We choose this profession- it did not choose us. Lets do our best Nurses.

[gwlillith]

Bottom line is, yes this doc is a bit of a pain and I took the brunt of it!! However, it was protocol for him to be called so he was trying to make a point that we blew it. NOTHING needed to be done/changed as the patient was already on antibiotics. Fortunately the majority of docs are much easier going....thank God for that!! They'd at least come to us to discuss it instead of running to the charge nurse and report it the way this doc did. When I then spoke to him about further orders, he completely blew it off as it wasn't a big deal he just should have been called. Gosh, nursing can be so exhausting!!!!!!!

Well, Lisa. Welcome to the wonderful world of nursing! This won't be last time this happens either!

I've worked nights for over 10 years, and yes maybe the doc should've been called, but sometimes in that type of situation where it wasn't critical, the nurse may have had other priorities. Do you really know that she was standing around riding the clock, or waiting for something. Maybe a ride home? You really can't say. Her shift was over and you just have to pick up where it was left off.

This happens alot, and nursing is a 24 hour job. When that clock hits 07:15, I'm exhausted and ready to go. Leaving the day nurse with what's left is the way it is! There's always something left to be done or do. I learned the hard way as a new grad when I stayed past 9am trying to get everything done because the day nurse thought I should have completed them on my shift! I finally learned to say, "hey, my shift is over and I'm going home, this is what's left to do...."

One of these days you will have to leave on time and tell the next shift what you didn't get done.

I'm not being harsh, and yes this is the MD's problem. But like I said, it won't be the last time this happens to ya!

Good luck .....

[Daytonite, BSN, RN]

I have to disagree with this. Part of a new grad's training is to learn to prioritize, delegate and be a team member. If they give up on learning those skills, or have no one there to guide them on how to learn to handle situations like the OP has posted then the skills will never get learned. Throwing one's hands up in the air and declaring, "I'm going home! Here, you do what's left," is not my idea of teamwork and I would not permit any new grad to develop that kind of attitude or action. That is the response of someone who is frustrated and not being shown how to deal with the situation. It is very unprofessional and unfair to the care of the patients. An experienced nurse who has open channels of communication with the other nurses they give report to and the doctors can make the distinction between what they need to finish up before leaving, what they can pass on to the next shift, and who on the next shift might be taking advantage of them. Picking up your purse and leaving the building because it is time to go is just not an appropriate attitude.

I worked the night shift for many, many years. I took the care to find out what each day shift nurse wanted from me in passing my patients on to him/her. I took care to find out what doctors were insistant that certain things (like calling labwork to them) be done. That is teamwork, and doctors are part of the team too. I found very few day shift nurses who didn't appreciate that I picked up the phone at 7 or 7:30am and called a patient's doctor myself to report something that I knew the doctor was going to want to know. If you've only worked night shift, you have no idea the expressions of frustration that come over doctors faces when they are being given second hand information. A simple phone call from the nurse who cared for the patient on the night shift would have given the doctor the opportunity to get answers to questions that the day shift nurse cannot answer. This tendency for night shift nurses to want to remain anonymous and uninvolved is what has given night shift a low opinion of their worth to the entire nursing team.

[fergus51]

I've worked both shifts and have to say there is a difference between being lazy and leaving work for the next shift and working hard and leaving work for the next shift. Sometimes things just don't get done on one shift. That's why we have nurses working 24 hours a day and not just 12.

I get so sick of the silly shift bickering at my job. Some duties have been assigned to days and some to nights. Fine, except sometimes things don't work perfectly. For instance days is supposed to be responsible for line changes. Well, if the TPN doesn't come until 645PM I don't expect them to stay past their shift to hang it. By the same token nights are responsible for baths and linen changes. That said, sometimes the linen will get dirty on days and they have to change it. I get really chocked when I hear someone say, "Well, that's night/day shift's job". If it needs to be done, do it. But if in your common sense judgement it should wait, then that's fine too.

To say that night shift nurses want to remain anonymous is just ridiculous to me. I would LOVE to have the same access to docs as day shift does. When I pick up OT on day shifts, it is a pleasure to be able to call the docs any time I want.

[gwlillith]

I have to disagree with this. Part of a new grad's training is to learn to prioritize, delegate and be a team member. If they give up on learning those skills, or have no one there to guide them on how to learn to handle situations like the OP has posted then the skills will never get learned. Throwing one's hands up in the air and declaring, "I'm going home! Here, you do what's left," is not my idea of teamwork and I would not permit any new grad to develop that kind of attitude or action. That is the response of someone who is frustrated and not being shown how to deal with the situation. It is very unprofessional and unfair to the care of the patients. An experienced nurse who has open channels of communication with the other nurses they give report to and the doctors can make the distinction between what they need to finish up before leaving, what they can pass on to the next shift, and who on the next shift might be taking advantage of them. Picking up your purse and leaving the building because it is time to go is just not an appropriate attitude.

I worked the night shift for many, many years. I took the care to find out what each day shift nurse wanted from me in passing my patients on to him/her. I took care to find out what doctors were insistant that certain things (like calling labwork to them) be done. That is teamwork, and doctors are part of the team too. I found very few day shift nurses who didn't appreciate that I picked up the phone at 7 or 7:30am and called a patient's doctor myself to report something that I knew the doctor was going to want to know. If you've only worked night shift, you have no idea the expressions of frustration that come over doctors faces when they are being given second hand information. A simple phone call from the nurse who cared for the patient on the night shift would have given the doctor the opportunity to get answers to questions that the day shift nurse cannot answer. This tendency for night shift nurses to want to remain anonymous and uninvolved is what has given night shift a low opinion of their worth to the entire nursing team.

I have worked day shifts and only choose night shifts for personal reasons. I know how hard and busy they can be, as well as frustrating, especially for new grads.

I'm insulted and offended by the insinuation that night shift nurses are uninvolved and in turn effects the whole nursing team. That's ineffective to start blaming one shift or another...if there's a communication problem than the whole team needs to be counseled.

There was no declaration of abandonment either, as you so simply stated. If there is optimum communication and concise complete reports on each shift, then the physicians should have no problem gathering the correct information needed on days or nights.

It would be terrific if this were always the case, but unfortunately after 12 hours there's bound to be a mistake or important information that may have been missed during report. Heck, I still worry after all these years when I drive home if I've forgotten something, and you know what gets me through? That the day shift nurse will be a great team mate and cover my a$$!:kiss