When to call the doctor?

NurseforPreggers · Sep 22, 2005

I work nights also and what I suggest is that when a problem presents use your nursing judgement to try to solve it (i.e. tylenol for fever). If you have done everything you can think of within your scope and the problem doesn't resolve, its time to call a doc. Don't call docs at night for things that can wait til morning. Sometimes its hard to determine when a doc should be called and when they shouldn't, but after a while you will have intuition to guide you as well. Follow your gut feeling, it hardly ever steers you wrong. Remember that the docs are getting paid to be on call and if you need to utilize them that is what they are there for. Don't call a doc before you have atleast tried to fix a problem though, unless it is an emergency.

sjb2005 · Sep 22, 2005

With time and more experience, you will learn when it's necessary to call the physician on a night shift. Consult the charge or senior nurse. Sometimes, even with the best advice, you will develop a "gut" feeling. If in doubt, call the MD. Better to be safe(and get chewed out) than to miscalculate and have your patient suffer. Be sure that you have implemented all your options and are prepared to present "your case" competently.Good Luck!

Hi, I am just wondering how you all decide when to call the doctor. I just switched to night shift which seems to have different guidelines for speaking to doctors. I don't want to leave things for the day shift to take care of that should be my responsibility. But I also don't want to call the doctor at 3 a.m. over something that will be seen as more minor. We do have parameters like vital signs that we use, but even then those are not always taken right- I had one respiratory patient with a fever over 102 and respirations got up to 50 (I am a peds nurse), and I asked my preceptor about calling, she said she would wait and see if the Tylenol would take effect, and it did- temp down to 99 and respirations in the 30's. Another thing was a med to be given twice a day that, if both doses were given, would exceed the weight guidelines according to our unit's drug guide, and one of the nurses suggested that she would give the first dose (it was a 1 a.m. medication that would be due for day shift at 1 p.m.) and leave a note on the chart for the doctor when they came in, and pass it on to the next shift as well. So that is what I did but I really wasn't sure- how do you decide? Those are just a couple examples, but overall basically I am wondering how you all make decisions about when to call doctors especially at night? Thanks for any advice...

KYnightnurse · Sep 22, 2005

Hi, I am just wondering how you all decide when to call the doctor. I just switched to night shift which seems to have different guidelines for speaking to doctors. I don't want to leave things for the day shift to take care of that should be my responsibility. But I also don't want to call the doctor at 3 a.m. over something that will be seen as more minor.
I am guessing you work in a hospital that does not have docs in-house when you need them. I worked at a hospital like that for six months, it was a frustrating environment. You should never have to worry about getting chewed out by a doc, or anyone for that matter, for calling when you think the time is right. Before calling, I would consult a few coworkers. You'll find everyone has a different answer and different approach to every problem. I currently work in a large metropolitan children's hospital where we always have residents, interns, and pharacists available. At your facility it may be common practice to give the first dose and leave a note for day shift. Where I work we would verify the dose with pharmacy and call the doc if the dose needed to be changed. As others have said, do what you are able to do before calling the doc ie: meds, comfort measures, etc. Good luck on night shift. I've been on nights for sixteen years and prefer nights to days. Things will come natural for you in due time. :)

perfectbluebuildings, BSN, RN · Sep 22, 2005

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fergus51 · Sep 22, 2005

We also try to pool our calls. Our docs are in house, but we do try to let them get a little sleep. When we have a problem, we tell the charge nurse and if we need to call right away she'll ask if anyone else needs the docs for anything before we call.

allnurses Guide · Sep 22, 2005

Fortunately we have an ER doc we can go to if need be. Of course we have to think about waking him up too.

I think it will come with experience. We have one doc who wants to be called about everything (he is a brand new doc and still very motivated). Most of the other docs trust our judgment about calling or not.

The other thing in our favor is we don't have alot of "critical" patients. We are a rural hospital and most of the really ICU-type patients go down the hill to another hospital.

steph

patwil73 · Sep 22, 2005

Hello Rachel,

How I make a decision to call a doctor -- first, I compare the problem to the pt's diagnosis (this tells me how serious the problem is usually, ie trouble breathing with CHF) then I see if there is anything already given to me (meds, tx, etc.) that I can do to rectify the situation. If my intervention helps or alleviates the problem I won't call, just leave a note. If intervention fails then I will call.

On medication, it depends if the dose given is unusual or way out of limits. If it is close and it is really late I'll usually give and clarify in morning. If it is way out or early enough (before 11pm) then I'll call. and if the prior nurse missed the dose requirements and left it to me, I'll leave them a note to double check their orders :)

Checking with your charge nurse is a great idea also as they problably know what the doctor will say. Just try to put the problem in context of severity and don't take the doctor yelling personally. You are the one "there" if you feel it is important, then it is important.

Good luck to you,

Pat

perfectbluebuildings, BSN, RN · Sep 26, 2005

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Daytonite, BSN, RN · Sep 27, 2005

In some places I worked a nurse was not allowed to call at doctor during the night without talking it over with the supervisor first and having her approve of the call. So, if you are on your own and can't decide whether to call or not, page the supervisor and get her input. In the middle of the night, you need to do everything you can for a situation that comes up before calling the doc, so you need to look through the doctor's orders in the chart to make sure something hasn't been missed by you because the doc is going to be really ticked off if he's already written orders to cover the situation you're going to call about. There are some calls to impart information only to the doctor that can wait until 6 or 7am. You'll have to learn which ones those are from your co-workers and supervisor. Be aware of nursing protocols that will allow you to give something like Tylenol for a fever, Mylanta for a sour stomach, or OJ for a low blood sugar without having to call the doctor first. The basic rule of thumb is that you only call a doctor in the middle of the night if you need an order for a stat medication, stat lab, or transfer to ICU right then. Now, that is just basic. You may have a doctor at your facility who is quirky about what he wants you to call him about. Also, before making the call, have the patient's chart and his med sheet in front of you so you can answer any question the doctor might pose. It would also be a good idea to peruse the doctor's progress notes to see if he has addressed the problem you're calling about and charted on it before. Finally, if the doctor gives you a hard time about calling him, ask him when he wants to be notified of the kind of information you are calling him about. That is how you learn individual doctor's preferences and how you will know when you can wait until 6am to call Dr. Smith rather than wake him up at 3am.

rn/writer, RN · Sep 27, 2005

Along with consulting the charge nurse and other co-workers, check for standing orders. Sometimes they're in a gigantic notebook with each doc's preferences. Sometimes they're part of the pathway for your patient's particular condition and might be found in the chart. In many cases, the standing orders spell out specific parameters for possible interventions as well as when to call the doc. Example: the standing orders for a diabetic patient might state that you must call doc if blood glucose level is below 60. Other standing orders might address such concerns as fever, constipation, pain control, and many more. If the standing orders are individual to the doc, reading them can give you a little insight into the personality and approach he/she takes. Some are more cautious than others. Some emphasize a particular area of concern and you would do well to be able to answer any questions about that topic, even if it has little to do with the reason for your call.

This is one of the challenges of working nights. Rise to it and you will be a better nurse for the effort no matter what shift you choose.

From one noc shifter to another, I wish you well.