[FlightRN2B]

I have really come to hate when you call a doctor before it gets late at night for pain control orders, even something as simple as tylenol because your patients bp is in the toilet, so giving him or her another 5 mg of Ms IVP. would be totally inappropriate but then you get the bums rush off the phone because your disturbing them........... I had to repeat the low bp about three times before he got the idea that I didnt want to give him more of what was ordered but try something else that wont kill the patient by dropping their pressure even further. Instead I got the... he's got pain meds ordered...now don't call me again for pain meds and then got hung up on.............oh well goodnight.....its off to bed so that I get have more of the same later tonight................

[Noney]

How about when they fall asleep while they're talking to you?

Noney

[zambezi]

I have found that if I have to call in the middle of the night, it is best to just ask what i want right up front. is..Hi Dr, i am taking care of Mr. X, his bp has been running low but he is very painful. All I have ordered for pain in ms but it has dropped his pressure, can I give percocet instead? If you lend them and answer they don't have to think as hard while they are half asleep...honestly, i don't know how they think at all after being woken up, i know i couldnt. Sleepy is no excuse for being rude of course. This usually works well for me and I often get what I want.

[Elspeth]

When I was a new grad over 20 yrs ago I worked permanent nights in a PICU. We had one very anal-retentive, obsessive-compulsive and of course excellent peds surgeon that DEMANDED to be called for EVERYTHING. I mean some of his parameters were indeed ridiculous. Naturally, I ended up calling him almost every night in the wee hrs. I would be sooo nervous before I called(I was a new grad, remember?LOL) But the fuunny thing was he always sounded WIDE AWAKE and coherent, ALWAYS. I dunno, maybe the guy never slept. We ended up over the years having a great working relationship b/c he had this thing about trusting us to call him and he told me he could always trust me. Now if they all were like that.
As far as the grumpy/rude ones I try to ignore it and pleasantly thank them for the order if I was lucky enough to get one and keep focused that I'm there for the patient, not for the MD!!!
BTW, we now have to have the MD repeat twice the exact order for all phone orders, and we verify....no sleepy/slurred speech accepted.....it seems a little silly at times, Dr:"Morphine 2 mg IVP" RN: Morphine 2 mg IVP? Dr: "Morphine 2 mg IVP". But it makes it safer. ALso, I'd get a buddy to listen in on a 2nd line if there's a language barrier etc to confirm the order as long as I'm not violating any HIPPA rules.....sheesh......

[Dave ARNP]

"Little things" like Tylenol, MOM, and small fluid bolus are ordered by a house ARNP at night.

Anything else that needs ordered from our practice they call me for. If the nurse thinks I'm a little out of it when they call, they bang the phone on the desk a couple of times... or tell me that they patient has just coded and want to know if I would like to come and explain it to the family....

That usually wakes me up.

David Adams, ARNP
-ACNP, FNP

[EastCoast]

Hi dave,
i am the house NP at a busy hospital and it is strongly discouraged that we cover any 'routine' orders. i feel badly and often will give tylenol / mom orders b/c i think it is ridiculous. however, the president of the medical stafff feels that many of these attendings will just let the HO's do all the work for them and they should know when they admit a patient to order pain/sleep/nausea/indigestion meds. as it is we cover all their crisises for the most part and usually do a better job than most of them would b/c i'm not in a rush to get the next patient thru the door.

my boss believes that my job is to care for any really sick patients either sending them to icu or trying to keep them out of the unit. i'm plenty busy most of the time.

honestly, i never mind covering most of these docs but there are a few who should get a few wake up calls now and again. i am not that thrilled about ordering sleepers on someone i don't know too well or pain meds on a psych patient or a drug seeker so i'll usually defer. if a doc consistently treats people like crap (me and nurses) i will not cover his routine problems. sorry...learn some manners!


about being rude...there have been times when i've been called for ridiculous stuff (once a nurse wouldn't call an attending to tell him the patient was expired b/c i hadn't 'offically pronounced' the patient b/c i was in an emergency, so the family had to wait 2 hours to be notified) and times when i thought it was ridiculous call and as it turns out it wasn't it just wasn't presented well or i didn't percieve it well. my last annoying call was from a charge person who had called the doctor but actually told the doc (who was in the house) that I knew that patient from the nite before so in fact i actually knew the patient better and so told me i needed to see the patient. i was a snot on the phone and apologized when it hit me the doc. should know better too.
i can count on one hand the times i've needed to say i'm sorry and none of them were proud moments. it makes you feel lousy afterwards so i don't know how these constantly rude docs can deal with themselves.

[Marie_LPN]

A nurse on our med-surg floor had this problem with a cranky doctor saying "do you realize you woke me up???". Nurse's reply "well unless that bed is going to grow legs and run out of your house, you can take the 5 minutes to learn that your pt. (insert problem here)". That doctor was notorious for being extremely rude when awakened (on a weekend he was on call).

Until that day.