If you think you need to call the MD, CALL THE MD!!!! - Page 4

Decisions to call the MD need to be made on the basis of, "Does the MD need to be aware at this time. Does the patient need interventions that are not ordered? Tests that are not ordered?" And that decision needs to be made by the nurse caring for the patient. (With input from others if necessary, but the decision needs to be made by the nurse caring for the patient.)
Never on the basis of, "Will someone be mad at me for calling?"

So often I hear, "It's Dr. X on call, she's nice, go ahead and call." The only time the identity of the doc on call matters is if it's, "This MD wants to know this immediately, this one would rather hear when they make rounds."
If you're afraid of being yelled at for doing your job, GET OVER IT.

And don't let a coworker talk you out of calling if you feel a call should be made. I've worked on units where you're supposed to get the charge nurse's permission. Those units will throw YOU under the bus along with the charge nurse if things go south. You're the nurse. YOU have the letters after your name. Make the decision. Get input if needed. I'll often have new grads tell me they want to call, and after discussing the situation, we work out that it's "just ..." or something that doesn't actually need a call once we think it through together. But if you think you need to call, it's YOUR patient being cared for under YOUR license, which makes it YOUR decision.

If it isn't emergent, I do not want to be called until 8am. I really resent middle of the night calls over inconsequential issues. And when/if you do call me I expect you to know the patient's history, diagnoses, course, medications and lab trends. I don't want to hear "I don't know." If you don't know, find out before you wake me up. thanks.

if the patient has a need that in my judgement should not wait until morning or has a condition such as a "critical lab value" which the facility requires notification of the provider - you will be called no matter how much attitude you sling.

There are a couple of NNPs I work with that are absolutely horrid, doesn't matter if you know the infant's hx, meds, and there are specific guidelines for calls; and your kid qualifies for a call. Doesn't matter if the group recently put out a memo pleading with the nurses to always call when infant is "out of guidelines" (there are extensive unit-wide and infant-specific guidelines we follow). Anyway, they will question every assessment you report and ridicule your interpretation.

It gave me considerable pleasure to call one of these . . . ahem . . . .ladies, when I was really worried about one of my former micropreemies that had a yucky green gastric residual and wasn't acting right. The infant had acted a "little off" sice shift change but had no reportable clinical symptoms until 11pm. She flippantly ordered an x-ray. A few minutes she was up there actually acting concerned about the x-ray. An hour later the infant was not only intubated, but we thought we would have to go straight to the oscillator. Overwhelming NEC, the scourge of the NICU. They agreed the labs showed a very sudden onset. This all went down within an hour of the first call. The next day when I came in at 6pm they were withdrawing support, the infant had just come back from surgery and had no viable bowel.

I heard this NNP later published a case study on this infant as it demonstrated the potentially incredibly fast progression of the disease and the need to act quickly.

Yet she continues to demonstrate the same manner that keeps nurses from calling unless they are positive there is a bad problem.

"If it isn't emergent, I do not want to be called until 8am. I really resent middle of the night calls over inconsequential issues."

Then perhaps you should have been a banker rather than a healthcare provider.