Quote from Blackcat99
B/P was 90/60. What would the B/P have to be before you would call the doctor on night shift? I work in the "skilled side" at the LTC. The doctor does not have orders or parameters in regards to calling him in regards to the low B/P's. The first thing this doctor does when you call him at night is that he calls the DON at her home at night and reports you for calling him at night. However, the nurse from the 3-11 shift says you are suppose to call the doctor each time you get a low B/P on nights. In other words, I would be calling the doctor every night at 1am to report these low BP's. The DON would then be awakened every night at 1am when the doctor calls and reports me to the DON. Is it not normal to have a lower B/P when you are asleep at night?
First, why doesn't this doctor write some parameters???
Then, what does your DON have to say about this ridiculous situation?
Lastly, what do the other nurses do?
Oh, is the pt in distress? Are you doing routine VS at night? It's not unheard of for old people, thin people, sleeping people, people on BP meds, LOL to have lower BP? There's good advice earlier in this thread about MAP and about not fearing doctors.
What time are you doing these VS? Usually, long-term VS are done monthly, but if you're on the skilled, presumably shorter stay, side, well, you will have to use good judgment. You can always RECHECK the BP after you get the pt moving, like flexing the hand and arm muscles.
Even when VS are ordered around the clock, a prudent nurse might determine that sleep is more important at that particular moment.
But your bosses need to protect you from this rude, unreasonable doctor. There's no reason, except to cover himself, that he isn't writing parameters for when to call at night re: sort of unusual VS. Obviously bad VS, pt in distress must be reported.
It's your license. Protect it. But be reasonable. You will learn what "reasonable" is with time.