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

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TiffyRN, BSN, PhD

2,315 Posts

Specializes in Nurse Scientist-Research.

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.

P_RN, ADN, RN

6,011 Posts

Specializes in ORTHOPAEDICS-CERTIFIED SINCE 89.

I once called the dreaded docor on Sundy. He shouted at me he was in

line for communion,I could hear the priest in the background.He told him you are the doctor to step aside and attend to his patiet and his*soul*had not eaned the rirght that day.

Blood all obver, Rapid response was there thank GOD.

Wow he was steamingwhen he got there. We were coding his 40 year all the while he ws pitching hi fit.. It was s femoral artery nick

Hust remember you are the advocate, If it doesnt look rignt, therere is your clue. Its called Nursing Intuition

kanzi monkey

618 Posts

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.

You called. She ordered an xray. She responded within a few minutes. Diagnosis within an hour. Horrific disease with rapid onset, devastating course and tragic outcome. The case is later used as an educational tool to prevent future similar events.

Sounds like everyone did the right thing. I know you didn't mean that you gained "considerable pleasure" from this event, but I'm not sure what your point was. Just because she may have a gruff personality doesnt mean she isnt excellent at her job (which it sounds like she is).

Also, in response to entire thread--call if you're worried. If the person you're calling isn't nice to you, get over it. If they are ignoring what you think is a dire concern, go up the chain. You may be wrong and get rebuked, but if you're truly reporting what you think is best for the patient, be like a duck, the harsh words are water. But learn from it.

And, please please please, for the love of allnurse.com, PLEASE do not gloat if you think a patient is having an issue, the covering disagrees, and your pt ends up actually having an issue. It is REALLY unprofessional and reflects poorly on nursing.

I try to answer all my pages-and I think some nurses think I'm "the nice one" to call because I am also a nurse and will talk through things with people when they're worried about our patient. I know the nurses that take advantage of me for this, or might just need to take a course or two and genuinely don't know what's going on. This is annoying to me. These nurses annoy me. They also interfere with my being able to address more pressing concerns with my other patients. Please remember if you are requesting call-backs for detailed conversations about what you might think is going on--some of us will try to cater to you, but it doesn't mean you aren't interfering with their work. If you can educate yourself through reading and discussion with other nurses, do it. I do this too--when I need a little help, I go to the interns, nurses, junior residents, and other NP/PAs. When I need a whole lotta help, I make a boss call to my chief or my attending.

The jury's not back yet on official definitions of "little help" and "boss calls"- and yes, I get somewhat reamed out for something on a daily basis.

Duck. Water.

Specializes in Med/Surg, Geriatric, Hospice.
"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.

So, you think it's OK to call MD's in the night for 'inconsequential issues'?

:icon_roll

Specializes in Med/Surg, Geriatric, Hospice.
What you "want" (as far as not being called) is inconsequential if you are the provider on call that night. 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. (I'm not taking the fall for anyone's "preferences")

If you are polite about it I will minimize the disruption, citing relevant facts only, requesting a course of action, checking to see if others need to speak with you before waking you and then letting you return to sleep promptly. Throw attitude around and you will get exactly the response I cited in my prior post and possibly a report to the chain of command.

Uhh.. I think a critical lab value could probably be categorized as 'consequential' and would not **** her off in the middle of the night..

wooh, BSN, RN

1 Article; 4,383 Posts

So, you think it's OK to call MD's in the night for 'inconsequential issues'?

:icon_roll

I think there's often disagreement over what is "inconsequential." It's the nurse's call. If you don't want to be called over something that's questionably "inconsequential," then I agree that you should have instead become a banker.

Ruby Vee, BSN

17 Articles; 14,030 Posts

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
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.

inexperienced nurses often do not understand the difference between something that needs to be addressed right now at 0200 and something that can wait until rounds. it's up to those of us with experience to mentor them in that regard . . . including the essential information to have in front of us before we make that call. you wouldn't make work for the next shift just to be making work for them. providers are our colleagues as well, and they count on us to have the information they need to make decisions before we wake them to make those decisions.

TiffyRN, BSN, PhD

2,315 Posts

Specializes in Nurse Scientist-Research.
I know you didn't mean that you gained "considerable pleasure" from this event, but I'm not sure what your point was. Just because she may have a gruff personality doesnt mean she isnt excellent at her job (which it sounds like she is).

And, please please please, for the love of allnurse.com, PLEASE do not gloat if you think a patient is having an issue, the covering disagrees, and your pt ends up actually having an issue. It is REALLY unprofessional and reflects poorly on nursing.

I knew when I posted I wasn't be as clear as I wanted. First, let me emphasize that with this very large group (I bet there are 50) of NNP's, there are only two that are this way.

The part that gave me pleasure was nothing to do with this infant dying so quickly. The part that I enjoyed was (I thought) proving to her that we are not all idiots just trying to ruin her night's sleep, I had a legitimate concern and my "worthless" assessment skills turned out to be right on. All involved agreed that the onset with this infant was very rapid as evidenced by a lack of left shift on the CBC (we didn't do CRP's back then) and that the infant was breathing on her own (RA) and even enthusiastically bottle fed a couple hours before (not easy for a 33wk AGA infant).

The part that distresses me is that in spite of this evidence of good judgement in a rapidly evolving situation (notable enough that she wrote a paper on it), this NNP continues to berate nurses for calling on issues that are required "calls" and consistently questions their assessment findings.

I'm just saying, of all people, she should have developed some respect for our concerns.

Elvish, BSN, DNP, RN, NP

4 Articles; 5,259 Posts

Specializes in Community, OB, Nursery.

There are times when something is iffy, and I call a doc/NP to let them know, because it could evolve into something worse and I don't want the first they hear of it to be when the **** is hitting the fan. Most appreciate the heads-up. I try to do this at a reasonable hour so that if I have to call them at 0300, they might have a faint recollection of the situation.

I would not call them at 0300 for a Colace, nor a Zoloft (once a doc told me about a nurse who asked him for a stat Zoloft order :rolleyes: ), nor would I call for anything that's WNL unless specifically asked to do so.

amygarside

1,026 Posts

This is such a great post.Most of the ones who get scared of calling an MD are the new ones, either because they are unsure of their patient's condition or they're afraid of getting scolded by the doctor.

chicklet74

32 Posts

So, you think it's OK to call MD's in the night for 'inconsequential issues'?:icon_roll
I think that since I'm the one assessing the patient I'll decide what's inconsequential and what isn't. I doubt this NP is scheduled to be on call without being paid for it and the amount of rest she gets isn't my concern.

bratmobile

103 Posts

Dr after after 3 calls in 2 hours: "And how many more times will you be calling me again tonight?"

Me: "Only as many times as I need to"

Dr: "Click"

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