be honest, now. how many of you find a patient that you think has an emergent problem and actually call the doctor and get orders first?
before icu (where we have standing orders), when i worked on the floor, i would ask someone to page the md but immediately start drawing needed labs, place o2, etc., while waiting for the md to respond.
when the md called, i would report the prob and say i drew this-and-that and did such-and such and what else do you want?
of course, i had worked with the same mds for years and could antipicate what they would want done. technically wrong, but i felt waiting on a return page that could take up to 20 min or more was worse in an emergent situation.
what about the rest of you guys? what's your procedure?
Before I worked in the ICU, I would get the house resident to my patient stat and when I paged them I would ask for a stat EKG, ABG's, labs, chest x-ray etc. When I was new, I would ask the charge nurse or more experienced nurses what they thought. Luckily we always have Docs in house to respond to emergencies and now in our hospital, we have a rapid response team which has been very helpful. Do you have issues with Doctors not calling you back in a timely manner? I can see how that would be a real dilemma. I guess I would never act alone, get your charge or your house supervisor involved in the decision making process, you don't want to lose your license over a Doc's lateness. If in doubt, don't do it.
Before I worked in the ICU, I would get the house resident to my patient stat and when I paged them I would ask for a stat EKG, ABG's, labs, chest x-ray etc. When I was new, I would ask the charge nurse or more experienced nurses what they thought. Luckily we always have Docs in house to respond to emergencies and now in our hospital, we have a rapid response team which has been very helpful. Do you have issues with Doctors not calling you back in a timely manner? I can see how that would be a real dilemma. I guess I would never act alone, get your charge or your house supervisor involved in the decision making process, you don't want to lose your license over a Doc's lateness. If in doubt, don't do it.
At my last assignment, I loved the hospital... the staff was awesome... the schedule was just what I wanted. Everything was great, except that almost all the docs never returned a page. EVER. I've never seen anything like it...
We had a house doc at night, but they were there to only cover a specific group. On more than one occasion, they stepped up and took over when the primary refused to answer repeated calls (and some of the house docs even refused to do that). There were cases where patients actually coded (or nearly-coded), were transferred to the unit, etc., and the primary never knew about it until the next time they made rounds.
I have no problem at all calling a doc during the night. I call for the good of their patients; I don't do it for the fun of hearing their sleepy voices... So if I feel it necessary to call, I expect them to answer and address the problem.
When I spoke to the managers and supervisors about this issue, they laughed it off as 'yeah, that's how they are'.
I was asked to stay on for another contract, and to return anytime, but for that reason I couldn't do it.
Emmanuel, I am flabbergasted! How did it become an acceptable practice for docs not to return pages? That is terrifying!! I don't think I could handle the frustration! Good for you for getting out of there.
Emmanuel, I am flabbergasted! How did it become an acceptable practice for docs not to return pages? That is terrifying!! I don't think I could handle the frustration! Good for you for getting out of there.
I have no idea how these docs got away with it, other than the nursing staff seemed to accept it. It was a small hospital, around 150 beds total. The floor I worked was actually 2 units combined, but staffed separately. The med/surg side was the beast when it came to this issue. The admitting docs were notorious for not returning calls, sometimes for hours and hours (as in as I'm finishing my shift in the morning) and sometimes not at all. The oncologists covering the other side were somewhat better. A few were quite prompt, and others needed to be paged repeatedly. That was completely unacceptable IMO, but the staff seemed to shrug it off.
Since then, I have interviewed for other assignments and I've asked specifically about this issue---how prompt are the docs in returning calls, etc.
In LTC we do a lot of minor stuff. Dressings for a skin tear or decub, tylenol for a headache or MOM or mylanta. All of these are things that need orders, but not for waking the doc up or calling them multiple times thru the day. (Now..they will be notified ASAP cause we all know these can indicate other problems)
I will also get urine specimines, stooll specimins or put O2 on, give a neb treatment or even send an emergent pt to the hospital before hearing from the doc. All of these are done with a doc that would approve these orders anyway.
I work med-surg and I don't wait. I order labs, do an EKG's, ABGs, Chest XRay the whole nine yards while the doc is being called depending on the patients condition and what's going on. I realize I'm the charge nurse and not the doc, but working 15 years with mostly the same trauma docs, I pretty much know what I can order and the docs appreciate it. However, we have no standing orders.
If the patient is stable, I might even wait for the quicker things like EKGs and ABGs and say "the patient complained of chest pain, I did an EKG and it shows.........".
It saves a step of me calling sayingt he patients having chest pain, and having the doc order an EKG and then having to call back yet again with the EKG results.
I have given an amp of D50 and narcan when necessary while the MD is being called. Otherwise, I wait for orders.
deeDawntee, RN
1,579 Posts
Before I worked in the ICU, I would get the house resident to my patient stat and when I paged them I would ask for a stat EKG, ABG's, labs, chest x-ray etc. When I was new, I would ask the charge nurse or more experienced nurses what they thought. Luckily we always have Docs in house to respond to emergencies and now in our hospital, we have a rapid response team which has been very helpful. Do you have issues with Doctors not calling you back in a timely manner? I can see how that would be a real dilemma. I guess I would never act alone, get your charge or your house supervisor involved in the decision making process, you don't want to lose your license over a Doc's lateness. If in doubt, don't do it.