calling the doc

Published

Specializes in Long Term Facilitly.

I work night weekends on a med-surg unit. I have been there for about 7 months. When I first started, the LPN's prior to calling the doc, had to discuss the reason for wanting to call the doc to the RN/PCC or the Supervisor and they would decide if if the nurse could. Then after three months, we were informed that only the PCC was allowed to call the doc. Now it's the LPN runs it by the PCC, she decides whether LPN calls or she calls. And every since I have worked there, I have been informed of how this Dr. is going to "chew your butt out when you call him so be ready". Not for something you have done wrong, this is just for calling him. Hell before I even call the doc, I am so damn stressed out it is unreal. First for having to run everything by the PCC....then wait to see if she/he gives me permission...or if she decides she'll do it or will I...and then wait to get my butt chewed. Understanding the PCC must know at all times what is going on with the patients. And then if I am told not to call....where am I protected as a nurse. And if I get to call and the doc yells at me and gives me no new orders except DON'T CALL ME....then what? All the other places I have worked....I just called....I didn't have to jump threw all these hoops. I would really love to chart "{Dr. informed of change of condition and no new orders except he states "don't call me again!"}

Up Vote Up Vote ×
Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

I telephoned a doctor to verify admission orders and obtain a T.O. for a sleeping aid on a psychiatric patient who had just been admitted at 9pm.

The doctor yelled, "I was trying to go to sleep! Why are you bothering me?"

I responded, "You're a doctor. Perhaps you should have chosen another profession if you didn't want telephone calls."

My point is to not be afraid to telephone the doctor. While some things are not worth waking someone up in the middle of the night, the cranky physician must realize that telephone calls and pages come with the territory.

Up Vote Up Vote ×
Specializes in Med/Surg.

What does PCC stand for?

It must vary by state, because our LPN's don't make MD calls at all, it is out of their scope of practice to take/write orders. RN's always call.

The thought I DO have for you is, ABSOLUTELY write what he said! I have many times written "Do not call MD" as their order, and in my nurses' notes, charted who and when I called, what I told them, and no new orders. You kind of HAVE to, to cover your own butt if nothing else. Granted, you KNOW that if something goes wrong he's going to be called again anyway, but still. I've had docs say "I won't order any more pain meds, don't call about them" on pts with history of abuse, and I write it as an order, both so that subsequent nurses know without a doubt not to, and we can tell the patient that he won't order any more (because he's GOING to keep asking...I'm thinking of one particular case, if you can't tell).

That's my :twocents:

Up Vote Up Vote ×
Specializes in Med/Surg.
I telephoned a doctor to verify admission orders and obtain a T.O. for a sleeping aid on a psychiatric patient who had just been admitted at 9pm.

The doctor yelled, "I was trying to go to sleep! Why are you bothering me?"

I responded, "You're a doctor. Perhaps you should have chosen another profession if you didn't want telephone calls."

My point is to not be afraid to telephone the doctor. While some things are not worth waking someone up in the middle of the night, the cranky physician must realize that telephone calls and pages come with the territory.

I agree. Eventually you get a very good idea of who to call on some things in the middle of the night, who not to. Comes with time.

We have one surgeon that is just so...CRUSTY to everybody. No matter what you do, it's going to be the wrong thing. We have a few new nurses on our unit, and I'm helping them with that when they get off the phone with them and he's just gotten done reaming them a new one. I say, you know what? If you HADN'T called him for whatever, he would have yelled about NOT being called. He is truly a case of YOU CAN'T WIN. He doesn't like getting called at midnight about blood sugars, even though HE orders them every 6 hours, and writes crummy parameters with no sliding scale (I believe it's usually less than 90 or greater than 180). Do I want to call the doc at one am (depending when I got to it!) to tell him about a blood sugar that's 86 and NORMAL? Heck no! But he told me to, and you're damned if you do, and damned if you don't. He'll either holler when he gets the call, or holler when he rounds in the am and WASN'T called (since it was close to 90). You eventually just have to throw up your hands and laugh and walk away. Otherwise you'll go nuts.

Up Vote Up Vote ×
Specializes in Management, Emergency, Psych, Med Surg.

Your responsibility at all times is to the patient. I know how frustrating calling an MD can be but I can offer you a few tips:

1. Get your act together before you call the MD. Get your MAR, the chart and the vitals with you before you call.

2. Don't place the MD on hold unless absolutely necesary. Stay close to the phone if you can so you can answer promptly.

3. When a physician gives you an order such as "don't call me any more for this (what ever the issue is) he or she is giving you a a direct order and it should be written as such. Example: "do not call md tonight for patient pain issues) telephone order dr_______/ your name and title.

4. Be prepared to get called on the carpet. He will be angry but you should respond that you will write the orders that he gives you and if he does not want to be called for a certain problem it will be documented as such.

5. Know your nurse practice act inside and out. You are responsible for protecting the patient and your license. If your supervisor does not back you up, you should consider going to another facility where you will get the back up that you need. Good Luck:lol2:

Up Vote Up Vote ×
Specializes in Day Surgery, Agency, Cath Lab, LTC/Psych.

In nursing you really have to grow a backbone. I don't call the docs to chat--it is strictly professional. I state my purpose in calling, request what I need and get on with it. I expect professionalism from them. Don't let them read the fear in your voice. You are just doing your job. Don't allow their behavior to change the way you feel about yourself. You are only responsible for how you act.

Up Vote Up Vote ×
Specializes in LTC, home health, critical care, pulmonary nursing.

I'm lucky that I don't get my feelings hurt easily. I don't care if a doc has his britches in a bunch, as long as my patients get what they need. Besides, the stupid things they yell on the phone sometimes makes for good stories.

Up Vote Up Vote ×

I agree. Ultimately it is your license on the line and you are advocating for your patient. Try not to take things personally. Even if the MD decides not to take action, you chart exactly that .. "MD notified. No action taken". Now if you felt differently about the decision then you can go to whoever is above that person, which is a totally different story. And with time you will learn what can wait until the MD comes on the unit or what is urgent and needs to be dealt with ASAP. In the end I would rather be "chewed out" than leaving this nagging feeling I have about a patient inside. Better safe than sorry.

Up Vote Up Vote ×
Specializes in LTC/SNF, Psychiatric, Pharmaceutical.
What does PCC stand for?

It must vary by state, because our LPN's don't make MD calls at all, it is out of their scope of practice to take/write orders. RN's always call.

The thought I DO have for you is, ABSOLUTELY write what he said! I have many times written "Do not call MD" as their order, and in my nurses' notes, charted who and when I called, what I told them, and no new orders. You kind of HAVE to, to cover your own butt if nothing else. Granted, you KNOW that if something goes wrong he's going to be called again anyway, but still. I've had docs say "I won't order any more pain meds, don't call about them" on pts with history of abuse, and I write it as an order, both so that subsequent nurses know without a doubt not to, and we can tell the patient that he won't order any more (because he's GOING to keep asking...I'm thinking of one particular case, if you can't tell).

That's my :twocents:

Yep. If the physician doesn't want to act and the patient has a bad outcome, it's documented you took all measures within scope of practice, and it's on his head.

BTW, I'm equally shocked that there are states where the LPN can NOT call physicians or receive telephone orders. LPNs have an extremely broad scope of practice here, and can do almost everything but hang blood, push IV meds, or do initial care planning. Calling the physician is part of the daily routine for any LPN in my area.

Up Vote Up Vote ×
Specializes in LTC/SNF, Psychiatric, Pharmaceutical.
In nursing you really have to grow a backbone. I don't call the docs to chat--it is strictly professional. I state my purpose in calling, request what I need and get on with it. I expect professionalism from them. Don't let them read the fear in your voice. You are just doing your job. Don't allow their behavior to change the way you feel about yourself. You are only responsible for how you act.

Heck, yeah! Do these docs think we're calling because they make for such scintillating conversation or because we want advice about our personal lives? Ha, ha. Seeing the personal lives of some of these doctors (and their personal lives often end up public, due to their own lack of discretion), I think they'd be the LAST people I'd want to make social calls on...:rotfl::rotfl:

Up Vote Up Vote ×
What does PCC stand for?

It must vary by state, because our LPN's don't make MD calls at all, it is out of their scope of practice to take/write orders. RN's always call.

The thought I DO have for you is, ABSOLUTELY write what he said! I have many times written "Do not call MD" as their order, and in my nurses' notes, charted who and when I called, what I told them, and no new orders. You kind of HAVE to, to cover your own butt if nothing else. Granted, you KNOW that if something goes wrong he's going to be called again anyway, but still. I've had docs say "I won't order any more pain meds, don't call about them" on pts with history of abuse, and I write it as an order, both so that subsequent nurses know without a doubt not to, and we can tell the patient that he won't order any more (because he's GOING to keep asking...I'm thinking of one particular case, if you can't tell).

That's my :twocents:

Also write in your note that your supervisor was notified of change in pts. condition and MD notified (or not notified).

Up Vote Up Vote ×

Not being sure who the PCC is either, if that is written in your facillity policy to first call them before the doctor, I would document in the chart they were called at (places a time) then the time the doctor was called if permission to call. The only disadvantage I can see to this system is the length of time before a doctor is called.

....she decides whether LPN calls or she calls.

If she calls, does she put the doctor order on the chart or tell you and you write it? If you write it I can see a problem also. The order would be from her not the doctor.

Up Vote Up Vote ×
+ Join the Discussion