calling the doc

Nurses General Nursing

Published

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!"}

Specializes in medicine and psychiatry.

A couple of days ago I was admitting a patient and the Dr called to give orders. He also informed me that he wanted to cover all the bases with this patient because if I called him later he would not answer. Big Saturday night? Who knows? I just smiled because I know if I really need that Dr I will be calling. If he does'nt answer it becomes his problem. I worked once in an institution where you had to ask the House Supervisor before calling the MD. Never once was I told no because I believe they knew that if they told me no I would call anyway if I thought it was necessary. It's just a bunch of silly games fueled by fear. Yes, I have been yelled at many times by Dr.'s but I just smile. On a rare occsion I redirect a physician back to reality but continue to smile as I do so. Only twice in my thirteen year career have I said, " Listen Buster...........". It is my job to protect the patient. The hell with the broken system is my motto.

Specializes in Day Surgery, Agency, Cath Lab, LTC/Psych.
Only twice in my thirteen year career have I said, " Listen Buster...........".

:yeah:

Specializes in thoracic, cardiology, ICU.

When i worked for a community hospital that happened all the time. It scared me at first when i was a new grad, until i realized, they this is why they're physicians and why they get all the pay perks for being the MD. one time i literally said "okay well i told you this patient is having chest pain with positive EKG, so now it's your problem. call me back when you want to do your job.." and i hung up. He called back a minute later and I already had the supplies i'd need like a nitro gtt, and some other stuff.

My advice to you is get all your info together before calling. be ready with the name, why the person was admitted, what's happened, any relevant lab values, vital signs, your assessment (like is this serious enough to call at 2am). If it's 2am and their multi vitamin hadn't been ordered.. i'd probably yell too if i got a call for that. But if you call them, you have your information together, its concise and direct, and he still yells at you, then its something that needs to be addressed at a higher level.

Might be a good idea to develop a unit based standard on when to call the on call docs like for mental status changes, escalation of care (like transferring to the ICU), stuff like that. Some docs don't want to be called ever, but i can sympathize with the docs that want to get some sleep but are being called for iron supplement orders or simple things that could be taken care of the morning. Some of these docs also are on call overnight and then have to work clinic the next am too. It's never an excuse for being a jerk when you're trying to do your job, but I think some nurses need to exercise more professional judgement if they want to be treated as professionals.

Specializes in Long Term Facilitly.

Thanks for your replies, it is frustrating due to the the time that is wasted prior to getting permission to notify. They say you can't put what the doc actually says if he is rude for that is called negative charting. I would never call unless it was important and always have everything in front of me prepared for the doc. I think the system is broke if you have to spend time tippy toeing around people who are suppose to be professionals. The next time I call for a BP that is sky high and I have nothing to admn and the doc yells at me and gives me no orders I will just call a RRT and then he can deal with it later.

Specializes in ED.

I never get intimidated by calling a doc in the middle of the night. Sorry, but he is making more money for being on call and sleeping than I am for being awake all night, monitoring and taking care of his patients. I once called a doc to let him know that his patient had converted back to sinus rhythm from a fib. The patient was NPO for cardioversion in the morning. I wanted to get a diet order and cancel the cardioversion if possible. The doc yelled at me, he had been in the ER till MN (I come in at 11PM) and asked if I knew what it was like to be up all night, finally get to sleep and then have some nurse call you to tell you your patient is in a normal rhythm!? So I replied that yes, I knew what it was like to be up all night (I am night shift) finally get home and fall asleep to be awakened by the telephone. Except, I informed him, that in my case the phone call was usually to ask if I wanted to change long-distance service, not regarding something important like someone's heart rhthym, so please I feel absolutely no sympathy for you. Well he came flying in that morning to crab to my NM. Fortunately, his partner was standing right there and heard the whole thing and reminded him that it was not only appropriate to call with this information but within policy. Years later, I get along well with this doc and it's kinda been a running joke between us about when I call him the middle of the night.

Follow your guidelines for when to call a MD, chart every time you call and if they say not to call again, right it as an order. If they don't like it, they won't do it again. Do not be intimidated! You are an important part of the team, not some flunky!

Specializes in LTC/SNF, Psychiatric, Pharmaceutical.
Thanks for your replies, it is frustrating due to the the time that is wasted prior to getting permission to notify. They say you can't put what the doc actually says if he is rude for that is called negative charting. I would never call unless it was important and always have everything in front of me prepared for the doc. I think the system is broke if you have to spend time tippy toeing around people who are suppose to be professionals. The next time I call for a BP that is sky high and I have nothing to admn and the doc yells at me and gives me no orders I will just call a RRT and then he can deal with it later.

Hmmm... I was always taught to chart exactly what the doctor said, even the juicy four-letter words. It's not "negative charting" if you're objectively stating the facts of what happened, and it is important to have it on the record that not only did the doctor not want to act on pertinent patient info, but he acted like a about it.

Specializes in Emergency.

Hi,

I had to put my two cents in on this one. When I first graduated last year and was a new nurse orientee, I heard horror stories about some of the docs we regularly deal with on my unit (telemetry/medicine). In my first few months, I did have some not so pleasant telephone conversations with docs because I was nervous and new, so I was still learning their individual personalities, and what I should call about and what could wait. I am lucky I have a strong personality, and a backbone, so I did not take the occasional rudeness personally. Yes, I did get reamed sometimes for stuff that could really have waited, but I learned from those times. I get along great with most of the docs, and they have come to realize that if I am calling them late, it's for a really good reason, not just for a vitamin order. I don't let them treat me like a doormat, and they respect that I can stand up for myself and the patient (even if they don't give me orders). They also know I will be thorough in my documentation of the call, orders or no orders.

After all, I have to cover my butt.

Now, lots of them joke with me when I call no matter what time it is.

Amy

When i worked for a community hospital that happened all the time. It scared me at first when i was a new grad, until i realized, they this is why they're physicians and why they get all the pay perks for being the MD. one time i literally said "okay well i told you this patient is having chest pain with positive EKG, so now it's your problem. call me back when you want to do your job.." and i hung up. He called back a minute later and I already had the supplies i'd need like a nitro gtt, and some other stuff.

My advice to you is get all your info together before calling. be ready with the name, why the person was admitted, what's happened, any relevant lab values, vital signs, your assessment (like is this serious enough to call at 2am). If it's 2am and their multi vitamin hadn't been ordered.. i'd probably yell too if i got a call for that. But if you call them, you have your information together, its concise and direct, and he still yells at you, then its something that needs to be addressed at a higher level.

Might be a good idea to develop a unit based standard on when to call the on call docs like for mental status changes, escalation of care (like transferring to the ICU), stuff like that. Some docs don't want to be called ever, but i can sympathize with the docs that want to get some sleep but are being called for iron supplement orders or simple things that could be taken care of the morning. Some of these docs also are on call overnight and then have to work clinic the next am too. It's never an excuse for being a jerk when you're trying to do your job, but I think some nurses need to exercise more professional judgement if they want to be treated as professionals.

I completely agree with this! I used to be a nurse before I went to medical school, and now I am a medicine intern, which means that I got lots and lots and lots of calls from nurses on "my" 12 patients I cover during the day and the 50-60 patients I cover overnight. I've been an intern for four months now and have been on call every 4 th night for those four months, and I cannot tell you how many pages I've gotten at 2 AM asking for multi-vit orders, or iron supplements, or for diet orders. In 999/1000 cases, these things can wait the 4 hours til the day team gets in, but I think that nurses sometimes forget that while they are on day/night shift, doctors generally are not, so a call at 2 am isn't going to get the "night shift" person taking care of your patient, it's going to get you someone covering them and 50 other patients, plus taking admissions. And I do understand that it's easy to forget,and I do understand that I chose this career. However, if I get a little snippy, perhaps you'll know why. Furthermore, your statement about having information ready is totally on point...not because I expect nurses to do my job for me, but as you say, nurses are supposed to be healthcare professionals to, and to call someone reporting that a patients blood pressure is low, and to now have the heart rate or a clinical assessment available is NOT professional. And I'm probably going to get a little snippy about it, especially if I've been up for 24 straight hours and I'm being worken up at 430 AM.

Anyway, sorry for the long rant. But seriously, no one should ever be afraid to call, but pretty please use your head before you do, and consider that the person you're calling is there to deal with emergencies, not iron supplement orders, they're not the patient's primary doctor, and please at least try to assess the patient before calling. These are things I didn't always think about or do completely as a nurse, and used to think MD's were out of line for EVER being snippy with me. But now I understand, at least in part..........

Specializes in CTICU, Interventional Cardiology, CCU.

Oh I had one of these the other night. When I first started as a new Rn I would dread calling the docs at 2am. But now a year and a half later I know that I am doing my JOB as a NURSE when I call the docs.

Since I work nights I have learned there are some docs that need to be called and others that are covered by the house MD or the tele resident. Which isn't always a good thing. But I call them first, and if I still feel uncomfortable I call the attending. That's what the attending doctor had an MD next to their name!!

So a couple of nights ago I had a pt. that had an order for 1 tab percocet Q6h PRN for mod-severe pain. It was from orders that were written 2 days previous. My pt. asks for pain meds. I give him the 1 tab percocet as per MD's orders. The pt. begins to rant and rave about he takes 2 tabs blah blah blah.

So the attending on the case is a transplant MD that NO RESIDENT COVERS, and the HOUSE MD does not cover. This specific MD has a specific protocol on my floor to call him or one of his partners on call. I knew the CCU resident wrote the orders so for fun I called the CCU resident first, I already knew she would not change the PRN order, and she didn't. So I call the attending at 10pm...yea 10pm. It wasn't life or death, and the this was the first time in 2 days the pt. had percocet. I gave 1 tab, but the pt. insested on 2 tabs.

I call the attending's ans service at 10 pm. No call back. I followed up at 12am. The attending called back and frreaked out on me. he MD said, "Did you call the CCU resident that wrote the orders?" I said "yes she won;t cover my floor and our floor protocol says and as Nurses we know to call you directly for any and all orders or anything for your pt's. So the pt. said he takes 2 tabs percocet and the resdient only ordered for 1 tab prn." The MD said, "well I guess you didn't use your brain, I didn;t write the transfer orders, call the person who did, right?" I said "I just told you I called the CCU resident that wrote the orders and she will not come to my floor and re-write them b/c as of now they are over 2 days old, and you have written orders since the transfer 2+ days ago. And you are the pt.'s attending MD, and you and your service does not have a resident or house MD that follows your service, AND WE as nurses are told to call ONLY you for anything. So if this is a problem you need to speak to my director about a change in protocol for you and your service."

The MD said, "just write the order", and hung up on me.

I laughed b/c I knew if I was a spanking new RN I would never had had the guts to say this...

It happens all the time, just document, document and remember they are the doctor not you. YOu are just the nurse, you report signs and symptoms and if the ATTENDING has a problem with that then speak to your nursing supervisor.

As I told one MD the other day, He got in my face about how I should have recognized blah blah blah...I said, "Dr.X I did recognize s/s I reported them to your resident and I called you when I felt the resident wasn't able to help. I AM NOT A MEDICAL DOCTOR, I AM ONLY A NURSE I REPORT ANY SIGNS AND SYMPTOMS I FEEL ARE NOT WITH IN THE NORMAL LIMITS. I DID MY JOB AS A NURSE, I CAN'T DIAGNOSE, I SUGGESTED IDEAS TO YOUR RESIDENT BUT I WAS IGNORED, HENCE THE RESON WE ARE IN THIS SITUATION NOW. I cannot read CXR's and prescribe Meds, I suggested things but was ignored so if that is a problem please talk to my supervisor."

Yea it had been a crappy week.

Specializes in Critical Care, Education.

Has your facility adopted the "SBAR" model for communication yet?

It really addresses all of those problem areas. We are using it for ALL inter-practitioner communications (nurse-nurse, nurse MD, etc.)

S-Situation: give your name & unit, patient name / location, code status. "I am calling about ....... This is a serious problem"

B- Background: Concise explanation of H & P to date; lab & dx results; physical assessment changes related to current problem/issue

A - Assessment: your conclusion about the current situation; your opinion of the severity & expectation of time line for action; if you think the situation is/could be life-threatening

R- Recommendation: what you think would be helpful or what needs to be done. Clarify when results/reaction will be checked (including repeat VS) and when and under what circumstances you will call back

Obviously, this communication technique requires the initiator to get her "stuff" together prior to making the call. It also gets right to the point and avoids wasting time for either party. We have had great success - physicians have been very receptive - they love it.

Has your facility adopted the "SBAR" model for communication yet?

It really addresses all of those problem areas. We are using it for ALL inter-practitioner communications (nurse-nurse, nurse MD, etc.)

S-Situation: give your name & unit, patient name / location, code status. "I am calling about ....... This is a serious problem"

B- Background: Concise explanation of H & P to date; lab & dx results; physical assessment changes related to current problem/issue

A - Assessment: your conclusion about the current situation; your opinion of the severity & expectation of time line for action; if you think the situation is/could be life-threatening

R- Recommendation: what you think would be helpful or what needs to be done. Clarify when results/reaction will be checked (including repeat VS) and when and under what circumstances you will call back

Obviously, this communication technique requires the initiator to get her "stuff" together prior to making the call. It also gets right to the point and avoids wasting time for either party. We have had great success - physicians have been very receptive - they love it.

I've definitely used it before.....not when I was a nurse, but 2 of the hospitals I rotated at as a medical student used it. I agree, I think it's really good in a lot of ways....I think it forces everyone to think about the problem because of the format (I seriously think that people sometimes don't come up with assessments/recommendations and just report the problem sometimes b/c they see something out of whack, and don't stop and think about it....I definitely fell into that trap as a med student, nurse,and now as an intern), I think it makes nurses/doctors/students/etc better at assessing b/c it forces them to practice, and most of all, the patients benefit b/c multiple people are THINKING about the problem. Unfortunately,we don't use it where I'm a resident. :( We have all electronic charting, and the way the nurses notes are is sort of strange and hard to explain....but not in a SBAR format or anytihng remotely user friendly, for them or for us.

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