Calling docs at night

[pumpkin455]

I have been a nurse for a little over a year now, and feel pretty comfortably talking to doctors. I do work nights, so we usually just have one surgeon on call that answers for all of the other ortho surgeons for whatever we may need in the middle of the night. So, the other night I called the on call surgeon for some PO pain meds for my pt who was POD 0 still and only had 2mg morphine Q2prn. I just wanted to get her some Lortab or Percocet to hold her in between the morphine. He told me to let her surgeon deal with it in the morning and hung up! What should I have done different? I know he was hesitant because he didn't know her, etc, but I have never had an issue with any of the other docs in the past. Tips, advice? What would you have done?

[Orange Tree]

I would have tried calling someone else and asking them for an order.

[skylark, BSN, RN]

I tend to check charts for prn analgesia at the start of the shift. If there is none precribed, I call the doc then, and aks them to consider prescribing some, so that I don't have to bother them overnight. They are more helpful at say 10pm than at 3am, and are usually grateful that i thought ahead rather than bother them later on.

[PMFB-RN, RN]

Either called him back every half hour until he either provides orders to deal with your patients pain, or provides an explanation why properly controlling your patients pain is contraindicated (I'd like to hear that one). OR Calling his boss or the patients primary surgeon and getting orders you need.

I would also document his response word for word in your note. Use quotation marks.

I have discovered that what a grumpy physician snaps back with in the middle of the night can be pretty embarrassing to them the next morning in the light of day with the whole care team present.

We are our patients advocate. If our patient is having unresolved pain it is our duty to make sure it is addressed. If that means waking up a physician because the on-call is not doing their duty then that's what I do.

[NC Girl BSN]

Sadly some oncall MD's will not interfer with previous MD pain orders. Its sad that he would not even entertain getting more info about the patient or given a 1x dose of something to hold them over till the morning. This has happened to me and the sadly the patient had to wait till the morning.

[caliotter3]

I would have called the primary physician and made certain that he knew who instructed me to place the call.