Calling an MD during night shift

[stepwintention]

Hello,

I hope everyone is doing well out there and having a blessed day. I wanted to start a discussion to see what others thought about calling the MD at night and what has worked for them when night shift doctors are crankier than usual as well as prioritizing when to call and when not to call. I recognize that day shift nurses have more direct access than night shift nurses so calling the MD or speaking to an MD can be frustrating at night when they are off their sleep schedule. We, the rest of the nurses, try to group our calls together so we can minimize the number of pages, but also end up endorsing some of our items to day shift depending on how important it is. I just notice that real world is not always like NCLEX and wanted to get more of an idea on what works and what does not.

Have a great one and thanks for any feedback.

[Guest219794]

Call the doc at night when it is for you patent's well being. Or, maybe look at it this way: If your mother was in the hospital, what sort of things would make you expect her nurse to call the doc?

It part of the job which they voluntarily chose, and for which they are well compensated.

As far as cranky?- irrelevant. Being a jerk or unprofessional doesn't relieve one of ones responsibilities.

If It it will do no harm to wait till morning, wait till morning.

[Not_A_Hat_Person, RN]

The way I see it, the on-call docs are being paid to be on call. Why not call them after hours?

[ICURN3020]

Grouping calls together is helpful. No physician appreciates being woken at 3:00am by a phone call and then again at 3:15am. Communication is vital so that staff have a general idea of what's going on with co-workers patients. We always do a quick walk around the unit before calling or paging, asking "Do you need to speak with Dr. So-and-so?"

Of course, sometimes things arise unexpectedly and even if you or someone else just called the physician, it is necessary to call again. You shouldn't feel bad for doing so either - that is what we're there for.

Just like any collective group of people, some physicians are just jerks and no matter what you do, they will act as such....whether on the phone or standing right next to you. It's intimidating at first, but your loyalty and obligation is to your patient, not their physician.

My personal rule is: when in doubt, make the call. I'd rather have a doctor mad at me for disturbing their sleep than to place a patient's health/life at risk. We frequently confer with one another as to whether we should call or let it wait. Ultimately however, I am responsible for my patient's health and well-being and if I feel uneasy waiting until morning or just have that gut feeling, I follow my instinct and place the call.

Definitely be prepared and be readily available if sending a page. I don't know how many times someone has paged a doctor and then leaves the floor to use the restroom or run to their locker. Understandably, the doctor tends to be irked by being placed on hold for five minutes which starts the conversation off on a bad note.

Know what you're going to say and don't be fumbling through the chart or hem-hawing around. Have any relevant computer screens up and ready so there's no waiting while you log into the system. Have as much information as possible to be able to intelligently and concisely paint a portrait for them of what exactly is going on with their patient. I've also learned that over time, most physicians develop trust in your nursing judgment and respect the work that you do (unless of course, you're calling at all hours for insignificant things that can absolutely wait until morning. That's a surefire way to get on their ****list.)

[Gooselady, BSN, RN]

Doctors go through years and years of training that clues them in DIRECTLY that when they are on call, their time (sleep, eat, family, whatever) is open to being interrupted. This is what I keep in mind when I need to make those late but important calls. This is the job they chose to dedicate their lives to.

If the doc is snarky or angry at being called, I refuse to take on any blame or guilt. Like the rest of you, we bulk our calls together and do whatever is legal and wise to NOT have to call them in the middle of the night when we know they are at home sleeping.

It's not like I 'remind' the p***** off doc that they basically AGREED to be interrupted a hundred years ago when they entered medical school. I'd just get the other butt cheek bitten off . I just refuse to take their peevedness seriously, and have had to wade through a lot of crap just to get a simple order. I don't mean to make it sound like I'm a duck with the water rolling off, it is NO fun to get chewed out for asking a doctor to do his job. It's not like I had the choice to write the order myself, or had ANY other choices BUT to call the doctor. Hello! It's not like I had a CHOICE whether or not to call, knowing I was going to get a snarky unprofessional earful before I got my much needed order. For patient care and my personal integrity, I dial the phone and wait to get blasted.

But I still don't have to personalize bad behavior OR even try to correct it. Not my job, I raised my kids and rarely agree to parent another adult. Except for that one a married fourteen years ago and took back for a refund seven years ago . . . that really cemented it for me NOT MY JOB. Just gimme the dang order and go back to bed, jerk.

[tyvin, BSN, RN]

When calling docs late evening or noc know what you want; have a short history available in case the doc doesn't remember or doesn't know the patient. Have the vitals, Dx, and why you're calling and what you want done. Be succinct. I learned early on if you know what you're talking about they will give you what you want, but know what you want before calling. :)

[Pangea Reunited, ASN, RN]

I don't spend the first minute of the call apologizing for the call, I just get to the point. I'm available, immediately, when I page someone. I've talked to the patient, the family, the RT, etc. and have suggestions ready. I know the patient. I can veto any unsuitable order on the spot instead of calling back twenty minutes later...

I also try to get to know people and their habits/preferences. If I have an important (but not deadly) issue at 3AM and the doctor is usually up by 4:30AM, I'll do my best to be creative and push the call forward. If I know someone is likely to be sound asleep by 9PM, I look for potential issues and get a call out before then.

[Davey Do]

Good enquiry, answers, guidelines.

If a Doc gets "snarky", I have no problem with treating them with empathy, allowing them to vent for a moment and reinforcing their feelings.

My main goal is the Patient's welfare. I stick to the subject at hand, and I say things like, "The Patient is_____ and I need ________.

I have mollycoddled and kissed Docs boo-boos and have never had an ongoing problem.

[psu_213, BSN, RN]

I also like the idea of clustering. I would really feel for the nurse that has to call Dr. Smith in the middle of the night 15 minutes after you talked to him.

First, be able to give a short succinct hx. on the patient and why they are in the hospital. This may be doc covering call for the group, and not be the patients primary doc. In an ideal world, they should know everything about the patient, but they may not…especially at 3 am when they are woken up from a sleep--deep or otherwise.

Also, have VS. I've make that mistake before. That is one the first thing the doc will ask for if you are calling about a change of condition. In addition, have easy access to things like labs, rad reports, etc. You never know exactly what the doc will ask for, so have some of the most common things ready.

My calls would go something like this: "Dr. Smith, this is psu_213 from 5 west at Memorial Hospital. I am sorry to wake you up in the middle of the night [i realize they are getting paid to be called, but I know that even if I was getting paid for a call, I would not be thrilled about being woken up…I am not truly sorry I have to call, but it starts things off a better note. OTOH, I'm not going to waste much time with my apology], but I am calling about Mrs. Jane Henderson. She is an 83 year old female patient of Dr. Johnson, here for treatment of pneumonia. Just now her blood pressure was 198/75, and this was confirmed with another measurement. Her heart rate was 74, respirations 12, sats 95% on RA. She woke up right away, was A&Ox3 and denied any headache. DO you want to order a PRN for hypertension?"

Answer his other questions, take his orders, ask if there is anything else he'd like to add (for example, to morning labs) and thank him for his time.

[canigraduate]

I want to reiterate to cluster the calls as much as possible. If you have something petty that you need to talk to the Doc about, piggyback it on to another call or wait until morning.

Know what's worth calling at night for. The only things I call for are for condition changes. Medication issues (unless you're calling about PRNs for condition changes), diets, order clarifications, all that can wait until morning when the doc is familiar with the patient. Because the day doc is likely to reverse what the noc doc ordered.

As the other posters have said, don't waste the doc's time. This is true day or night. Make sure you have a recent set of vitals, any relevant labs, and an SBAR ready. Or whatever your facility uses for report sheets.

[caliotter3]

If I ever had a question about calling the doc or not calling the doc, I discussed it with the house supervisor. She had no problem separating the necessary from that which could wait until the end of the shift.

[ClaraRedheart, BSN, RN]

I've had a doctor ask me why I hadn't called sooner once. Only been in practice for a year, but I haven't made that mistake again. Their job is to care for their patient's, as is yours. There are a few who I hate calling, however... I'd rather wake them up and have them roll their eyes and curse as soon as they hang up the phone than not wake them up and something seriously bad happen because I let a condition go unchecked or a concern go un-addressed.