Charge nurse calls doc at night

Sour Lemon · Mar 21, 2018

Tell me what you guys think of this.....
my current job (NICU) on nights, when you have an issue with your patient you report to your charge nurse and then the charge makes the decision to call the physician or not. I have a couple issues with this.... 1. Your charge calls, gets telephone order read backs, places orders and then tells you-what if she misinterprets those orders, placing wrong orders? That will fall on you. 2. What if your charge disagrees with needing to call doctor, so you go above her and do it anyway? Places staff in an awkward/power struggle situation.
I overheard scenario #2 the other night... nurse wanted to call to clarify a medication order so she could "protect herself" (rightfully so). Charge nurse told her she is protecting herself by following her orders..... ouch... and talk about awkward.
has as anyone ever heard of this practice?? It's bizarre to me!

The charge nurses at my hospital typically contact the MD when needed and I love it! On the rare occasions where they think the doctor doesn't need to be contacted and I do, I go ahead and call. It does feel a little awkward, but I downplay it in an attempt to smooth things over which seems to work well.

MunoRN, RN · Mar 21, 2018

That pretty clearly violates the basic standards of safe and effective communication, which is that the person who's recognized and has the best understanding of the problem should be the one who directly communicates the problem to the person who needs to know about it. The whole point of "the telephone game" is that it shows you what can happen to information when it goes through third parties first.

klone, MSN, RN · Mar 21, 2018

Agree with Muno. The provider should be contacted by the nurse caring for the patient.

Triddin · Mar 21, 2018

Some of our charge nurses do this, some dont, but we try to clump our calls together if the charge nurse takes the orders, then they are writing the orders. Our charge nurses are pretty good about getting a thorough report about what our concerns are and what we want, and if they are the ones talking to the MD, I'll chart something such as "discussed with charge about xyz, charge spoke with doctor and received such and such orders. If she placed the wrong orders in the chart, that is on her

Nurse-please, BSN · Mar 21, 2018

Triddin,

That is the reasoning for why the floor does it this way. To avoid multiple calls to the provider during the night.

klone, MSN, RN · Mar 21, 2018

Triddin,
That is the reasoning for why the floor does it this way. To avoid multiple calls to the provider during the night.

But, the logical solution to that (which is what we've done at every place I've practiced) is to check with all the nurses, and let them know they will be calling the provider, and then all of the nurses who need to talk to them provider all speak to the provider one at a time.

Nurse-please, BSN · Mar 22, 2018

Klone,

That is what we did at my previous place of employment. This is only my second job as a nurse so just wanted to get a feel for others had experienced.

**NICU Guy, BSN, RN** · Mar 22, 2018

Our nurses call the doctors. Our doctors are on the unit (call rooms) 24/7. The nurses are the best source as to what is going on with the baby. Unless there is a habit of nurses calling the doctors for stupid reasons, why would going through the charge nurse be better policy? What if the doctor has additional questions? The charge nurse goes to the nurse, gets the answers and calls back? If there are new orders, the doctor gets out of bed, gets on the EMR and places the new orders or if the baby has become unstable, they come to the bedside.

Maybe I am missing something. We have 80-100 babies at any given time. The doctors are being called numerous times throughout the night. They are getting paid to be at the hospital, why wouldn't the bedside nurses call them?

JKL33 · Mar 22, 2018

I would not agree to this. I don't communicate with providers by the grapevine method.

#1 Reason: Patient safety

#2 I am admittedly particular

#3 You learn a lot when you comport yourself professionally and communicate with providers appropriately

#4 I have seen units where the nurses have been directed in this way and it gets passed on and passed on over time until new nurses literally don't know that they are "allowed" to call a physician/provider. Sad and scary, since that is our duty; it is prudent nursing practice.

#5 (Just a teeny little bit) - - heck no, I am not reporting to someone with my same license so they can decide how they want to handle my matter. I will do that myself, TYVM.

To the OP, I would handle this by the "carry on" method. Carry on as usual. If that causes a problem, have a professional response ready, such as, "I'm not comfortable with that and I won't be doing it. I have a legal duty to communicate with my patient's physician/provider on behalf of my patient."

Crush · Mar 22, 2018

That pretty clearly violates the basic standards of safe and effective communication, which is that the person who's recognized and has the best understanding of the problem should be the one who directly communicates the problem to the person who needs to know about it. The whole point of "the telephone game" is that it shows you what can happen to information when it goes through third parties first.

I I have never worked anywhere where only the charge nurse can call the doctor. Ridiculous. Best person to call is the one who actually needs them and knows firsthand what is needed. Also good practice day or night to ask around before making the call in case someone else also needs something.

Nurse-please, BSN · Mar 22, 2018

Our nurses call the doctors. Our doctors are on the unit (call rooms) 24/7. The nurses are the best source as to what is going on with the baby. Unless there is a habit of nurses calling the doctors for stupid reasons, why would going through the charge nurse be better policy? What if the doctor has additional questions? The charge nurse goes to the nurse, gets the answers and calls back? If there are new orders, the doctor gets out of bed, gets on the EMR and places the new orders or if the baby has become unstable, they come to the bedside.
Maybe I am missing something. We have 80-100 babies at any given time. The doctors are being called numerous times throughout the night. They are getting paid to be at the hospital, why wouldn't the bedside nurses call them?

We have a smaller unit than you and only have one MD on at night. My best guess is that they used to have issues with multiple calls during the night and my assumption is this was something requested by the doctors, for their convenience.

If the charge has further questions she just walks into the next room and asks that nurse (we have open bays). Still, if that nurse isn't around what does she do?