Charge nurse calls doc at night

[Nurse-please]

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!

[Julius Seizure]

Well that's just a whole lot of bull poo. As someone else said, if they're in house, then that's their freakin' job.

It's their job if they are on call from home, too.

[klone, MSN, RN]

It's their job if they are on call from home, too.

Right, but being "on call" is different from being "in house" - I could see the rationale for not wanting 12 phone calls when a physician is at home sleeping. But if they're overnight hospitalists, they're not expected to be sleeping, they're expected to be WORKING.

[Nurse Beth, MSN]

Usually this is a poorly thought-out knee-jerk reaction to doctors being called at night for issues that could safely wait.

Honestly, a good example of why some people shouldn't make decisions.

[Nurse-please, BSN]

Usually this is a poorly thought-out knee-jerk reaction to doctors being called at night for issues that could safely wait.

Honestly, a good example of why some people shouldn't make decisions.

Nurse Beth,

Could you elaborate on that statement? Are you saying a good reason why those nurses shouldn't make decisions, as in call the doctors, or management should have never responded that way?

[Nurse Beth, MSN]

Nurse Beth,

Could you elaborate on that statement? Are you saying a good reason why those nurses shouldn't make decisions, as in call the doctors, or management should have never responded that way?

The scenario I've seen is:

Doctor complains about being called at night by nurse for an issue that could have waited.

Nurse manager decides the solution is to block all calls to docs except for those that go through a Charge Nurse.

The solution is to coach the nurse, rather than take away aspects of her nursing practice.

[hawaiicarl, BSN, RN]

I see both sides of the argument on this one. Since I have been charge for decades, I don't particularly like the third wheel part of it, and the liability that I would be the one making all the calls and taking all the phone orders. On the other hand I have listened in on calls where the MD gets absolutely inane calls at 2 or 3 in the morning. Some examples ... floor nurse called hospitalist while we were coding a patient to see if she could give the patient a back rub ..... floor nurse calls to ask provider for an order, and when he asks for the MRN so he could look the patient up on the computer, they did not know where to find the MRN. I can see why whoever is in charge of physician satisfaction scores would establish a screening process, especially if there are a bunch of new grads on the floor.

Cheers

[Nurse-please, BSN]

I think a solution to this problem, and one I have used as a new grad, would be to go to your charge for advice prior to calling the doctor. There are a lot of things that can be resolved by speaking to other staff, calling a physician is last resort. But at the end of the day, it is their job to be on call. Patient comes first.

[canoehead, BSN, RN]

I could live with running my concerns by a charge nurse first, two heads are better than one. But I would not be waiting for the charge's permission to call, nor would I allow her to call on my behalf (except simple things, like a Tylenol order). OP I would go ahead and make your own calls, and then wait for directives from your manager to stop. Ask your manager to put that particular directive in writing, or make a policy, and then you'd be happy to follow her directives.

Then send your nursing board a copy of the policy and ask them what they think. When you get their reply, you'll know whether you need a new job.

[Nunya, BSN]

It's a NICU, the doc is in house, I'm assuming her/his main shift is night shift and then they go home... I'd call. If someone goes into Neonatology hoping to sleep all night then they're REALLY in the wrong field, cuz those babies don't care what time it is!

[JKL33]

I think a solution to this problem, and one I have used as a new grad, would be to go to your charge for advice prior to calling the doctor. There are a lot of things that can be resolved by speaking to other staff, calling a physician is last resort. But at the end of the day, it is their job to be on call. Patient comes first.

Yes, that's generally a good idea. Utilize your resources and learn from the wisdom and experience of coworkers.

But I still make the distinction that the "last resort" idea can be taken too far. Guidance with regard to items that "definitely do not warrant a call" is one thing. Getting the wrong idea that one must "do everything in your human power not to call" is a dangerous train of thought.

:)

[FolksBtrippin, BSN, RN]

I have worked on a unit that operated this way (day shift) and it was convenient when we had a very experienced, very smart and on the ball charge nurse. When we didn't, oh hell no.

It is helpful on this particular unit because the staff nurses are severely over burdened. If we had to wait for a provider to call us back we would never get anything done.

It's a band aid for other problems I guess.

On night shift, I see the point.

[kbrn2002, ADN, RN]

I work in a SNF where we do not have MD's in house at all much less after hours. Every call outside of regular office hours has to go to the on-call. I've never felt any guilt for calling no matter the time of day or night. The MD on call is being paid to take those calls and they are generally very good about accepting calls. I guess I have a hard time picturing why a doctor that is physically in the hospital would be upset about pages/calls.