Do you call the doctor at night for low B/P's on night shift?

Specialties Geriatric

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B/P was 90/60. What would the B/P have to be before you would call the doctor on night shift? I work in the "skilled side" at the LTC. The doctor does not have orders or parameters in regards to calling him in regards to the low B/P's. The first thing this doctor does when you call him at night is that he calls the DON at her home at night and reports you for calling him at night. However, the nurse from the 3-11 shift says you are suppose to call the doctor each time you get a low B/P on nights. In other words, I would be calling the doctor every night at 1am to report these low BP's. The DON would then be awakened every night at 1am when the doctor calls and reports me to the DON. Is it not normal to have a lower B/P when you are asleep at night?

Specializes in Emergency, Telemetry, Transplant.
Why are you taking blood pressures at night?? People, especially sick people, need sleep.That said, I wouldn't call the doctor to tell him the bp was low if the patient were asymptomatic.

I know when I worked as a CNA, we had to take BPs q shift x3 for a resident who fell. It did not matter how they fell (even if they stood from their w/c and was assisted to the floor by an aide and had no apparent injury) the VS were done no matter what for those 3 shifts. If they were sleeping comfortably in bed with no distress, VS had to be taken because they fell 15 hours ago. If not, incident reports and write ups for the nurse and aide on duty that night. :down:

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Specializes in Emergency, Telemetry, Transplant.
Why are you taking blood pressures at night?? People, especially sick people, need sleep.That said, I wouldn't call the doctor to tell him the bp was low if the patient were asymptomatic.

And another thing....each month, every residents' VS and weight had to be taken within the first 5 days of the month. 1st and 2nd shift complained that it was unfair that they had to get these VS and weights and 3rd shift had none. So, each unit was divided into thirds--each shift was responsible for one third of the VS and weights each month. So one third of the residents was woken up at night to have a full set of VS and lifted out of bed so that their weight could be recorded. (I don't think we have a smiley for "the most incredibly stupid policy ever.")

As for the OP, since the resident is awake, check to see if they are symptomatic (i.e. are they alert, oriented at their baseline, not lightheaded--if they can tell you this), check the prior BPs, look at the other VS (for example, I would be quite concerned with this BP and a HR in the 130s, no so concerned with this BP and HR in the 60s), perhaps recheck the BP with the pt now awake. If all this 'checks out' I would not call the MD.

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Specializes in Emergency, Telemetry, Transplant.
We normally don't have monitors in LTC and many B/Ps are taken manually. We don't calculate the MAPs. Takes way to much time when you have 20-30 B/Ps to check in one shift.

To the OP. I would call the MD if the low reading is way out of the norm from the patients' baseline. If the patient is symptomatic, i.e. altered mental status.

I think what this person was saying is only calculate the MAP in the case where a BP is 'borderline.' Yes it would take too long to calculate every MAP, by calculating one or two takes approx. 10 seconds: mdcalc.com | Mean Arterial Pressure (MAP)

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Did not read all the comments. But many x's vs are taken at night. We seem to have established that. I have worked in both hospital 23 yrs and NH 16. I would never call a Dr. for that B/P ever unless s/s were noted. I would ALWAYS push fluids if I had an 80/50 and recheck in an hr. 70/40 would get a phone call but only after I did everything else. And this might have been mentioned but ( and I'm sorry) the Dr. does not seem to want phone calls if that's the B/P so why are you still calling him? ( it's just a question-not meant to sound rude)

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Did not read all the comments. But many x's vs are taken at night. We seem to have established that. I have worked in both hospital 23 yrs and NH 16. I would never call a Dr. for that B/P ever unless s/s were noted. I would ALWAYS push fluids if I had an 80/50 and recheck in an hr. 70/40 would get a phone call but only after I did everything else. And this might have been mentioned but ( and I'm sorry) the Dr. does not seem to want phone calls if that's the B/P so why are you still calling him? ( it's just a question-not meant to sound rude)

The RN supervisor from the other shift said I was suppose to call the doctor on night shift when patients have low B/P's like 90/60.

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B/P was 90/60. What would the B/P have to be before you would call the doctor on night shift? I work in the "skilled side" at the LTC. The doctor does not have orders or parameters in regards to calling him in regards to the low B/P's. The first thing this doctor does when you call him at night is that he calls the DON at her home at night and reports you for calling him at night. However, the nurse from the 3-11 shift says you are suppose to call the doctor each time you get a low B/P on nights. In other words, I would be calling the doctor every night at 1am to report these low BP's. The DON would then be awakened every night at 1am when the doctor calls and reports me to the DON. Is it not normal to have a lower B/P when you are asleep at night?

When a doctor is on call, they are on call! Don't let them make you feel scared to call them. If that type of behavior from doctor continues, report them and DOCUMENT. If you feel something needs to be reported, then do it. This is that PT's life. I've been in similar situations and I just held my breath and called them. Now I serve as an on call member of the team, I get paid more too;). At first I got goofy calls so I implemented a training that would give scenarios and, what are emergencies and what are not emergencies. This helped a lot.

Just remember that being on call is in that doctors job description. The doc is not staying on call out of the goodness in his/her heart. Lol. But good luck and stand up for yourself and the patient! :)

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What did your supervisor say? If I was placed in that position the very first words out of my mouth to that doctor would be " The 3-11 RN supervisor told me I needed to call you about this B/P" lets see where it goes from there.

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Specializes in Emergency, Telemetry, Transplant.
I would ALWAYS push fluids if I had an 80/50

I would be a little careful with this comment. All else being equal, fluids would be appropriate. But say they are a dialysis pt on a strict fluid restriction or the are a CHF'er. Point is, some critical thinking has to go into this before just saying 'push fluids.'

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Yes of course CHF and dialysis would be exceptions to the rule. But it's what we do as a routine with our elderly Pts. first before we start IVs on them. That is me and the other RNs I work with. Including our supervisors who would ask if we tried pushing fluids first.

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Specializes in Emergency, Telemetry, Transplant.
Yes of course CHF and dialysis would be exceptions to the rule. But it's what we do as a routine with our elderly Pts. first before we start IVs on them. That is me and the other RNs I work with. Including our supervisors who would ask if we tried pushing fluids first.

All I'm saying is that there is a lot more to it than just "push fluids." Is 80/50 "normal" for this pt? Are they at the baseline level of orientation? What is their HR and other VS? What are their other comorbidities? Etc, etc.

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