Don't wake the Dr, Or maybe I should?

Ruby Vee, BSN · Mar 3, 2017

Night shift nurses in which instances/circumstances do you call the Dr. I work night shift 11-7, I've been a LPN for about 5 months now and I've called the Dr maybe 3 times. Twice in which it was through the night. Of course you would call the doctor if a death occurs or say someone glucose levels are extremely high or low. When do you decide it's time to wake the DR. and make the call?

Usually, there's some sort of protocol for your unit or your facility. Standing orders, for example, may say "Call for respiratory rate > 40, temperature > 102.5 and XXXXX". Other times, it's not in the standing orders, but in a protocol. (There's probably a list of policies and protocols somewhere -- these days they mostly seem to be online.) As an LPN, you probably are not the charge nurse. The charge nurse is a resource for you, either to help you decide whether or not to call or to call for you in some instances.

If you're working night shift, you may have the opportunity to chat with a colleague about the criteria they use for when to call a doctor. In some cases, it may be different for each doctor. I'm sure other LTC nurses will chime in . . . my background is in ICU, and I didn't notice you were on the LTC forum until I'd already started to answer.

Beautiful_Soul · Mar 4, 2017

I am the charge nurse on my shift and on the other shifts the LPN's are considered the charge nurses along with the RN supervisor. And yes they're are standing protocols like the ones you mentioned, also in many cases I have just opted to fax the Dr. instead for non- emergent situations.

CapeCodMermaid, RN · Mar 5, 2017

If YOU think you should call, then call. Certainly with any drastic change in status, a fall with an injury, any time you think the patient needs to go to the hospital.

preemiepoweredRN · Mar 7, 2017

I remember starting off as a new nurse, always being terrified to call the doctor and wake them in the middle of the night. Over the years I've realized that if I'm concerned enough about my patient to consider calling the doctor, I should call them-hands down. I know its different in LTC vs hospital setting where our doctor is often in-house, but they are getting paid to be available..so with that said, it shouldn't be seen as an inconvenience to them.

notanumber · Mar 9, 2017

I'm an LPN and night charge nurse as well (1900-0700). Essentially, if there is a significant change in a resident's condition that I cannot fix through set protocols (e.g. initiating palliative orders already in place and decline is expected, or treating hypoglycemia according to protocol) and the resident has become acute/unstable, then I will call the physician for directives.

Examples: fall with significant injury (large laceration needing stitches, query of fracture), new severe pain or increase in existing pain that is not well-managed, significant exacerbation of chronic diagnosis (e.g. CHF) that cannot be resolved by PRN or other nursing interventions and is causing the resident distress, hypoglycemia not resolved through following protocol, resistant and/or symptomatic hyperglycemia, symptoms of CVA or MI, urinary retention if resident does not have order for foley catheter.

If you are unsure of what's going on OR the resident's condition has become unstable and cannot be resolved by set orders, call the doctor. Just make sure you have done your assessments fully and have all the information at hand to present. Look at level of interventions (we use the MOST), recent medication changes, baseline VS compared to current VS, recent medical history (falls, hospitalizations, new diagnoses, recent infections). If you are prepared, even if it ends up being a non-issue, most doctors will appreciate your thoroughness and caution. Don't worry about the ones who respond grumpily - that's their problem, you are the patient advocate and erring on the side of caution especially as a new nurse is never wrong.

Don't forget to notify the primary contact of the resident's change in status and what you are doing about, and follow-up again when you have more information.

heron, ASN, RN · Mar 9, 2017

As a long time night-shifter here, I want to say that calling at 3am for an issue that can wait until daylight is a great way to train an md to send your call to voicemail and go back to sleep.

TheCommuter, BSN, RN · Mar 10, 2017

Of course you would call the doctor if a death occurs or say someone glucose levels are extremely high or low.

At many of the facilities where I previously worked, most physicians did not want to be awakened from their sleep at 2:00am for a death notification. After all, this is LTC. This is often the last place these residents will ever live before checking out.

One former DON obtained standing orders for the physician to be notified of any deaths at 6:00am when day shift nursing staff arrived.