Quote from onduty23
i am a new nurse i worked night shift. so my dilema is it approriate to call the doctor for certain manners or not. take for instead a pt ask me to call his doc for meds to make him make stools. do we call doc late at night for such matters or wait till morning. when do you guys feel it approriate or not to call doc i need situations?
also it is my understanding we only called the doc for critical lab values is this true?
not just for critical lab values.
in fact, there are some "critical" lab values that i wouldn't
call the doc about in the middle of the night. positive blood cx on someone already being tx'd appropriatly? nope (a "critical" lab value in my facility). ok if you arn't sure the lab is being treated correctly, but if the patient is arleady on broad-spectrum abx becasue the doc anticipated
positive blood cx, then i'm not calling. it can wait until morning.
call a doc for an alert k+ level on a patient that has a prn for kcl iv? nope, again, not calling.
call a doc for an alert bun or creat in a dialysis patient? again, no, not calling.
i could go on, but i'll spare you
my (general) rule:
is the phone call going to address the patients comfort and/or well-being, and is it (or should it) going to change management?
as for the laxative (and other basic needs) request: is there some nursing
intervention that can be done first? warmed prune juice with a couple of pats of butter in it (i know,
, i agree) works wonders. unless the patient is on a restricted diet (and a very restricted diet, at that) this is within the scope of nursing interventions.
c/o gas pain? forget the rx for gas-x, walk them. (if possible)
can't pee? hands dipped in warm water (and some privacy -- some people get "stage fright") will work, too.
(i worked as a cna on a post-op floor, so many of my nursing intervention ideas come from that population)
there are many, many things that docs need to be made aware of in the middle of the night. critical labs are only a small part of it, (and those may have already been covered--in anticipation--with prn orders, negating the need for a call.) unrelieved pain is one. any
significant change in patient status. much of this is difficult to determine when you are new. that is where your coworkers come in. but is always better to call, than to not call. as daytonite said, have your info together and know what you want to say.
it is also nice (though not necessary) to check with your coworkers to see if anyone else needs something they were going to call about a little later.
sometimes, there are things that need to be taken care of on your shift, but don't need to be addressed immediatly. these things can wait until after 6am, when most docs are already up. iv blew and can't be restarted and you want an order for a picc? that can usually wait until morning. especially since (this is my current job) i'm not coming in during the middle of the night to put the picc in (now, if the patient is getting something critical, you may need to call anyway to give the doc the option to come in and put a central line in -- even though that will never happen if you work where i work. it still gives them the option.)
i will say this: in the medical world (docs and med students) much ado is made over the 2am nurse call for a tylenol order. this is what i have to say: 1. if you don't want to be called for it, order it on the admit orders, i can't control when the patient spikes a temp; and 2. i didn't call to ask for tylenol, i called because the temp spike. thought you might like other things, like cultures, maybe an xray, maybe a ct (depending on the situation -- when i worked inpatient, i mostly worked surgical icu, so these were the common orders). i didn't call for the tylenol order,
but did ask you for it while i had you on the phone.