so frustrated with docs/when and when not to page

kmr · May 20, 2005

I have been a nurse for 16 years. Experience helps and it also helps when you know the docs. But I ALWAYS err on the side of caution. If they get mad or yell at you oh well. Sometimes you have to page at night! I have been yelled at when clearly it was a necessary call. Sometimes they are just poops!

I have also found that if I have all my information ready and I try to anticipate any question they may ask so I don't hem and haw around and also get straight to the point as soon as they get on the phone it helps. I assume of course common sense is used and like you said you don't page for a colace order at 3am. There should be standing orders for those types of things. You can also discuss this with your Head Nurse and ask her what you should use as guidelines since you are still a relatively new nurse. Good Luck to you and I am sure you will do fine!! :)

Franlpntorn · May 21, 2005

I have been a nurse for 16 years. Experience helps and it also helps when you know the docs. But I ALWAYS err on the side of caution. If they get mad or yell at you oh well. Sometimes you have to page at night! I have been yelled at when clearly it was a necessary call. Sometimes they are just poops!
I have also found that if I have all my information ready and I try to anticipate any question they may ask so I don't hem and haw around and also get straight to the point as soon as they get on the phone it helps. I assume of course common sense is used and like you said you don't page for a colace order at 3am. There should be standing orders for those types of things. You can also discuss this with your Head Nurse and ask her what you should use as guidelines since you are still a relatively new nurse. Good Luck to you and I am sure you will do fine!! :)

There should be more standing orders but JACO don't like them. I don't know why. I think some of goes to the Hospial they need doctors with out them no money.

So the board that could make the life of the RN less insane could care less. We have a big book with them but some times it won't cover the problem. Then you call the on call doc. No way to win

leslie :-D · May 21, 2005

as an easy example, there are usually parameters to follow when giving certain meds and to call md if they fall below or rise above what is ordered.

often times a doctor will irritably yell, "you called me for that? don't ever call me in the at this hour again!"

as others have done, as well as myself, i calmly ask the doctor if i should write that as an order. that will usually shut them up. but the bottom line is you need to cya because no one else will.

but some of it is nsg judgement...if a diabetic's bs is 65 and it says to call md for

if the bs is consistently low, then you need to tell the doctor so insulin dosages can be modified. just cya and document all interventions, including conversations.

leslie

PMHNP10 · May 21, 2005

I'm a relatively new nurse who works night shift (actually 2 years now) and I STILL struggle with this issue, I never know when it is appropriate to page. I mean, I know I shouldn't page for a Colace order at 3am, and I know to page for emergency situations, like respiratory distress, etc....however there are many things in the middle where you just aren't quite sure if you should be waking the doc up at 3am for certain issues/or bothering them when they are in the ED/OR. I feel like there are so many things we need to page on (cover our a--) and document for legal issues, but there is also this fine line where you aren't sure if its really APPROPRIATE. I guess the fact that I'm not a well seasoned nurse adds to this struggle of mine, and its probably one of the most frustrating parts of my job. I don't like to bother people, and I'd be really upset if a doc yelled at me for paging him "for something stupid". It bothers me to hear these doctors complaining about the nurses in this way, ...they just don't even consider what we are going through! What about the fresh post op patient with nausea who is refusing to take the Anzemet already order for them, and DEMANDING that you page the doc for Reglan at 2am?!?! Its just SO frustrating...I'm so sick of being the middle man...anyone else struggle with this or have any advice on how to deal with it? (Sorry for the randomness/mixed thoughts of my post)

I'll worry about the patients first, my license second, my next meal third, what I'm going to do when I get off of work fourth...how I'm going to motivate myself to start exercising again, 10th...how I'm going to decorate my new house when I move back to TX 56th...the doctor's personal issues...hmmmm...I'm all out of space to worry about them.

Look at it this way. You are a patient (not MD) advocate. If you advocate for the patient and the MD gets cranky with you, so what? He can't fire you. On the other hand, if the patient doesn't get what they want/need because you don't try, rest assured that when they complain, you very well could lose your job. Also, MDs get well compensated to do their job. If they have a problem with doing their job, it's their problem, don't let them make it your problem. If he/she doesn't like being called in the middle of the night, maybe next time they will ask the patient what meds they prefer for n/v, HA, etc. etc. I know as a nurse I usually ask them what they druther.

Tweety, BSN, RN · May 21, 2005

It's definately a good idea to look at trends. Has the patient been this way before, is it a new finding, is the patient now symptomatic, has it been called already be a previous nurse. I read the doctors note and chart to get a feel for what the doctor knows already.

And like some stated before, I get my ducks in a row before I call. Nothing makes a nurse look more bad when you call "The patient's temp is 103.5"...Doc asks "what is his 02 sat and urine output?"........Nurse....."I don't know let me find the CNA........".

Or Nurse: "His BP is 210/120"....Doc. "Did you give the prn I ordered...."......Nurse (quickly flipping to prn sheete and finding doc left orders days ago to address this problem)...."hehehehe....sorry, but no...".

Again, best to err on the cautious side and risk getting yelled at if you're unsure of whether to call or not. As was stated, your the patient advocate. What does the patient need?