How to call a provider at 3 am

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    A brief, useful tip sheet for calling any PA, NP, or doctor during the wee hours of the morning

    How to call a provider at 3 am

    I've worked nights on and off for about 10 years- I have many stories from calling providers in the middle of the night, good, bad and funny.

    Bad story: My patient status post-GI surgery complains of chest pain at 4 am, I call the intern and no response, CP worsens so I call the rapid response team. I was yelled at for not calling the intern first and wasted rapid response time. After I persisted something was wrong I did a repeat EKG and she was having an MI.

    Good story: After accidentally calling an attending he laughed and said I made him feel young again! He advised me on what to do and asked I pass it along to the intern covering.

    Ugly: Being screamed at for calling an on-call Dr and waking up his baby...

    Worst: When I called to get a med order corrected, a Dr told me "how dare a nurse question a physician's orders"

    Here is my simple list of what to do at 3 am

    1. Know who is on call. I once paged a surgical attending at 3 am instead of the intern! Luckily the attending thought it was funny and was very kind about it.

    2. Have your data ready when you call: Why you are calling, last set of vitals, last labs, I/Os etc. Don't assume the person you are waking up at 3 am is instantly going to know which patient you are talking about or if they've ever seen the patient

    3. Check your orders to ensure you don't have what you already need- PRNs, labs, NPO etc

    4. If you're not sure about something check with a more senior colleague, they are a wonderful resource

    5. If you are not getting a response from a provider don't be afraid to go up the chain of command, it's there for a reason!

    6. NEVER apologize for calling a provider; everyone is on the same team and caring for the patient, it does not matter what time you're calling with patient care concerns

    7. ALWAYS repeat back what the provider says to confirm; you can hear some funny things after you woke someone up, I've even had a doctor fall asleep on the phone with me!! It's always awkward if you have to call back 10 minutes later to clarify an order.

    8. SBAR- it works, use it, love it, and it cuts down on communication errors.

    9. If someone is being inappropriate when you called- screaming, swearing, berating or refusing to call back; report the person to the appropriate person. This behavior should never be tolerated

    10. If dealing with the person mentioned above in #9 remain calm and professional and report them to the appropriate management

    11. Creativity and problem solving can go a long way on night shift and prevent the need to call anyone. If your patient is constipated and has not GI meds ordered, take them for a night time stroll, give them prune juice etc. If your patient is anxious, sit down and talk to them for a while. Sometimes talking can go a lot further than any meds. Even if it's asking your patient about their kids or dogs or their job.

    Patient care and safety always come first, never be afraid to call the provider. To make everyone's job easier and for the best possible patient care. The night shift is there for a reason. Patients crash on night shift and have unexpected needs, don't feel bad, take care of your patient.

    From your friendly neighborhood night shift nurse practitioner
    Last edit by Joe V on Jun 14
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    19 Comments

  3. by   Orion81RN
    I absolutely love this. Thank you!
  4. by   Jules A
    Quote from Orion81RN
    I absolutely love this. Thank you!
    I do too although as someone getting woken up all hours of the night I appreciate the compassionate RN who apologizes for waking me. I always say "never a problem!" but appreciate their acknowledging they are waking me up and feel it also indicates they were being thoughtful about the need before they called. I know its my job but just saying common courtesy goes a long way.
  5. by   AceOfHearts<3
    Make sure you enter any orders while on the phone with the provider! Do not just get the order and repeat it back then try to enter it in once off the phone- you never know if any additional things will pop up that require you to seek clarification before the new order is complete.
  6. by   AceOfHearts<3
    Also, make sure day shift is aware of any PRNs that might need ordered. Mr. Smith had a hard time sleeping last night, but didn't want me to call the doctor. Can you ask on rounds today about getting a PRN sleep aide ordered?

    When I was on day shift and I was alerted to something like that I always phrased the request so the provider knew it might prevent an after hour page- Hey Dr. Green, I was told Mr. Smith had trouble sleeping last night- could I get an order for a PRN sleep aide so the night shift nurse doesn't have to page you after hours tonight if he has trouble again?

    We were afraid a patient might need a PIV in their foot one time. Our IV team informed us it would require an order before they could do that. I was day shift and we just barely managed to get a PIV in in the patient's arm. The provider was very happy when I paged them during the afternoon to request the order, especially when I explained I was requesting it now to avoid a night time page if it became necessary (night shift nurse loved that I had thought ahead and got the order too).
  7. by   Jules A
    I also hope OP was writing from RN experience and not as an overnight hospitalist calling for things like med orders.
  8. by   bagladyrn
    I'd add to this to check with your coworkers to see if anyone else anticipates needing to call the same provider. That way you can save them an extra wake up.
    As a side note, I once sent the police out to contact a doctor who was not responding. He was in the middle of moving and had left his phone at the other house.
  9. by   bagladyrn
    I'd add to this to check with your coworkers to see if anyone else anticipates needing to call the same provider. That way you can save them an extra wake up.
    As a side note, I once sent the police out to contact a doctor who was not responding. He was in the middle of moving and had left his phone at the other house.
  10. by   Have Nurse
    Good old Law Enforcement. Love it!
  11. by   BlackbirdRN
    What I don't see is is do what every you can do to avoid calling a Dr. at 3 am by anticipating problems based on your first assessment at the beginning of your shift.

    Much easier to call someone at 12 mn rather than at 3 am. For example: if you think your patient will not be able to void 8 hrs post-op and it has already been 6 hrs since the patient returned from surgery, get the straight cath & leave the catheter in if more than 300 cc at 12mn, not 3 am. Get additional pain meds, sleepers, tylenol for temps, nausea prns etc.

    If you are lucky, the on call intern is smart enough to call you at 12mn as ask you about the patients you have of his/her and then they will ask you who else has their patients so they can talk to them and get all those preventive orders out of the way. If not call them and help them learn this is a good way to not be woken up.

    Then the only calls you are making are the ones that could not be anticipated.
  12. by   mrcleanscrubs
    Anyone who feels as though they may need to call a provider in the middle of the night should do so, and with no remorse or fear.
    Why, you may be asking?
    Well, the provider on call is at home, in bed, sleeping, and getting paid a nice salary to answer that phone when need be.

    I have heard many nurses say they are afraid to call the provider in the middle of the night.
    This attitude needs to shift into another direction; if a provider is mad at the nurse for calling about the welfare of a patient, then that provider is acting completely unprofessional and obviously does not care enough about their patients to be bothered for less than five minutes.

    We receive such grief from providers for doing the right things.
    We, as nurses, are on our feet for 12 to 16 hours over night, by our patients' sides, non stop providing care. Do you think I am going to think twice about calling a provider in the middle of the night? Nope :-)
  13. by   Crush
    SBAR, and always check with co-workers to see if they have any needs as well.
  14. by   Ruby Vee
    Quote from Jules A
    I do too although as someone getting woken up all hours of the night I appreciate the compassionate RN who apologizes for waking me. I always say "never a problem!" but appreciate their acknowledging they are waking me up and feel it also indicates they were being thoughtful about the need before they called. I know its my job but just saying common courtesy goes a long way.
    I love the original post as well, although I will say that apologizing for calling someone at 3am is the social grease that makes the call go more smoothly. No, you're not sorry (and if you've followed all of the steps above, you shouldn't be) for calling, but you might feel just a teensy bit badly about having to wake someone up from a sound sleep, or immediately after they've gotten to sleep after baby-wrangling, or just as they were falling asleep after being in the OR for 16 hours . . . . It's not a bad thing to start your call of by saying "I'm sorry for having to wake you . . ." It gives them an extra second or two to clear the fog from their brain and understand who they're talking to.

    Of course, I did once accuse my father of being a pervert when he called me at noon after a busy night shift (my night shift, not his) and when I didn't immediately recognize his voice, he told me he used to change my diapers. I got huffy and hung up on him. My father thought it was funny and told everyone he knew . . . that story still comes out on holidays even though Dad is gone now.

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