Midnight Dr. Call.

Nurses General Nursing

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I will be graduating in a couple of weeks. I was wondering when is it appropriate to call a doctor in the middle of the night?

Your experience and ideas are appreciated.:balloons:

Specializes in Leadership, Psych, HomeCare, Amb. Care.

One more thing-let me know what you guys think.

I was always taught to not apologize to the MD for calling. Don't say "Dr. Smith, I'm SO sorry for waking you but...."

I agree completely.

If there are no standing orders, no ROC, and the patient status demands it, then the call is necessary for the patients well-being.

Of course, you extend the general social courtesy at 3am, "Sorry to wake you up now, but Mr Smith's BP is dropping...."

This just shows you are aware that he/she is not a cog in the machine, ready to be activated at a moments notice. You are sympathetic, not apologetic.

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I agree with all the posts so far. Good critical thinking and planning.

I had one experience w/ calling the Doc at 02:30 in the morning. The pt. was in excruciating pain and the current pain meds ordered weren't helping I called to get a new PRN order to shorten the time between doeses or to increase the med. I got the PA instead of the PCP, he was royally ticked that I called. He stated... "and you're calling me at two thirty in the morning for THIS?" I asked him ... "what would you suggest I do with a pt. in a pain crisis?" He shut up after that and gave me the order. I was polite, but to the point that this is his job to intervene when the current orders are insufficient. With some Docs you can't win no matter what time it is when you call. As someone else stated before, have all your information at your finger tips, the chart, a set of all vitals, and a current PO. It will go smoother if you have all of your ducks in a row, as another poster said.

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Specializes in FNP, Peds, Epilepsy, Mgt., Occ. Ed.
Teaching hospitals generally set parameters where you always call the resident (at any time) to report specific changes. Although it's been 9 years since my last full-time stint on nights at a teaching hospital, I can still recall, "NHO T>101.5, HR100, SBP160, DBP 100" Being able to call a doc without having to worry about waking one up was great. Do I miss it? Not particularly.

Having parameters doesn't mean the doc still won't chew you out for calling.

One of my pet peeves was calling for a parameter and being asked "Why are you calling me for this?"

"Because you (or your fellow resident) gave us that parameter!" (Heeere's your sign)

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Specializes in Emergency Department.

Remember the doctors are paid the big money to be called in the middle of the night, it is their job. If the pateints condition changes and you need the MD call

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Specializes in cardiac, GI, ER..
I agree with all of the above posts. I am a night-shifter.

One more thing-let me know what you guys think.

I was always taught to not apologize to the MD for calling. Don't say "Dr. Smith, I'm SO sorry for waking you but...."

I agree with all of the above. PLEASE NEVER NEVER NEVER :nono: apologize for calling ANY doc. That is what they get paid for. Its like saying Dr smith I am so sorry that you have to wake up and help me do the job that ONLY YOU get paid 100,000 dollars for doing.....

I had to write a doc up for telling me not to call him (the on call doc) after 10pm or before 6 am for anything.:angryfire

That really makes me livid.

Use your best judgement, becasue if you should have called and you dont you get reamed, if you call and you shouldnt have you get reamed. Just do the best you can for your pts and whatever with the docs. It will all come to you.

Good luck

Donna

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after 12:00 we have to go through the house supervisor and then call the doc. We have prn orders we can use, but for a change in a pt that warrants a call we do after the proper steps.

It is always good to follow procedure and policy. Just make sure the supervisor isn't being lazy and just shining you on. Make her come look at the patient, make her chart her findings if they go against your own instinct.

New grads do tend to be nervous and "anal" but it's because of how we have been trained and our lack of experience that we are fearful. Fear can be a good thing. Some more experienced nurses are less careful, less fearful and that is not bad as long as they are still holding to a strict standard and not just being lazy, tired, distracted, careless.

You can't go wrong by fully assessing your patient - what do you see, hear, smell, what are the vitals, what is the patient telling you. What do you NOT see, hear, smell, etc.? In other words, is the pt splinting his abdomen and being very still and there is an absence of bowel sounds? Are lung sounds distant? Could these things be bowel obstruction or pheumonia? Sure, even if there's no fever yet. Is the patient not moving all extremities and is there a change in mental status, responsiveness, ability to talk or swallow? Might this be a stroke? Is there a change in VS? Just be a good assessor, be honest, be persistent. Don't allow yourself to take someone else's word that the condition is not serious or the call to the doc is not needed if you genuinely feel uneasy about your patient. Call the Sup again. Get the Sup over to see the person. Ask her if she would be terribly upset if you called anyway, in view of the fever, the absent or diminished BS, whatever. Be nice, be respectful, take advantage of your newness to make the Sup help you through this. "Oh, I'm so worried. Please take a look at Mr. Jones, please?" Who could resist your effort to do right by your patient?

Also, if the doc is rude, just remind him or her that you are just trying to take care of his patient and that his patient needs him and you are just trying to keep everybody out of court. That ALWAYS has worked for me.

You'll be fine, dear, and please accept my congratulations.;) :Melody: :w00t: :caduceus: :loveya: :bow: :heartbeat

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Specializes in Gerontology.

A bit more advice. DON'T call for: A laxative order, to report a urine infection, to clarify a non-urgent order (diet, physio etc), or to report blood work that is just a little off but not life threatening, - esp if the blood work was done at 0700 that am!

And don't apologize for calling!

Finally, when in doubt - call! We don't have supervisors where I work, so I have to depend on my instincts. If you are concerned, worried or in doubt - call. Better to call then and be safe, then 1 hour later to say the pt is coding!

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Many of you say do not apologize for calling however I usually apologize just to be nice. I know it is there job but I still say sorry. Just like when I leave work for another nurse to follow-up with. Maybe it is just my personality but I see nothing wrong with an I'm sorry for waking you Dr. X but pt y whatever it is. I feel they are a little more recpetive if you are polite. I also tend to make suggestions if there is something specific I am looking to get.

A little off topic what is your facilities policy on sending labs on pt. For example my pt was transfused overnight and Dr did not write for follow-up H/H or K replaced etc. Do they have problem doing labs not ordered? What about sending stool for OB or C-diff. etc. Just curious because I have worked different places with different policies on this.

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If you feel the doc needs to be called then it's warranted. Provided you have a pressing issue that can't wait until morning. And as the previous posters noted, make sure you have all your info in front of you. Also repeat any order given back to the doctor. I've a had a few so groggy that they've been hard to understand.

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Specializes in FNP, Peds, Epilepsy, Mgt., Occ. Ed.
Also repeat any order given back to the doctor. I've a had a few so groggy that they've been hard to understand.

I've had doctors fall back asleep on the phone!

I also remember another nurse calling a doc in the middle of the night and getting orders. He came in the next day and said he had a vague memory of getting a call but no memory at all of the orders he gave! Fortunately they were perfectly appropriate. He was an attending and really could do the job in his sleep!

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Specializes in FNP, Peds, Epilepsy, Mgt., Occ. Ed.
A bit more advice. DON'T call for: A laxative order, to report a urine infection, to clarify a non-urgent order (diet, physio etc), or to report blood work that is just a little off but not life threatening, - esp if the blood work was done at 0700 that am!

I worked with one nurse who would call for things like a bedside commode. She really drove the doctors nuts!

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Thank you all for your responses, you're great!! My father-in-law was a physician in So. Cal. and I also worked for him for many years. He was great about being called, even in the middle of the night, and I never remember him getting mad @ the nurses. He had a great relationship with them and they respected him for that.

I just completed my precepting on days and found that the nurses are even hesitant about calling during the day and will make the pt wait for pain meds, etc. because of their dread of calling the physician. Having previous experience in a physician's office, I found that difficult to understand. But, I guess that all comes with experience and building that professional relationship with the physicians.

I also found it odd that the physicians, for the most part, only make rounds once/day.Where as my father-in-law always made rounds am & pm.

Thanks again for your input and I'll keep your experience & advise in mind as I start my new career. Have a great weekend!:balloons:

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