Getting orders noc shift

[Nursing_excellence, ADN, BSN]

Hi. Im a new grad nurse who just started working in a snf. I was supposed to orient that night. (I work 11 to7) but 2 nurses called in sick so they had to put me on the floor. Then around 2 am. I had a patient who was nauseous and was asking for a medicine. I looked at her prns and nothing for nausea. So i thought i need to call her doctor to get an order for antiemetic. But my charge nurse said that we cant call that physician until 9 in the morning. So she told me to just hand it off to the next shift. And they will f.u with the doc. Is this common in snf? I know it does not look emergent or anything. But my resident was uncomfortable and there was nothing i could do about it.

[MJLPN727]

its too bad your facility doesn't have standing orders for something like that (nausea, diarrhea, tylenol, etc) it might not be a bad idea to discuss bringing up to avoid these things in the future. i understand not wanting to call a doctor for non-emergent problems however is there no one on call in your faciliry at all? What if something emergent did come up?

[amoLucia]

Might you have tried something like ginger ale or dry crackers first?

I always ask the pt 'what did you do at home' or';what used to work for you for this'. Sometimes you can help without a med.

At least it will look like you tried SOMETHING rather that just leave the pt alone to experience discomfort.

[Nursing_excellence, ADN, BSN]

There's no one in the facility that can prescribe medications. If it's emergency. We send the residents out of the facility, to the ED. The DON is already aware of this. One time a nurse called the Doctor for a critical lab at noc shift. Idk what lab it was. But the doc got mad. Reported the nurse to the don and the nurse was asked to do an incident report for not following the "do not call the doctor before 9am.anyway it is just this specific doctor that we cant call at noc shift. The others we can.

[Nursing_excellence, ADN, BSN]

I usually think about those things too. But the patient was on TF and NPO. Also the patient was chinese speaking and it didn't seem like we were understanding each other that much. I gave her an alcohol swab to smell. It works on other patients according to my professors in nsg school. She said she felt better when i was leaving for my shift.

[MJLPN727]

that's good you found a simple trick to work. Hmm, thats a little challenging that you don't have anyone to reach out to for orders. I wonder how that works for protecting your license. Do you have a supervisor in house to bounce ideas off overnight? for the SNFs i have worked in, we have someone on call every night // or the residents PCP is the contact person 24/7, but we can certainly reach out to them about questions and needing new orders or updating them on the status of residents if there is a change in condition. It sounds like its kind of leaving you stranded that you really cant reach out about emergent conditions. Also, you technically need a doctors order to send anyone out 911, so you'd have to contact anyways...? If I were you I'd review this all with your DON/ staff educator so you have a really clear understanding and then review your facility's written policy in the policies and procedures.

[MJLPN727]

I just saw that you said this was the only doctor who does not want calls before 9a. how often is this doctor on call?

[JKL33]

Hi. Im a new grad nurse who just started working in a snf. I was supposed to orient that night. (I work 11 to7) but 2 nurses called in sick so they had to put me on the floor.

They didn't have to do that, and they shouldn't have.

One time a nurse called the Doctor for a critical lab at noc shift. Idk what lab it was. But the doc got mad. Reported the nurse to the don and the nurse was asked to do an incident report for not following the "do not call the doctor before 9am.anyway it is just this specific doctor that we cant call at noc shift. The others we can.

If I were disciplined in any way as described above I would report them to CMS for de facto not having a physician on call.

[MJLPN727]

I cant imagine doing an incident report for contacting the doctor for an emergent condition/ change in status / etc. That's definitely a red flag to me. Remember at the end of the day youre responsible for everything you do. In this situation, you handled it well without needing a medication/doctor's input but it's really great and a sign that youre critically thinking that youre wondering what this means for next time because you may not always be able to intervene without contacting the doctor. It is better to get a doctor mad at you and do what you must for your patient than to let a problem get out of hand because "the doctor didnt want to be bothered before 9" won't hold up before the board.

[RecoveryRoomRosie]

If someone is NPO and on TF, the new complaint of nausea is important to pass along to the MD no matter the time of day as this may indicate a bigger problem such as a bowel obstruction. If this happens again, turn off the TF and check a residual to see if the pt is absorbing the feeding.

[CapeCodMermaid, RN]

It's your license if the patient takes a turn for the worse....too bad if the docs don't like getting calls. CALL anyway. I do, however, agree with the gingerale and cracker suggestion.

[CoffeeRTC, BSN, RN]

There's no one in the facility that can prescribe medications. If it's emergency. We send the residents out of the facility, to the ED. The DON is already aware of this. One time a nurse called the Doctor for a critical lab at noc shift. Idk what lab it was. But the doc got mad. Reported the nurse to the don and the nurse was asked to do an incident report for not following the "do not call the doctor before 9am.anyway it is just this specific doctor that we cant call at noc shift. The others we can.

This is not legal for a LTC facility. While the Dr. might be mad that a critical lab wasn't called in earlier, it still needed to be dealt with.