If you think you need to call the MD, CALL THE MD!!!!

[wooh, BSN, RN]

Decisions to call the MD need to be made on the basis of, "Does the MD need to be aware at this time. Does the patient need interventions that are not ordered? Tests that are not ordered?" And that decision needs to be made by the nurse caring for the patient. (With input from others if necessary, but the decision needs to be made by the nurse caring for the patient.)

Never on the basis of, "Will someone be mad at me for calling?"

So often I hear, "It's Dr. X on call, she's nice, go ahead and call." The only time the identity of the doc on call matters is if it's, "This MD wants to know this immediately, this one would rather hear when they make rounds."

If you're afraid of being yelled at for doing your job, GET OVER IT.

And don't let a coworker talk you out of calling if you feel a call should be made. I've worked on units where you're supposed to get the charge nurse's permission. Those units will throw YOU under the bus along with the charge nurse if things go south. You're the nurse. YOU have the letters after your name. Make the decision. Get input if needed. I'll often have new grads tell me they want to call, and after discussing the situation, we work out that it's "just ..." or something that doesn't actually need a call once we think it through together. But if you think you need to call, it's YOUR patient being cared for under YOUR license, which makes it YOUR decision.

[loriangel14, RN]

And just remember - this is what they are getting paid the big bucks for! They are the patient's doctor. There is no reason they should get upset with us for calling.

[blondy2061h, MSN, RN]

I let SEVERAL people, including the in house resident and the charge nurse talk me out of calling the attending one time when I, as the nurse taking care of the patient, really couldn't get over the feeling that something was wrong. It ended with us coding the patient. Never again.

[MJB2010]

I agree. I think you need to trust your gut! Sometimes you can tell something is not right, even if you can't put your finger on it. I'd rather call then regret not calling later.

[ukjenn231]

i agree, this drives me absolutely insane. i started my career at a large teaching hospital where residents would answer pages and even come assess the patient in the middle of the night (gasp!) now i work at a private hospital system as a traveler, i would be the eager beaver to page any doctor at 3am if i felt like i should because of exactly what you said... i was told by a surgeon that if i ever called him again in the middle of the night for this issue again, he'd go "ballistic" on me. mind you, i was calling because i just got the patient from pacu and the only pain med ordered was 1 percocet ONCE A DAY.... i also called a doctor at 4:30 for a change in condition (specifically, the patient had virtually no urine output in 4 hours) and he went off at me and then the next day wrote an order "do not call me in the middle of the night for anything." SERIOUSLY? Wish I could say that... oh patients don't press your call light for anything I want to sleep... if you call a doc for a bp less than 210/100 they will virtually hang up on you... UGHH big rant but as you can tell, this has been on my nerves :):)

[BonnieSc]

Well, conversely, I had a new float pool nurse ask me if I thought she should call the doctor in the middle of the night to get an order for compression boots. A few experiences like that will sour a doctor.

I DO think about a doctor's personality and expressed wishes before I call, if there's any doubt. If there's no doubt, I call no matter what. If I'm waffling, and I know the doctor doesn't ever seem to mind, I call right away. If I know it's a doctor who doesn't like being called, I might think longer and ask another nurse for an opinion.

There's no excuse for rudeness on either end, and I do hate it when I'm taking report or working as charge and I say "did you call the doctor?" about something critical and the nurse says "oh... I didn't want to bother him". But I think it's the reality of working in the hospital that we're going to think about who we're calling.

I'm also very careful, when I'm making a "difficult" call, to have my SBAR very well lined up and ready to go.

(And don't forget, the residents DON'T make big bucks. They did choose to go into medicine--so they know that involves late-night calls--but they work hard for not much money.)

[Cat_RN, ASN, BSN, RN]

Yes, and please don't 'wait for day shift' to call for pertinent things happening NOW that require an intervention and orders. This drives.me.crazy.

[dudette10, MSN, RN]

I agree with you, wooh, and I make the call if it's something that can and should be taken care of right then, but no one likes to be yelled at.

I got yelled at by a doc one night for a long-ish run of (surprisingly) asymptomatic V-tach. No orders given. I had to stay over to chart, and guess what? The doc came in earlier than usual and made the patient his first visit of the day. So he yells at me for calling, then makes the patient his priority round? Yeah, thanks, *******.

This is the only place I've worked, but I have heard talk of some hospitals that will counsel doctors for less-than-professional treatment of nurses, and the collaboration between nurses and doctors is superior in those hospitals. As I said, I agree with you, but the root of the problem also needs to be addressed. Medical directors and DONs need to grow a pair and face this issue head on in community hospitals. Docs yelling at nurses results in less-than-optimal PATIENT CARE.

[NayRN]

And then there are the stupid reasons for calling a doc that are required

Lab called at 6 pm with a positive blood culture in 1 bottle. Critical lab. Core measure. So I call the doc, he starts vanc. I go home.

2 am, lab calls with a 2nd bottle positive. night nurse calls doc back (critical lab, core measure, have to call or get pulled into office for falling out on core measure) doc says "you woke me up for that! You don't need to call me for this!"

(Same doc who says "that is an over the counter med. You don't need to call me for tylenol!") (Yeah, I do)

Anyway, next day, I was back.

Another call from lab.

MRSA in the urine. Sigh. Wait a little while (patient is already on vanc).

Another call about an hour later-3rd bottle positive! MRSA in the blood. Had to call. "Why are you calling me for this?!" Hang up.

A little while later-Different patient, same doc-

Orders one time 10 meq K+ on patient about to go to surgery. K level is 3.4. Patient has one peripheral line. Has to be on tele for K+ administration with a double pump to dilute K, surgery is on their way.

Called doc (10 am) "can I wait to give this K until after surgery?" "no give it now. why are you calling me for this?"

Hung the K, clamped it, handed patient to pre op nurses.

3 hours later patient comes back-with the K still clamped and attached to their line. Told ya so.

Doc comes to the unit a while later. "are you the nurse who called me?" yes.

"I know you are new, and there is a learning curve. Next time, ask the charge nurse before calling me about these things."

End conversation. I didn't bother telling him that I had been on this floor for 4 years, I AM the charge nurse, and the only reason he didn't recognize me is because out of all of the hospitalists he is the only one I never met for 3.5 years of night shifts. Or, I could have told him that next time he gets called with a critical lab, we need a "do not call physician for" future critical labs of the same sort when it will not change treatment. He does not want advice from nurses, however.

I have told the same physician in the past-yes I need to call you for tylenol. It is outside my scope of practice to prescribe medication. The patient is requesting tylenol at 2 am for their morphine rebound headache, and that is all they have ordered.

And I will continue to call you as needed and as required. To protect my patients, my license, and my job. Because you can be darn sure that if I didn't call you, and you saw that the K was not scanned and administered until 4 hours after you ordered it, I would hear about it then. Boy would I.

[RNperdiem, RN]

Reason#105 why I like my job: There is a doctor who is in charge of the ICU at all times who is usually physically present in the unit or a quick text page away when needed. Some of the other units staff NPs who can handle most patient issues.

I remember what it was like to call dotors at home, try to reach someone who has an office practice or (the worst) try to talk to a doctor who is in surgery(message yelled back and forth using the circulating nurse).

I guess what I am saying is that some people have it easier when contacting doctors and others don't have it as good.

[VickyRN, MSN, DNP, RN]

I do some legal nurse consulting on the side and at the heart of a medical malpractice case is the fact that a nurse did NOT call the physician concerning a significant change in a patient's status. Avoid harm to your patient and being deposed to explain your negligence in a court of law (which is a lot more traumatic than having an irate doctor "yell" at you for making that call in the middle of the night). When in doubt, make that call!

[MLMRN1120]

This was something that I really had to get over when I was a new grad. Now that I'm in icu I feel like the docs are a bit more receptive and respecting of the nurses, they value our input for the most part.

On the floor was a completely different story, I work in a large teaching hospital where (some not all) of the residents present with a god complex of sorts and a 'how dare this lowly nurse try to advise me' attitude. The difference between me now and me 3 years ago is I do not tolerate being belittled by arrogant docs anymore.

I can remember a time when I would call for something important and doc would basically speak to me like I was a child. That's something I will no longer accept, but it took a while before I was confident enough in my practice to tell them so.

One incident I remember occurred on another nurses patient around change of shift about 630. All the docs were coming onto the floor...long story short, i was sharing the room with this other nurse and walked in to see my patient. His roommate seemed..off, wasn't making much sense.

I poked my head into the hallway and asked the nurse 'is 30a ox3?' apparently he had been. I said we might need a rrt stroke alert, come see him. Resident walking down the hall says not to bother with rrt bc he's here to see patient. I didn't feel right about it so I called it anyway to get neuro on board. Rrt comes, neuro comes, resident throws me under bus saying that I overreacted and wasting time because patient was 'talking funny when he woke up' as he rolled his eyes like a teenager.

So at this point patient had come wandering out of his room and was basically walking into a wall..(think windup toy that hits a wall) yep that's normal. So end result, yep patient went to stat head ct and this nurse learned to never let belittling docs make me question my best judgement! Sorry this was so long :)