I'm sorry sir, I cannot call the neurosurgeon at 3AM for that...

Nurse Leigh · Mar 16, 2012

I do understand, really I do. Many MDs do not take kindly to receiving middle of the night calls for things like this. Having said that, it would be so much better if MDs would utilize the available standing order sets that address things like meds for headache, pain, fever, indigestion, nausea, vomiting, constipation and diarrhea. It is ludicrous to assume that just because at pt is admitted with A-fib that the won't have a headache or a bout of heartburn while admitted, and it seems prudent to have options for these eventualities already ordered. I am so appreciative when the admitting doc implements orders like these as I know I have options to offer my pts. Would also be nice if the order sets also indicated that pharm could sub different meds if pt allergic or allow pharm to change route if pt unable to swallow or strict NPO etc. Would just make it better for the MDs, nurses, and especially for the pt!

LynnLRN · Mar 16, 2012

I probably would have called the doc for tums. I know when I have heartburn sometimes it is AWFUL and I do not feel like the patient should be punished because we don't want to bother the doctor. I do not feel bad for waking up doctors. I am sorry but it is common knowledge that doctors get calls at all hours (I remember seeing this in movies as a child). So a doctor knows years before becoming a doctor that this is what he/she is signing up for.

MomRN0913 · Mar 16, 2012

I would have called the doctor for that. I can imagine how frustrating to a patient it must be to not be able to take something simple over the counter that he could just pop at home, because he "needs an order"

Why the neurosurgeon? Isn't there a house doctor or a resident who you could get to write the order.

I feel bad for the guy. Not getting any sleep due to heartburn and probably pretty uncomfortable after the surgery.

And sure it was heart burn?

EJBNeuroRN · Mar 16, 2012

Yes, heartburn can be very frustrating and painful. Unfortunately our facility does not have standing house orders where we can give patients OTC meds when they are needed. The only physician on the case was the neurosurgeon because the patient did not have any other medical issues. I did check with the charge nurse and she said because the surgeons usually have early scheduled surgeries that calling for tums would be inappropriate. Yeah I feel bad for the guy, but I can't reach into my medication stash a pull out some tums for anyone who asks!

MunoRN, RN · Mar 16, 2012

Sorry but you gotta call. Telling a patient essentially "sucks to be you" is sub-standard Nursing care. I agree we need to use discretion when calling at night, which is why we often forge orders or give patients tums, cough drops, and other things out of the "secret" drawer without an order, but it shouldn't be like that. Particularly with heartburn since it's not only uncomfortable, but stress ulcers in hospitalized patients are a real concern and can lead to much worse, even life threatening conditions.

Too many surgeons are control freaks and don't want any calls going to a hospitalist, but that doesn't mean we shouldn't call when the Surgeon is negligent in providing an accurate plan for what the patient may need at night, that's the Surgeon's problem not the patients or yours. If the surgeon is annoyed with call, remind them that there is a process for developing protocols for this sort of thing that he is more than welcome to utilize, or do a better job of writing orders in the first place.

Bruce_Wayne, ASN, RN · Mar 16, 2012

I know that this really bad advice, but I see nurses write orders for things like that all the time. They put it down as a telephone order and flag for the doc to sign in the morning. I know it's wrong, but it happens.

EJBNeuroRN · Mar 16, 2012

I'd rather write the order as a telephone order than call the doc in the middle of the night! Has anyone dealt with a neurosurgeon at 3 AM? It's not pretty.

Furthermore, since this is turning in to a more serious discussion than originally intended, what are some nursing interventions you all would do in this situation. Instead of fixing with meds what are some other things you would do?

Bruce_Wayne, ASN, RN · Mar 16, 2012

Pretty much every pt that has surgery on my floor gets protonix and/or reglan to prevent post-op GI problems, and the hospitalist is almost always consulted for pts that have surgery.

MunoRN, RN · Mar 16, 2012

I'd rather write the order as a telephone order than call the doc in the middle of the night! Has anyone dealt with a neurosurgeon at 3 AM? It's not pretty.
Furthermore, since this is turning in to a more serious discussion than originally intended, what are some nursing interventions you all would do in this situation. Instead of fixing with meds what are some other things you would do?

Elevating the head of bed sometimes is enough. Milk, soda water, or other acid buffers may also help.

sharpeimom · Mar 16, 2012

when i get heartburn, sitting up very straight and sipping at very cold ice water works better than meds. by very cold, i mean let the cubes have time to really chill the water. sometimes a few sips of a soft drink makes my husband burp and helps his heartburn.

a physician neighbor stopped to return a book he'd borrowed from my husband and he shared a funny story.

a patient called (during dinner) and asked him to write an order for a nurse to come to his house and rub his neck and back because they were stiff and ached. :eek: :rotfl:

Vespertinas · Mar 16, 2012

I'm glad the conversation went in this direction. I don't think the patient has outrageous expectations in this scenario. He's in a ridiculous situation and I feel sorry for him.