Walkie/talkie patient with a cervical neck fusion on his second day post op. Continues to have sore throat and hasn't eaten much in the last day.
Patient: I'm having really bad heartburn, could you get me some tums?
Me: I'll check your chart to see if you have something that could help like Mylanta...No, I'm sorry the doctor didn't prescribe anything. Have you tried eating soda crackers, drinking water, going for a walk...etc.
Patient: Can't you call the doctor, you guys do that kind of thing all the time.
Me: You want me to call the neurosurgeon for some tums?
Patient: Well, yeah
Me: I'm sorry sir, I can't wake up the neurosurgeon for tums.
Patient: Well, don't you have some in your purse that you can slip me??
Me: Um, no
What are some things patients have asked you guys to call the MD for?
This is something I hate dealing with. Most drs seem to understand we only page them at home as a last result. Some have blown up at some nurses with similar pages esp at 3am because someone will be in house at 6am and he/she only wants to be paged for either stat consults or emergencies only. not sleeping pills at 3 am or heartburn meds etc. i rather risk a dr whine and yell or not call back at 3 am then have to hear the patient/family the rest of the shift.
On a side note, I had more flexibility with standing house orders at the LTC center I worked at! Tums 3AM?? Sure!! cough drop? Absolutely! Straight cath and UA for confused older patient with temp? Just give me the flashlight.
Hospital on the other hand...no standing house orders..
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
PMFB-RN, my apologies for misunderstanding. I'm sure we have some great PRN OTC order sets, however, this particular neurosurgeon on the case does not believe in having lots of PRN meds, from what I have heard from other nurses he was lucky to have Percocet...
*** Ah well there you go. Now we KNOW that particular physician enjoys speaking with nurses at all hours of the night. You are cheating him by not waking him up. He is an adult and professional who has made his decisions. I would call this physician on every occasion there was a need to do so.
That's the thing. There isn't one right answer for these types of situations.
I would definitely be in the "try other things first" camp. If that didn't work, I don't know. I mean, I have HORRIBLE reflux. (I need to lose weight, and the "good" reflux meds interact with another med I take, so I make do with pepcid and prilosec.) So I get that heartburn sucks. I also know that if admitted to the hospital, I'm going to make sure during waking hours that my admitting doctor has ordered my daily reflux medications. I'm someone isn't a chronic GER, and gets heartburn at home, do they go to the pharmacy at 3am?
And the "risk of aspiration" is a bit ridiculous. These aren't tube fed people without a cough reflux being left laying in trendelenburg. A guy walking around the room is not going to aspirate because of a lone night of heartburn.
I don't know, tough situation. I don't avoid making 3am phone calls because I'm afraid of being yelled at, but because there are things that really can wait. Not every discomfort needs a medication. Truly, not every discomfort needs an intervention. Sometimes in life, we're uncomfortable.
I don't know what I'd do. But whatever I'd do, I wouldn't judge another nurse based on what they decided to do about a case of heartburn in a guy with a cough reflex at 3am.
Sure you can call the neurosurgeon at 3am for that. You know why? It will be your ass he'll ream the next day when he rounds on the patient who complains to him that he was up all night with terrible heartburn and the nurse said she couldn't call him about it.
Welllll....we can probably assume that if the OP finds herself in this position, it's bc the scenario you described is not the likely one. If it was, we probably wouldn't be having this discussion. Then again, you know what happens when we "assume"...
I would have called the resident on-call for some zantac, you should be able to do that at any hour if the patient makes a request and is uncomfortable. If you are in a facility where someone had cervical surgery I don't understand why you wouldn't have access to MDs around the clock?
I would have called the resident on-call for some zantac, you should be able to do that at any hour if the patient makes a request and is uncomfortable. If you are in a facility where someone had cervical surgery I don't understand why you wouldn't have access to MDs around the clock?
I would call the doctor and let him decide what to give the patient. He's the one that went to school for who know how many years.
I think you did the right thing to assess the patient and in the absence of evidence of something acutely dangerous going on, offer nonpharmacological/nursing measures first.
I might not have verbalized it the way you describe your interaction. I might have, instead of telling him I would not call the neurosurgeon for that, said something to the effect of: "I'll make you a deal. Let's try X, Y, and Z first, and if you're still uncomfortable in X amount of time, I'll give the neurosurgeon a call."
This way, the patient is being taken seriously, and I'm covering my behind. Best of both worlds!
anotherone, BSN, RN
1,735 Posts
This is something I hate dealing with. Most drs seem to understand we only page them at home as a last result. Some have blown up at some nurses with similar pages esp at 3am because someone will be in house at 6am and he/she only wants to be paged for either stat consults or emergencies only. not sleeping pills at 3 am or heartburn meds etc. i rather risk a dr whine and yell or not call back at 3 am then have to hear the patient/family the rest of the shift.