Midnight Dr. Call.

TazziRN, RN · Apr 25, 2007

Anytime the pt's condition changes for the worse and a new order is needed.

Kerrigan 06 · Apr 25, 2007

Agreed, and to put it in the way I try to make the decision to call or not to call at 2:30 a.m.: "Is it safe for the patient to continue in this condition/this problem to go unresolved/this lab to go unreported until 6 a.m./rounds?"

If so, I either wait and call after 0600 or pass it in report to be told to the appropriate doctor when they come by. If not, I call.

MrChicagoRN, RN · Apr 25, 2007

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:

You aren't going to be left alone.

You will likely have some prn orders, you call when condition warrants it, as Tazzi said.

Your preceptor will help you decide when changes occur requiring you to call.

And don't ever feel bad for calling. While you want to be co9nsiderate of the doc's need to sleep, your first obligation is to the patient. Not the MD.

MedSurgeNewbie · Apr 25, 2007

Good Doc's dont mind, I have even been thanked for calling -

Lorie P. · Apr 25, 2007

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.

crissrn27, RN · Apr 25, 2007

Some docs aren't gonna be happy if you call them at 1430 or 0230, so don't sweat it. If you feel you need to call them, do it. This is their job, if they didn't want 0230 calls they should have gone in to another field. That said, if you really like the doc, of course you don't want to be waking him up every hour for a tylenol order. Try to group things together with other nurses before calling, ask around to make sure no one else needs to talk with the doc before you call. If it is a "iffy" situation ask a couple of other nurses what they think before deciding to call.

santhony44, MSN, RN, NP · Apr 25, 2007

When you do have to call a doc in the middle of the night, make sure you have the chart in front of you and all your information together before you call. Even the ones who understand that this is part of your job won't be happy if they have to be kept hanging while you go find out something you should've known before you called.

As someone else posted, some aren't going to be happy to be called no matter what. That's not your fault.

Tweety, BSN, RN · Apr 25, 2007

I agree with the above. Make sure you have all your ducks in a row. Docs don't mind being called when necessary but when you call and say "his O2 sat is 76%" and she/he asked "what are the rest of his vitals and urine output" you'd best have that information and not go "ummm..........Jane, run go take his vitals for me real quick" or "ummmm........let me find the CNA and ask".

blackIrish · Apr 25, 2007

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...."

queenjean · Apr 25, 2007

Agreed, and to put it in the way I try to make the decision to call or not to call at 2:30 a.m.: "Is it safe for the patient to continue in this condition/this problem to go unresolved/this lab to go unreported until 6 a.m./rounds?"

In addition to this, I always ask myself, "What will the phone call change?" Is there a med, lab, or procedure that the physician could order that would benefit the patient? Is the lab a significant change for the worse? For example, a patient who is being treated for low potassium; if his afternoon lab was 2.5, and a lab comes up in the middle of the night that is 3.0; that's still a low potassium, but I'm not going to call that because it appears the treatment is working (unless, of course, the physician left parameters to call).

I also don't clarify orders in the middle of the night if they aren't pertinent to the current treatment. We have a nurse who clarifies EVERYTHING, and the docs hate it. Who cares if the physician didn't mark a diet at 0300? If the patient is vomitting and doesn't want to eat, don't worry about clarifying that, leave a note or pass it on to day shift. Who cares if the doc didn't clarify if he just wanted O2 on at 2L or if he wanted you to titrate it to a certain sat level? This is a call that in most circumstances can wait three hours for a more reasonable hour of the day; or you let your coworkers know that "If someone needs to call Dr. S's group, I have a question for him, too."

And santhony's advice is spot on; always get your info together (chart, MAR), get your vital signs, think of any question the doc might ask about. And when you call, introduce yourself, and give the doc a little background. They might or might not be familiar with this patient, and they might also have been sleeping HARD. Some little script like "Hi Dr. S this is Jean from SVHC calling about Dr. P's patient F.M. in room 306. Are you familiar with her? No, well, she's a 53 year old with KNA admitted with chest pain; no significant medical history, her CEs have been negative, EKG and tele normal. The reason I'm calling is that she is complaining of a headache rated 7/10 and she has no orders for any type of pain med." And then you can answer questions and go from there, but you given the doc some basic info as well as a chance to wake up.

eltrip · Apr 25, 2007

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.