Nurses- medical provider needs your opinion!

bagladyrn, RN · Jul 18, 2015

I call because I am REQUIRED to call for certain changes in pt. condition whether he (the generic provider) considers it significant or not. I am not going to be thrown under the bus for not informing the provider.

if the on call is civil I will be as concise as possible.

However, if someone is consistently rude I can turn into "little Mary Sunshine " - disgustingly cheerful at 2 a.m.ï¿½ï¿½

edited to add- You really don't want to piss off an old night nurse with a telephone!

jadelpn, LPN, EMT-B · Jul 18, 2015

HE may think the phone call is unnecessary, however, nurse managers get a little cranky when nurses start cowboying it up.

It doesn't have one thing to do with the lack of critical thinking skills. It has everything to do with the fact that we are required to inform, we are required to get orders...all those things that as a provider and/or an NP you need to furnish, or not--as you see fit for the patient.

I am sure that your husband's tune would change if in fact a nurse starts thinking for him, and he comes into round to a hot mess.

As a provider, one takes the responsibility of managing the overall care of a patient that they admit, or that they take from another provider. The nurse is responsible for assessing, advising, and then carrying out whatever order you choose for the patient--even if the nurse believes that something else could be more effective. We can only do what the provider wants us to do for the patient.

Equally, there are nurses who get all in a tither when they call a provider with a "This is what is happening. I am going to do x,y,z are you OK with that" to have a cranky provider who acts as if they have not a CLUE why anyone would call and disturb them barking "why did you call me" stuff. Easy solution? Don't be on call. Don't take acute care patients in a hospital. And don't expect if you do so to have nurses driving the care of your patients without your input--cause that can get dangerous, and then this thread would be about nurses who are in the gray area of somewhat practicing medicine.

heron, ASN, RN · Jul 18, 2015

Hard to know how to answer without knowing what kind of calls tick him off. Could you give us a clue?

Postpartum RN · Jul 18, 2015

Yes please do give us some examples of what kinds of calls are annoying. However trust me all the nurses and including myself who works nights, we do not want to call the doctor on call as much as he doesn't want to be called. We do as much as we can within our scope and critical thinking and then call the MD. However I am sure that some nurses do call with silly things at times, however on the other hand what may seem silly to a doctor in the middle of the night may not be silly to the nurse who is responsible for the pt on his/her shift.

On our unit, if we are calling for something that is needed but not really urgent, we try to combine our phone calls as much as we can and ask all the nurses on the unit if anyone is about to page the doctor or perhaps did just page them, it's easy we use the vocera to broadcast it to all the nurses on our unit that someone is calling MD.

I do understand how MDs could get ticked off when receiving multiple calls all night long, esp minutes apart from the same unit...I know it's not a job I would want to do because I would lose my patience as well and normally I am a very patient person :)

Jensmom7, BSN, RN · Jul 18, 2015

I'm a Hospice Nurse, so calls to the MD usually involve symptom management.

I generally know what I have in mind when I make the call, and there are a lot of docs who try to tell me "Just do what you think is best, I'm ok with it" because they are uncomfortable with the meds and dosages given in Hospice.

That's when I have to remind them that while I have several letters after my name, they don't include the ones that would let me write orders without talking to an MD first.

Also, as someone else pointed out, if you don't like being bothered, don't take on call. Most of us like dealing with the physician on call about as much as s/he likes getting those calls. However, I personally don't feel the need to just go ahead and throw myself under the bus because someone doesn't like being interrupted to do their job.

Libby1987 · Jul 18, 2015

Four things..

Have the foresight to write thorough orders and parameters for predictable issues.

Help those nurses put the pieces together, you know, teach a man to fish? Be a mentor and develop a great staff. Everyone is new in the learning process at some point, no one comes out of school really getting it until they've learned it and if everyone is just out for themselves it won't happen, and then you're just stuck with what you've got.

I don't know how many facilities he takes call for but he could make pre-emptive calls in blocks and deal with what's brewing but not yet problematic enough to call and piss him off.

Deal with the realities that healthcare is 24/7 and calls happen.

emmy27 · Jul 18, 2015

I can't remember the last time I called a doctor for "advice". I'm calling for orders or to provide a mandated update on a critical value or condition change. Do I loathe calling the on-call doc to report some not-actually-all-that-critical facility-designated "critical value" so I can chart that it was reported as mandated by my employer? Yes. Am I willing to skip it and risk getting fired for failure to follow policy? Nope.

Do I often have an idea of what order is likely forthcoming or might be a good idea? Yeah. Will I word it in the "We have problem X and they're allergic to med Y, can we have an order for Z instead?" way to move things along if I'm comfortable with the provider and know they aren't going to bite my head off for daring to have an opinion? Sure.

But I'm not taking it on myself to practice medicine without a license to save the on call doc a phone call, no. And I don't know many nurses who call the doc for advice- I ask my charge nurse when there are multiple options for nursing interventions or ordered meds/treatments and I'm uncertain about which way to go. If I call the doc, it's virtually always because I don't have the tools in the form of orders for meds, treatments, or diagnostics to address a situation, and no, I'm not going to generate those on my own, because that's illegal, unethical, and a good way to lose my job and/or license.

Consistently writing complete order sets that preemptively address common situations is probably the best way to prevent "annoying" calls from nurses. Believe me, we don't want to call him for Tylenol at 0200, either.

Jules A, MSN · Jul 18, 2015

As someone who has been on both sides of the fence I get it! If you have not been on call there is no way you can truly understand how disruptive it is to life and especially sleep. I know it is my job, I signed up for it and am well compensated but again that doesn't negate the difficulty so I am very appreciative for those who are cognizant of this, which is most of my fabulous team.

To RNs I can offer, know what the provider is likely to want and be prepared with it. Obviously everyone is different but for me some of the hot buttons include that my RNs know if it is a new female admission who is under 50 with an intact uterus that I will want to know Hcg results, please don't make me start to fall back asleep while you fumble through the EMR to find it, same thing with allergies. I can't remember exactly who is allergic to what and if I'm ordering a medication please refresh my memory. I appreciate your fine skills but at 2am I don't need the 20 minute run down of your head to toe assessment. Give me the meat and potatoes, tell me what you want and 99% of the time I will order it for you or give a thoughtful explanation as to why I won't. If you need to call me with something less than earth shattering because of a new unit policy we both probably don't agree with please clarify "sorry to bug you with this but Nancy Nurse-Manager is requiring we notify providers if a patient sneezes more than twice in an hour". I get that and won't blame the messenger. I know many will say they have no need to apologize for calling a provider on call but personally I appreciate it especially in the example above and will reply "no worries thats what I'm here for". Lastly and this is so rare I'm hesitant to even mention it but if something can wait until I'm back onsite please don't call "just to give you a heads up". :)

For the provider here are some things I try to remember which are helpful to me:

1. Most importantly I don't ever want my RNs to hesitate to call me when something is changing. Often times a skilled RN can sense something that is just "off" and I want to hear that now so I can get online and review the case to see if there is anything we are missingnot when the patient is coding. Calling me to say "Mrs. XYZ has me concerned but I can't really put my finger on it" is something that I greatly appreciate. There have been times when it was nothing and a couple of times when an astute RN saved all our bacon. If they are hesitant to call because I'm nasty it will come back to bite me. I have also gotten a few calls over the years with questions about med orders that absolutely were my error, or a lab collection I forgot to order and I definitely want those calls which possibly seem to get "overlooked" if a provider is crappy to the staff.

2. I try to remember they truly don't understand how disruptive being on call is and most definitely are thoughtful before calling, unless you are crappy to them as noted above.

3. I make it a point to answer the call really cheerfully which sets the tone for the rest of my conversation and reminds me of #1 & #2. Remember some nights you will be bugged incessantly and some nights nothing so it all comes out in the wash.

4. My staff knows my hot buttons. I'm very clear upfront with the things that I will want when they call me so that really cuts down on calls where they don't have their information readily available. Nurses in general are fairly sharp and will give you what you want if they know what that is so tell them.

5. I usually ask "what do you think would help?". The truth is they are my eyes, ears and often brains so I have no problem deferring to their preferences especially at 3am. In the few cases where I don't agree with their request I take the time to pleasantly explain my rationale and offer a different solution.

6. For the rare times when I got a bit snippy, although totally justified imo, I have always felt bad after so the moral of that story is just don't do it, no matter how justified you might feel because it is their job to call and our job to answer.

Good luck to everyone, we are all trying to work toward the same goal, right?

TriciaJ, RN · Jul 18, 2015

I once read about a study that showed how patients have poorer outcomes when the nurse has a high threshold to call the MD. Sometimes patient status changes are subtle and a nurse has to deliberate if it's necessary to report to the doctor. If she calls too soon she may get her head bitten off for a situation the MD deems trivial. If she hesitates, the situation may escalate quickly and the MD will demand to know why he wasn't notified in a timely fashion.

Things are rarely black-and-white for a nurse. Having a collaborative relationship with the provider goes a long way to streamline workloads for everyone, and create better outcomes for patients. Having to tiptoe around prickly personalities hugely contributes to nursing stress and burnout and poorer patient outcomes.

~PedsRN~, BSN, RN · Jul 18, 2015

The one day I don't call for a new fever of 100.7 will be the one day the patient goes septic and dies in 48 hours. That would be my luck. I am going to cover my own behind, just like I am sure the docs cover theirs. I do not make medical decisions, I do not write orders, I do not diagnose patients. I can critically think and problem solve all day long, but at the end of the day I have to protect my own license, follow a chain of command, and document that I have done so. There have been plenty of times where my critical thinking has gone down a very different path from the physicians. You know?

Libby1987 · Jul 18, 2015

I'm not terribly concerned about OP's SO but the reasons I call the on call doc is not so much to protect my license but to protect the patient, that's my primary motivation. That subtle priority perspective gives me a very thick skin and I think helps convey a clearer message.