Nurses- medical provider needs your opinion!

[Buckeyeqt]

My SO is a medical provider at a hospital (internist). He does a call shift to answer questions from nurses. He has NPs in his group as well. He was venting the other day and mentioned how he wasn't so short with the nurses when he first started, but now the phone has a bad connotation as he knows when it rings it's due to a problem he has to help with. It's silly when it's his job to answer, but he says he gets annoyed but he said he likes nurses who think critically and he said the ones who usually call tend to call for mundane reasons and he admitted his med group has started to see a pattern in the nurses who do keep calling because they choose not to figure out a problem themselves. They have NPs with their group as well. He also mentioned the NPs have started to get cranky with phone calls too even though some were the floor nurses at one point. Is it common when you call for help, to deal with the providers who are moody and what's a good way to remind them you call because it's their job to answer and they should try to be more understanding? NPs---can you relate to this? He said he's trying to remember it's his job to help and he wasn't always like this, but I guess when he feels the answer is right infront of your face and you still call for help-he feels it's a waste of his time. I informed him id get feedback from here-what would you guys want him and his colleagues to know regarding your position when you do call for advice? ..He's trying to work on getting past being short. It's not all the time just when he thinks phone call is unnecessary.

[TriciaJ, RN]

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?

I can't "like" this enough. In fact, I can't "like" it at all because the "like" button doesn't appear at the bottom of this post for me. What's up with that?

Anyway, I really, really like this post.

[Dranger]

Nurses need to:

1. Check the MAR first

2. See trending vitals, baseline mental status etc

3. Not inappropriately page specialists, "BP is 103/65 pulse 70, should I hold Coreg" to the cardiologist

4. ICU nurses should reorder restraints on vented patients and order am xrays per protocol, do not page the 3am pulm doc

5. Blood cultures are positive, but the abx they are on cover that bacteria. Do not call.

6. Ask for non specific labs, BNP, d-dimer, c-reactive, ESR etc. We know the are sick or have heart failure/chronic clotting issues. IF the labs won't change the plan of care there is no point in ordering them. You always have to think, if I tell the MD x and y what is he really goingto do about it.

I honestly think they get annoyed because they are either stressed admitting patients and brainless phone calls are a nuisance. Use critical thinking and judgement before you call.

[KelRN215, BSN, RN]

Being on call sucks, I agree with that. My last job as a home health supervisor involved a lot of stupid calls when I had to take call. I seriously once had a nurse call me at 4am telling me that she needed to leave a shift because of an issue with the patient's parent and then refused to tell me what the issue was because "she knew I was sleeping." I was like "well you already woke me up so you best share the issue." It's also annoying when someone calls and hasn't thought themselves to call the MD about a clinical issue. For example: "I haven't been able to straight cath this patient with chronic urinary retention all day, neither could the nurse before, he bleeds when we try." HELLO? Call the Urologist! Why do I need to tell you to do that? Also once got a call to report that a patient with a seizure disorder who had daily seizures had 2 seizures in 12 hrs, all of which lasted

I don't get the sense that that's what the OP is talking about though. There are real reasons why a hospital RN needs to page the MD in the middle of the night. Fortunately when I worked in the hospital, residents were in house overnight. Some services (like plastic surgery) weren't in house overnight and they would get cranky when we called but when your patient's surgical wound is leaking and needs to be stitched, what exactly would you like me to do about that?

Hospital policy usually does mandate that RNs notify MDs of critical lab values but we can use our discretion. For example, in Oncology if your patient is admitted with fever/neutropenia and his ANC was 0 yesterday and he's already covered with triple IV antibx, is it really necessary to call the provider at 4am to notify him that the ANC is still 0? No, it isn't.

[OCNRN63, RN]

I can't "like" this enough. In fact, I can't "like" it at all because the "like" button doesn't appear at the bottom of this post for me. What's up with that?

Anyway, I really, really like this post.

That happens to me, too. I have no idea why.

[Jules A, MSN]

That happens to me, too. I have no idea why.

I notice it if I'm attempting to like something when I just posted in that thread and didn't refresh. Try refreshing?

[Rose_Queen, BSN, MSN, RN]

I can't "like" this enough. In fact, I can't "like" it at all because the "like" button doesn't appear at the bottom of this post for me. What's up with that?

Anyway, I really, really like this post.

That happens to me, too. I have no idea why.

I've noticed it happens if I respond to a post and the other person's response appears between the time I load the page and the time I hit the "post comment" button. The like button will appear if the page is reloaded.

[OCNRN63, RN]

Being on call sucks, I agree with that. My last job as a home health supervisor involved a lot of stupid calls when I had to take call. I seriously once had a nurse call me at 4am telling me that she needed to leave a shift because of an issue with the patient's parent and then refused to tell me what the issue was because "she knew I was sleeping." I was like "well you already woke me up so you best share the issue." It's also annoying when someone calls and hasn't thought themselves to call the MD about a clinical issue. For example: "I haven't been able to straight cath this patient with chronic urinary retention all day, neither could the nurse before, he bleeds when we try." HELLO? Call the Urologist! Why do I need to tell you to do that? Also once got a call to report that a patient with a seizure disorder who had daily seizures had 2 seizures in 12 hrs, all of which lasted

I don't get the sense that that's what the OP is talking about though. There are real reasons why a hospital RN needs to page the MD in the middle of the night. Fortunately when I worked in the hospital, residents were in house overnight. Some services (like plastic surgery) weren't in house overnight and they would get cranky when we called but when your patient's surgical wound is leaking and needs to be stitched, what exactly would you like me to do about that?

Hospital policy usually does mandate that RNs notify MDs of critical lab values but we can use our discretion. For example, in Oncology if your patient is admitted with fever/neutropenia and his ANC was 0 yesterday and he's already covered with triple IV antibx, is it really necessary to call the provider at 4am to notify him that the ANC is still 0? No, it isn't.

When I worked hospice, I used to have to take call. My favorite "stupid nurse" call was from a nurse who was calling about one of our patients who was staying at the ECF where the nurse worked. She called to get permission to send our patient to the ED because the patient fell and was having severe pain. (Our policy was the on call nurse had to be notified of any change in level of care.)

I asked her a few questions about what happened, then said, "Sure go ahead and send her ." The nurse said, "Well, actually this happened 6hrs ago, and she's already back from the hospital.

I could feel myself getting ready to explode, because this phone call was around 0100. As calmly as I could, I asked why she called me at this hour if the patient was already seen in the ED and is back in the ECF. The nurse, all bright and chipper, said, "Oh, we just wanted to get the OK to send her from you. We have to chart that we asked for the OK."

I really wanted to reach through the phone and choke her.

[dirtyhippiegirl, BSN, RN]

More comprehensive order sets. (Pain meds, tylenol, antiemetics.) Strict orders on when to call for abnormal vital signs. Parameters on cardiac and bp meds. Electrolyte replacement protocols.

I have to call with certain lab values per department policy. Even stuff that is not going to change the tx plan. They audit my charting to make sure it gets done within X amount of time.

On the other hand, I have worked nights and seen nurses call for ridiculous reasons. Order reconciliation does not need to happen at 3 am with a patient who has been on our unit for two weeks.

[scottaprn]

As an NP I think I understand the calls mandated from the hospital that the nurse would rather not make. As mentioned by the previous poster it is nice if you include "sorry to bother you but the hospital policy requires I do so".

It does drive me crazy to get calls where the nurse doesn't assess the patient before calling. One night last week I was called at 2:45 to see if I wanted to discharge a post-op drain and the nurse couldn't tell me the drain output. Then at 430 I got a call because the patients operative leg was swollen and the nurse couldn't tell me about pulse, motor or sensation distal to the surgical site.

Not using your nursing assessment is inexcusable.

[calivianya, BSN, RN]

5. Blood cultures are positive, but the abx they are on cover that bacteria. Do not call.

Oh, I wish. Lab calls blood cultures as criticals to us, and they document what time they call us. If I haven't documented that I called the provider within an hour of what time lab documented they call me, I get written up. I have to call every critical, no exceptions. Management has been auditing critical result notification in the chart a lot lately, and I know plenty of people who have gotten written up over not documenting that they notified the provider in a timely manner. Avoiding MD annoyance is not a good enough reason for me to get written up.

On the list of other stupid things that management is doing, we now have to have an order for Tylenol for pain OR fever to give Tylenol for fever. Supervisors told us that they will be checking the reason we give our Tylenol since so many of us had been giving Tylenol ordered for mild pain when the patient had a fever. Apparently, that's practicing medicine without a license, so now if I have Tylenol ordered for pain and the patient has a fever, I have to call a provider to get them to change the order so I can give the Tylenol.

Of course, I like to ask the patient if they are having symptoms with the fever - chills, fatigue, muscle aches, etc. - and call it discomfort. Discomfort is pretty similar to pain, right? So, I'm giving that Tylenol for mild discomfort, not for fever. I can sort of get around the order parameters that way.

My hospital, at least, seems like it's trying to take away nurses' critical thinking.

[trudeyRN]

This reflects what pretty much everyone has already said, but when I read "mundane questions" and "lack critical thinking" my first thought was they are probably nurses with a healthy respect of scope of practice and and a smart inclination to protect their license. They have thought critically know what is required next is doctor's orders (even as they possibly know what the solution will be).

[~PedsRN~, BSN, RN]

If they don't want to be called, then they need to provide me with parameters and orders that are going to make my calls unnecessary. But when I have an order that reads "Notify Physician of temperature over 100.7", don't bite my head off when I call you and let you know that your patient has a temperature of 100.9. My orders state to call you and let you know. If you didn't want to know, DON'T CHECK THAT BOX ON THE ORDER SET.