RN responsibility verses Dr.

[purpledolfin214]

I get confused with some test questions when it comes to contacting the physician. Can anyone give me a list of reasons when you need to contact the dr? and When you should not contact the Dr. and handle the situation yourself (as a nurse)? I guess I just need clarification about the scope of practice for a nurse. Thanks everyone for your help!

[cardiacRN2006, ADN, RN]

Here's a good situation. I had a post-op open chole pt out of nowhere spiked a temp. She was running low all night, and then at 1000 she gets all hot on me. (no PRN orders for Tylenol either). Did I call the Dr right away? No. I sat her up in bed, took off the covers, turned down the temp in the room, gave her an IS and spent the next hour trying to teach a spanish speaking only lady in pain how to deep breathe. Then I put her in a chair and made her sit up. I also made her cough up all her nasty lung cookies that she had been storing in there. Took the temp again in an hour, it was now higher. That's when I called.

[ukstudent]

I think the OP is a student. She asked about test questions. For test question you will always have prior Dr's orders for meds and treatments. You only call the Dr to let them know change in patient status, and then only if it is critical.

[cardiacRN2006, ADN, RN]

Actually, my point was that there are things that you should do prior to calling. My situation was an excellent example of that, because the first thing the doctor asked me was if I had been encouraging IS. IS wasn't ordered, it's espected. Your nursing school tests are going to give you situtations and you will have to choose to assess or call the doctor. Calling the doctor is usually the last thing to pick on a test. They want to see what you would do, not the doctor. But, I digress.

You can call the Dr anytime. It doesn't have to be 'only critical' information. Certainly my temperature scenerio wasn't critical. I just needed an order for Tylenol. Also, you need to call a doctor anytime you hold meds. Those times aren't critical.

[Daytonite, BSN, RN]

As a night shift staff nurse and a nursing supervisor on the night shift for many years I can tell you that one of the biggest questions new grads and nurses new to the night shift always had was "just when do I need to pick up the phone and call the doctor", particularly in the middle of the night? The rule of thumb is when the patient's condition has changed or taken a turn for the worst. Secondarily, you call when you need, or anticipate that the doctor is going to give you a order for a medication or treatment to be started right then and there. You cannot allow a patient to lie in increased pain or danger of their situation. This is why you must know the medical treatments of conditions and what the doctors are likely to order. We called when we detected diminishing respiratory status; for highly elevated temps where the doctor almost always ordered blood cultures, sometimes x-rays of the lungs and a change of antibiotics; for arrhythmias on the telemetry patients; suddenly elevated blood pressures; falls where the patient was injured; panic lab levels when the doctor had not left parameters to correct drug levels such as heparin, aminophyllin or insulin; post op pain medication not working and the patient remaining restless and in pain. There are many more scenarios that could happen. Keep in mind that you NEVER watch any patient's condition going down the toilet or potentially starting that journey without notifying the doctor. This is akin to passing the buck, if that phrase makes you feel a bit better. Notifying the doctor gets the monkey off your back. When you're on the job, it's better to call and get your butt chewed out by an angry physician than do nothing and wait, only to have the patient decline and everyone look to you for having failed to notify the doctor so something could have been done to prevent the patient from injury or agony.