How to call a provider at 3 am

I've worked nights on and off for about 10 years- I have many stories from calling providers in the middle of the night, good, bad and funny.

Bad story:

My patient status post-GI surgery complains of chest pain at 4 am, I call the intern and no response, CP worsens so I call the rapid response team. I was yelled at for not calling the intern first and wasted rapid response time. After I persisted something was wrong I did a repeat EKG and she was having an MI.

Good story:

After accidentally calling an attending he laughed and said I made him feel young again! He advised me on what to do and asked I pass it along to the intern covering.

Ugly:

Being screamed at for calling an on-call Dr and waking up his baby...

Worst:

When I called to get a med order corrected, a Dr told me "how dare a nurse question a physician's orders"

Here is my simple list of what to do at 3 am

1. Know who is on call. I once paged a surgical attending at 3 am instead of the intern! Luckily the attending thought it was funny and was very kind about it.

2. Have your data ready when you call: Why you are calling, last set of vitals, last labs, I/Os, etc. Don't assume the person you are waking up at 3 am is instantly going to know which patient you are talking about or if they've ever seen the patient

3. Check your orders to ensure you don't have what you already need- PRNs, labs, NPO etc

4. If you're not sure about something check with a more senior colleague, they are a wonderful resource

5. If you are not getting a response from a provider don't be afraid to go up the chain of command, it's there for a reason!

6. NEVER apologize for calling a provider; everyone is on the same team and caring for the patient, it does not matter what time you're calling with patient care concerns

7. ALWAYS repeat back what the provider says to confirm; you can hear some funny things after you woke someone up, I've even had a doctor fall asleep on the phone with me!! It's always awkward if you have to call back 10 minutes later to clarify an order.

8. SBAR- it works, use it, love it, and it cuts down on communication errors.

9. If someone is being inappropriate when you called- screaming, swearing, berating or refusing to call back; report the person to the appropriate person. This behavior should never be tolerated

10. If dealing with the person mentioned above in #9 remain calm and professional and report them to the appropriate management

11. Creativity and problem solving can go a long way on night shift and prevent the need to call anyone. If your patient is constipated and has not GI meds ordered, take them for a night time stroll, give them prune juice, etc. If your patient is anxious, sit down and talk to them for a while. Sometimes talking can go a lot further than any meds. Even if it's asking your patient about their kids or dogs or their job.

Patient care and safety always come first, never be afraid to call the provider. To make everyone's job easier and for the best possible patient care. The night shift is there for a reason. Patients crash on night shift and have unexpected needs, don't feel bad, take care of your patient.

From your friendly neighborhood night shift nurse practitioner