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50 Things New Nurses Need to Know About Calling Doctors and Other Providers

Few things give a new nurse more stress than having to call a doctor or other provider. Other providers include advanced practice nurses and sometimes physician's assistants. It is far easier to ask a coworker for help or even a manager, but calling a provider is often fraught with feelings bordering on terror for some. Most nurses can remember the first time they called a with an inward shudder. It's part of the job, and you do get used to it after a while.

It also depends on when you call the doctor or provider. If you are calling in the middle of the night, your breath is more likely to hitch than if you are calling on day shift. Even better is having a hospitalist or APRN on call who is usually awake during the nighttime hours, though that isn't possible in every nursing setting. With that background, here are 50 helpful hints for new grads when making calls to doctors and other providers.

  1. Use the SBAR method: situation, background, assessment, and recommendation.
  2. Know the patient's code status.
  3. Always have a set of vital signs and allergies, no matter what you are calling for, including patient weight, especially in pediatrics.
  4. Access the chart and open to the last set of orders that were written. Also know the medications the patient is on, the IVs that are running, and drip rates.
  5. Pull up the latest blood work, most importantly the CBC and BMP.
  6. Know your patient's history in case the provider on call isn't familiar with them.
  7. Get straight to the point, and do not engage in chit chat.
  8. Ask around to other nurses before you call because they may know the answer.
  9. Realize that you are only doing your job and protecting your patient.
  10. Realize the doctor or provider has a duty to the patient, and they need to help you.
  11. Don't take a cranky provider personally. It has nothing to do with you.
  12. Clarify orders specifically before hanging up the phone. Always read back the order, even if they are in a hurry. Most hospitals require "read back" to be documented.
  13. Call doctors or providers with any condition change, no matter how silly it may seem.
  14. Don't let your fear keep you from confronting a doctor or provider.
  15. It is okay to give your opinion on what should be done. Your assessment is just as valid as theirs is.
  16. Take orders from doctors or APRNs, not medical assistants. Also, confirm the credentials and spelling of the provider's name prior to hanging up.
  17. Try to find somewhere quiet to make your call.
  18. Don't wait for the doctor or provider to respond to you. Get your work done while you are waiting.
  19. You may need to interrupt patient care to answer a call, unless it is an emergency.
  20. Everyone's time is precious. Don't make them wait on hold forever and don't stay on hold forever.
  21. If the provider is talking too quietly, don't hesitate to make them speak up.
  22. If they have an accent that throws you, don't be afraid to make them repeat themselves. It is for your patient's safety -- and yours!
  23. If a doctor or provider recommends a questionable course of action, take it to your charge nurse and up the chain of command.
  24. Providers can be wrong, and we are the last check between them and the patient.
  25. Politely excuse yourself from taking care of another patient before answering a call.
  26. Don't run down the hall because a provider is calling.
  27. If a provider's earlier written order is too difficult to read, call for clarification.
  28. Try to develop professional relationships with doctors and providers so calls are not so awkward.
  29. Always be polite, even if they aren't.
  30. Be assertive and firm if you need to, but don't become aggressive.
  31. Always thank them for their time. It is their job, but thanks go a long way.
  32. Don't develop attitudes about certain doctors or providers because of their reputations. Take them as they are at the moment you call them because the rumors may not be true.
  33. If the rumors are true, remember that you are a professional and deserve respect.
  34. Don't let a provider's treatment of you carry through the whole shift, making your work time miserable.
  35. If a doctor or provider is very out of line, document with an incident report, tell the charge nurse, and be sure your nurse manager is aware of their behavior.
  36. Talk to the provider like your equal. You are.
  37. Organize yourself so that you can address all problems at once and avoid multiple phone calls.
  38. Give on call doctors and providers the benefit of the doubt because they are often clueless about someone else's patient.
  39. Don't make nervous jokes on the phone, no matter how charming you may think it is.
  40. Execute orders as quickly as you can and report if that causes problems.
  41. Vent to other nurses if you are upset over how you were treated.
  42. Don't always expect the provider will be hostile. In many situations, they aren't.
  43. If you don't know something, don't be afraid to admit it. Offer to call back with the information.
  44. Don't allow coworkers, patients, or family interrupt you while talking to a provider. Politely ask them to wait a moment until you are done.
  45. Try to talk to doctors and providers on land lines as cell phones can drop calls or make it hard to hear.
  46. If your cell phone is malfunctioning, don't be afraid to ask them to call you back or offer to call them back.
  47. Don't allow a provider to make you take informed consent from a patient. It is their job to inform the patient and yours to witness -- even with blood products.
  48. Always have a clean piece of paper and working pen on hand. Don't put the order directly into the chart or the computer as it may change or be transcribed incorrectly.
  49. If the provider has the capability of sending electronic orders, ask them to do so.
  50. When in doubt, call. Nothing is silly or bothering them if it keeps the patient safe.

Calling doctors and provider is one of those skills that get better with experience. If you are a new nurse, hopefully these tips will help you. If you are an experienced nurse, please share your tips that you've learned over your years in nursing. Put them in the comments so other nurses can benefit.

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    • Featured Replies

    Very good article. I was very nervous in the beginning because I had less confidence, but calling providers has become second nature, even grouchy ones. I've had MDs with really nasty hostile attitudes towards nursing staff, but this has been a minority (thankfully). Whenever I get the bad attitude though, I am able to be assertive, stating that I am just trying to advocate for the patient, that I am not calling to annoy the provider. Most of the time this is enough to get a civil response. I also am not afraid to talk to a provider if my feelings were hurt by the interaction, as I feel that I am too old to accept blatant disrespect (this has been rare in my experience, but has occurred).

    I have found that most providers are glad to hear updates and like to collaborate with me to provide care for patients. I have also learned a lot from various physicians, NPs and PAs and this has helped me become a better nurse.

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    Also, learn WHO to call. I never bother calling Dr. IDontCare for pain medication. I will wait until that doc goes home and call the on-call provider.

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    We have a night hospitalist that often gets a bad wrap from newer or inexperienced nurses (you can be both or either or!) but honestly, if he gets an attitude with your call it really means that you didn't do your homework before you paged him. I would also say, if you have a clue, be ready to ask for what you need, want, or feel/learned what might be helpful in the situation. Remember that you are the patient's advocate and the eyes and ears for the practitioner. For example, if it's pain control, always ask the patient what has worked in the past and look at their home meds...you'd be surprised as a new nurse just how often reordering some needed home meds get overlooked at admit. Of it's more serious, do your homework and utilize support staff peers before calling, unless the patients about to code or is coding, and ask to trouble shoot with a respiratory therapist or pharmacist, etc. Lastly, if you're working with other nurses, try to cluster calls by making sure to ask the other nurses if they might need anything from the MD you're about to page (non-emergent of course). Oh yeah, if an MD/NP/PA does a really awesome job for you or your patient, take the time to recognize them the way that your entity allows (send them a kudos or something) Extend them the same courtesy you would like to receive!

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    Also, learn WHO to call. I never bother calling Dr. IDontCare for pain medication. I will wait until that doc goes home and call the on-call provider.

    Same difference about learning which service you need, which is the primary team and which are the consulting teams, if you need the intern, the resident, or the attending (and who's who out of all of those)! :roflmao::confused:

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    • Guides

    I'm a nurse practitioner and sometimes I cover off shifts and have to be called in the middle of the night. One thing that gets under my skin is when I get called by a nurse when the lab relayed a critical lab value. As a rule of thumb, before calling regarding a critical lab value, make sure you have all the details of the lab panel. For instance, I would get called that a pCO2 on the ABG is 80 (which is high) but the nurse does not have all the other components of the ABG (pH, pO2, HCO3) available because all the lab called about was the pCO2. Sometimes the patient is already known to have pCO2 in this high range and though it is high it may be compensated with a normal pH. Wait for all the results to be available before calling.

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    I was nervous for a very long time about calling doctors. It got better when I changed my perception of myself.

    I am not some little annoying nurse who is bothering the doctor with questions in between handing out pills and changing sheets.

    I am a frontline professional working to coordinate the necessary and optimal care for my patient, and I am calling to collaborate with the physician/provider in order to meet the needs of the patient.

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    #51: ask around, "does anyone else need Dr. Such-n-So, I've got to call him. Nothing endears a doctor to you and your floor as much as "bundling" the half-a-dozen phone calls he is likely to get from a busy floor as morning rounds take place, and AM labs come back.

    #52: Just keep in mind, if it is something that can easily wait till he rounds, let it wait as long as the next nurse knows it needs to be addressed. Even if he is a late rounder, it may be prudent to let the next shift call. I don't know anyone that wouldn't rather take a phone call about a patient after breakfast, rather than at 5am. Most responsible docs want to be able to have the chart in hand and eyes-on the patient before giving orders. There are just too many factors that may be left out of a phone report to make an informed decision in many instances.

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    In LTC, it helps to remember it is a 24 hour facility and all three shifts are responsible to make time appropriate call. Sometimes it is 3 PM and yes sometimes (rarely) it is a 3 AM call.

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    • Author

    #52: Just keep in mind, if it is something that can easily wait till he rounds, let it wait as long as the next nurse knows it needs to be addressed. Even if he is a late rounder, it may be prudent to let the next shift call. I don't know anyone that wouldn't rather take a phone call about a patient after breakfast, rather than at 5am. Most responsible docs want to be able to have the chart in hand and eyes-on the patient before giving orders. There are just too many factors that may be left out of a phone report to make an informed decision in many instances.

    As someone who worked almost exclusively on 3rd shift, I've found that 1st shift can get annoyed when you do this. They shouldn't, but I can see their point that I am pushing my work into their shift. Now, I suppose it would depend on the patient, doctor, problem, on coming nurse, and so on. So do this with caution if you work an off shift. If it is truly something a doctor will cover during rounds, you can keep it in your pocket. Just make sure you have a good reason for asking your following coworker to handle it. That's been my experience, anyway.

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    Ask about follow up orders while you have them on the phone. Example:

    When I call about low BP post-op, I will almost always get an order for albumin or a unit of blood. Instead of hanging up immediately, I ask if I can go ahead and start a Neo drip if I can't get the SBP over 90 after the infusion or if they want me to call them back.

    Or I get an order for some IV lopressor for a patient who is tachycardic and having frequent PVCs...then I ask if they want me to go ahead and hang an amio or cardizem drip if the heart rate stays above 100.

    Ask them if they want to be notified for x situation or if they want to wait until rounds. Sometimes things definitely need to be addressed, but can wait a few hours. Sleep is important.

    Pain...I might get an order for some Percocet, and I will ask if I can put in for dilaudid or fentanyl for breakthrough pain. I hate having to call in the middle of the night for pain medicine.

    They almost never say no, and more often than not, I end up using my "follow up" orders. Makes things much, much easier. And faster.

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    As someone who worked almost exclusively on 3rd shift, I've found that 1st shift can get annoyed when you do this. They shouldn't, but I can see their point that I am pushing my work into their shift. Now, I suppose it would depend on the patient, doctor, problem, on coming nurse, and so on. So do this with caution if you work an off shift. If it is truly something a doctor will cover during rounds, you can keep it in your pocket. Just make sure you have a good reason for asking your following coworker to handle it. That's been my experience, anyway.

    I see your point, but why are there so many posts saying "it doesn't matter if the doctor is a grouch- it's your responsibility to call, but it's OK to awaken an attending physician for something that he will handle at a reasonable hour, just so the next shift nurse doesn't get annoyed? I've seen nurses call back normal X-ray results to an attending at 5am when the doc had a 7:30 surgery scheduled the next day. She just wanted to see if he had any "further orders" (in that the patient was still sick). I work 3rd shift, and I find 1st shift is under the impression that if they are "leaving work to do" it's OK-"that's why we have more than one shift" but if we leave something for them to handle- we are lazy and keep "dumping our work on them". Me- if it badly needs called I call, if it can wait- I let it wait. I don't want the doctor caring for my loved one to be going on 2-3 hrs of uninterrupted sleep if it can be avoided. Sometimes not calling is being a patient advocate too.

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