50 Things New Nurses Need to Know About Calling Doctors and Other Providers
Calling doctors and providers is often a skill that new nurses need to practice often before they feel comfortable. If you want the inside track on how experienced nurses take calls from providers, here are 50 items to consider when making a call.
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.
Use the SBAR method: situation, background, assessment, and recommendation.
Know the patient's code status.
Always have a set of vital signs and allergies, no matter what you are calling for, including patient weight, especially in pediatrics.
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.
Pull up the latest blood work, most importantly the CBC and BMP.
Know your patient's history in case the provider on call isn't familiar with them.
Get straight to the point, and do not engage in chit chat.
Ask around to other nurses before you call because they may know the answer.
Realize that you are only doing your job and protecting your patient.
Realize the doctor or provider has a duty to the patient, and they need to help you.
Don't take a cranky provider personally. It has nothing to do with you.
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.
Call doctors or providers with any condition change, no matter how silly it may seem.
Don't let your fear keep you from confronting a doctor or provider.
It is okay to give your opinion on what should be done. Your assessment is just as valid as theirs is.
Take orders from doctors or APRNs, not medical assistants. Also, confirm the credentials and spelling of the provider's name prior to hanging up.
Try to find somewhere quiet to make your call.
Don't wait for the doctor or provider to respond to you. Get your work done while you are waiting.
You may need to interrupt patient care to answer a call, unless it is an emergency.
Everyone's time is precious. Don't make them wait on hold forever and don't stay on hold forever.
If the provider is talking too quietly, don't hesitate to make them speak up.
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!
If a doctor or provider recommends a questionable course of action, take it to your charge nurse and up the chain of command.
Providers can be wrong, and we are the last check between them and the patient.
Politely excuse yourself from taking care of another patient before answering a call.
Don't run down the hall because a provider is calling.
If a provider's earlier written order is too difficult to read, call for clarification.
Try to develop professional relationships with doctors and providers so calls are not so awkward.
Always be polite, even if they aren't.
Be assertive and firm if you need to, but don't become aggressive.
Always thank them for their time. It is their job, but thanks go a long way.
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.
If the rumors are true, remember that you are a professional and deserve respect.
Don't let a provider's treatment of you carry through the whole shift, making your work time miserable.
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.
Talk to the provider like your equal. You are.
Organize yourself so that you can address all problems at once and avoid multiple phone calls.
Give on call doctors and providers the benefit of the doubt because they are often clueless about someone else's patient.
Don't make nervous jokes on the phone, no matter how charming you may think it is.
Execute orders as quickly as you can and report if that causes problems.
Vent to other nurses if you are upset over how you were treated.
Don't always expect the provider will be hostile. In many situations, they aren't.
If you don't know something, don't be afraid to admit it. Offer to call back with the information.
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.
Try to talk to doctors and providers on land lines as cell phones can drop calls or make it hard to hear.
If your cell phone is malfunctioning, don't be afraid to ask them to call you back or offer to call them back.
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.
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.
If the provider has the capability of sending electronic orders, ask them to do so.
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.
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.
all true! The one I always forget is the name....mainly because the docs all answer our phones "ICU" and expect us to know who is working that night. It is awesome to have the fellow and resident on the unit at all times.
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.
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.
This is such a good post that I wish it was in the original article. New nurses -- and experienced! -- take heed, because this is how you do it.
Something I try to do as a night shifter is anticipate needs and call the provider earlier in the night. Much if the time a trend is already established, like pain not being managed by 10 pm or so. I'd rather call someone at 10 rather than have to wake them up later. Obviously, I'll do what's best for the patient, but I really try to respect the providers time as well.
Something I try to do as a night shifter is anticipate needs and call the provider earlier in the night. Much if the time a trend is already established, like pain not being managed by 10 pm or so. I'd rather call someone at 10 rather than have to wake them up later. Obviously, I'll do what's best for the patient, but I really try to respect the providers time as well.
Also a night shifter here!! Often times I will call a doc around 9 or so, even if there's nothing technically wrong. I say I just wanted to "touch base" and let them know the BP unusually high for that time of night and see if they want to add anything to hs meds or have me put in for something PRN for later, just in case.
I don't do this with everyone, because, as I'm sure you know some docs need to feel like everything was their own idea. But that's a whole different thread!!
1) Please know the patient's name and brief history when you call - I have 30-50 patients at night. Tell me you are calling about room 1118 isnt helpful. Tell me you are calling about Ms. Smith, or if you want to be really helpful, Ms. Smith, Dr. So and Sos pt in room 18.
2) Please know what you are calling about. I am always shocked when I get paged "hi, patient so and so has a really high blood pressure." "Ok, what is it?" "Oh, let me look that up for you." I mean really?
3) Non urgent things, including benadryl requests, non-fever elevations in temperatre (100.1, etc), patient having 2 IV fluid orders after returning from the OR, all of these things should go through either text paging system, or be bundled with a bunch of other stuff.
4) Edited in - please dont page for things you know are wrong for the patient. Unless the patient has an actual allergy, I am never ever going to order benadryl or ambien for a 98 year old. No, I am not ordering dilaudid because the patient "doesnt want to swallow pills". I get that the patient is hungry and is complaining a lot but no I am not giving the patient with small bowel obstruction a regular diet.
More edits
5) When you come back from break, please make sure issues were actually paged. One of the things that makes me angriest is at 4 AM when I start recording vitals for the list, I see that the patient had a fever overnight. Ill call the floor "Why was I not paged when this pt had a fever?" "Oh, I was on break, i thought the covering nurse paged you." I would so much rather get paged twice about an actual issue that not get paged at all.
6) If possible, try not to page when we are signing out. I get its the end of your shift and you want to clear things up as much as possible for the new shift, but sign out of 30-50 patients is honestly a very dangerous time, and distractions for non urgent matters are pretty bad.
7) Just a bit of perspective - Last night i had 35 patients. If each nurse pages me twice overnight (on average, really though most of the nurses wont page me at all, and a few will page me a lot), thats 70 pages. Even if I hang up after only 1 minute of waiting on the phone, thats an entire hour out of my night spent waiting for the unit secretary to find the nurse who paged me. And I find that 1 minute spent waiting is on the shorter end.
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.
You should report this, not the nurse calling, but the situation itself. My facility has a policy that I must call all critical labs within 30 minutes of the lab reporting it as critical.
I love most of our ER docs. We've worked together for so long we trust each other. They know I won't pull them out of a patients room unless *we* need them *now*.
example of a typical convo...
Me:
hey doc, I have a 75yo lady who tripped over her walker and fell and now has shortening and rotation of her left leg with intact msps - she has no med allergies. I'd like to get her some pain meds to get her a little more comfortable until you have a chance to assess her.
doc:
sure, give her 4mg zofran iv and you can decide if you want to give her 4mg morphine or 0.5mg dilaudid iv. I'll see her soon.
Specializes in ACNP-BC, Adult Critical Care, Cardiology.
We've raised it as an issue. Blood gas results automatically print at the nurses station and are available on the EMR in less than 20 minutes. That's within the window for a critical care nurse to apply judgement on the urgency of the result. There's no reason for a nurse to react in a knee-jerk fashion by calling a provider right away just because a "messenger" from the lab called about a critical result without waiting for the full panel. Now if it's taking forever for the result to show up, I would appreciate a heads up that the results are taking a while.
suanna
1,549 Posts
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.