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

[Lynda Lampert, RN]

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.

[BostonFNP, APRN]

Example: had a resident refuses anything but Tylenol for pain relief in my cirrhosis pt, despite the 4-5/10 back ache reported.

I like APAP for pain relief :)

[CountryMomma, ASN, RN]

I like APAP for pain relief :)

I don't mind it but I'm skittish about Tylenol use in liver disease patients.

[BostonFNP, APRN]

I don't mind it but I'm skittish about Tylenol use in liver disease patients.

Even in end-stage cirrhosis doses up to 2.5g/day are safe, safer than NSAIDS.

[Jensmom7, BSN, RN]

Even in end-stage cirrhosis doses up to 2.5g/day are safe, safer than NSAIDS.

I get twitchy when I have a Hospice patient with liver disease. Pain management can be such a crapshoot for these people.

I have one now, the attending refuses to sign a CII for the Morphine that she's most likely going to need at some point (usually around 2am), because "I just saw her, she's not in any pain and besides, I know all about Hospice and Morphine."

Okay, Skippy, just don't get snarky with the on call nurse who is going to be giving you a call in the middle of the night. Besides, my Medical Director said if the attending persists in being a booger snot regarding patient comfort, call him and he WILL order Morphine, and have a little sit-down with said attending. I would pay good money to see that encounter...

[Apples&Oranges]

We had a brandy new resident (he was VERY IMPORTANT fyi, he was a SURGICAL RESIDENT - they are VERY IMPORTANT, just in case anyone was not aware...) who routinely told the RNs when we called around 8p,:

Resident: "Can you ask your "little friends" (huh?) if they think they'll need anything else tonight? Cause I'd like to get some sleep."

Me: (after asking my 'little friends') "Yeah, so, the other nurses don't need anything right now, but..."

Resident: "K. Let's keep it that way. I really don't want to be woken up tonight. So don't call me."

Well isn't that precious. Oh, kiddo, you are PGY1, not entitled to preferential treatment, and you just guaranteed yourself at LEAST 4 phone calls. And you're 26. I have to be up alll night. Suck it up.

That said, if you're a gem when I call and say, "Hey, I'm so sorry to wake you, quick question, BP 240/110, HR 90, can I put in a one time and PRN q1 hydralazine...?" and you are NOT a jackass? I will try REAL hard not to call you at 4am. Promise.

[BostonFNP, APRN]

I ask nurses all the times to see if anyone else on the floor needs anything when I get a call in the middle of the night. I must be an awful person.

I do it in a nice way though.

That being said, I have several colleagues that as very rude in the middle of the night, and while it is unprofessional and not good for patient care, I do have to say that they do get significantly less calls.

[lpn.rn.bsn]

Know your patient's favorite color and underwear size! Doctors are humans, why take so many steps before calling? Last labs, meds etc... all could be looked up in the chart. I get that I will need to have a set of vitals ready and pertinent labs, but I am not jumping through hoops before I call.

[BostonFNP, APRN]

why take so many steps before calling? Last labs, meds etc... all could be looked up in the chart.

Often times when I am on call I am either not at a computer or I am asleep. Often I don't know the patient, what they are in for or being seen by VNA for, their hospital course, or what meds they take.