Thoughts?

You're definitely doing the right thing by writing the provider up for their behavior. Your charge nurse should do it as well. I have worked with a lot of clinicians who are just rude to everyone if they get called after 9pm. They do it because they can get away with it. In theory, if enough people write them up, it will be addressed in some way. In theory.

That being said, as angry as the patient's family was, I'd have explained that the person on overnight is not the regular provider and wouldn't be able to discharge them. I would have waited until 0700 and called the doctor myself, during/after shift change.

I see nothing has changed in 30 years. You are forced to call during off hours. I say forced, because you are not calling for your own pleasure.

You correctly anticipate that the person you connect with will be, at the very least, incivil. More likely, rude, unprofessional, and downright ugly. Although it is their job.

A nurse would be out of a job, but we put up with this nonsense.

11 hours ago, Swellz said:

That being said, as angry as the patient's family was, I'd have explained that the person on overnight is not the regular provider and wouldn't be able to discharge them. I would have waited until 0700 and called the doctor myself, during/after shift change.

Even though it is not their attending the NP's and PA's discharge for them and have access to their notes. Its hard to tell when they will round depending on their surgical schedules and when you call in the morning, you get the same NP or the PA either way. They have access to charts and notes indicating possible discharges, etc. The NP did say they would pass onto the rounding team this information finally at the end. The only reason this is an issue because they complained they were woken up. In my mind, its 0630-ish, closer to 0700 and you are getting paid to be on call until 0730 so if someone calls, it is still your job to answer.

On 6/13/2019 at 7:57 AM, NRNPH said:

Granted, I should have talked to the CN first (I ALWAYS do before I call except this one time)

On 6/13/2019 at 7:57 AM, NRNPH said:

All I get back from the Manager is that moving forward it is mandatory to talk with CN before contacting MD

See I don't like this, and this is why. If you are an RN you are the primary person responsible for advancing your patient's needs and concerns. But beyond that, this "middle man (woman)" process means that when there is an issue with a phone call it is solved by chastising people for not using it, rather than reviewing situations and supporting and training people [on things that every RN should learn to do, mind you].

It also discourages the normal process of RNs refining their own trouble-shooting skills and is a drag on confidence-building. Then when the situation rolls around that the RN has to make an independent decision (one that is totally within a normal RN scope!!), s/he has little history of doing that and the chances are lower that "the best" decisions will be made...so the decision is criticized and someone says, "see, this is why you have to talk to the charge nurse first." What a set-up! ?

To the spouse who has driven two hours and arrives at 0630, I would have said, "I apologize if we did not communicate very well about the way this usually works: The staff who is going to help get everything set up for you will be coming around this morning; I will let them know you are here." I'm sure a little bit of discussion would ensue, and I would provide the usual (validation/reassurance, etc.), then I would do a little concierge (Get a cup of coffee while he waits, etc.).

If it's true that there is no provider-on-call shift change at 0700, then I would have called. If I knew they would be changing over at 0700, I would have waited and called before I left, after the new person was on call. Either way they just need a brief synopsis of the situation. They don't need to hear play-by-plays...they just need to know that the spouse has arrived and is very stressed about getting back home.

On 6/13/2019 at 7:57 AM, NRNPH said:

Am I wrong for being frustrated with some providers here that get upset but their job is to be on call?

The NP to whom you spoke should have maintained his/her professionalism. But there is a sweet spot as far as: yes, they are on-call so they should take the calls pleasantly...vs. the idea that we don't need to call them for things we can reasonably troubleshoot.

6 hours ago, NRNPH said:

Even though it is not their attending the NP's and PA's discharge for them and have access to their notes. Its hard to tell when they will round depending on their surgical schedules and when you call in the morning, you get the same NP or the PA either way. They have access to charts and notes indicating possible discharges, etc. The NP did say they would pass onto the rounding team this information finally at the end. The only reason this is an issue because they complained they were woken up. In my mind, its 0630-ish, closer to 0700 and you are getting paid to be on call until 0730 so if someone calls, it is still your job to answer.

I hear you that they are on call and are expected to respond and be professional. I appreciate that you were trying to resolve something for a patient. My thoughts are that this is something that could have waited; it would have inconvenienced your patient and their spouse, but it would not have hurt them.

Thank you all for the input! I wish my unit could explain and talk to each other in such a supportive and learning way. Its a practice, always things to learn and a different perspective to see.