When do you call the doc?

I'd run it by another nurse first to get a second opinion. Yes, sometimes you will still call the doc. And sometimes you'll call the doc when it wasn't really necessary. This is one of those skills that take awhile to evolve.

i'd try to get another nurse's opinion; but if you have to call the doc, that's what (s)he gets the big $$ for! i'd rather call the doc & not need him, than to have needed to call, and not. ya know?! they kinda don't look on it too kindly if you don't call the doc when supposed to, especially if anything happens to the pt. i don't know if it helps... i hope it does.

It takes time to learn. As you get into your unit and build a working professional relationship with the physicians, you will learn what to call them over and what can wait until 6am or until they round. Always ask a colleague what he/she would do. Especially folks who've been there much longer than you have (they likely know the physicians very well). When I am at a new facility (agency) I always ask my colleagues what they would do in that situation with this physician. Just remember, that it's ultimately your responsibility to make the decision to call.

When I have been in this position, example. A physical therapist or occupational therapist is working with a patient. They come to me and say so and so is different they just don't seem to be able to follow direction as they did yesterday. I always go look at the patient myself first, take vitals, go to the Mar review medications quickly to see if any doses have been changed or a new medication added since yesterday or in the past couple of days. Then if I do not know the patient well, say it is my first day having them I will quickly ask my co-workers have any of them had them as their patient so as to give me a base line. Finally, I will call a doctor. Mind you this is when it is clearly not a medical emergency but just rather vague. I work day shift so I am lucky in that I do not have to worry about it being the middle of night.

I always trust bouncing things off my co-workers first. It helps me to see if there might be something I have missed, if there is something safely I am able to do to help rectify the situation. Two heads are better than one.

I call the doc when I need something only they can do - example: new meds for pain, some labs, interventions (like giving blood, placing on bipap), etc.

If the situation is serious enough I call the Medical Response team and then the doctor.

So in your example (my pt just doesn't look right) I would consult with another nurse and try to figure out what is wrong. Are they just sleepy from a lot of pain meds and given enough time and watching they will wake up (no call), or are they really sleepy and their respirations dropping to 6 and I really have to rub hard on their sternum to get them to wake up = narcan and then call doc to change pain med orders.

Essentially it comes down to - do I have the tools at hand to solve the problem or do I need more tools? If I need more tools I call the doc.

Hope this helps

Pat

PS you will find as time goes on which docs you can call and which you will try much harder to exhaust all your tools before calling :)

Working 11-7 in a LTC facility I have this feeling all too often! I generally call the MD if I have a resident that I feel needs to go out to the ER for an eval. I get my vitals, get some history on the resident and present to the covering and get the order. Oh, I always call just to obtain T.O.'s for RN pronouncement as well.

I wouldn't call up the MD at 2am to get an order for butt cream, but if it's an emergent situation, I feel it's right. Borderline stuff I usually report to the day shift. For instance, I had a woman with a FBS of 283 this morning. Order says to call MD if sugar > 280. The covering probably would have implemented a sliding scale of insulin coverage. Come to find out when I reported to the day nurse, the PCP didn't want to change any of her diabetic orders from speaking with him on the phone the other day.

It's always a tough judgment call, but usually I call for emergent situations that require immediate intervention at night.

the hospital I work at is great w/calling the MD. Each of our pts is assigned to a team based on diagnosis. So you contact the "team" pager and it's always a resident who answers. This is nice bc I dont have to worry about calling the attending at 3am! So I contact w/any change...weird vitals, pt throwing up, change in resp status...anything that is out of the ordinary for the pt and might be significant.

Thanks everybody - it's very nice to hear voices of experience and reason. evilolive, I sometimes work 11-7 so that really helps. I just dread the experience of calling a doc... I feel so dumb with them -

....annnnd of course I had to call a covering MD to send out TWO residents at the same time this morning ... at 5-6am... ugh.