When do you know to call the doctor?

[missmollie, ADN, BSN, RN]

I'm in orientation, on my 7th week, and I feel like every week I'm presented with new issues concerning patients. Having patients with different issues is wonderful, but only because I have my preceptor there.

I am now calling doctors and talking to them about issues that arise. I seem to be calling the same service a few times a day, and with each new lab value, I feel that I have another compelling reason why there might be an issue.

So as an experienced nurse, when do you know a call needs to be placed? What questions do you prepare yourself for before calling, and when do you stop and think you might need more information? Are there any processes or questions you think through before calling the doctor, or does it just take some experience?

Thanks in advance. Any opinions or thoughts can only make me a better nurse. I appreciate it!

[NOADLS]

If you are on the fence, consult your charge nurse. If you are on the fence, it doesn't hurt to call the doctor. But if you don't call the doctor and something adverse does happen while you had every opportunity to call the doctor beforehand...

I would also advise you to have all of your assessment information before calling the doctor. If you are unsure of whether or not you have all of the assessment information, either consult the in charge nurse or proceed with the call. If the doctor asks for something and you don't have it on hand, take it as a learning experience that you need to work on your assessment skills.

[CocoaLoverFNP]

Remember SBAR when calling the doctor:

S - ituation (I am calling you because of your patient's low SBP in the 80's)

B - ackground (Room 7, John Doe, admitted for chest pain, EKG was normal on admission, BP 200's on arrival in the ER yesterday, given labetalol, hydralazine, clonidine, and nitro paste yesterday as well, last dose this am)

A - ssessment (Alert, oriented, no pain, no dizziness, appears relatively asymptomatic, completet set of VS, etc.)

R - ecommendation (I suggest 250cc NS bolus now and reassess. Would you also like me to hold his scheduled metoprolol at this time?)

As far as knowing when to call doctor, experience is really the best teacher for that (when you absolutely have no idea!). However, when in doubt, ask your charge RN or experienced nurses whether calling the doctor is warranted.

[jessRN465]

I work on day shift, and labs are drawn early morning so that when our doctors round, they are able to see them. I never call the doctor prior to rounds (unless very serious obviously!!) because they will be up on the unit (always prior to 8am).

I call for the following reasons *if ordered after rounds or results after rounds completed*

-results from a lab (only if abnormal)

-results from a study (ct, X-ray, etc)

-requesting a medication or care (inserting/removing foley, for example)

-change in patient status (increase in BP, LOC, etc)

-if family or pt is asking questions I can't answer and requesting I ask a doctor

-if my task list says notify Md

It's really on a patient to patient basis though..

[Adele_Michal7, ASN, RN]

I agree with previous posters, especially re: waiting for doctors to round on non-emergent issues.

If labs come in and they aren't STAT labs or critical values, I usually know they can wait for when the hospitalist makes rounds.

If there's a STAT lab that comes in or a critical value, I will inform the MD regardless of whether they are in house, or I need to page them.

I try to cluster MD notifications. Since I work on a unit with another nurse, we make every attempt to coordinate before we call a hospitalist or MD. Calling for two issues at once is better than calling separately.

Oh, and don't forget to ask to whom you are speaking with. Lol. It's easy to do when you are first starting out.

[mmc51264, BSN, MSN, RN]

we have a text paging system which is great b/c we can send and "FYI" page for a lab value, etc. Also, we can do a mini SBAR so they be prepared when they call back. You will learn what warrants what level of contact :)