When To Call The On Call Doctor

[MJ48]

I have been working at a LTC for about a year now as a new grad on the day shift. Over the past couple days I have a resident who has been having a fluctuating temp with a cough. I did a chest assessment. Airways clear, no abnormal breathe sounds present. The resident did not show signs of pain or express any concerns. When I took her temp during my shift I think it was 35.7. The night shift nurse reported to me that I need to call the on call doctor because the resident has pneumonia. However, I did not. One at that time I did not think it was warranted. Second one of my RPN's called in sick. So I had to do the morning and noon pass and for me to do it safely it took me a good few hours. Also being the RN the PSW staff comes to me several times to ask for stuff and asking me to do things. Right around the end of my shift the resident's temp went back up. Since it was the end of my shift I had passed all the relevant information to the on coming RN and left the decision up to her, if she wanted to call the on call doctor. But now I feel like I should have the doctor and that I passed the buck to the on coming RN. Was I wrong not to call the on call doctor.

[brownbook]

First of all....is the patient okay? It doesn't sound like the patient was in acute distress. Yes ideally you should have called the doctor. I can sympathize with your messed up shift.

I am really impressed by your NOT coming here to whine, make excuses about it wasn't your fault, blah blah blah. You know you should notified the doctor, you feel troubled by what happened. Give yourself credit for admitting your maybe "error" in judgement.

[kaylee.]

Well you concluded no call was warranted during your shift. At very end of shift a temp of 102 should be called, but the RN to do it is the gray area.

In these cases I usually offer to put a call out for them to take over. Easy because u are headed home.

I guess the situation and whether you should have called depends on the details: a 4pm temp of 102 should be called by you at the time. However a 7pm temp just happened. Also, if cultures already were done and there have been ongoing temp spikes, and the pt not in distress...this is nursing judgement.

Its also about teamwork: u placing the call is out of courtesy even though they could do it.

[ChryssyD]

Well, I won't mince words. Yes, you should have called the MD. You clearly had concerns (rightfully), and yet you chose not to inform the doctor. Never be afraid to kick a problem upstairs--there is a reason doctors make so much more money than nurses do. They are expected to make hard decisions.

Maybe a fever and cough is a run-of-the-mill virus. Maybe it's the flu. Maybe it's pneumonia. That's not the nurse's call--it's the doctor's. Let them deal with the unknowns. Your job is to alert them to possible problems, not diagnose illness. You aren't sure it's pneumonia? So what...let the doctor make that call. That's his/her job, not yours.

[amoLucia]

''When in doubt, err on the safe side".

I'd have called.

[psu_213, BSN, RN]

First, what is an RPN? Just curious, I've never seen the abbreviation before.

It probably should have been called. If the pt has a negative outcome, it does not look so go for you to say "I told the next nurse she should call." If nothing bad happens to the patient--great! but in the interim, you have the peace of mind knowing that the doctor is aware.

[missmollie, ADN, BSN, RN]

You did your assessment and chose not to call the doctor based on that assessment. I think your decision was fine. Until there is an issue, you don't call the doctor because there is a change in the patient's condition. Often there are nursing interventions you can use to negate a call to the doctor. Don't second guess yourself.

By the end of shift, that might have warranted a call. I agree with other posters on calling before you leave, but only if you felt it was necessary. Don't let someone else try to tell you how to do your job. You are the nurse and it is your call.

[Horseshoe, BSN, RN]

I have been working at a LTC for about a year now as a new grad on the day shift. Over the past couple days I have a resident who has been having a fluctuating temp with a cough. I did a chest assessment. Airways clear, no abnormal breathe sounds present. The resident did not show signs of pain or express any concerns. When I took her temp during my shift I think it was 35.7. The night shift nurse reported to me that I need to call the on call doctor because the resident has pneumonia. However, I did not. One at that time I did not think it was warranted. Second one of my RPN's called in sick. So I had to do the morning and noon pass and for me to do it safely it took me a good few hours. Also being the RN the PSW staff comes to me several times to ask for stuff and asking me to do things. Right around the end of my shift the resident's temp went back up. Since it was the end of my shift I had passed all the relevant information to the on coming RN and left the decision up to her, if she wanted to call the on call doctor. But now I feel like I should have the doctor and that I passed the buck to the on coming RN. Was I wrong not to call the on call doctor.

Okay, not calling because your assessment shows no reason to suspect a deterioration in the patient's condition is a legitimate excuse for not calling the doc. However, the rest of your reasons for not calling (bold was my emphasis) are NOT legit. Being too busy will never get you off the hook if you have missed something.

Since, according to your own post, the patient's temp spiked right "around" the end of your shift, I would absolutely have called the doctor rather than leaving it up to the oncoming nurse. Do I think it's a black and white issue that could get you in huge trouble? Probably not, unless the oncoming nurse did not let the doc know and there was a bad patient outcome. In that situation, both of you would probably be held accountable.

I agree with an earlier poster: "When in doubt, err on the safe side."

[canoehead, BSN, RN]

If its in your assessment, then you make the call. I would take exception to an offgoing RN telling me to make a call based on her assessment.

[MJ48]

First, what is an RPN? Just curious, I've never seen the abbreviation before.

It probably should have been called. If the pt has a negative outcome, it does not look so go for you to say "I told the next nurse she should call." If nothing bad happens to the patient--great! but in the interim, you have the peace of mind knowing that the doctor is aware.

In Ontario, RPN, stands for licensed practical nurse.

[MJ48]

If its in your assessment, then you make the call. I would take exception to an offgoing RN telling me to make a call based on her assessment.

If I had to do it all over again I would call the on call doctor. The on call doctor was eventually called and the resident is doing fine. The doc gave a script for abx for I think about a week.

I did question in my mind why the off going night nurse didnt call the on call doc herself if she felt it was warranted. When I did my assessment I did not find anything that warranted a call. I probably should of asked her why she didnt call herself. In the end the resident got the care she needed and is doing well.

[Have Nurse, ADN, RN]

Yes. You received report and were given important instructions. You are not there to diagnose. It was good that you checked her lungs but as you are a new grad, you do not have the background to truly understand lung sound changes which can happen rather quickly. Next time listen.