I decided to reblog this post about Guide to Calling Doctors at Night for all of you that just graduated nursing school, getting ready to start your first real nursing job (probably on nights) that have never had to call a physician in the middle of the night.
The first time you do it, you’ll feel like Neville Longbottom the first time he got on a broom, almost breaking his neck and breaking his arm. After a few shifts, you’ll feel like freakin Harry Potter flyin’ around that Quidditch stadium. So, pretend I’m that Hogwarts Professor we never see again for some reason, teaching you how to hop on your broom for the first time.
(HINT – Doctors that become your best buds and trust you are AWESOME)
The nurses spend a large part of their major years in night shifts. They are inevitably going to call a doctor sometime at night. Learn how to call doctors effectively to save yourself some time and effort and help patients get better faster. To make it a little less painful, here are some hints.
#1 – Don’t Immediately Apologize for Calling Them
Yes, it’s not good you had to wake them up, but it’s their job, and you’re just doing yours. It’s all business.
Doctors are used to it, and they expect you to call at night once in a while. Doctors must pick up the phone when they are needed. So, don’t apologize for calling doctors at night.
#2 – Don’t Get Nervous and Just Say the Patient’s Name and Ask Your Question
If it is the on-call doctor, they may not be familiar with your patient. If you’re not sure, first ask if they are familiar with your patient. If they’re not, give them a summary of the patient’s main problems. It’s very important to give them a brief summary of why the patient is in the hospital before jumping into what you need. They have to have some background first before being able to give you an educated response.
#3 – Be Prepared for Everything
Have a fresh set of vitals, know their allergies, have their labs pulled up, anticipate their questions, and be in a quiet area because they’re probably half asleep and will talk softly. If possible, know what order you want.
For example, if they haven’t voided in 8 hours after a foley was D/C’d, anticipate an order for a straight cath if their bladder scan shows more than 500 ml. If they’re in terrible pain after a thoracotomy earlier that evening and it’s not controlled at all despite all of your PRN’s, anticipate (or suggest if asked) a PCA on the lowest setting. They will appreciate it if you anticipate their questions.
Because the on-call doctor needs to stay awake and get as much information as possible, don’t make them go through every detail you can think of. Be specific and tell them all you need quickly instead of trying to give them a long, drawn-out story.
Brevity is key.
#4 – If It’s a Recurring Problem, Ask Them When They Want to Be Notified Again
If you’re calling because they had a 3-second pause and their heart rate is in the ’40s, and he tells you he doesn’t care, ask when he wants to know and write the order. Get an order for it because if you don’t get an order for it, along with how often, the nurse on the next shift will just be in the same situation … calling to notify for the exact same issue.
#5 – Make Sure You Have Scratch Paper Handy to Write Down Orders
You think you’ll remember it, but then she gives you four unexpected med orders, and your tech is trying to talk to you while you’re on the phone, and now you’ve forgotten them all before you’ve hung up. If you don’t write down the order, you can easily forget it.
#6 – Don’t Page and Go Do Something Else
If you’re waiting for a call back, don’t go to something you cannot be interrupted during… or leave the unit. Don’t call and then leave to get coffee, or pull a sheath and are stuck holding pressure. Then, you’re playing phone tag and it’ll take even longer to get your need addressed.
(Now, it occasionally happens where you page and something unavoidable happens, but that’s the exception and not the rule!)
#7 – Ask Your Colleagues If They Also Need to Speak with That Specific Doctor
Another thing that, rightfully so, bad them off is multiple calls from the same unit about things that could have all been asked in one call. Just like we can’t stand being constantly interrupted while passing meds or doing an assessment, they don’t like being interrupted dealing with other patients or finally getting sleep after a really long day.
#8 – If They’re Mad, Don’t Take It Personally
The sooner you figure that out, the better. Doctors can get mad and rude, but that doesn’t have to make you terrible for the rest of the shift. Maybe they had a patient they had been heavily invested in die earlier that day, maybe their kid won’t stop crying, and he had just fallen asleep, or maybe they’re just awful. But you’re not!
You know you did everything right to help your patient, and sometimes things just happen. Often, they’re not upset with you personally. You may need to command a little respect, “Hey, Dr. Smith I get that you’re upset but my protocol requires me to call you within 30 minutes of an alert lab value, regardless of the time of day.”
#9 – Be Polite, Clear, and Concise
Make sure that you stick to the point, avoid rambling, and are clear about what changed or what you need. Don’t provide minimal information and then demand answers. However, if you’re new, what’s important might be difficult to distinguish from what’s a lower priority or irrelevant. This balance takes time to learn, so give yourself some grace as you learn what truly is pertinent and how to communicate it concisely.
#10 – Express gratitude
A quick, “Alright, thanks Dr. Smith,” goes a long way. Don’t be overly glowing or gushy. That’s unnecessary, but a quick show of appreciation is helpful whenever a team works together to meet a common goal: Caring for a patient.
RING RING!! RING RING!!
“This is Dr. Smith. Someone paged?”
“Hi Dr. Smith, this is Jaclyn Evans from the observation unit. I have a question about the patient Edward Godwin in room 8123. Are you familiar with him?”
“No. Who the hell is that?”
“He came in yesterday for chest pain and is here overnight for observation. His cardiac work-up thus far has been essentially negative. He is scheduled for a stress test in the morning. His only history is GERD and HTN. I’m calling because he is bradycardic. When awake, his heart rate is 45-50, and when asleep, he’s gone as low as 35. He’s asymptomatic. I’ve also noticed an increase in his PVC’s. He had occasional PVC’s at the beginning of the shift, and now he’s having 25/minute.”
“What was his mag potassium this morning?”
“K was 3.2, Mag 1.6 and replacement was not administered. It looks like he received his scheduled HCTZ and lasix this morning and has voided approximately 2.5 liters since 0700 today.”
“Draw a STAT BMP, give 40 mEq PO potassium x 1 dose and a mag rider of 2 gm IV x 1 dose. Call me back if his K is less than 3.0”
“There are no labs ordered for tomorrow. Do you want a BMP in the am as well?”
“Great. And his heart rate?”
“I don’t care.”
“How low can his heart rate get before you want to be notified?”
“As long as he’s asymptomatic, I don’t care.”
“K thanks bye!”
“GRrrrrr…” (grumble, grumble) (hangs up)
Orders you would enter:
BMP in am
magnesium sulfate 2 gm IV x 1 dose now
40 mEq potassium PO x 1 dose now
Call if K+ is less than 3.0
Call with symptomatic bradycardia, do not notify for asymptomatic bradycardia