I decided to reblog this post 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 actually breaking his arm. After a few shifts, you’ll feel like freakin Harry Potter flyin’ around that Quidditch stadium. So, pretend I’m that Hogworts Professor we never see again for some reason, teaching you how to hop on your broom for the first time…
I worked nights as a new grad. It’s great because you have time to learn, but it sucks because the only time you get to know physicians is when you call them in the middle of the night and piss them off. You become the annoying nurse that wakes them up every time they’re on call instead of your best bud.
(HINT – doctors that become your best buds and trust you are AWESOME)
To make it a little less painful, here are some hints.
#1 – Don’t immediately apologize for calling them. Yes, it sucks you had to wake them up, but it’s their job and you’re just doing yours. It’s all business.
#2 – Don’t get nervous and just say the patient’s name and ask your question. This 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 brief summary of the patient’s main problems.
#3 – Be prepared. 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 morphine PCA on the lowest setting.
#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 40’s and he tells you he doesn’t care, ask when he wants to know and write the order.
#5 – Make sure you have scratch paper handy to write down orders. You think you’ll remember it, but then he gives you 4 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.
#6 – Don’t page and go do something else. Nothing makes them more upset than waiting on hold while you finish getting someone off the bedpan for 7 minutes. I think I’d be grumpy too!
#7 – Ask ALL of your fellow RN’s if they also need to speak with that doctor . Another thing that, rightfully so, pisses 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 pissy, 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 feel like crap 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, so there!
EXAMPLE OF HOW CONFIDENT AND AWESOME YOU WILL BE:
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