Advice from Kati Kleber (aka Nurse Eye Roll), who’s been there, done that….
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. You become the annoying nurse who wakes them up every time they’re on call, instead of [their] best bud.
(HINT: Doctors [who] 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 [the patient’s] allergies and have their labs pulled up, anticipate [the doctor’s] 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 eight 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 PRNs, 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 three-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.
#5 – Make sure you have scratch paper handy to write down orders. You think you’ll remember it, but then [he’ll give] 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.
#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 seven minutes. I think I’d be pissed too!
#7 – Ask ALL of your fellow RNs 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.
#8 – If they’re grouchy, 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 workup 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 to 50, and when asleep, he’s gone as low as 35. He’s asymptomatic. I’ve also noticed an increase in his PVCs. He had occasional PVCs at the beginning of the shift, and now he’s having 25 per 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) (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
To read more, visit NurseEyeRoll.com.
Learning how to be a great nurse at the bedside while maintaining your sanity at home is no easy task. Becoming Nursey: From Code Blues to Code Browns, How to Take Care of Your Patients and Yourself talks about how to realistically live as a nurse, both at home and at the bedside…with a little humor and some shenanigans along the way. Get ready: It’s about to get real, real nursey. You can get your own copy at NurseEyeRoll.com, Amazon or Goodreads (ebook).