The Nurse’s process of Calling Doctors at Night:
one of the tasks that a nurse dreads doing is calling up doctors at night. There’s a big fear of being scolded or being thought of as stupid by both the doctor and the rest of the medical team. But it’s actually a very vital part of your duty as first-line contact with the patient. Here are tips to help you become more confident about picking up that phone in the middle of the night!
KNOW YOUR MEDICAL BASICS
In assessing patient status, you should be able up know the difference between normal and abnormal findings. Constantly reading up and reviewing your theoretical medical knowledge will help you understand if a patient’s behavior is expected in his/her course of treatment. For example, surgical patients fresh from operation are expected to experience pain and some minor bleeding but they should not be having fever or passing out whitish stool.
CREATE A SYSTEM
Calling at night should only be reserved for medical emergencies. Unnecessary calls can be limited if you create a system to avoid them. It is a general rule to ask all your concerns or clarifications during work hours. If non-urgent, it is also better to message the doctor first and ask permission if you can call to clarify. It is also good to ask the doctor on what conditions or situations should they be contacted for a specific patient.
ASSESS IF CALLING IS NECESSARY
It’s also important to ask yourself is if you should really contact the doctor. Things such as request for additional supplies or patient complaints should first be handled by you or your nursing supervisor. You can also ask peers initially about illegible orders. A removed IV line can be reinserted by the nurse, depending on the hospital policy. In general, you should first exhaust all possible and reasonable means to address the situation if it is within your control. Contacting the doctor becomes necessary for cases wherein a decision has to be made, information impacts or may change treatment process, the patient is showing changes in mental status, or when patients are refusing treatment of a doctor’s previous orders.
ASSESS IF THE INFORMATION NEEDS TO BE RELAYED ASAP
The nurse should also assess if the concern is urgent or not. Although a patient transferring rooms is important for the doctor to know, this can be relayed via email or messaging. Relaying slowly decreasing input and output monitoring but with stable vital signs may be delayed and addressed in the morning. Urgent information that should be relayed regardless of time of day includes sudden patient deterioration, escape, and other medical emergencies that require immediate decisions.
KNOW WHO TO CALL
Once you decide that a call to the doctor really is necessary, you should then determine who you should be calling. It is common for patients to have multiple doctors or to have residents on call to assess the situations first and report directly to the attending physician. If there are residents in the hospital, they should be the first to know about what is happening to the patient. The call should also be directed to the doctor or service that has jurisdiction over the concern. For example, concerns about sudden spike in blood sugar should be relayed to the endocrinologist while infection of a surgical site should be relayed to the surgeon. General patient concerns such as request for discharge against medical advise should be relayed to the attending physician.
KNOW ALL THE FACTS
Before making the call, gather all the relevant information you may need to relay. Basic things to have in hand are the vital signs monitoring, the latest laboratory results, the list of medications, latest changes to treatment, and the doctor’s last orders. Having them with you will help you answer the questions the doctor may have regarding your update. You should also organize all your questions and concerns so that you will only have to call once.
DELIVER THE MESSAGE
It is best to keep your message as short as possible. Be direct to the point and avoid small talk so that you both don’t lose precious time. Of course don’t forget to greet the doctor, introduce yourself (including from what hospital you belong to as some doctors practice in multiple hospitals), and the give relevant information on the patient you are referring to (specifically name, age, sex, room number).
A common method for giving updates is the SBAR (situation, background, assessment, recommendation), with 1-2 sentences summarizing each component. In using SBAR, you begin with the situation or the reason you called in the first place. You then give some background through relevant events that led to the situation. You then provide your best assessment of the situation or the patient condition, and you give a short recommendation that can be acted upon and ask for the doctor’s orders. An example of an SBAR update is as follows:
“(intro) Good evening Dr X, this is Nurse Y from Z Hospital.
(situation) I am calling because patient A, 27/F, room 301 had a seizure.
(background) Her vitals were stable the whole afternoon but she became irritable around 1 hour ago and her companion noticed her limbs trembling for about 5 minutes before reporting to me.
(assessment) Seizure has stopped but is still unresponsive. Vital signs remain stable at BP 120/80, HR 90, RR 20.
(recommendation)You should see her as soon as you can.
(request for order)What do you want me to do at this moment?”
DOCUMENT THE ORDER
Oftentimes, doctors will ask more about the patient status so you should have those information at hand. You should also always have a pen and paper with you so that you can write down once the doctor starts to give orders. Write them down clearly so that you don’t forget and you don’t have to call again. Also, always read back the order to ensure that you understood correctly. Don’t forget that verbal orders should be documented in the chart so that other members of the medical team will know what happened and what interventions have been given.
GIVE FEEDBACK ON THE ORDER
If an order was given for you to carry out, report back to the doctor on the order’s completion and presence of any side effects. If non-urgent, this feedback may be given by message or email for the doctor to see upon waking up.
The doctor, as head of the medical team, is often appreciative of relevant updates of their patient’s status. The most common reason doctor’s get mad at night calls is if they believe it was not necessary, so make sure you followed our tips in determining the need for making the call.
If they do get mad at you or sound cranky in the middle of the night, don’t take it personally. Most likely they are just tired as doctors often crave for rest. Don’t let your fear of confronting a doctor distract you from your duty as nurse to protect the interest of the patient!