It’s easy to feel nervous about being a (literal) dream crusher, but keep in mind that the phone call in question could mean the difference between life and death. To help ease your guilt, we asked veteran nurses on our Facebook page for their top tips for midnight calls to MDs.
1.
“In nursing school I was taught to have my ducks in a row…do a good SBAR, and if they complain, to say, ‘What part of me calling about YOUR pt is a problem?’ I have only had to say it once in seven years.”
—Jennifer J.
2.
“Be polite…do not make apologies…state the facts…get your orders…YOU’RE GONNA BE OKAY!”
—Elizabeth F.
3.
“Know the code status, current vitals, meds and diagnosis.”
—Patti S.
4.
“Be prepared with all of the information the provider needs to give orders on the patient. It is okay to ask about possible labs, meds. When you show you are knowledgeable of the patient’s condition, then you will be treated with respect. (Some docs are always grouchy when they are awakened, some are grouchy in the a.m., some in the p.m. They are human like the rest of us.)”
—Krista S.
5.
“Have the chart in front of you. Get a set of vitals right before you call. Any recent labs. Do a patient assessment right before you call. List of things you want orders for. Have pen and paper ready. Spit out gum or food. Speak calmly and distinctly. It’s all in [the] presentation and how you ask. Be professional. Check for standing orders for that doctor first. Many docs have standing orders for headaches, nausea, constipation, etc. He will sign off [the] next day and okay to continue use or not.”
—Edith T.
6.
“Have your ducks in a row. Period.”
—Dawn P.
7.
“The on-call doc should expect to be called. I used to work the night shift and never worried about calling a doctor. These calls are very important for the patients’ well-being!”
—Gail C.
8.
“My advice is to make sure you don’t let the doctor hang up before reading the orders back to them.”
—Amber C.
9.
“First rule, patient comes first. Next, have you facts. Latest vital data, last meds, have the file in front of you, know the patient’s name, bed number and diagnosis. Remember, they chose medicine!”
—Adrienne B.
10.
“Old-school method without hospitalists available: Check for any standing orders, confirm doc on call for the service, consult any other staff [who] may have requests for the doc and have chart to give SBAR report.”
—Paula B.
11.
“Talk fast.”
—Susan K.
12.
“They can smell fear—be confident!!”
—Brenda O.
It’s clear from this advice that preparation and confidence are key when waking doctors before dawn. With these tips and telephone in hand, go forth, nurses, and save lives!
What do you think? Share your tips in the comments section below.
1) Make sure person you are calling is THE ONE ON CALL!!! I get 2 -5 calls a night on my NIGHTS OFF because nurses are too lazy to check the call sheet before making a 1:41 AM phone call and just call me because I am usually on! (I now have to turn my phone off now when I’m not working — hate it because I have kids away at school!)
2) “I’m sorry to call you” is the WORST way to start a phone call. You are not sorry. You are calling because you better have some very important information regarding our mutual patient. I am getting paid to take the call. Just get down to business. (AN MAKE SURE I AM THE ONE ON CALL THAT NIGHT!!!)
3) “Are you on tonight?” is another BAD way to start a call. You should KNOW that I’m on before making the call!!!!
I’ve also discovered doctors DO make mistakes when giving verbal orders over the phone, so if any one is questionable due to the patient’s condition, don’t be afraid to ask him (in the event he hadn’t “thought of it”), and don’t be afraid to ask if he wanted to order a specific lab test if it seems it didn’t cross his mind. Doctors “routinely” spit out orders and sometimes they’re not totally thinking or awake or they might be mistaking a r/o diagnosis. Don’t be intimidated; after all, it’s your patient too, and you’re just as responsible for their well being.
Having worked as a Certified Nurse Midwife who took calls in the middle of the night, the only thing I would add to the wonderful advice, is don’t be afraid to convey a sense of urgency. If you need the provider to come in to see the patient now because you know they are getting worse, rather than waiting until the morning, say so! They may actually thank you some day!