My sweaty palm gripped the phone to my ear. Ring… Ring… I knew he must be in a deep sleep, which made me queasy.
“Hello?” said a gruff voice on the other end.
“Uh, Hello? Yes. Dr. Brown, this is Sarah on 3-East. Sorry to bother you. I’m calling you about Ms. Thompson. Her blood pressure is elevated.”
“What is it?”
I fumbled for the paper in my pocket. It wasn’t there! Oh no. I left it in her room. As I frantically logged into the computer to pull up vitals, he sighed audibly.
“Uh, so at 2100 it was 158/88, and now… 202/91.”
“Did you check the other arm. What is she on for blood pressure? Pain?”
I urgently pulled up the medications list. I’d have to go ask about pain and recheck vitals then call him back. As I hung up the phone, I felt clumsy and incompetent.
Maybe you’ve been there. Calling a doctor, especially at night, can be intimidating. For a new nurse, it is nerve-racking, but even the most seasoned nurse may cringe at the idea of calling certain doctors known for their reputation of getting rude or angry.
I’m here to tell you it gets easier with practice. With this guide, a little preparation, and critical-thinking you can turn a stressful situation into effective interprofessional communication.
Prepare for Report
1. Who Is the Patient?
Be ready with a brief description of the patient to inform the on-call physician or jog the attending’s memory
2. What Is the Problem?
Clearly state why you are concerned and the known or suspected cause
3. Give SIGNIFICANT details
Always have vitals and chart access if possible. The doctor could ask for labs or other information and having it handy could save you.
4. Give Recommendations
Tell the doctor what you think you should do or what orders you would like. If the doctor is coming out of a deep sleep then he may appreciate not having to think so hard.
SBAR format
Stands for: situation, background, assessment, and recommendation. It is not the only tool out there, but a recent article found this method to be effective for communication and patient safety.
Whatever tool you choose, BE BRIEF. Don’t spend the first 30 seconds apologizing for calling. As a nurse, you are the patient’s advocate. Sometimes that means making a call, speaking up, or even challenging a provider when you feel a situation is unsafe or you’re not getting the response you need.
Trust your gut.
When in doubt, make the call.
Think Critically
· Is anyone else in the unit paging the on-call doctor?
If so, team up and cluster your calls.
· Does the call need to be made now?
If yes, then make it. If you’re worried about a patient now it is better to call sooner than later.
In some cases, it might be appropriate to wait until 0500 when the doctor is probably awake.
· Use available resources
Charge nurses, Nursing Supervisors, and more experienced colleagues can help you make a difficult decision. They can give you the confidence to make a tough choice.
And bonus: you will have someone to commiserate with if the call goes south.
When a patient declines or a situation turns urgent, contacting the physician should not be worrisome. Using your nursing judgment, critical thinking, and preparing ahead, you can command the situation and make the call productive. Using this ultimate guide will help you gain the respect of colleagues and promote positive outcomes.
