. Good one.
No, its not some random attending. And yes, they do notice.
Cool story, bra, but orders are generally not clarified very well. So yeah, by law, I'm supposed to call you and get such clairified (no matter the time). If Im doing a 24 hour chart check at 2am and I cannot read your
chicken scratch writing about NG's to gravity or suction, you are most definitley getting a call. Give me attitide and I will probably turn you in to the supervisor.
🙂
Its your job. do it.
Ah, but therein lies the rub. It's actually
not my job. You have to realize that there's a huge disconnect between what the nurses jobs are and what the overnight resident's job is. At most places the overnight intern/resident is carrying multiple pagers, covering many patients who are not his own. His job is to keep all the patients alive and not in excessive pain throughout the night, to make sure all the labs got ordered, to follow-up on a handful of things the day team couldn't get done and signed out to him, and to make sure patients get whatever bowel preps and hydration and stopping of anti-coagulation meds, etc such that they can get whatever procedure they are scheduled for in the morning. And that's it. They are hugely overworked just to accomplish those tasks most nights. And by orders of the attendings, chiefs, etc, that is all the nighttime shift ought to be doing.
The nurses, by contrast, tend to have a lot less to do once their patients go to sleep, so the nursing administration, in its infinite wisdom, has decided that that's the perfect time for them to do a chart review. Which is fine if folks flag things for the day team to follow up on. But not such a good idea if it means they are going to call up the overnight doctor at 3am to ask him what the daytime team meant. That may be
protocol, but it's protocol for nurses, not for the doctors. It is NOT "by law". Sorry, but if they told you that, they lied. It is one groups job (the nurses), but not the other's. So there's a conflict built into the system. It's put there because nurses work shorter shifts, and when the patient's are tucked in bed asleep, they have downtime that the hospital wants to utilize, and they didn't think through the consequences on the poor overnight docs who have to field these calls. Honestly, if it doesn't involve patient care for
that night, the daytime team really should handle it the next day. It's simply inappropriate for a night time doc to be starting new courses of treatment for patients in the middle of the night, and not appropriate (and often malpractice) to try to decipher the scribbles of someone who is going to be back in the hospital before the patient needs the medication anyhow.
The better nurses save the issues that don't have to be addressed that night for a morning call. The less keyed in ones make multiple calls throughout the night. But don't get confused -- while you may feel it's your job to make those calls, it is often NOT the poor SOB on the other side of the line's job to attend to those calls. He has been given his own set of marching orders and they almost certainly don't align with yours, because his role is to maintain the status quo until the cavalry arrives, not unearth new issues to deal with.
