Is it permissable to ignore a page?

[coolman12]

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Another med. studnet and I were on call the other night and it was a rather slow night and were watching a football game on tv. He got a page the other night from a nurse with a request for an order and blew it off saying it wasn't necessary. He didn't bother to reply and ignored the page. I was a bit surprised by his reaction because it wasn't like the nurse was requesting something completely absurd (I've heard about and have experienced those pages before). Is this professional to do so and will it give him a bad rep? I've gotten my share of good and useless pages and I can't reply to them all or I'd go loony, but if I got a page from someone who is respectable and doesn't throw pages at me like darts, i'd atleast respond. Your thoughts?

 

[smq123]

Definitely not professional. DO NOT get in the habit of doing this. You should respond to pages and not blow any of them off.

Why are nurses paging students for orders anyway?

 

[Winged Scapula]

Like smq, I'm not sure why nurses are paging students for orders. The below is meant more for residents but is a good lesson for students:

Pages should not be ignored. In the example provided, it appears to me that the student ignored the page because he couldn't be bothered during the game. You have no idea when a page is bogus or not, or whether the order is necessary. Just because "nurse X" has a reputation for calling with BS, doesn't mean that she will every time.

The liability remains with you if your ignore a page and something goes wrong. Believe me, these nurses are documenting "paged Doctor/Student X and they didn't answer". Looks bad in a court of law. I wouldn't want that to be me and it damn well better not be on any of my patients. 😡

Besides, you ignore a page and they just keep paging. If not you, someone else. And it gives you a lazy reputation; once reps are earned they are hard to change.

The only acceptable excuse for not giving a prompt response to a page is in a code/trauma/doing a procedure situation. Those calls should be returned as soon as you can, or have someone else return them for you.

 

[Frugal Traveler]

Many medical students are younger and have never had a real job. On the wards gets blurred with school... in reality, when you are on the wards, treat it like a job. Be professional at all times to every staff member.

I was paged by accident once for a patient emergency when the intern should have been paged, so bottom line is if you have a pager, then ANSWER IT. You never know when stuff like that is going to happen.

 

[tetris]

A nurse once accused me of not answering a page (she told my attending about it) when in fact I never heard one. During my lunch break, I went to the office that gives out pagers to have them make sure it was working properly. It was, and I told my attending that I had it tested. She said the nurse must have been in a bad mood.

 

[Ludicolo]

No.

Why are nurses paging students for orders anyway?

I'm guessing they were on a sub-internship.

 

[NarcolepticRN]

At my facility we have the option of paging STAT, callback, or FYI. Many many pages are FYIs. Often I get called back anyway cause our docs are just that good. If I WERE to page "callback", I expect to hear back. If I don't, I assume the doc was tied up. As long as we communicate at some point about whatever issues I'm concerned about, I'm not going to put the doctor's name all over the chart for not getting back to me right away. In general I trust that I'm not being inappropriately dismissed. However, if I page STAT and I don't hear back right away, I might call a rapid response (since a patient tanking is pretty much the only reason to page STAT).

 

[Apollyon]

Not answering a page almost got a fellow intern fired when I was prelim IM (behavior like that made it clear why he didn't match for prelim, although he had matched for ophtho). At Duke, you can - clearly - be fired for not responding to pages. First is oral reprimand, then written, then final warning, then discharged. This is summary and unappealable.

(I was categorical at Duke - prelim was elsewhere.)

 

[ANCAdoc]

At my facility we have the option of paging STAT, callback, or FYI. Many many pages are FYIs.

What a great system. This should be more widely used. Occasionally, I will get text pages from nurses just to give me a heads up about something that is a formality. I absolutely love that. Doesn't waste my time and doesn't waste theirs. To have a system such as yours would be even better, particularly when on call.

 

[SoCuteMD]

Nope, I return every page no matter how many times that nurse has paged me in the last hour. It may be nothing, but it may be something.

I was quite amused when my senior was paged while we were eating lunch and running the list, returned the page, and the nurse informed her that I hadn't returned my page (my pager had been silent for about 1/2 an hour).

 

[dragonfly99]

No he should have answered the page, unless it was just an FYI type of page.
When I did internship if we didn't answer a page that would get us into deep sh-t. Even if we DID answer our pages, if a nurse said we had not, that would get us into deep sh-t. This med student could get in big trouble if he doesn't change his ways and this wasn't an isolated incident. Sometimes you just get paged for dumb stuff...it comes with the job. Not all nurses are as nice as NarcolepticRN....

 

[gutonc]

I'm guessing they were on a sub-internship.

So what? They still have no legal responsibility for patient care and can't write orders. Sure, you can make an MS4 feel important by paging him/her but you might as well be paging the echo tech for all the good it will do you.

To the OP, ignoring a page is NEVER appropriate. If it's not directed at you, redirect it. If it's a BS page for a K of 3.4 @ 3am, you answer it. Period. You can get all pissy if you want but you still answer it.

 

[maceo]

A nurse once accused me of not answering a page (she told my attending about it) when in fact I never heard one. During my lunch break, I went to the office that gives out pagers to have them make sure it was working properly. It was, and I told my attending that I had it tested. She said the nurse must have been in a bad mood.

at my place where i trained the institution kept track of all pages sent and received and whether it actually was received. So you could call paging operator and verify who paged and exact time.

 

[Winged Scapula]

at my place where i trained the institution kept track of all pages sent and received and whether it actually was received. So you could call paging operator and verify who paged and exact time.

Ours too. Saved my butt on at least 1 occasion when the nurses were paging another resident with the same last name and claimed I wasn't answering.

 

[chitown82]

So what? They still have no legal responsibility for patient care and can't write orders. Sure, you can make an MS4 feel important by paging him/her but you might as well be paging the echo tech for all the good it will do you.

To the OP, ignoring a page is NEVER appropriate. If it's not directed at you, redirect it. If it's a BS page for a K of 3.4 @ 3am, you answer it. Period. You can get all pissy if you want but you still answer it.

While we don't have any legal role, I think it's great when Sub-Is are given some responsibility and are paged by nurses. On my Sub-I, the nurses page the M4 directly with most issues/questions. We would then put in orders (if appropriate) and discuss them with our senior who had to co-sign them. When you are trying to function as an intern, you want to know everything that is going on with your patients. If the nurse pages the senior and he/she is not sitting next to you, it is inevitable you will miss things (Mr. Brown's sugar is high, his pressure is low, he is in pain) unless your senior goes looking for you. Later when you are rounding and your attending asks how Mr. Brown's glucose control has been, you happily report "just fine" when this may not be the case at all (and the senior has to jump in, making you look lazy).

 

[Top Gun]

Many pages are BS, and are definitely a royal pain. But sometimes one can come in that suggests that the patient is going south. And even if a page is BS, if you don't answer it, the nurse can complain to someone senior to you, and you will get crapped on. You will also get a rep as a lazy resident/sub-I. So answer the page, no matter what.

 

[SocialistMD]

At my facility we have the option of paging STAT, callback, or FYI. Many many pages are FYIs.

I was trying to avoid this, but in my opinion/from my perspective (that of a surgery resident), there is nothing worse than an FYI page. Information I need requires an action on my part. If that is not the case, the page is unnecessary noise. I really have wracked my brain trying to figure out when an FYI page (I'm not including trauma pages, even though they are technically FYI pages) would ever be beneficial when I'm on in-house call (I can see the benefit if I'm getting ready to leave and I find out a patient will be here in 30 minutes or so), and I can't ever see the necessity of an FYI page about a floor patient. Without hijacking this thread, anyone care to share some good reasons for FYI pages?

 

[Winged Scapula]

FYI: your patient is in the room (OR)

FYI: your patient is back from CT scan

FYI: patient in room 241 needs scripts to go home

FYI: admission for Attending X has arrived on floor and is in room X

FYI: cookies in break room 😀

I can think of a fair few...

 

[dragonfly99]

Agree with WingedScapula...there are lots of examples of helpful "FYI" pages. Of course,they CAN be overdone. I think the one about cookies in the breakroom is one I could do without...I mean just having my pager go off elicits a negative-type Pavlov's response...LOL!

 

[HerBigBrownEyes]

I definitely agree with what everyone has said, you must always answer a page. However, I have been paged on multiple occassions while I'm "off duty" because a nurse mistakenly thinks that I am on call/on duty. Some of these have been post-call. Typically, I leave my pager in my car when I am not on duty (along with my white coat). I've never gotten in trouble for this, but I wonder if what I am doing is wrong. I was wondering how others handle this situation or what liability it is to not respond to a page during the protected "post-call" period.

 

[SocialistMD]

I don't think we have the same definition of FYI.

FYI: your patient is in the room

Not an FYI. Requires you to go to the room/start the case.

FYI: your patient is back from CT scan

Not an FYI. Requires you to look at the CT scan/plan an intervention (usually this page is accompanied with "Can the patient eat now?" thus further disqualifying it).

FYI: patient in room 241 needs scripts to go home

Not an FYI. Requires you to write orders.

FYI: admission for Attending X has arrived on floor and is in room X

Not an FYI. Requires you to go see the patient.

FYI: cookies in break room

I'll grant you this one, but nurses at our hospitals don't page residents to share food...
😉

 

[Apollyon]

I definitely agree with what everyone has said, you must always answer a page. However, I have been paged on multiple occassions while I'm "off duty" because a nurse mistakenly thinks that I am on call/on duty. Some of these have been post-call. Typically, I leave my pager in my car when I am not on duty (along with my white coat). I've never gotten in trouble for this, but I wonder if what I am doing is wrong. I was wondering how others handle this situation or what liability it is to not respond to a page during the protected "post-call" period.

This was a Duke bummer - you had to have your pager on ALL THE TIME. Only time off was when you were on vacation. That is it.

 

[NarcolepticRN]

I don't think we have the same definition of FYI.

I agree. I think we don't have the same definition of FYI.

From a nurse's perspective, that is exactly what these pages mean--"for your information, pt X is back from CT, therefore please do what you will, but I do not require a callback". In many cases an FYI is intended as a courtesy. Sometimes an FYI will report a change in a patient's condition that is of questionable importance--"pt Z whose HR has been 105-115 x 24 hours is now throwing PVCs. Her K of 3.7 wasn't repleted yesterday. She's asymptomatic" I'm not necessarily concerned about this patient, but I don't want to assume that the doctor wouldn't want to do something. If I don't hear back or get an order, I'm fine with that. The page was just a heads up.

 

[Winged Scapula]

I don't think we have the same definition of FYI.

My idea of an FYI page is a page which doesn't require a call-back, not necessarily one which doesn't require you to do anything. There are few of those (ie, even a "your patient's labs are normal" requires you to do double check and make sure). About the only one I get these days are, "your patient has gone home" (since I round early and then leave the hospital, I ask them to text me when the discharged patient has actually left).

 

[Winged Scapula]

This was a Duke bummer - you had to have your pager on ALL THE TIME. Only time off was when you were on vacation. That is it.

Yep, we were expected to leave our pagers on post-call for exactly this reason...the nurses couldn't figure out who to call (for some, still to this day, unknown reason) and would often page the person writing the orders.

 

[SoCuteMD]

This was a Duke bummer - you had to have your pager on ALL THE TIME. Only time off was when you were on vacation. That is it.

My hospital apparently has this policy as well, but we were only very vaguely informed of it at our program orientation. The conversation about it went something like, "Official hospital policy is that you have your pagers at all times, the program is willing to use direct phone numbers in lieu of that." I quickly handed over my cell phone number to the program and shut off my pager, but I'll be in trouble if the higher-ups in administration ever try to get in touch with me.

I was never told that we were required to return pages post-call, so I'm not sure what the deal is with that. I try to remember to make sure my patients charts have the "coverage" pager in then as well as my direct pager - that makes it easy for the nurses to find whoever is covering. It also avoids the barrage of pages you get ALL DAY when you are on call for a particular team.

 

[EternalMD]

My last night float coverage, I made it a point to write down "night float" next to my pager on every note and order i signed. Despite this effort, i still received an annoying number of pages post-call. There is only so many times that you can answer a page saying "i was just night coverage, please call the primary team". This isnt something only nurses do - once i received a call from a fellow resident paging to ask me if its okay to change the pain order on his patient.

 

[lord_jeebus]

Where I did internship, all pages had to be sent through the hospital's web paging system - and the IT guys had it set so you could disable having pages sent to you post-call or on days off - the nurse would get your "vacation message" (eg. "please page ____ for ICU patients today") instead of the option to send a page. I don't know how I would have gotten by without it.

 

[SocialistMD]

I agree. I think we don't have the same definition of FYI.

My definition is the 10pm page to the in-house call resident (not from a nurse, but from the comm center):
"Pt xxx + APPY coming from yyy hospital. ETA 0000"
When I call back to ask who accepted the patient (as I'm the one who accepts patients to the surgical service from outside and I'm curious as to why I hadn't heard about the patient before this), I'm told it was an EM attending and that the patient is coming through the ED. I'm then told the page was just an "FYI."

Those are the FYI pages I get and those are the pages for which I don't see the point.

 

[Apollyon]

Where I did internship, all pages had to be sent through the hospital's web paging system - and the IT guys had it set so you could disable having pages sent to you post-call or on days off - the nurse would get your "vacation message" (eg. "please page ____ for ICU patients today") instead of the option to send a page. I don't know how I would have gotten by without it.

The Mt. Sinai (NY) system was like that - you could sign out your pager to another person, so all your pages would go to them.

 

[Winged Scapula]

The Mt. Sinai (NY) system was like that - you could sign out your pager to another person, so all your pages would go to them.

The ones we got when I was a senior resident were like that - you could forward to other numbers, set message to say, "pager 2068 is in surgery and unavailable", "pager 2068 is out of the hospital and unavailable", "pager 2068 is in hospital and available", etc.

 

[eforest]

At one couple hospital I rotated at, residents and fellows routinely do not return pages. I always wondered why this was permissable. I could get people to return pages- I either paged them to my cell phone number, or when paging IR, for instance, I found that if I went to the IR suite, and paged from there, that I could always get a return page. A resident gave me the latter tip.

 

[notinkansas]

It's pretty much never OK to ignore a page. In general, nurses are eager to find reasons to complain about doctors, especially residents. Not answering a page gives them a great excuse to do so. If you are not in a position to return a page (eg, sterile, putting in a line and all the nurses have left the room so nobody can answer your pager for you) I've found it's better to physically go to the floor that paged you and say I was putting in a line, find out who paged and then further ask if anybody else needs anything.

Remember, all doctors are wealthy, and privileged, and we became that way by exploiting the working class. We don't work hard, and there is no possibility we could be doing something else when a nurse pages. All nurses are hard working people who are struggling to survive in a society where they are exploited by wealthy people. Nurses advocate for their patients, and play a major roll in preventing the doctors from killing patients. And doctors certainly don't care anywhere near as much about patients as nurses do.

 

[drfunktacular]

It's pretty much never OK to ignore a page. In general, nurses are eager to find reasons to complain about doctors, especially residents. Not answering a page gives them a great excuse to do so. If you are not in a position to return a page (eg, sterile, putting in a line and all the nurses have left the room so nobody can answer your pager for you) I've found it's better to physically go to the floor that paged you and say I was putting in a line, find out who paged and then further ask if anybody else needs anything.

Remember, all doctors are wealthy, and privileged, and we became that way by exploiting the working class. We don't work hard, and there is no possibility we could be doing something else when a nurse pages. All nurses are hard working people who are struggling to survive in a society where they are exploited by wealthy people. Nurses advocate for their patients, and play a major roll in preventing the doctors from killing patients. And doctors certainly don't care anywhere near as much about patients as nurses do.

So wrong... but still...

 

[JMK2005]

It's pretty much never OK to ignore a page. In general, nurses are eager to find reasons to complain about doctors, especially residents. Not answering a page gives them a great excuse to do so. If you are not in a position to return a page (eg, sterile, putting in a line and all the nurses have left the room so nobody can answer your pager for you) I've found it's better to physically go to the floor that paged you and say I was putting in a line, find out who paged and then further ask if anybody else needs anything.

Remember, all doctors are wealthy, and privileged, and we became that way by exploiting the working class. We don't work hard, and there is no possibility we could be doing something else when a nurse pages. All nurses are hard working people who are struggling to survive in a society where they are exploited by wealthy people. Nurses advocate for their patients, and play a major roll in preventing the doctors from killing patients. And doctors certainly don't care anywhere near as much about patients as nurses do.

It is so wrong, but sadly so true in some minds.

 

[DickyV]

FYI: cookies in break room 😀

I'm pretty sure this one should be classified as STAT.

 

[Acherona]

I ignore pages by accident all the time. This usu happens on overnight call when I'm either getting so many pages at once that the vibrations merge together and I don't realize I have multiple pages, or I'm so delirious that I just don't register it, or I'm doing something and then forget about it until later and when I call back the nurse is long gone. If it's important I guarantee they will page again just like if I see that my orders haven't been carried out I'll make a stink if it's important. Even if I call back as the pager is going off half the time the person has already walked away and I refuse to stay on hold for more than like 30 seconds in that case. If you ignore the second page about the same thing then it could get serious.

btw that guy sounds like a douche if he's doing that as a med student.

 

[bucknut101]

During my ophtho residency we would cover no less than 7 different hospitals while on call. A frequent (and frustrating) problem was receiving a page with only the last 4 digits of a call back number. And this was despite cleary stating on my pager greeting to "please leave all 7 digits of your call back number as I cover 7 different hospitals." And yes rather than call back every possible number I would ignore the page. Usually they would figure it out and page again with the full number.

 

[medicienne]

Yep, we were expected to leave our pagers on post-call for exactly this reason...the nurses couldn't figure out who to call (for some, still to this day, unknown reason) and would often page the person writing the orders.

Not for us. We have a central 'switchboard' service with operators who have the exact schedule so anyone who calls them to page us can get to the right person. So I can turn my pager off when off-duty.

 

[Raggaman]

Our hospital operators have the on-call list and appropriately page the right person. But saying that, on numerous occasions I have been "paged" by people using the operators and the page never came thru. I have also been paged when I have been off duty and never saw the page till the next day.
I am also a fan of FYI text pages so I dont have to bother calling. All us residents use text pages to each other for FYI texts such as "lunch lecture cancelled" etc. Makes life easier.

 

[Substance]

Provided the page isn't STAT, I ignore pages when:

1. I'm post-call or not at work.

2. I don't receive the entire call-back number.

3. I call back and nobody answers after 10 rings.

4. I call back both immediately, one minute, and five minutes in and the line is busy.

5. I'm currently at a designated event that is a do-not-page-unless-STAT.

 

[Miami_med]

Provided the page isn't STAT, I ignore pages when:

1. I'm post-call or not at work.

2. I don't receive the entire call-back number.

3. I call back and nobody answers after 10 rings.

4. I call back both immediately, one minute, and five minutes in and the line is busy.

5. I'm currently at a designated event that is a do-not-page-unless-STAT.

I pretty much utilize the same rules, except I do not give a 5 minute call back from a busy signal. You need to do what you need to do, but you can't let your pager become the best way for the nursing staff to relieve their personal frustrations with patients. Earn a reputation for being reasonable and for solving problems when they need to be solved.

You should respond to all pages, but sometimes a callback takes a minute or two, because I would never complete any task or finish a sentence when talking to a patient if I immediately jumped to answer every page the second it came in. Also, where are these programs where the PDs are so malignant that they berate people for their treatment of routine pages? I occasionally run afoul of a nurse manager, but I don't think my PD pays attention to that sort of thing unless something really goes wrong. If he were paying attention, he's certainly not shy about expressing disapproval.

I heard that once upon a time at my institution (though not any more), each floor had a nurse manager, and only that manager could page the on call resident. It sort of created a filter, and I'll bet the sheer volume of pages diminished significantly. It probably made it so that you were actually paged about things that required attention, as opposed to half of what I get paged about now. The reality is, that when cross-covering 80 people, covering trauma, covering codes, covering small procedures, and covering new consults, the sheer volume of inappropriate floor pages makes it impossible to answer everything in a completely timely manner. Once central line can put me 10 pages behind. A legitimate trauma can be even worse.

 

[Dejavu]

Agree with WingedScapula...there are lots of examples of helpful "FYI" pages. Of course,they CAN be overdone. I think the one about cookies in the breakroom is one I could do without...I mean just having my pager go off elicits a negative-type Pavlov's response...LOL!

Yeah, but wouldn't the cookies help counteract the negative Pavlov thing a little bit?

 

[Dejavu]

It's pretty much never OK to ignore a page. In general, nurses are eager to find reasons to complain about doctors, especially residents. Not answering a page gives them a great excuse to do so. If you are not in a position to return a page (eg, sterile, putting in a line and all the nurses have left the room so nobody can answer your pager for you) I've found it's better to physically go to the floor that paged you and say I was putting in a line, find out who paged and then further ask if anybody else needs anything.

Remember, all doctors are wealthy, and privileged, and we became that way by exploiting the working class. We don't work hard, and there is no possibility we could be doing something else when a nurse pages. All nurses are hard working people who are struggling to survive in a society where they are exploited by wealthy people. Nurses advocate for their patients, and play a major roll in preventing the doctors from killing patients. And doctors certainly don't care anywhere near as much about patients as nurses do.

Having been a nurse, a nurse anesthetist and now an anesthesiology attending, I have to put in a plug for nurses. They are screwed if they do call you and piss you off and screwed if they don't call you and the doc yells because he/she was never informed of something. They don't all spend all day trying to find a reason to hate docs. Maybe I work with a better class of nurses than you all do, but being nice to them has saved my ass and often times saved me from nuisance calls as well. I love the nurses I work with and can appreciate the position they are in, having been there myself. However, I agree that you can always run into a malignant one, but taking a deep breath and zenning yourself to a happy place before answering will help. And being willing to answer the simplest of questions kindly will endear you to the nursing staff. Believe me, there is nothing better than having a hospital full of nurses looking out for you.