1) When you return a page, make the nurse wait until you've found the patient in the EMR and on your paper sign out (if you have one.) I guarantee that 9 times out of ten, you will have waited longer on hold for the nurse (after
immediately returning their page) than it takes you to find the patient, so don't feel bad about wasting their time. Even if it's a "simple question" there's a reason the primary team bothered to put all that info on their sign-out, (hopefully) and you want access to it before answering the question.
2) Once you've found the patient, ask the nurse for a complete set of vitals. (Unless it's a question about reordering a home med or something) I guarantee you they will call with one abnormal vital or other complaint, but will not have all the info for you. You need all the info, and making them get it (Look it up, or actually go get it in the more egregious situations) gives you time to
read the signouts you've just found. Now you know what's actually going on, overall, with the patient, and you're much better able to answer questions.
i found that residents would often sign things out like "there's a pm cbc and lytes" ....
and then move on. so great? what do you do with that data?
or "follow up this CXR" . "f/u this CT scan" ok.... does it change management? why are we scanning this dude's head? what are we tryin to rule out/rule in?
DO NOT let anyone sign you out bull**** work they didn't do during the day.
often times people will not explain things to you unless you ask. ask ask ask. dont worry about being annoying. you dont know what you're doing.
I second and third Reovlution and GlutonNC's comments on this. Unless there's an action item, people shouldn't be ordering things (labs) or asking you to follow up on them (imaging) overnight. If there is an action item, you want to know what it is, and what the general plan is.
If you're in a hospital with and EMR and the ability to "alert" labs to yourself (a VAMC, perchance?) learn how to do this, so that rather than going through 6 sheets of sign outs every 2 hours looking for labs you were supposed to check, they just pop up as they are resulted. You still need to go through the sign outs periodically to make sure the labs have been drawn and sent (VAMC?) and call and harass someone if they're way overdue, but this tip will save you many minutes of finding and checking patient charts, I promise.
Of course, I agree with the above advice about asking your senior (everything for the first few days, then anything you're not sure of, but not the same simple question repeatedly.) I also agree with the comment on Benzos (rarely useful, except ETOH withdrawal), benadryl for old people (Though the other sleep aids are not fool-proof in this age group either), and lactulose. (Though I must admit, I didn't give much for constipation on night-float, it's more of a daytime problem.)
I would also caution you about fluid status and urine output - you want to make sure you have the whole story before ordering boluses OR lasix overnight. Give the day team the benefit of the doubt that they know what they're doing, and if something has changed, thoroughly reassess it. Sometimes people don't pee because they're asleep, but otherwise, you may need to do an in-person assessment of the patient, because even with accurate vitals, you can't rely on getting the whole story from the nurse.
Finally, I totally agree with writing a note. If you see the patient, order imaging (in which case you should probably be seeing the patient before or after the order) add anything other than a routine med (or stop something), or make any other major change to the plan you need to document why in a brief SOAP note. The day team will thank you (literally) and you've CYAd. I was thanked by attendings multiple times on each night-float block for simple, brief notes that explained the info I had, my assessment, and what I did. It's good patient care, but if that doesn't inspire you, let the opinion of your staff doctors motivate you.
Oh, and finally, finally, Buffy is on FX at 6 AM by which time things have usually quieted down, and if you're lucky, you can get a breakfast sandwich during the mid-hour commercial break. Good luck everyone!
