<p class="wp-block-paragraph">You should call the doctor as a nurse whenever there are changes in the patient&#8217;s status and behavior. Critical lab values or critical results, adverse reactions, and care management issues warrant a call to the doctor. Thus, contacting the doctor as a nurse requires critical thinking skills and clinical expertise.</p>



<figure class="wp-block-gallery columns-2 is-cropped wp-block-gallery-1 is-layout-flex wp-block-gallery-is-layout-flex"><ul class="blocks-gallery-grid"><li class="blocks-gallery-item"><figure><img src="https://www.nursesophieconsulting.com/wp-content/uploads/2021/02/calling-the-doctor-4.png" alt="contacting the doctor as a nurse" data-id="5915" data-full-url="https://www.nursesophieconsulting.com/wp-content/uploads/2021/02/calling-the-doctor-4.png" data-link="https://www.nursesophieconsulting.com/?attachment_id=5915" class="wp-image-5915"/><figcaption class="blocks-gallery-item__caption">A nurse calling the doctor</figcaption></figure></li><li class="blocks-gallery-item"><figure><img src="https://www.nursesophieconsulting.com/wp-content/uploads/2021/02/calling-the-doctor-2.png" alt="When to call the doctor" data-id="5912" data-full-url="https://www.nursesophieconsulting.com/wp-content/uploads/2021/02/calling-the-doctor-2.png" data-link="https://www.nursesophieconsulting.com/?attachment_id=5912" class="wp-image-5912"/><figcaption class="blocks-gallery-item__caption">A nurse reviewing clinical data on a clipboard</figcaption></figure></li></ul></figure>



<h2 class="wp-block-heading" id="h-collect-clinical-data-before-contacting-the-doctor-as-a-nurse">Collect Clinical Data Before Contacting The Doctor As A Nurse</h2>



<p class="wp-block-paragraph">Before I elaborate on when to call the doctor as a nurse, it is crucial to collect clinical data beforehand. First, there is something a nurse can always do before calling the doctor as a nurse. Thus, you should take immediate actions during an emergency.</p>



<p class="wp-block-paragraph">When you identify critical patient events to report to the doctor, you have to assess the patient quickly. Besides, you should have the following information readily available: </p>



<ul class="wp-block-list"><li>The patient&#8217;s full name and date of birth</li><li>Date of admission, Chief of Complaints, and the most current vital signs. </li><li>Your clinical observation or assessment. It is preferable to use the <a href="http://www.ihi.org/resources/Pages/Tools/SBARToolkit.aspx" target="_blank" rel="noreferrer noopener"><strong><em>SBAR</em></strong> <strong><em>Tool</em></strong></a>.</li></ul>



<p class="wp-block-paragraph">The <strong><em>SBAR</em></strong> involves a quick clinical summary starting with the situations, background, assessment, and recommendations. ;<br>Make sure you introduce yourself to the doctor. For example, you must state your name and the nursing ward that you are calling from. Here is a script that you can use.</p>



<p class="wp-block-paragraph">&#8221; Doctor Y, I found patient X lying on the floor while attempting to go to the bathroom alone&#8221;</p>



<p class="wp-block-paragraph">No one witnessed the <strong><em><a rel="noreferrer noopener" href="https://www.nursesophieconsulting.com/the-role-of-nurses-in-fall-prevention-programs/">fall,</a></em></strong> and the patient said he hit his head. His vital signs are as follow. Also, he reports a mild headache. He shows disorientation to the current place and situation. ;<br>The doctor will guide you about the way forward per the information you provided.</p>



<div class="wp-block-media-text alignwide is-stacked-on-mobile"><figure class="wp-block-media-text__media"><img src="https://www.nursesophieconsulting.com/wp-content/uploads/2021/02/calling-the-doctor-1.png" class="wp-image-5913 size-full"/></figure><div class="wp-block-media-text__content">
<p class="has-large-font-size wp-block-paragraph">The nurse must identify the patient properly.</p>
</div></div>



<h2 class="wp-block-heading" id="h-change-in-patient-status">Change in Patient Status</h2>



<p class="wp-block-paragraph">Nurses learned in <strong><em><a rel="noreferrer noopener" href="https://www.nursing.umaryland.edu">Nursing ;School </a></em></strong>to monitor the patient&#8217;s status and to identify sudden changes to report to the doctor. Most hospitals have what we call <em><a rel="noreferrer noopener" href="https://www.aafp.org/journals/fpm/blogs/inpractice/entry/potential_standing_orders.html">&#8220;</a></em><strong><a rel="noreferrer noopener" href="https://www.aafp.org/journals/fpm/blogs/inpractice/entry/potential_standing_orders.html"><em>Standing Orders</em></a></strong><em><a rel="noreferrer noopener" href="https://www.aafp.org/journals/fpm/blogs/inpractice/entry/potential_standing_orders.html">&#8220;</a></em> with instructions about what to do if a patient becomes unstable.</p>



<p class="wp-block-paragraph">Let’s assume that you have used or implemented the protocol. Thus, you go ahead and inform the doctor right away. You have to make sure that you have some clinical data when contacting the doctor as a nurse.</p>



<p class="wp-block-paragraph">A change in patient status will be a patient who was on a <strong><em><a rel="noreferrer noopener" href="https://medlineplus.gov/ency/article/007700.htm">cardiac monitor</a> </em></strong>showing normal sinus rhythm &#8211;<strong><em><a rel="noreferrer noopener" href="https://www.verywellhealth.com/normal-sinus-rhythm-nsr-1746285">NSR</a></em></strong>. The patient suddenly starts showing <strong><em><a rel="noreferrer noopener" href="https://www.mayoclinic.org/diseases-conditions/supraventricular-tachycardia/symptoms-causes/syc-20355243">SVT</a></em></strong> superventricular tachycardia. That condition is an emergency, and the nurse should activate the rapid response team-<a href="https://psnet.ahrq.gov/primer/rapid-response-systems" target="_blank" rel="noreferrer noopener"> <strong><em>RRT</em></strong> </a> for immediate interventions.</p>



<p class="wp-block-paragraph">Depending on the nursing unit, the nurse can review the standing orders to identify medications to administer to the patient. Also, the <strong><em><a href="https://cpr.heart.org/en/cpr-courses-and-kits/healthcare-professional/acls" target="_blank" rel="noreferrer noopener">ACLS</a></em></strong> algorithm will guide the team to take appropriate actions. Besides, the crash cart usually has reference cards for staff to use during cardiac emergencies. It is crucial to review the protocol before contacting the doctor. You can obtain your <a href="https://acls.com/?uid=aff%7C2341892&;sscid=21k5_g73mbutm_source%3Dshareasale&;utm_medium=affiliate&;utm_campaign=2341892&;utm_content" target="_blank" rel="noreferrer noopener">BLS, ACLS and PALS</a> online today. <em><strong>( I might earn a small commission when you sign up)</strong></em></p>



<h2 class="wp-block-heading" id="h-when-to-call-the-doctor-as-a-nurse-change-in-patient-behavior">When To Call The Doctor As A Nurse: Change In Patient Behavior</h2>



<p class="wp-block-paragraph">It is the nurse&#8217;s responsibility to observe the patient’s behavior and to identify abnormal behaviors that require immediate interventions. Thus, the nurse should investigate why a patient suddenly becomes agitated and contact the doctor as a nurse. Some patients become aggressive because of a Urinary Tract Infection. Therefore, the nurse should assess the last time the patient urinated. Besides, a description of the urine color, odor, clarity will help guide the doctor&#8217;s decision.</p>



<p class="wp-block-paragraph">Another example is patient non-compliance or refusal of treatment. There are many reasons why some patients deny treatments and often request to leave against medical advice &#8211;<strong><em><a rel="noreferrer noopener" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2664598/">AMA</a></em></strong>. The nurse must attempt to deescalate the aggressive patient. Lastly, the nurse needs to decide when to call the doctor as a nurse to address the behavior.</p>



<p class="wp-block-paragraph">You have to maintain your safety and the patient&#8217;s safety as much as you can. The nurse can also administer medication as needed to calm the patient until a provider arrives. Thus, nursing interventions are ;necessary during emergencies.</p>



<h2 class="wp-block-heading" id="h-critical-and-abnormal-test-results">Critical And Abnormal Test Results</h2>



<p class="wp-block-paragraph">While the patient is in the hospital, the doctor will order some diagnostic testing to help guide the treatment plan. Some of the tests might be CBC, BMP, X-ray, CT scan, MRI, and more. Most facilities have a protocol when to call the doctor as a nurse for critical results.</p>



<p class="wp-block-paragraph">What are critical labs or diagnostic results? they are clinical findings that require immediate interventions to prevent complications or worsening of medical conditions. An example of a critical result is low Hemoglobin and Hematocrit because the doctor must correct the acute anemia immediately. You have to contact the doctor with the vital signs, the patient&#8217;s symptoms, and previous laboratory results for analysis.</p>



<p class="wp-block-paragraph">Long term care and other clinical settings might have different protocols. However, one hour is the standard in most clinical settings. If a patient demonstrates sudden shortness of breath, the nurse must activate emergency response and call the doctor within one hour.</p>



<p class="wp-block-paragraph">Besides, the doctor would like to know as soon as possible. The timely report will help the provider develop the best treatment plan for the patient. Thus, the earlier you inform the doctor, the better it is for the quality of care of the patient.</p>



<div class="wp-block-media-text alignwide is-stacked-on-mobile"><figure class="wp-block-media-text__media"><img src="https://www.nursesophieconsulting.com/wp-content/uploads/2021/02/callnig-the-doctor-3.png" class="wp-image-5911 size-full"/></figure><div class="wp-block-media-text__content">
<p class="has-large-font-size wp-block-paragraph">Always call the doctor when necessary.</p>
</div></div>



<h2 class="wp-block-heading" id="h-contacting-the-doctor-as-a-nurse-following-adverse-events">Contacting The Doctor As A Nurse Following Adverse Events</h2>



<p class="wp-block-paragraph">Let’s talk about adverse events. First let us describe what adverse events are. Adverse events are something that happened to the patient that is not part of the outcomes. Moreover, the patient did not come to the hospital or did not go to long-term care to fall. Another example is having an allergic reaction to a medication regardless if the patient knew about the allergy. If the healthcare team fails to ask the patient about the allergy that is definitely an adverse event.</p>



<p class="wp-block-paragraph">Let me share some examples of a few adverse events with you because I review them often. For example, you must call the doctor as a nurse for all patient suicide, elopement and more. Thus, it is important to monitor the patient&#8217;s behavior during your shift.</p>



<p class="wp-block-paragraph">Other adverse events are signs like palpitations, fever during blood transfusion. Moreover, you should call the doctor for all blood transfusion errors. Lastly, all patient falls with or without injuries are reportable to the doctor. </p>



<p class="wp-block-paragraph">You can visit <a href="https://www.jointcommission.org/assets/1/18/SEA_55.pdf" target="_blank" rel="noreferrer noopener">The Joint Commission</a> website to obtain a complete list of adverse events. Please keep in mind that the list is subject to changes. In addition, the list often includes some of the most common adverse events observed during The Joint Commission inspections. </p>



<div class="wp-block-media-text alignwide is-stacked-on-mobile"><figure class="wp-block-media-text__media"><img src="https://www.nursesophieconsulting.com/wp-content/uploads/2021/02/calling-the-doctor-5.png" class="wp-image-5914 size-full"/></figure><div class="wp-block-media-text__content">
<p class="has-large-font-size wp-block-paragraph">The nurse must review all clinical data.</p>
</div></div>



<h2 class="wp-block-heading" id="h-care-management-issues">Care Management Issues</h2>



<p class="wp-block-paragraph"> Care management issues mostly involve the management of the patient care. Let’s review when you want to contact the doctor as a nurse. Some of the examples are delay in patient care. It is crucial to call the doctor as a nurse if an urgent test is not done during you shift. </p>



<p class="wp-block-paragraph">The doctor needs to know about the delay in testing because he or she is responsible for the patient care. The result of the diagnostic testing often guides the treatment plan. Thus, a test omission can delay the patient&#8217;s outcomes. </p>



<p class="wp-block-paragraph">Another care management example is low urine output and poor intake. When you call the doctor as a nurse, you should report the amount of urine that the patient makes per hour. Besides, the doctor will also need the patient&#8217;s intake including Intravenous fluid, full and thin oral liquids.</p>



<p class="wp-block-paragraph">It is imperative to contact the doctor as nurse early on to avoid preventable adverse events. Thus, you can prevent an acute kidney failure and other acute injuries. It is your duty to monitor the patient and to identify early warning signs. Failure to identify and report sudden clinical changes can lead to a lawsuit whenever there is patient harm.</p>



<h2 class="wp-block-heading" id="h-final-thoughts">Final Thoughts</h2>



<p class="wp-block-paragraph">It is essential to know when to call the doctor as a nurse. Some of the reasons for contacting a doctor are change in patient status and change is patient behavior. Additional reasons are critical test results, adverse events, care management issues and more. You have to follow your facility’s protocol to identify when to call the doctor as nurse to report critical results.</p>



<p class="wp-block-paragraph">Nurses are patient advocates and monitor the patients to observe their response to the treatment plan. Thus, the doctors rely on your clinical judgment to alert them about abnormal findings. The nurse&#8217;s critical thinking can impact the patient&#8217;s outcomes. Do you feel confident when you call the doctor? Leave a comment and share your stories below. </p>



<h2 class="wp-block-heading" id="h-when-to-call-the-doctor-checklist"><a href="https://www.nursesophieconsulting.com/wp-content/uploads/2021/02/When-to-Call-the-Doctor-Infographic.pdf" target="_blank" rel="noreferrer noopener">When To Call The Doctor Checklist</a></h2>



<p class="wp-block-paragraph"></p>

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