Do's
1. Assess your patient fully before you dial. Take current vital signs and be clear on the concern you're reporting. If you're not sure the call is warranted, ask around first. Your supervisor has probably seen the same thing and knows whether it can wait.
2. Have everything in front of you. Pull the latest lab and diagnostic results and the patient's medication list. Keep the chart open to the last written order, and have paper ready for new ones.
3. Use SBAR: Situation, Background, Assessment, Recommendation. It keeps the call short and complete. SBAR is a structured communication tool that gives you a clear way to speak up and frame an urgent concern (AHRQ).
4. Read every order back, and have the doctor repeat it when you can. Reading back a verbal or telephone order is a Joint Commission National Patient Safety Goal, not just good manners (Joint Commission). Some drug names sound nearly identical, like cefotaxime and cefuroxime, which is why look-alike and sound-alike names sit on a dedicated safety list (ISMP). If an order sounds wrong or confusing, clarify it. Doctors make mistakes too, especially when just woken.
5. Document everything, including the time and length of the call. If the doctor gets upset and makes a scene, document that as well and tell your charge nurse.
"Doctors aren't always grumpy. They might yell at you for calling late, then greet you the next day like nothing happened," a nine-year ICU nurse said.
Don'ts
1. Don't be intimidated out of calling. You've heard the horror stories, but stay assertive and professional. Plenty of doctors want updates on their patients, whatever the hour.
2. Don't get aggressive. Speak up for your patient, but stay respectful no matter how cranky the response.
3. Don't take the reaction personally. Carry it through your shift and it drags down the care and safety of every patient after.
4. Thank the doctor. Helping patients is the job, but appreciation builds a working relationship that makes the next late call easier.
5. Don't pretend to know what you don't. If an order involves a procedure or drug you're not familiar with, ask a colleague or call back. Facing a frustrated doctor beats risking your patient's life.
Frequently Asked Questions
When should a nurse page a doctor at night? Call when a patient's condition changes in a way that can't wait until morning: new or worsening vital signs, a concerning lab or test result, uncontrolled symptoms, or anything that needs a new order. If you're unsure, check with your charge nurse or supervisor first, since they've likely seen the same situation.
What is SBAR and why use it? SBAR stands for Situation, Background, Assessment, and Recommendation. It's a structured communication tool that keeps an urgent call short and complete and gives nurses a clear way to voice a concern (AHRQ).
Why read an order back to the doctor? Reading back a verbal or telephone order is a Joint Commission National Patient Safety Goal. The person who gave the order confirms what you recorded, which catches mishearings before they reach the patient (Joint Commission).
Why are similar drug names dangerous? Many medications look or sound alike, so a rushed phone order can be misheard. ISMP keeps a list of confused drug names precisely because these mix-ups cause real errors, which is why you confirm the spelling and dose on the call (ISMP).
What should I document about the call? Record the time, the length of the call, what you reported, the order you received, and your read-back confirmation. If the doctor becomes hostile, document that too and tell your charge nurse.
What if the doctor is rude or dismissive? Stay assertive and professional, and don't let the reaction stop you from advocating for your patient. Don't take it personally or carry it into care for your other patients.