Saturday, July 30, 2005

Night of a thousand beeps

7 pm. Beep! It's a nurse. "Are you on call?" Yes, I am. An inpatient is anxious, agitated. Okay, let's figure this out. 7:30 pm: beep, again. Another patient has a headache. Not a new problem. Fine, we'll try to treat it. Thank you. 7:45 pm: beep, a pharmacy inquiring about a prescription. Easy question. Thanks. No problem.

8 pm. Beep. A confusing situation in the ER. Unfortunately, the patient can offer no meaningful history. The patient is on many meds, but can't tell us what they are. Much head-scratching and discussion about what might be going on. 9 pm. Beep! An inpatient psych patient with diabetes, and some rather high blood sugars. Page the hospitalist. Nice discussion about coordinating care. I love to work with colleagues in other specialties! Thank you, thank you. Good speaking to you. Goodnight.

10 pm. Beep. A suicidal patient at another hospital, in another city. Oregon has only two or three available psych beds. Tonight, they are mine to share. Is this patient okay for transfer? Yes? Okay, transfer. Bye.

Midnite: Beep. Nurse with question. 12:30: Beep. Another question. No problem. Thanks. 1 am: Beep. Patient in ER. Needs an assessment. Fine. And an admission. Okay.

2 am, 2:30 am, 2:45 am. Beep. Beep. 3 am, 3:15 am, 3:30 am. Now the nurse sounds sympathetic. "You aren't getting much sleep tonite, are you?" I ask, aren't I sleeping now? Isn't this my dream? She laughs. She has three patients to discuss.

4 am, 4:10 am, 4:20 am. Now the nurses apologize with every call. "I'm so, so sorry to wake you up like this!" They are so nice. I would be very grumpy, if I had enough energy. But I'm fighting a brain fog. Now the ER is calling, again...beep!

Let's wake up, here. Sit up. Waggle head. Move around a little. Turn on some lights. Waggle head some more. Be on! Now, call ER.


"Sorry to wake you up! We need you for a few patients here."

No problem...except, excuse me for a moment, my beeper is going off again...

It is now 8:30 am, and I am officially off call.

Good night!


Anonymous Anonymous said...

Were all those nursing calls from the same nurse,and were they all truely emergent. Sometimes,I think there are a few nurses,who call repeatedly for unnecessary questions, or 3 separate calls for sleep meds,when they could have called once.

9:36 AM  
Blogger shrinkette said...

There were some real emergencies last night. (I have to keep this vague because of confidentiality.) I'm wondering how the whole process could be improved. A question may seem unnecessary to docs, but not to nurses on the front lines. When patients are pressing nurses for information or treatments, the nurses often bring their issues directly to us. What hospitalized patient wouldn't like to hear the nurse say, "I'll contact the doctor right away"?

Any comments from nurses?

9:57 AM  
Anonymous Maria said...

Don't you wish you had a resident? ;)

3:56 PM  
Blogger Keith, RN said...

I'm a nurse but I don't work in a hospital so I can't really comment on that situation per se. I will say, though, that I manage the outpatient care of over 80 chronically ill patients (HIV, Hep C, mental illness, brittle diabetes, substance abuse--sometimes all of these diagnoses at once), and I don't know what I would do without the docs and mid-levels that field my questions. As a very independent nurse, I make alot of decisions on my own and often look to the docs for back-up after the fact, but sometimes a doc's input is just darn necessary when I'm thinking about my license and my legal scope of practice. When one is "just an RN" without prescriptive authority, one knows that one's decisions can have great repercussions. A nurse can often imagine this scene: a malpractice case in the courtroom, and the prosecutor says, "Why didn't you call the doctor first?" Can the nurse say, "I was afraid to wake the doctor up because I already called her at 2am and 3am"? Making that call can be hard, and the doc's grumpiness can be harder, especially if the doc is condescending, but not making the call and then being strung up for one's decisions is a scary thing.

7:20 PM  
Blogger Dawn said...

eek sounds like you had a rough night. hope you have/had a nice sleep.

12:25 PM  
Blogger shrinkette said...

Thanks for the great comments! Every doc has nights like this, but it's much harder for some of the other specialties. Madhouse Madman's night calls are so much worse than mine!

6:01 PM  
Anonymous Anonymous said...

I try to group my phone calls if they are not toooo emergent. I also call the house supervisor to see if there are any other pending issues that can be brought to the physician in question.You are right though, when I have an anxious, awake, ranting individual at 0148 who is demanding my time, attention and that "something be done right now!!"it tends to get called on.Very few nurses I know of purposely space calls and seek to deprive the on call of sleep.It ruins a working relationship.

7:25 PM  

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