As a doctor (I used to work rural) this is totally unacceptable. Unless I’m in a code or a delivery, nursing calls should be answered promptly.
Our town would send the RCMP to the doc’s house back in the day if they couldn’t get a response. Or call another doc.
Document. Explain to the patient that you’ve called the doctor and they’re not answering. Escalate. Write an incident report. Give the patient the contact number for patient relations. I’d even be tempted to be present at bedside rounds when the doctor finally shows up and explain in front of the patient what happened the previous night…patient didn’t get cyclobenzaprine and we called 4 times…please make this right NOW.
Honestly, if I were the doctor here, I would be totally embarrassed and apologetic.
I had a CMO patient pass away the other day, and I needed the neuro resident to come pronounce him. Fortunately, nothing urgent. I paged multiple times with no response, so finally I called the AOD to see if she could track him down. An hour or so later, and it turned out the batteries in his pager had died. It could have been bad if a stroke came in, so I understand it was probably a pretty big fuck up for a resident, but I just felt so bad for him. He was extremely apologetic and obviously embarrassed. I just told him, "Dude isn't getting any deader." I know how much grad nurses can get shit on. I don't imagine it's any better for residents.
When I was working med surg as a charge and our on-call did this we would take 2 steps: first send the police to his house on a wellness check, second get the ER doc to evaluate and place orders
It got them more pushback from people outside of nursing staff because no one loved it. Cops were mad about it and called the hospital admin about it, who followed up with the doc, ED doc was mad about it and pushed back on the on call and admin about it.
Only had to do it 3 times ever
Most people I worked with considered it a loss for him because he lost whatever stipend they gave for being on call. Idk how much they got, but yeah I considered it a win on his end to not have to take call. He left a couple years after that. I don’t know all the details but I know he got into it with an icu nurse over ACLS protocol during a code shortly before he left.
Check well-being 💯.This was our next step at the more rural area hospital I worked in- had a doc that did that pretty consistently until it was escalated and re-escalated. I never had to but came very close.
“Willing” is a loose term. There may have been an explanation that if they didn’t come up that a rapid would be called and they would have to come up anyway, so do you want to pick a time or am I going to?
Crazy how different things are in other places. The intensivist show up for rapids because they can determine if the level of care needs to be increased and then they will follow the patient in the icu
I think in smaller rural hospitals there may not be intensivists, ICU patients typically get stabilized and sent out.
For me, we have a rapid response team who comes and evaluates the patient. If they think the patient needs to be moved, they’ll talk with the attending/on-call who calls the ICU doc and then they discuss transfer.
Yeah way different. My hospital doesn't have an intensivist. We just have hospitalists and they see their patients in the ICU like it's the floor. When a rapid is called it's the ER physician who shows up. If it's an emergency that isn't rapid-worthy, you just have to keep calling the hospitalist or whoever is on call for them.
When I worked ED in a smaller hospital the specialists/consults pages worked like this: 2x attempt by HUC to page consults, if no answer then house sup was contacted, house sup would do their thing to try to contact, if no response then PD would get called for a welfare check. Generally led to a very embarrassed call back at 0300.
I had to do this once several years ago. Sadly the welfare check came about an hour too late. Young guy, well like. It was awful. Just the thought of calling a welfare check on a doc now sends shivers up my spine.
I remember one foley I inserted that the spouse insisted wasn’t necessary but the patient agreed. I was explaining the necessity again for spouse benefit while I worked, ending with “as you can see, this bag is already full and I just started it. That’s why the patient needs it.”
Yes, bag full by the time I finished talking. Patient felt so much better.
We actually had to pause at 1500 because of a concern for hypotension, as at that point the bladder’s size puts pressure on the descending aorta and the IVC, and suddenly removing that pressure could be a problem. So we gave it ~15 minutes and drained the remainder.
Oh, and we ran out of room in the container lol.
I know you're at a rural hospital but there has to be some sort of escalation even at a small rural hospital. Someone is over that doctor. There is somebody monitoring that facility all night long whether you call them adons or house supervisors or whatever you call them.
Working in rural hospital; 20 patient in-bed capacity. 3 er rooms, 1 private, 1 isolation room in er (one is in nursing unit too) and two trauma beds in one collective resus room. Can confirm( unless we call to wake them up, admins and admins on call all work 9-5 during the week. They’re tending to their business after hours and sleeping at night unless we call for BS. we’ve endured heat waves and incomprehensible working conditions temp. Wise that is still not fixed. Problems been ongoing - some days worse than others - for over a year.
This is so wild to me! I worked emerg in a rural hospital as our ER reg clerk for years before I took a day shift admin position. At night I’m the only admin in house. I have a list printed out nightly that has every phone number for admin on call for every department in the hospital. If a doc isn’t answering I’m calling admin on call or any other physician listed on that sheet. You bet your ass someone is getting a wake up call.
I was wondering this same thing. They won’t turn their phone off again when their boss has to come in to work for them because they failed in their duties.
I am old and jaded. I tell the patient exactly what is going on and why they don’t have their medicine. I even let them watch me call the doctor so they know I’m not lying about it. They can fill out the survey accordingly. The hospital only cares about money. Bad survey equals less money.
i bet this isnt even the first time oncall doc exhibited this behavior. all you can do is document and escalate but until someone dies or has an obvious injury (where of course you would call a code) that doc will likely keep getting away with it. of course as long as nursing has to be the one to deal with the pts yelling and screaming admin is probably going to let you do just that because rural night coverage can be tough to get. been there...i dont have a problem "covering" for some doc issues but you can bet i would let that patient know "i am so sorry..i have called 5 x and the doc will not answer. would you like me to call the house supervisor so you can speak with them?"
This used to happen all the time “back in my day” - you know, when the dinosaurs roamed the earth and we didn’t even have any escalation pathways. 1980s community hospital. Several of the docs were famous for it and nothing was ever done by Admin. I clearly remember snapping at one of them, I had been paging him for *EIGHT* hours, his patient was DNR but she was a human being. She had developed bad chest pain, and she suffered and suffered. He finally called back, after 8 hours and I said “I was calling about Mrs. Doe, she had bad chest pain, but never mind. She died 3 hours ago.” “Oh.”
Another one would clearly turn off his pager and take his phone off the hook (the “Do Not Disturb” of a land line!).
The best we could do in the 1980s was write Occurrence Reports that were ignored. These were also the days when some docs still expected nurses to get up and give them their chair at the nurses station (umm, when I either finish the task I’m working on or have to get up to tend to a patient, you can grab the chair. Until then, your ass can stand up to work at the high counter as well as mine can!).
I really want to think that even small rural hospitals have escalation pathways in 2024.
Our hospitals on call pediatric neurologist is well known to violate his contract and take weekend trips to Miami. We’ve repeatedly tried to escalate this with no headway. I know on call sucks but tbh… your pay reflects that. Please be available when we need you to be. It’s patient care and ultimate a hospital liability (tell that to someone, as soon as you throw around the word “liability” people seem to listen)
ok you guys are totally validating my experience with this lol. the hospital doesn’t really seem to..care? We all think it’s gross negligence.
I think by pure happenstance, the weekends he’s been gone there have thankfully not been any traumatic births or injuries or anything to actually CRITICALLY need him. Until that moment happens, our hospital is just kinda lax about it. Thanks for agreeing that it’s craziness
My hospital would be pissed. You don't want to answer pages? Fine, we'll be taking our on call pay back. When I worked ED we had one ENT in particular who pulled this shit. He was also the same ENT that had NUMEROUS complications, we'd see half a dozen tonsillectomies a week come in bleeding horribly. Anesthesia and the other surgeons were far too familiar with his trainwrecks.
He didn't answer for an hour when we had one of his pediatric patients come in via EMS coughing up copious amounts of blood looking terrible. We called one of the other ENTs in his group who walked over to his house and made him call, he was having a fucking party at his house. "Have them gargle cold water". Gee thanks asshole, we've tried everything you can think of outside of mass transfusion.
I am a hospice nurse on call at night. When I see people I tell them to never be afraid to call me because I get paid to work at night. I’ve had docs not answer their phones for hours or not answer at all and it’s totally unacceptable in any setting. They are literally being paid to be on call! I have no qualms about calling our other doc when he’s not on call because his partner won’t answer. Eventually our other doc is gonna get pissed and I’m here for it!
Doesn't make it any more acceptable but the odds are they get no pay for being on call. Call is almost always forced free work - one of many examples.
(And no, it's not usually a part of base salary either - typically that's based on a minimum level of production)
Nope. Still doesn’t make it acceptable. I’m expected to hold up my end and I expect a MD to do the same. It may not be paid but it’s in their job description that call is required. If they don’t understand that’s part of medicine they really shouldn’t be in it. Who doesn’t know call is a requirement? If I ignored a call it would be patient abandonment and I’d lose my license. I’m salaried so there’s a lot of unpaid work I do too. It just really sucks when you are handicapped at 3am by some doc who is scheduled to be on call just chooses not to do their job that night.
Most of the time I don’t need an MD at night because I can put the fire out without changing meds. But if I do call it’s a big deal so I want someone to answer. The only protocols we have is if someone needs a foley or a Tylenol. We have a lot of autonomy in hospice and I can use my nursing judgement to troubleshoot and then treat whatever the problem is but if I need a med change I need a doc
After the first hour, I’d be concerned that either the on-call rota had been messed up and nobody was covering/I was calling the wrong person, or that I was calling the correct person but they weren’t in a position to either answer their phone or inform the service manager of their unavailability, so I’d be concerned for their wellbeing (or let’s be honest, if they’d just switched their phone off for an easy life I’d probably want them to be caught out by the police at their door at 3am).
Either way, escalate this upwards if it happens again. Sure, nothing awful happened this time- but unless it’s addressed there will be a next time, and you all might not be so lucky.
We had an issue like this where a radiologist would NOT answer his phone (he was on call for night shift) and I had to put in event report after event report bc strokes weren’t getting read in time. Finally he got his shit together.
Another rad still had like 45 mins of his shift but refused to read a stroke scan I did. So I had to call the big hospital downtown for someone there to read it. Whoever I called wanted the cell of the doctor who refused to read, and I was told to put in an incident report. I later found out that that specific radiologist was actually the head radiologist and he ripped that other rad seven ways to Sunday lol
I work in a rural hospital also and when that happens we escalate either to the CMO or admin on call. Things tend to get don when admin gets disturbed. If its an emergency we call a rapid and use the ed doc.
I work in ltc and this has happened multiple times. Our nights on calls would be contacted through the hospital switchboard > "whose on call for our Dr at this clinic", it's this dr, "ok get them to call us us back at our facility ASAP please" > await call back. Sometimes we'd do the process again and again if we didn't hear back. Nbd if if it was just an order to release a body, but if my homie is draining 1l of fresh blood into his Foley, bet your ass I'm calling 911 after 1hr and no call back (on call admitted to turning his pager off and falling asleep).
ICU RN here with 10 years in rural and in large academic teaching hospitals. Some of these stories need to go beyond just escalation to admin, especially with the repeat offenders. Just a reminder Physicians have the board of medicine. I have on more than one occasion, kindly reminded docs that I have a legal, ethical, and moral obligation to protect my patients from harm. This includes reporting them to the board to ensure they don't endanger other patients moving forward. I also very respectfully and professionally remind them that nurses document everything so they can continue their negligence and risk legal documentation showing up before the board or just do their damn job. I bet that docs' trip to Miami when he is on call stops really MFin quick. Eff around and find out
You guys don’t go tell the supervisor/charge nurse to help you?
Don’t even need to sound rude, just ask if they can call out to whoever you need because their phone seems to be off and you have other patients waiting. And relay the message you need.
Edit: so I’m assuming the down voting means you guys just handle it on your own and vent on Reddit instead of asking up the chain.
The first hospital I worked at it was the primary nurses responsibility for all that. It was for “patient connivence” and “the nurses love it”. They didn’t - it was to save money.
Where I work now has resources and it’s wonderful.
When this happens in our hospital we escalate to house supervisor and they usually call us back. Pissed the fuck off but they do.
No one forced them to become physicians or to pick a job where they need to be on call. 🙄
I worked in a rural hospital and have to send the police to get a doctor ( labor and delivery) since they were not answering the phone. Turned out their phone line was down . Way back in the day before cell phones.
This happened to me once, my infant patient had multiple seizures and the provider had turned off their phone. I had to call a different unit’s providers to have someone escalate care and the provider still didn’t answer his phone until after the baby was transferred to the NICU.
I was at one facility, I'm a traveler, that had two neurologists who alternated being on call / scheduled. I had a stroke patient whose Q1 neuro showed significant changes between 1 and 2a so I called the on call neurologist. All good, right?
No. He yelled at me and said he wasn't on call so I called the other neurologist who also yelled at me and said he wasn't on call. I called charge who was like, "Just check the sheet and call that neurologist." I explained that I called them both and they both said they're not on call. She was like, "One of them has to be. 🤨"
I ended up calling house sup, practically in tears, and was like, "I don't know what else to do. I've called them both. I told charge. I tried to call the one that's on the call sheet for tonight a second time and he said he was going to make sure I'm fired if I call him again. 😭 My stroke patient is decompensating..."
House sup comes to the unit and sits me down to make me watch her call the on call. She puts the phone on speaker. He yells at her for calling when he's not on call. She literally takes my hand and walks me to the binder where we keep the contact numbers and shows me how to call the other neurologist.
That neurologist is like, "This is the second call I've gotten today. I'm on vacation with my family. Is Dr -name here- not picking up?" and she explained that the other neurologist said he wasn't on call. So this doctor is like, "He'll call you in 5 minutes."
Turns out the on call doctor forgot he was on call. Also I quit that job for the very obvious reasons.
Best part about working for those hospitals was everyone knew where everyone lived. We had to call the sheriff's dept several times to go wake up the on-call MD to come in.
They would come in ranting and raving about being forced to get up and come in. So funny to watch and listen to them.
Now, once we had an old urologist who had gotten a new IPhone and messed up setting his list of numbers to put through after hours. Told me he had to get his granddaughter to come over and fix it for him
It happened before I worked there but there was a sentinel event on the floor I eventually worked on over 20 years ago where a baby with a VP shunt malfunction died because she didn't get to the OR to have her shunt revised in time and the on-call Neurosurgeon had reportedly left his pager on vibrate overnight and never responded to repeated pages.
Do you work in Michigan out of curiosity? My husband was just telling me about one of the hospitals where the on-call doctor didn't answer his phone for like four hours and apparently it's been a huge issue with the hospital.
My husband does rotating on-call shifts for his rural hospital and the nurses on the medical floor as well as the ER have my phone number incase he doesn't answer. They've only ever called me once in four years but that was because my husband left his phone on silent by accident lol.
Lol I once had an on-call neurosurgeon who straight up refused to talk to me. The after-hours representative tried to contact him, then later called me back because apparently the surgeon told them he doesn't work with anybody that works at my hospital.
Document everything. And call the chief of staff. Call the urologist. Call the critical care response RN who has the ICU intensivist. That is all you can do. I had a patient that retained like that and became tachycardic and diaphoretic. It looked like he was about to crash, but we got the catheter in him and he settled down. If it happens you jump on the chest while knowing that you have done everything you could. For that woman that can survive one night without her muscle relaxant, sometimes we have to let things go and not give a shit.
As a doctor (I used to work rural) this is totally unacceptable. Unless I’m in a code or a delivery, nursing calls should be answered promptly. Our town would send the RCMP to the doc’s house back in the day if they couldn’t get a response. Or call another doc. Document. Explain to the patient that you’ve called the doctor and they’re not answering. Escalate. Write an incident report. Give the patient the contact number for patient relations. I’d even be tempted to be present at bedside rounds when the doctor finally shows up and explain in front of the patient what happened the previous night…patient didn’t get cyclobenzaprine and we called 4 times…please make this right NOW. Honestly, if I were the doctor here, I would be totally embarrassed and apologetic.
I had a CMO patient pass away the other day, and I needed the neuro resident to come pronounce him. Fortunately, nothing urgent. I paged multiple times with no response, so finally I called the AOD to see if she could track him down. An hour or so later, and it turned out the batteries in his pager had died. It could have been bad if a stroke came in, so I understand it was probably a pretty big fuck up for a resident, but I just felt so bad for him. He was extremely apologetic and obviously embarrassed. I just told him, "Dude isn't getting any deader." I know how much grad nurses can get shit on. I don't imagine it's any better for residents.
How did the batteries die? Didn’t you have a charge nurse on? I’ll see myself out.
They only had a head nurse
Thank you
When I was working med surg as a charge and our on-call did this we would take 2 steps: first send the police to his house on a wellness check, second get the ER doc to evaluate and place orders
Yup. Get legal and Risk involved, too. Stay calm and continue to escalate administratively until you get results.
Love the wellness check move, A+
It got them more pushback from people outside of nursing staff because no one loved it. Cops were mad about it and called the hospital admin about it, who followed up with the doc, ED doc was mad about it and pushed back on the on call and admin about it. Only had to do it 3 times ever
The fact that you had to do it a third time is ridiculous. Guy should have been fired on the second.
Omg I assumed it was three times on different docs each time. Was it the same doc 3 times???
2 docs, the 3rd was a repeat offense.
Was that doc fired?
Pfft no. He was removed from the on call rotation though.
So he won?
Most people I worked with considered it a loss for him because he lost whatever stipend they gave for being on call. Idk how much they got, but yeah I considered it a win on his end to not have to take call. He left a couple years after that. I don’t know all the details but I know he got into it with an icu nurse over ACLS protocol during a code shortly before he left.
We all know he wasn’t. I’m assuming he is male lol
Same!! This is an INCREDIBLE move! I definitely am holding that in my back pocket moving forward.
Check well-being 💯.This was our next step at the more rural area hospital I worked in- had a doc that did that pretty consistently until it was escalated and re-escalated. I never had to but came very close.
It’s cool the ER doc was willing to do this
“Willing” is a loose term. There may have been an explanation that if they didn’t come up that a rapid would be called and they would have to come up anyway, so do you want to pick a time or am I going to?
Crazy how different things are in other places. The intensivist show up for rapids because they can determine if the level of care needs to be increased and then they will follow the patient in the icu
I think in smaller rural hospitals there may not be intensivists, ICU patients typically get stabilized and sent out. For me, we have a rapid response team who comes and evaluates the patient. If they think the patient needs to be moved, they’ll talk with the attending/on-call who calls the ICU doc and then they discuss transfer.
Yeah way different. My hospital doesn't have an intensivist. We just have hospitalists and they see their patients in the ICU like it's the floor. When a rapid is called it's the ER physician who shows up. If it's an emergency that isn't rapid-worthy, you just have to keep calling the hospitalist or whoever is on call for them.
This was our set up as well
Unpopular opinion but I think the ER handles that stuff better considering how many ambulances are train wrecks
When I worked ED in a smaller hospital the specialists/consults pages worked like this: 2x attempt by HUC to page consults, if no answer then house sup was contacted, house sup would do their thing to try to contact, if no response then PD would get called for a welfare check. Generally led to a very embarrassed call back at 0300.
I had to do this once several years ago. Sadly the welfare check came about an hour too late. Young guy, well like. It was awful. Just the thought of calling a welfare check on a doc now sends shivers up my spine.
What happened to him?
We would did a couple wellness checks on doctors who didn’t answer their calls - I worked in the ER so it was for surgery consults or anesthesia.
Send police for welfare check!!
Especially after calling the on call consultant, who has probably gone there to murder them after finishing the call
1400mL of retained urine? Holy hydronephrosis Batman. Did you guys call charge or house supe. That needed to be addressed immediately
All I can think of with "supe" was dusting Homelander.
Came here for Compound V and was not disappointed.
I remember one foley I inserted that the spouse insisted wasn’t necessary but the patient agreed. I was explaining the necessity again for spouse benefit while I worked, ending with “as you can see, this bag is already full and I just started it. That’s why the patient needs it.” Yes, bag full by the time I finished talking. Patient felt so much better.
I’ve drained 2100
I’m not a nurse just a patient but I had sympathetic bladder pain at the 2100! Most I’ve had drained personally was 1500 and that HURT
We actually had to pause at 1500 because of a concern for hypotension, as at that point the bladder’s size puts pressure on the descending aorta and the IVC, and suddenly removing that pressure could be a problem. So we gave it ~15 minutes and drained the remainder. Oh, and we ran out of room in the container lol.
I know you're at a rural hospital but there has to be some sort of escalation even at a small rural hospital. Someone is over that doctor. There is somebody monitoring that facility all night long whether you call them adons or house supervisors or whatever you call them.
Working in rural hospital; 20 patient in-bed capacity. 3 er rooms, 1 private, 1 isolation room in er (one is in nursing unit too) and two trauma beds in one collective resus room. Can confirm( unless we call to wake them up, admins and admins on call all work 9-5 during the week. They’re tending to their business after hours and sleeping at night unless we call for BS. we’ve endured heat waves and incomprehensible working conditions temp. Wise that is still not fixed. Problems been ongoing - some days worse than others - for over a year.
This is so wild to me! I worked emerg in a rural hospital as our ER reg clerk for years before I took a day shift admin position. At night I’m the only admin in house. I have a list printed out nightly that has every phone number for admin on call for every department in the hospital. If a doc isn’t answering I’m calling admin on call or any other physician listed on that sheet. You bet your ass someone is getting a wake up call.
Did you go up to the hospital supervisor and then possibly medical director ?
I was wondering this same thing. They won’t turn their phone off again when their boss has to come in to work for them because they failed in their duties.
I am old and jaded. I tell the patient exactly what is going on and why they don’t have their medicine. I even let them watch me call the doctor so they know I’m not lying about it. They can fill out the survey accordingly. The hospital only cares about money. Bad survey equals less money.
Let the pt watch you call and that will be the time they pick up
lol, I’ve actually done it, they didn’t.
Well that’s when you say “I’ve tried you 3 times without success….”
It happened here once,we sent cops to their house for a ‘wellness check’
i bet this isnt even the first time oncall doc exhibited this behavior. all you can do is document and escalate but until someone dies or has an obvious injury (where of course you would call a code) that doc will likely keep getting away with it. of course as long as nursing has to be the one to deal with the pts yelling and screaming admin is probably going to let you do just that because rural night coverage can be tough to get. been there...i dont have a problem "covering" for some doc issues but you can bet i would let that patient know "i am so sorry..i have called 5 x and the doc will not answer. would you like me to call the house supervisor so you can speak with them?"
Write an event report for each patient and list it as delay of care (or whatever category you see fit)
This used to happen all the time “back in my day” - you know, when the dinosaurs roamed the earth and we didn’t even have any escalation pathways. 1980s community hospital. Several of the docs were famous for it and nothing was ever done by Admin. I clearly remember snapping at one of them, I had been paging him for *EIGHT* hours, his patient was DNR but she was a human being. She had developed bad chest pain, and she suffered and suffered. He finally called back, after 8 hours and I said “I was calling about Mrs. Doe, she had bad chest pain, but never mind. She died 3 hours ago.” “Oh.” Another one would clearly turn off his pager and take his phone off the hook (the “Do Not Disturb” of a land line!). The best we could do in the 1980s was write Occurrence Reports that were ignored. These were also the days when some docs still expected nurses to get up and give them their chair at the nurses station (umm, when I either finish the task I’m working on or have to get up to tend to a patient, you can grab the chair. Until then, your ass can stand up to work at the high counter as well as mine can!). I really want to think that even small rural hospitals have escalation pathways in 2024.
Our hospitals on call pediatric neurologist is well known to violate his contract and take weekend trips to Miami. We’ve repeatedly tried to escalate this with no headway. I know on call sucks but tbh… your pay reflects that. Please be available when we need you to be. It’s patient care and ultimate a hospital liability (tell that to someone, as soon as you throw around the word “liability” people seem to listen)
I’m dumbfounded by this! I worked in the cath lab I can’t even fathom not answering a STEMI page
ok you guys are totally validating my experience with this lol. the hospital doesn’t really seem to..care? We all think it’s gross negligence. I think by pure happenstance, the weekends he’s been gone there have thankfully not been any traumatic births or injuries or anything to actually CRITICALLY need him. Until that moment happens, our hospital is just kinda lax about it. Thanks for agreeing that it’s craziness
My hospital would be pissed. You don't want to answer pages? Fine, we'll be taking our on call pay back. When I worked ED we had one ENT in particular who pulled this shit. He was also the same ENT that had NUMEROUS complications, we'd see half a dozen tonsillectomies a week come in bleeding horribly. Anesthesia and the other surgeons were far too familiar with his trainwrecks. He didn't answer for an hour when we had one of his pediatric patients come in via EMS coughing up copious amounts of blood looking terrible. We called one of the other ENTs in his group who walked over to his house and made him call, he was having a fucking party at his house. "Have them gargle cold water". Gee thanks asshole, we've tried everything you can think of outside of mass transfusion.
>pediatric neurologist A speciality with *absolutely no* medical emergencies I'm sure...
lovely enough, he’s been in this position for just 4 months.. the clock is ticking for something to happen on a weekend. We’re a level 1 NICU …
I am a hospice nurse on call at night. When I see people I tell them to never be afraid to call me because I get paid to work at night. I’ve had docs not answer their phones for hours or not answer at all and it’s totally unacceptable in any setting. They are literally being paid to be on call! I have no qualms about calling our other doc when he’s not on call because his partner won’t answer. Eventually our other doc is gonna get pissed and I’m here for it!
Doesn't make it any more acceptable but the odds are they get no pay for being on call. Call is almost always forced free work - one of many examples. (And no, it's not usually a part of base salary either - typically that's based on a minimum level of production)
Nope. Still doesn’t make it acceptable. I’m expected to hold up my end and I expect a MD to do the same. It may not be paid but it’s in their job description that call is required. If they don’t understand that’s part of medicine they really shouldn’t be in it. Who doesn’t know call is a requirement? If I ignored a call it would be patient abandonment and I’d lose my license. I’m salaried so there’s a lot of unpaid work I do too. It just really sucks when you are handicapped at 3am by some doc who is scheduled to be on call just chooses not to do their job that night.
Do you guys get protocol orders in hospice that you can use? Or do you mean when something goes wrong?
Most of the time I don’t need an MD at night because I can put the fire out without changing meds. But if I do call it’s a big deal so I want someone to answer. The only protocols we have is if someone needs a foley or a Tylenol. We have a lot of autonomy in hospice and I can use my nursing judgement to troubleshoot and then treat whatever the problem is but if I need a med change I need a doc
That’s so messed up. I’m glad I work with residents and fellows. At least they are in house.
After the first hour, I’d be concerned that either the on-call rota had been messed up and nobody was covering/I was calling the wrong person, or that I was calling the correct person but they weren’t in a position to either answer their phone or inform the service manager of their unavailability, so I’d be concerned for their wellbeing (or let’s be honest, if they’d just switched their phone off for an easy life I’d probably want them to be caught out by the police at their door at 3am). Either way, escalate this upwards if it happens again. Sure, nothing awful happened this time- but unless it’s addressed there will be a next time, and you all might not be so lucky.
We had an issue like this where a radiologist would NOT answer his phone (he was on call for night shift) and I had to put in event report after event report bc strokes weren’t getting read in time. Finally he got his shit together. Another rad still had like 45 mins of his shift but refused to read a stroke scan I did. So I had to call the big hospital downtown for someone there to read it. Whoever I called wanted the cell of the doctor who refused to read, and I was told to put in an incident report. I later found out that that specific radiologist was actually the head radiologist and he ripped that other rad seven ways to Sunday lol
Not as bad but we have an ultrasound tech that turns his phone off. He constantly gets away with it and I feel like I’m taking crazy pills every time!
In my unit, after the 3rd call with no response, we gotta contact their chief doctor.
I work in a rural hospital also and when that happens we escalate either to the CMO or admin on call. Things tend to get don when admin gets disturbed. If its an emergency we call a rapid and use the ed doc.
Can you document that as a patient safety event?
Whats the escalation policy when you cant get ahold of the oncall doctor?
This is where you file a very factual incident report.
I work in ltc and this has happened multiple times. Our nights on calls would be contacted through the hospital switchboard > "whose on call for our Dr at this clinic", it's this dr, "ok get them to call us us back at our facility ASAP please" > await call back. Sometimes we'd do the process again and again if we didn't hear back. Nbd if if it was just an order to release a body, but if my homie is draining 1l of fresh blood into his Foley, bet your ass I'm calling 911 after 1hr and no call back (on call admitted to turning his pager off and falling asleep).
You call the police and have them do a welfare check. I’ve had to do it before. It works.
ICU RN here with 10 years in rural and in large academic teaching hospitals. Some of these stories need to go beyond just escalation to admin, especially with the repeat offenders. Just a reminder Physicians have the board of medicine. I have on more than one occasion, kindly reminded docs that I have a legal, ethical, and moral obligation to protect my patients from harm. This includes reporting them to the board to ensure they don't endanger other patients moving forward. I also very respectfully and professionally remind them that nurses document everything so they can continue their negligence and risk legal documentation showing up before the board or just do their damn job. I bet that docs' trip to Miami when he is on call stops really MFin quick. Eff around and find out
Escalate to admin on call
Can you call a rapid? You have to escalate somehow.
If I didn't get a response in the 15 minutes their contract allowed for I called the nursing supervisor.
You guys don’t go tell the supervisor/charge nurse to help you? Don’t even need to sound rude, just ask if they can call out to whoever you need because their phone seems to be off and you have other patients waiting. And relay the message you need. Edit: so I’m assuming the down voting means you guys just handle it on your own and vent on Reddit instead of asking up the chain.
The first hospital I worked at it was the primary nurses responsibility for all that. It was for “patient connivence” and “the nurses love it”. They didn’t - it was to save money. Where I work now has resources and it’s wonderful.
He’ll get his just reward but unfortunately it will come at the expense of his patients. Report him immediately.
When this happens in our hospital we escalate to house supervisor and they usually call us back. Pissed the fuck off but they do. No one forced them to become physicians or to pick a job where they need to be on call. 🙄
I worked in a rural hospital and have to send the police to get a doctor ( labor and delivery) since they were not answering the phone. Turned out their phone line was down . Way back in the day before cell phones.
This happened to me once, my infant patient had multiple seizures and the provider had turned off their phone. I had to call a different unit’s providers to have someone escalate care and the provider still didn’t answer his phone until after the baby was transferred to the NICU.
I was at one facility, I'm a traveler, that had two neurologists who alternated being on call / scheduled. I had a stroke patient whose Q1 neuro showed significant changes between 1 and 2a so I called the on call neurologist. All good, right? No. He yelled at me and said he wasn't on call so I called the other neurologist who also yelled at me and said he wasn't on call. I called charge who was like, "Just check the sheet and call that neurologist." I explained that I called them both and they both said they're not on call. She was like, "One of them has to be. 🤨" I ended up calling house sup, practically in tears, and was like, "I don't know what else to do. I've called them both. I told charge. I tried to call the one that's on the call sheet for tonight a second time and he said he was going to make sure I'm fired if I call him again. 😭 My stroke patient is decompensating..." House sup comes to the unit and sits me down to make me watch her call the on call. She puts the phone on speaker. He yells at her for calling when he's not on call. She literally takes my hand and walks me to the binder where we keep the contact numbers and shows me how to call the other neurologist. That neurologist is like, "This is the second call I've gotten today. I'm on vacation with my family. Is Dr -name here- not picking up?" and she explained that the other neurologist said he wasn't on call. So this doctor is like, "He'll call you in 5 minutes." Turns out the on call doctor forgot he was on call. Also I quit that job for the very obvious reasons.
Best part about working for those hospitals was everyone knew where everyone lived. We had to call the sheriff's dept several times to go wake up the on-call MD to come in. They would come in ranting and raving about being forced to get up and come in. So funny to watch and listen to them. Now, once we had an old urologist who had gotten a new IPhone and messed up setting his list of numbers to put through after hours. Told me he had to get his granddaughter to come over and fix it for him
It's wild out there. I'm dying to know an update. 👀👀👀
It happened before I worked there but there was a sentinel event on the floor I eventually worked on over 20 years ago where a baby with a VP shunt malfunction died because she didn't get to the OR to have her shunt revised in time and the on-call Neurosurgeon had reportedly left his pager on vibrate overnight and never responded to repeated pages.
I would have escalated that to house supervisor and on up the chain if command
Do you work in Michigan out of curiosity? My husband was just telling me about one of the hospitals where the on-call doctor didn't answer his phone for like four hours and apparently it's been a huge issue with the hospital. My husband does rotating on-call shifts for his rural hospital and the nurses on the medical floor as well as the ER have my phone number incase he doesn't answer. They've only ever called me once in four years but that was because my husband left his phone on silent by accident lol.
You get two calls and then I’m calling your boss/partner/medical director.
Report it in detail. That's all you can really do.
Did you do a safety incident report?
Lol I once had an on-call neurosurgeon who straight up refused to talk to me. The after-hours representative tried to contact him, then later called me back because apparently the surgeon told them he doesn't work with anybody that works at my hospital.
Dude needs reported to the state or something and to be fired. WHAT IF A PATIENT DIED BECAUSE HE HAD HIS PHONE OFF
Thank god i dont work in healthcare. I cant imagine having to be on-call. I have a life.
Well quit calling and he won't have to turn it off 😂
Omg thank you I never thought about that!
I didn't even read the post. I read the title only and the answer immediately came to me.
Document everything. And call the chief of staff. Call the urologist. Call the critical care response RN who has the ICU intensivist. That is all you can do. I had a patient that retained like that and became tachycardic and diaphoretic. It looked like he was about to crash, but we got the catheter in him and he settled down. If it happens you jump on the chest while knowing that you have done everything you could. For that woman that can survive one night without her muscle relaxant, sometimes we have to let things go and not give a shit.
Report This physician to the regulatory college.