5 Questions to Ask Before Calling the Doctor
Communication is an essential element of coordinating patient care — and nowhere more than in the hospital, where a patient's status can change in a second. To convey those changes accurately and keep your patient safe, the nurse and provider need to communicate well.
As a nurse, it can be hard to know exactly what your patient needs. Do you call the doctor immediately, wait it out, or call an RRT? When you're unsure, calling the provider is the common reflex — but not every issue needs a call. Cutting unnecessary calls sharpens your problem-solving and lets providers work more efficiently too. Here are five questions to ask yourself first.
1. Is the Patient Stable?
Being a great nurse means learning to prioritize. Whenever there's a change in status, ask yourself first: "Is the patient stable?" It often seems obvious, but calling a Rapid Response can feel nerve-wracking — many new grads worry it wasn't necessary. With experience, recognizing a true RRT gets easier. To assess stability, do two things first, in this order:
You must see your patient. Sometimes you'll know immediately that emergent intervention is needed — if they're unresponsive, not breathing, and/or pulseless, activate a Code Blue at once. It won't always be that black and white, so move to the next step.
An updated set of vitals is essential. "Is the patient stable?" really means "are their vital signs stable?" Compare: a patient who is SOB, tripoding, 80% on 4L NC with an RR of 48 needs an emergency response now. A COPD patient who is mildly SOB, 88% on 2L NC, RR 28 and mildly labored can likely be handled by phone with adjustments to respiratory treatments and oxygen.
If the patient is stable, move on to the next question.
Related: Six Steps for Sepsis Management · 5 Vital Sign Errors to Avoid
2. Is There More Information I Need to Know First?
This depends on the situation and takes a little investigation. If the patient is SOB — what's their history? Any asthma, COPD, or CHF? If they have back pain, have they had it before, and what do they usually take? The same complaint may have happened earlier in the stay — what was done and how did they respond?
Investigating trends in labs and vitals matters too. A BP of 180/90 means something different depending on their baseline — and the same is true for a 90/40 in someone who runs in the 90s/40s. If you're called about an elevated troponin or lactate, what were the previous values? Note all of this so you can anticipate the provider's questions and help them decide.
3. Are There Any PRN Orders?
Patients often have "PRN" (as-needed) medications already ordered for pre-established reasons. Check the MAR before you call. Common PRN medications include:
Other frequent PRN orders: oxygen via NC titrated to SpO₂ > 94%, a heating pad for back pain, and "may shower PRN." Whatever the order, it's your job to look for which PRNs are available and use them appropriately. If your mildly SOB, wheezing COPD patient has a Duoneb ordered, give it — and if a treatment doesn't help, then calling the provider is likely warranted.
Also check out my nursing medical abbreviations graphic.
4. Can I Phone a Friend?
Sometimes you're unsure what your patient needs and unsure if it warrants a call. Asking a fellow nurse — especially one with more experience or skill in that area — can sharpen your clinical judgment. Do they think a call is needed, or is there a nursing intervention to try first? Not sure whether that rhythm is a run of VTach? Grab a nurse who's strong at rhythm interpretation. Even the nursing supervisor can be a resource.
A Colleague Is Not a Substitute
Bouncing ideas off colleagues can save an unnecessary call — but it doesn't replace the provider. For any new significant change in status or vitals, the provider needs to be called regardless.
5. Am I Calling the Right Person?
You've exhausted your options and gathered your background — now make sure you're calling the right provider. First, check the attending of record. Is there an in-house team — a hospitalist group, house coverage, or resident team — covering that attending? If not, you may need the attending's on-call service. This is facility-specific, so lean on colleagues if you're new.
The general medical team can usually help, but sometimes a specialist is the right call. A positive blood culture on a patient followed by Infectious Disease? Call ID. Uncontrolled BP on a dialysis patient? Nephrology is the better choice. You can still call the general team — just don't be surprised if they ask you to page the specialist instead.
