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 I had been working at my current job for about a year when a physician colleague asked if I would take call for him while he went out of town.
I was happy to help out, and to be honest, I was somewhat flattered.
For most of my career, I had been told that physicians didn't entirely trust us NPs with call. Taking a turn in the call rotation felt a bit like I had finally been invited to sit at the grown-up table at Thanksgiving dinner.
Until the first time my pager went off, it didn't even cross my mind that I had never had any formal training in the art of call.
Now after 4 years, I take call every other week for six facilities. In the beginning I made my share of mistakes. But looking back, I learned some important lessons. Let's take a look at some of those here.
Be Available
It's not all about the money. Even if the money is good, it's still work. Being constantly available - whether you're called or not - is the expectation.
Sure, you can still go about your business, but knowing that the phone may ring anytime will keep you from doing things like attending a concert, going out for drinks or doing any activity that takes you out of cell phone range.
Test Your Skills
Taking call will test your clinical skills in new and unexpected ways.
Do you remember learning in school that 90% of the diagnosis is made based on history alone? That statement is never truer than when you're taking call.
If you're talking directly to the patient, your decision will be based entirely on subjective information.
A key difference between call and an in-person encounter is that you have to rely on your ability to elicit a clear history from the caller.
There are no charts to review and no vital signs neatly recorded next to a list of medications.
This different way of working and thinking is a challenge that can be nerve wracking at first. Honestly assess your current skills, and acknowledge areas that need improvement before you take call for the first time.
Be Diplomatic
Whenever you take call, it's your license on the line. Take a careful look at your ability to be assertive.
This is especially true if you are taking call for a facility where a nurse, rather than a patient, will be calling you to report new developments and receive treatment recommendations.
Your assessment and the resulting treatment plan are only as good as the assessment done by the nurse on the other end of the phone.
And you don't get to choose the nurse. The least experienced or least skilled nurse is just as likely to be calling as the most experienced and trusted nurse. At best it's uncomfortable to send your nurse colleague back for more information, especially if you're still in the novice stage yourself. At worst it will be taken as an insult.
But the bottom line is that you're responsible. You put patient safety at risk if you base your treatment decision on a poor or incomplete nursing assessment just because you didn't want to make waves.
Think Like Your Colleagues
We don't all think alike. If you're sharing call with other providers, you'll eventually be asked to make a treatment decision for one of their patients.
Have a sense ahead of time about how your colleagues would prefer you to handle their cases, especially if it's one of their "regulars."
Take a few minutes to sit down with your call partners to get a sense of how they handle typical call scenarios.
It's good for everyone involved if you can all be on the same page, and it will help you avoid professional misunderstandings down the line.
Know What You're Getting Into
Certainly some of the issues surrounding taking call are about the money. Compensation structures vary a great deal. Call can be lucrative or closer to an act of charity.
Before you can begin to calculate compensation, define the call structure and the potential impact on your life. Some call compensation is paid out per call, and sometimes the arrangement is a lump sum paid to you for unlimited calls. I am not an advocate of the per-call system - if I have to be on call, I want to get paid.
If you're asked to take call, get an estimate of the volume before you agree on reimbursement. I also recommend setting a date to revisit the numbers.
In my experience, call volumes can quickly exceed original projections. Will a phone be provided for you, or do you have to use your own? Call can eat up your cell minutes, so factor that into your compensation.
Rewards
Call can be rewarding, both financially and professionally.
If you're ready to embrace the challenge of call, you'll learn new skills that will ultimately sharpen your diagnostic and communication acumen.
Because call isn't part of any clinical rotations, I urge you to seek out opportunities to learn about it. Set aside some time to talk to your preceptors, and ask them to share some of their experiences and insights with you.
During your first few call rotations, ask for backup; it's nice to know you have someone you can consult.
Your willingness and ability to take call will be seen as an asset to any employer and be much appreciated by your colleagues.
Renee Dahring is a family nurse practitioner who works in several correctional facilities in the Minneapolis-St. Paul area. She has more than 5 years' experience as an NP recruiter and is the Career Coach blogger for ADVANCE for Nurse Practitioners.
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