Top 10 Strategies to survive being on call

Black on call pager

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We’ve all experienced the hustle and absolute pandemonium of being on call.  The constant “beep, beep, beep” of the pager is the stuff of nightmares.  Seriously, is pager PTSD a thing? Every advanced practice provider, whether you’re a nurse practitioner or physician assistant, has come to abhor the dreaded pager. On call week is a blur of multi-tasking.  In this post we’ll explore the top 10 strategies to survive being on call. These tips will help make being on call smoother and avoid having your significant other, family, and friends running for the hills.  It’s all about work life balance. But what can be done when one’s at the mercy of the pager? 

1. Prepare for clinic ahead of time. 

Many advanced practice providers don’t have the luxury of having a call week devoid of everyday clinic responsibilities. It’s usually on call duties in addition to clinic. So there’s scheduled clinic and inpatient hospital call. This makes for a significantly longer work day. Which is quite frankly, exhausting.  The week before being on call take a look at your clinic schedule and review your cases.  If possible complete pre-charting on your consults and follow ups so that they already have a skeleton template prepared that you can fill in on the day of the visit.  (We’ll talk more about templates, electronic medical record documentation, and dictation preparation in a later blog post). Make sure all of the patients have their pre- or -post appointment imaging, labs, and diagnostics scheduled or at least an outline or “cheat sheet” of what tests you think may be needed for the visit.  

2. Grocery shop and meal prep before the week starts.

Since you probably won’t have time to grab lunch in the cafeteria, it’s a good idea to prepare all your meals and snacks for the day and take them to work. You’ll need groceries. Be sure to pack a protein bar or something nutrient dense since it may be the only thing you have time to eat for the entire day.  Meal prep definitely goes for your family as well. Unless you want them to eat frozen pizza and Spaghettios® every night.  Unless you’re dealing with toddlers or that’s your normal menu (been there before) they make take offense. 

Grabbing take out every night may not be a feasible economic option if you’re trying to stay within a budget. So prepare at least three quick dinners that can get them through the week while you’re working late or too tired to cook.  While at the grocery store fill up your gas tank. The less you have to do when the week starts, the better.  

3. Stay caffeinated and hydrated. 

Now is not the time to go on a caffeine strike.  Repeat, now is not the time. You’ll need at least one caffeinated beverage per shift. You’ll learn to love caffeine. Some people are more sensitive to the effects of caffeine so know your body. With that being said, also stay hydrated and bring your water bottle instead of running to the cafeteria for beverage breaks. The cafeteria is probably on the other side of campus and has a long socially distant line.

4. Sleep when you can.

Often times it’s difficult to wind down after the shift because your mind is racing with thoughts of what may have been forgotten. “Did that one patient’s family ever show up? I wonder how the sweet old lady on floor 9 is doing.  Did I forget to write the prescription for nausea?” Learn to disconnect. Turn your mind off so that you can sleep since it may only be for a few hours. 

5. Come to work with a good attitude.

This can be challenging since as the week progresses more tasks accumulate. There’s just not enough time in the day to get it all done. Patience and time will start to run thin. Don’t sabotage your day by coming to work with the wrong mindset.  Be kind to your colleagues, friends, and family.  It’s not their fault the pager is blowing up.  Each day find a quiet space, even if it’s the stockroom while you’re grabbing samples. Recite 3 things that you’re grateful for so that you can refocus on what’s important and make it through the day. 

6. Don’t be afraid to ask for help.

It’s easy to feel obligated to know everything and do everything.  But, there is no shame in asking for help.  One of the first things I learned in undergraduate nursing school is to always ask for help if a) you don’t know how to complete a task and/or b) you’re drowning.  Also it’s expected to delegate tasks to your care team.  If the scheduler can make sure an appointment gets on the calendar let them take over that responsibility. If a brilliant nurse can triage ask them to help triage while you attend to other patient needs.  Be kind, help others, and they will be quick to help you as well. 

7. Don’t procrastinate.

Tasks can easily pile up within a few hours of your on call shift.  Have the mindset that “there is no tomorrow”.  Everything for that call day needs to get done that day or else before you know it, you’ll be drowning in a sea of tasks.  Document as you go using your prepared cheat sheet mentioned above and templates. If phone dictation is an option, stop what you are doing and dictate a note so you don’t lose your way. 

Prioritize and place orders based on highest level of need.  No one wants to finish out the on call assignment with two weeks’ worth of documentation and pending orders.  Prevent repeat pages by documenting your assessment and plan as you go and no one will have to page you twice. 

8. Warn family and friends.

Tell your family and friends that the on call week is coming up. Let them know that you won’t be available for dates and extracurricular activities during the week with the exception of your kid’s play, recital, soccer game, etc.  Those can’t be missed.  A warning lets you off the hook. A warning also lets them know that you’re not being flaky.  Explain that you would otherwise really like to participate but you’ll be busy with an on call assignment. This may also excuse them from enduring your overall crankiness and fatigue.  Check in with them when the dust settles and your routine is back to normal.

9. Treat yourself.

Either at the end of each shift or the week reward yourself with a small treat. This could be something as small as your favorite latte, a smoothie, watching that show on Netflix, or going for a walk on your favorite neighborhood hiking trail. It’s “OK” to do something just for you, especially when you’ve been serving others.  Reward yourself for making it through the day. 

10. Unplug and digital detox.

Lastly, after carrying the on call pager for a week and constant interaction with people, you’re more than likely going to want some time to unplug. It’s “OK” to take the weekend off from social media, email, etc.  Just be sure to return phone calls and catch up with everyone once your mood improves and you’ve had a chance to catch up on sleep.  

Surviving an on call assignment can definitely feel like a gauntlet. The on call experience in healthcare is unique given the level of complexity that can be involved in caring for patients. This post was all about some top strategies you can employ to make being on call a success. You can make it through the trials by preparing ahead, keeping a cool head, knowing when to ask for help, and taking care of yourself.  Warn your family and friends that you’re going to be tired and hangry so that they can give you some space to make it through the week.  Keep your outside obligations light along with your calendar and you’ll be at the finish line in no time.  

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