We need to become jack-of-all trades. In the daytime, there are specialty pharmacists to take care of each case, but in the evening I go from solving problems for neonates to handling chemotherapy questions in elderly patients.
I got a call past midnight from a cardiology NP. “I have a patient transferred here with a recent history of heparin-induced thrombocytopenia. I need to start argatroban. The order set doesn’t match up with my drug resources, and it’s been two years since I’ve ordered it.”
I told her that it’s been a year for me, and together we worked it out. We were patient with each other until we both felt secure in our decision for the drug. I told her how I’d compound it and she didn’t mind when I called back later to find out the patient’s hepatic function because I’d forgotten how important it was for argatroban during our first conversation. We worked out why the order set didn’t match what her drug resource was telling her—the dose for argatroban is different immediately prior to PCI, but the patient wasn’t about to undergo the procedure. After handoff at the end of my shift, I sat down with the night nurses to go over the orders together and answer their questions, since nobody uses this fussy drug very often.
Overall, a great collaboration between me and the NP, who is also a young practitioner, and a great refresher on my knowledge. I highly recommend evening and night staffing, especially when you’re new.