Appointment setting / triage question

[Altra, BSN, RN]

Hello office practice nurses, a couple of recent experiences have left me bewildered.

1. I called PCP to schedule annual physical. I was asked if there were any areas of concern, and I did describe Symptom X. The tone of the conversation immediately changed, and I was asked "does Dr. NiceGuy know about this?" I replied that yes, he did ... we discussed it at my physical last year. I also provided an additional 2-sentence description covering the decision points that I would ask a patient I were triaging to make the decision about how acute/concerning Symptom X was in that patient. I did so without saying anything obnoxious like, "I'm an RN, blah, blah ..." What particularly irritates me about this conversation is that I have been a patient of this practice for a long time, and I am very well aware that the person(s) who answer the phone and make appointments are not nurses, and in fact not MAs either.

2. My spouse called PCP to report 2 weeks of intermittent abd pain after eating. Spouse was told, "you'll have to speak to the nurse to make that appointment". Spouse replied, "oh ... do they have the ability to order testing prior to the appointment, and that's why I have to speak with her?" No, that was not the case - "no testing will be ordered until seen by the physician" ... but you can't make the appointment until you speak with the nurse. And the nurse will return your call - tomorrow.

My gut reaction to both of these scenarios is that this amounts to triage by untrained staff gone awry. What am I missing here?

[kcmylorn]

Let me first state- I am an RN that does triage in a primary care office. Triage can only be done by a LICENSED RN- please hear me again all of you(?)well meaning unlicensed personel out there in cyber space.( and I'm not talking about having a driver's license). That is the LAW, we RN's did not make that up and it is a law for very good reasons

This point may have cost me my job this week. The week had 1 more day to go. I have been confronted with this very noxious and outragous behavior this week at least 2 times. I am sick and tired of the receptionist and MA's doing triage. They are neither licensed nor are they educated to be doing triage.

The 2 calls that the OP presented should "legally" and in the best interest of the patient( not the receptionist or MA and their over inflated ego's) have went like this:

Caller: "I would like to schedule an annula physical."

Receptionist: "Are there any areas of concern? "

Caller: "Yes." It was at this point that the receptionist should have said "Let me let you speak to the NURSE. Let me transfer you to the NURSE" or if the nurse was busy: "Let me take you phone number and I'll have the nurse call you back" . Boom. End of receptionist's involvement- none of the receptionist's business what your concerns are=. That receptionist can not do a blessed thing about your concerns. It is not the receptionist's business. HIPPA. That receptionist is not in the "need to know loop". Too much lack of supervision has gone on with all the unlicensed personel in the healthcare field. And this is what happens when an unlicensed person hears "licensed"( those who have gone through an RN program, graduated and passed nursing boards or NCLEX and hold the educational credential and license to deem the initals RN) doing their job and think that is all I have to do- I can do that. This frosts my backside to no end.

The second senario sounds like the receptions wanted the caller to speak with the nurse to determine the possible causes of the intermeittent abd pain and make a clinical decision from what infor gathered to make a judgement as to if it was something that needed to be sent to the ED at that point =an medical emergency, or urgent- can this be handled in the office at a same day appt or the next day or a routine appt possibly 7 days out because there were no open appts and if urgent, means it would have to be double or even triple booked appt. where the patient is booked for an appt and if all 3 people show upfor that time slot then it willbe another triage scenerio in the waiting room.

Primary care offices are vastly under staffed and over booked now a days and this is only going to get worse because of the new health care reform and newly insured people in this country. These offices have ran on little to no shoestring staff for years and now they can't anymore. The hospitals are are not seeing these patients where does common sense tell the powers that be these patients are going to go not that their is more patients gaining insurance through the state insurance exchanges.

My major malfunction this week came when I was sitting right next to our receptionist( I am a new hire into a new triage position for this clinic, I am not new to clinic triage) and she passed me over and took the triage call to another nurse who is not the triage nurse. When I spoke to the office supervisor about this, she spoke to this receptionist. So the receptionst took the next triage call in another language and triaged the call herself. What she didn't realize- I understood the medical terms she was asking the caller in her native language. I had a melt down. and now I fear for my job instead of the receptionist fearing for hers for doing something that was out of her area to do in the first place. May be if a few of these ballsy unlicensed personel get reported to the Board of nursing and sued for fraud( practicing nursing with out a license) they will learn their lesson. leave nursing to the licensed nurses. Those who the states say are legally allowed to practice nursing. I am so fed up with nursing, I am ready to throw the towel in. JMHO

[kcmylorn]

I also need to add- MA's are cheap to pay. That's why alot of family practice clinics hire them and farm out all the tasks they can to MA's and receptionists and fly under the state radar not to get caught letting these people do triage. Afew phone calls to the state may cure that. Names dates and times- documentation and since you are the patient- that will carry more weight.

[kcmylorn]

Week is done. I think I still have my job. The receptionist did it again today. Today it was a pair of 3 yr old twins. I directly asked her about this and let her see me writing down every word of her response- When I asked her if that was a triage her response(verbatium) was "we have appointments, though and their 'big'" Does this mean she now has second thoughts about the 5 week old she triaged yesterday? She really thinks her triaging in another language makes it ok?

This is how things have gone awry, and how these untrained and unlicensed personnel get away with thier illegal behavior. They know what they are doing or they wouldn't be doing it in such a clandestine manner- in this case in another language she thinks others don't know what she is doing. I will be willing to bet, that in the OP's case, the RN didn't even know the call came in, but it is the RN who will be blamed if there is a serious problem with the intermittent abd pain case. No doctor or nurse fools around with a complaint of abd pain. Just goes to show you how irresponsible these unlicensed personnel are.

There is no way this RN is going to take any fall for unlicensed personnel over stepping their bounds on any witness stand. I am documenting exact quotes of the conversations I have had with them warning them not to do it and their responses, in addition to thier name dates and times. In the event that I would be called into court over one of their illegal practicing nursing with out a license insidents( fraudulant insidents), I am going to give up these names, dates and times and the circumstances surrounding the event. These unlicenced personnel do not know when they have crossed the line from the task they are supposed to be doing and into the critical thinking decision making realm of a licensed nurse. Example: they are taught how to perform Vital signs not how to interpret those Vital signs. This fool today, also, gave abnormal lab results over the phone. I point blank asked her if she knew what those abnormals meant. She just glared at me. I showed her my triage log and asked her to write her triages on it. Her response was" that log is only for your triages"

These receptionists and MA's should be given a script what to say- as in the above post and if they don't follow it, they should be fired. They are a major liability to these practices. Not the kind of employee that should be in today's healthcare workplace.

[Sally Now]

Yes, this is a major issue in a lot of places. Until relatively recently, experience (whether as MA or receptionist) was enough. Not anymore. Unfortunately, the formal policies, scripts, ancillary/UAP training on the issue and appropriate triage staffing are not usually in place. This is a management issue, they must provide the written policy and procedures, the education on those two things, the scripts, and ensure there is enough triage (RN) staffing. Having said that, many are now dealing with crisis management - EMR implementation and meaningful use attestation prep (money) and until there are lawsuits (money) this will not get the priority attention it deserves. I'm struggling with this as a triage RN. We don't even have electronic protocols, I'm using the Briggs' book. And every day, I hear receptionists and MAs continuing to triage. It's a management issue, and we must find a way to make them take notice.

[g8sushma, ASN, BSN, MSN]

this is seriously dangerous practice, but this happens in my hospital too we have surgeons letting techs take out stiches. i know for a fact that this is not legal in ny, however i told my nurse manager and she tried to justify it. so it is in her hands now.