Quote from Zippy Head
Ever since I was a little RN, admitting would call and tell me that my patient had been Observation status for too long and today, right now, it had to be changed to Inpatient status, meaning I had to call the MD and get that changed. The first few years, I was working nights, and I would get this hassle heaped upon me near to midnight. I recall the charge nurse enforcing that view, making me call an MD at midnight to change to Inpatient. He was not pleased.
Now I'm a bigger RN and nothing has changed. My hospital recently changed from non-profit to for-profit, and they are noticeably more disagreeable regarding the Observation topic. Case managers chase after the RN and stress her out about this "changing to Inpatient status," and if that doesn't work, they bully the charge nurse.
My question to you: whose job is this? The MD admits to Observation, yet Admitting won't call them. Case management won't call them. Everyone dumps on the RN, like it's her job to do everything (another topic). This thing must go on in your hospitals, how do you handle it?
The answer to that lies within your organization. My hospital may say it is the nurse's to track, others will tell Case Management to have it properly handled. It all depends on the views of the administration/management.
My first job ever was at a hospital with very aggressive case managers. They'd do exactly as you described wanting this and that phone call made. Sometimes I'd help out, sometimes not. Depended on what kind of acuity I was facing with regards to my pt. load. In the end though, if it did not get done, admin. was not calling for my head, they were writing up the case manager. That, more than anything else, is what decides who's "job" it is. Case management knew, if I was busy and ignoring their requests, they'd have to do it for themselves or perhaps face a write up.
On the other hand, when I was a travel nurse, I worked at a few facilities where it was different. There were less case managers and the impetus of this task seemed to fall more on the shoulders of the nurses. It was a different atmosphere though. Case management was too busy to spend half an hour convincing nurses to make a phone call for them that would take less than five minutes to do for themselves. At these hospitals, nurses were more aware of a pt's admit status, it was considered a part of report. Our rounding sheets had that info. directly beneath the name.
I do consider this issue a part of nursing. There are insurance repercussions for the hospital, and more importantly, the pt. if someone spends time in the hospital under the wrong admit status. Insurances will jump on this mishap and not pay for whatever time the pt. was there under "observation" status. They pay many people much money to find things of this nature. When this happens, the hospital will hand the bill to the pt. We as nurses are not doing our pt's any favors if we fix their hyperglycemia, but send them home unable to afford insulin because they instead have to pay a hospital bill that could have been avoided for them with a proper admitting order.
The case managers at your facility sound like the one's from my first job. Don't let them bully you into neglecting your patients while you make phone calls they can/should be making. You are an RN, not the Social Services Dept. secretary. If you are busy and don't see yourself having a window of opportunity to make the call for them.......say so and leave it at that, walk away, don't even bother listening to their pleas. They may counter with the age old "It only takes two minutes", to which I always replied "And you've wasted ten minutes trying to get me to do if for you..........you could have corrected five improper admits while you were standing here bothering me." They got the point eventually. Remember, most case managers are slow learners.......nurses who realized they could not tow the line as a nurse so they jumped ship over to case management. They are a dime a dozen, don't let'em bother you.