Patients on the telephone

firstyearstudent · Apr 12, 2009

I would hope that whoever had the privilege of taking care of her...

I'm intrigued by what you wrote. I in no way would consider it a "privilege" to take care of your mother or anyone else's. Nor would I consider it a "privilege" for another nurse to take care of me or one of my family members. If it was a privilege, we would pay for it, right, not expect to get paid for it. Giving care is almost always a burden for the caregiver, at least in my book. Is it worthwhile and fulling "work." You bet it is.

Virgo_RN, BSN, RN · Apr 12, 2009

If there are other things I could do, I just leave them and go do those other things and check back in later. If I really need them off the phone, I will stand there with my supplies/meds in my hands and wait for them to get off the phone. Usually they're pretty good about reading my nonverbal communication and will get off the phone.

What irritates me more are those phone calls that get forwarded to my phone from the front desk from family members while I am in the middle of patient care, asking me why their loved one is not answering the phone.

eriksoln, BSN, RN · Apr 12, 2009

This issue is one of many examples of how focusing on "service" rather than "health" puts the pt. at risk.

With that said, it is my belief (and the governments apparently) that pt. autonomy, their right to choose regardless of whether we as healthcare workers agree with their choice, is not always respected.

If someone puts off treatment/meds/tests because they are more concerned with making sure their business stays on the right path or cant have their chat with a family member interupted...........its their right.

What we do as professional nurses in response is the tricky part. Snide remards and passive aggressive verbal jabs are not a part of the nursing process.

To deal with a situation like this, first pt. education must be implemented. Making sure the pt. has a clear understanding of the effects of delaying treatments is of top priority. "If you cant go for your CT now Mr. Wilson, I am not sure they can reschedule for later in the day, you may have to wait until tommorow. That'd mean an extra day in the hospital." Or......."If you dont feel you need your breatheing treatment now, I can give it to you within the next half hour, but anywhere beyond that will mean having to wait for the next dose. Are you sure you are OK without it?". Nothing personal, just information for them to chew on.

Second, document like a beast. When the pt. is the one who delays treatment, if the proper documentation is in place, you will help your unit avoid being hit with "unecessary hospital days" marks.

firstyearstudent · Apr 12, 2009

This issue is one of many examples of how focusing on "service" rather than "health" puts the pt. at risk.
With that said, it is my belief (and the governments apparently) that pt. autonomy, their right to choose regardless of whether we as healthcare workers agree with their choice, is not always respected.
If someone puts off treatment/meds/tests because they are more concerned with making sure their business stays on the right path or cant have their chat with a family member interupted...........its their right.
What we do as professional nurses in response is the tricky part. Snide remards and passive aggressive verbal jabs are not a part of the nursing process.
To deal with a situation like this, first pt. education must be implemented. Making sure the pt. has a clear understanding of the effects of delaying treatments is of top priority. "If you cant go for your CT now Mr. Wilson, I am not sure they can reschedule for later in the day, you may have to wait until tommorow. That'd mean an extra day in the hospital." Or......."If you dont feel you need your breatheing treatment now, I can give it to you within the next half hour, but anywhere beyond that will mean having to wait for the next dose. Are you sure you are OK without it?". Nothing personal, just information for them to chew on.
Second, document like a beast. When the pt. is the one who delays treatment, if the proper documentation is in place, you will help your unit avoid being hit with "unecessary hospital days" marks.

I get what you are saying, but what about when pt. autonomy and customer service starts impacting not only that particular patient's care but the healthcare system in general -- because of associated costs. It's not just one patient, per one nurse and that nurse isn't hired by or paid directly by that particular patient. We have a system where we are working with many patients and procedures and we're trying to control costs. How do we do that (without treating patients like cattle)? What if the patient doesn't want the CT Scan today so they have to stay in the hospital another day in order to get cleared for possible discharge. The patient doesn't pay out of pocket, but someone is most definitely paying.

I was recently talking to a friend of mine, who is not a healthcare worker and who is suspicious and antagonistic with the healthcare system. She in all seriousness told me that she thought doctors should come to your house to perform minor surgeries so that patient's wouldn't be inconvenienced. Can you imagine how expense that would be?!?!? There's just no conception among the general public or maybe it's just a lack of concern about healthcare costs -- which are out of hand here in the U.S. and do not correlate with quality of care.

eriksoln, BSN, RN · Apr 12, 2009

I get what you are saying, but what about when pt. autonomy and customer service starts impacting not only that particular patient's care but the healthcare system in general -- because of associated costs. It's not just one patient, per one nurse and that nurse isn't hired by or paid directly by that particular patient. We have a system where we are working with many patients and procedures and we're trying to control costs. How do we do that (without treating patients like cattle)? What if the patient doesn't want the CT Scan today so they have to stay in the hospital another day in order to get cleared for possible discharge. The patient doesn't pay out of pocket, but someone is most definitely paying.
I was recently talking to a friend of mine, who is not a healthcare worker and who is suspicious and antagonistic with the healthcare system. She in all seriousness told me that she thought doctors should come to your house to perform minor surgeries so that patient's wouldn't be inconvenienced. Can you imagine how expense that would be?!?!? There's just no conception among the general public or maybe it's just a lack of concern about healthcare costs -- which are out of hand here in the U.S. and do not correlate with quality of care.

Actually, as long as the documentation is in line.......yes, they would pay out of pocket. Thats a "case manager" issue. When the insurance says we took too long to give the required care, the insurance hits the hospital with "unecessary hospital days". When the case manager reports the delay was in fact the pt's doing, and documentation shows such...........the insurance will go after the pt. Its not common because its rare the proper documentation is in place. Plus, once the word gets out that a pt. is delaying tx, most managers consult the case manager to discuss the billing implications with the pt. Once educated on the personal costs......most patients change their tune. Thats where colaborative care is working.....case management educating pt's on personal health care costs so they can make more informed decisions.

I have seen even where the entire plan of care is changed to make the pt. happy. After talking to the case manager and DON, a pt. stressed they did not like the "hurried, robotic treatment hospitals give". She consistently did things (like being on the phone, but many others too) that slowed down the care process. It was as though......if she wasnt disrupting the flow of care, for herself and others, she was not happy. So, after a coordinated meeting with a charge nurse, the DON and a case manager...........the care plan was completely redone. She was discharged, and everything was scheduled as outpatient. She signed the necessary forms needed to prove she knew there was an increased risk involved in the early D/C but still prefered it. She was off the unit a couple hours later, her OP tx went very well and she no longer had an effect on the flow of care for other patients. Ideal all the way around.

Its not our job to convince someone to be interested in better health. We must educate so informed decisions can be made and be available if help is needed.......and only for the help asked for, not the ritualistic predetermined care we want to give.

firstyearstudent · Apr 13, 2009

Actually, as long as the documentation is in line.......yes, they would pay out of pocket. Thats a "case manager" issue. When the insurance says we took too long to give the required care, the insurance hits the hospital with "unecessary hospital days". When the case manager reports the delay was in fact the pt's doing, and documentation shows such...........the insurance will go after the pt. Its not common because its rare the proper documentation is in place. Plus, once the word gets out that a pt. is delaying tx, most managers consult the case manager to discuss the billing implications with the pt. Once educated on the personal costs......most patients change their tune. Thats where colaborative care is working.....case management educating pt's on personal health care costs so they can make more informed decisions.
I have seen even where the entire plan of care is changed to make the pt. happy. After talking to the case manager and DON, a pt. stressed they did not like the "hurried, robotic treatment hospitals give". She consistently did things (like being on the phone, but many others too) that slowed down the care process. It was as though......if she wasnt disrupting the flow of care, for herself and others, she was not happy. So, after a coordinated meeting with a charge nurse, the DON and a case manager...........the care plan was completely redone. She was discharged, and everything was scheduled as outpatient. She signed the necessary forms needed to prove she knew there was an increased risk involved in the early D/C but still prefered it. She was off the unit a couple hours later, her OP tx went very well and she no longer had an effect on the flow of care for other patients. Ideal all the way around.
Its not our job to convince someone to be interested in better health. We must educate so informed decisions can be made and be available if help is needed.......and only for the help asked for, not the ritualistic predetermined care we want to give.

You're absolutely right. I guess if I wasn't overworked and overburdened and underpaid, this would all make sense not only in theory, but in practice as well.

dream'n, BSN, RN · Apr 13, 2009

Well, even though it is frustrating to us, we have to keep in mind... being in the hospital is a HUGE inconvenience to a patient. I mean, yes, it's an inconvenience when we have to "tip-toe" around the phone cord to get vitals, admin meds, etc... but it would suck even more if someone had to wake us up every 4 hours, constantly come in our room and disrupt us, give us no privacy and on top of all of that... being sick at the same time. We are nurses and nurses are "persons educated and trained to care for the sick". Part of our care is respecting patients and their privacy. When I find it difficult to deal with "rude" patients I try to look at it from the other side. What if it were my mom in the hospital (who is 6 hours away) and I didn't have any time off that would allow me to go see her... wouldn't I want her to be able to talk to me whenever I had the chance to talk to her? Would I really want her to be lonely and laying in a hospital bed with nurses who were frustrated at her because someone called to check on her? I would hope that whoever had the privilege of taking care of her would "respectfully" ask my mom to get off of the phone nicely if the procedure absolutely called for it. Otherwise, I'd want them to be happy that she had someone who cared about her enough to be on the phone with her for so long.
I don't know... just my own thoughts.

While I guess I can understand that being ill and in a hospital could be an 'inconvience' (odd word, since it's THEIR health afterall) to the patient and/or their families, it is my duty to provide the best nursing care that is needed for them AND all of my other patients to heal. Sorry if I sound mean, but my nursing priorities are more important than their personal telephone call. I would be polite, but really I do not have time to wait for personal phone calls to end to do my job. I think very logically about my time, the time I spend waiting for someone to finish a call is time I will not have to perform other duties. I am responsible for other patient's nursing care and also for my own time management. Personally, I consider it VERY rude for someone to continue a personal phone care when a nurse/tech/Dr. is their to provide them treatment. But I also find it rude for people to continue cell phone chit-chat at the bank teller, at a cashier, etc.

dream'n, BSN, RN · Apr 13, 2009

"Its not our job to convince someone to be interested in better health. We must educate so informed decisions can be made and be available if help is needed.......and only for the help asked for, not the ritualistic predetermined care we want to give".

Of course, but only if we can get them off the phone long enough to give them the information that they are delaying care.

SoundofMusic · Apr 13, 2009

I will sometimes try to tell them, "Please, don't get off the phone for me" -- and I proceed to give them their meds or whatever while they're on the phone. Sometimes that works. Most seem to WANT to get off the phone when I come in . . . and then they proceed with their usual 20 questions, or crazy requests, or what have you.

**canoehead, BSN, RN** · Apr 13, 2009

I stand there and count to ten silently. If they don't make some indication that they want me to proceed, or say "hold on a minute" then I leave and go back when I get to it, usually in 15 minutes or so.

It's more likely that someone will come out of the room and say the patient is ready for me now. I say something along the lines of "OK, I'll finish what I've got going now, and be right in." What I'm doing at the moment can take 30 seconds or 30 minutes, but remember that as a nurse you are in charge of prioritization.

Only twice have I felt the need to document every time I went into the patient's room, and it served me well. If I'm going in every 5-10 minutes, and documenting each interaction, the patient may not be getting what they asked for, but they are certainly not being neglected. I'll even document that I told the patient they need to give me time between calls to complete the requested task...

This post makes me sound like a real dog's behind, but I'll trip over myself to help someone in need. I've got to maintain boundaries so I can provide care to everyone, and not just those demanding it. I really think new nurses need to learn the coping skills that develop through the years, but not from nurses that abuse their power. Don't sit around just to teach someone a lesson, but if you really have another sick person to tend to don't be ashamed or embarassed about putting them first.

eriksoln, BSN, RN · Apr 13, 2009

I stand there and count to ten silently. If they don't make some indication that they want me to proceed, or say "hold on a minute" then I leave and go back when I get to it, usually in 15 minutes or so.
It's more likely that someone will come out of the room and say the patient is ready for me now. I say something along the lines of "OK, I'll finish what I've got going now, and be right in." What I'm doing at the moment can take 30 seconds or 30 minutes, but remember that as a nurse you are in charge of prioritization.
Only twice have I felt the need to document every time I went into the patient's room, and it served me well. If I'm going in every 5-10 minutes, and documenting each interaction, the patient may not be getting what they asked for, but they are certainly not being neglected. I'll even document that I told the patient they need to give me time between calls to complete the requested task...
This post makes me sound like a real dog's behind, but I'll trip over myself to help someone in need. I've got to maintain boundaries so I can provide care to everyone, and not just those demanding it. I really think new nurses need to learn the coping skills that develop through the years, but not from nurses that abuse their power. Don't sit around just to teach someone a lesson, but if you really have another sick person to tend to don't be ashamed or embarassed about putting them first.

Exactly. For every pt. on a phone, there is someone else down the hall just wishing to themselves you would come and help them out. Nothing wrong with going to the more receptive people first. If you dont have the time for me, I dont need to have the time for you either. Its that simple.

I used to say something to the lazy RNs when I was a CNA that might apply here. When I ran into one of those RNs who wanted to monopolize my time, throw everything and anything on me they possibley could, I always gave them the same warning:

"I'm so bussy, if I hit the ground running and skip my lunch break, I'll get about 80% of the work I should, in an ideal world, be getting done. I can be very aware and in control of where the 20% I dont get done lands. Dont thing for a second I wont choose to have that entire 20% land on you if I desire to."

Same thing with the pt. who doesnt want the tx. Its not like I dont have other things to do, and with more receptive pt's. If what you want is to be left alone, you will get what you want.

Of course, I will document very well why it is you got what you got, and how it was your choice to get what you get:p.

marmsgirl · Apr 13, 2009

Many times when i come on shift my patients are on the phone. I usually do quick hi while doing kinda drive by assessment ~ if they are laughing on phone with family they are not dying or groaning with pain. So i go check on my other patients and come back. If they need something they usually will make gesture for me to stay and get off phone.

Part of my reasoning for this was when my mother was in the hospital, she was on phone all the time with family out of state. It lifted her spirits talking on phone with family.