On call calls

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    I work mostly on call. My question is are there calls that you receive from pt's or families that want you to make a visit when it isn't an urgent situation or if its for something that could be solved over the phone or taken care of by a family member? How do you handle these situations?
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  3. 9 Comments so far...

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    Luckily I work with an excellent group of nurses, that do a fabulous job case managing. If you are gettinga lot of "nonsense" calls, it could be related to poor case management. There's always going to be those families that call for ridiculous reasons....not a lot you can do about them. I generally go if they call...because I have learned, if a family calls.....they need you. It may not be for the reason they gave on the phone either...its just their way of telling you ~they need help~. I dont EVER want to be "that nurse" who didn't go, and it turned out to be something very serious.....
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    Thank you for the response. I agree with you. I don't want to be 'that nurse' either- . Some nights it can be frustrating when I am driving long distances...:/
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    I know what you mean about long distances. ...i generally have to drive a minimum of 30min, which is not ideal....but i live outside of town.

    Start by talking to your case managers regarding those pts who tend to call regularly. Maybe the nurse can make their visits on fridays, to hopefully cut down on weekend calls. Or....maybe those particular pts need to be seen more frequently.

    Ideally, on call is for emergency situations only. Not for med refls, supply deliveries, or constipation (bc something should have been done during week). Those three seem to be the more obnoxious calls i get. And, oh, falls.....and most of my falls are facility patients.

    What type of calls are you getting? Like i said, i would start by reaching out to the case managers.....
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    Supplies, constipation, CVC dressing changes, medications not helping pt for over 24 hours, things that the family could take care of easily or could wait until the next morning, etc. that's a good idea about the Friday visit, or increasing the visits. We are pretty good about increasing the visits for the most part.... but we are also understaffed during the day- another case manager is needed but not being sought as of yet. A couple of times I've felt I should have visited a pt when I didn't and seen pt's that I shouldn't have. I'm still learning.. Thank you- I will talk to the team , because I can think of 2 pt's right away that would benefit from an additional visit or a Friday visit.
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    Do your case managers do tuck in calls? We have a volunteer who calls our families every Thursday to check on supplies. Its helped a lot!!!
    Nurse_Diane and Marshall1 like this.
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    One more thing...we use pt education handouts r/t foley care, nausea, constipation, pain, etc. Ive learned you can teach and teach, but some just dont remember in the heat of the moment. If families have something they can refer to, most of them will....which saves a phone call. If i don't have a handout for a particular symptom or procedure, i hand write it to leave with family. Works wonders.....most families dont want to bother the nurse, they just want to make sure they are doing the right thing.

    Those constipation calls KILL ME!!

    Our emergency plan is pretty specific too. Says to call if "temp >100 AFTER ADMINISTERING TYLENLOL'" or call "if pain not managed AFTER ADMINISTERING PAIN MED"...etc
    sclpn likes this.
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    We do not have any handouts or emergency plan. Thank you for your help- ill talk to the the about that. That would be very helpful for us and make taking call a bit easier- especially for the full time nurses .. Great suggestions.. We have CHF patients and flow sheet would be helpful for them too. Thank you again.
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    We have a handout that we do on admit that I really like. It's called My Emergency Plan. It covers: Breathing/lungs, Heart Failure, Chest Pain and a bunch of others, 9 total. As an example:

    Breathing/Lungs

    Call Nurse at Agency
    Increased shortness of breath
    A couch that gets worse
    Change in color, thickness, odor, or amount of sputum
    You become restless or agitated
    Fatigue/weakness
    Loss of appetite or weight
    Fever, oral greater than 100.5

    Call 911
    Difficulty breathing
    Severe shortness of breath or wheezing that does not respond to inhalers or breathing treatments
    Change of color to your skin to gray or blue OR if you become blue around the lips
    You develop confusion

    During the admit we go through the ones that pertain to that patient. This chart is then put on their refrigerator door with our magnet that has our on-call number.
    Marshall1 likes this.
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    If they actually say "i want a nurse visit" I have to go, which I don't always agree with, because like everything else, people learn the system and some abuse it. I got a call this weekend "I dont feel right, I need a nurse" nothing in particular, and I live an hour away, so any visit I go on is at least 3hours. 2hours in drive time and an hour or more at the pt house. she was fine of course, all I did was talk to her after checking her out.

    What ticks me off the most is when I get a call and they say, "my mom/dad had bm, I need a nurse to clean him/her up" and they actually think I am going to drive an hour to do that. uh no, that is not what we do. then they call back and say they are in pain/resp distress and need a nurse. I have to go and they actually alow them to sit in waste until I get there. when this happens, i make them help me and explain it is neglect to leave them that way. Or I have the calls from them go to the admin on call to deal with.

    we have a few that it is like the boy who cried wolf, the first few times, I rush over there, then the more they do it, the less I rush.

    don't get me started on the facilities that call with "change in condition" the pt didn't eat as much for dinner and they want a nurse. Or they want crisis care on a calm and comfortable pt because they don't have the time to check on him during the night. I got that one this weekend.

    I could go on an on, my only outlet is to complain and make remarks to the triage nurse, but when I get there, Im all smiles.

    I don't think there is an easy way to handle these patients, our poor case managers are so overworked they don't have time to tuck them in well. Some of them have 20+ pts each. There is no way I would be a case manager at my agency, no wonder we cant keep anyone.

    On call is the job no one wants and usually agencies cannot keep them long. I've been doing on call for 7 years, I don't know if I can go back to case management, I must be crazy.


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