Calling DNS in middle of the night. Can someone please explain to me...?

Daytonite, BSN, RN · Oct 6, 2005

It's a privacy and confidentiality thing. It is a generally accepted practice to never give out any employee's phone number unless the employee has OK'd it. Most large companies won't give out employee numbers. The accepted practice is to get a name and phone number from the caller and tell them that you will have to call one of the administrators and that you or someone else will get back to them shortly. Then you disconnect from the caller and place a call to the DNS and tell her what is going on. The DNS might want to call the name and number of the person at the hospital, or she could have given you other instructions.

When I was a hospital supervisor, our supervision staff had home numbers of all the doctors and all managers of all the departments of the hospital. (They were actually kept in a lock box in the nursing office that only the nursing supervisor's had a key to!) We were to never give those numbers out to anyone under any circumstances. We could call any one of those persons ourselves and discuss the problem we were having, but that was as far as we could go. Now, sometimes a doctor would ask us for the name and number of the other person involved in the situation and he would tell us he would take care of it. Other times, our nursing administrator would give us specific instuctions as to how to procede with a situation and then tell us to call her back if there were any more problems with it.

FYI. . .none of the LTCs I worked in would take an admission during the night hours unless we were specifically instucted that a Mr. XYZ would be coming in for admission at 2am. The homes need to have all the financial and other administrative information in place before they OK an admission--this is just the business end of things. Sometimes a hospital will try to dump a hard to place patient on a nursing home in the middle of the night by buffaloing the night staff in the LTC, but it is rare.

From what you've written it sounds like the home you work at doesn't want that patient back for some reason. There's cases where they can do that. However, not knowing all the circumstances involving this patient, I would just have told the hospital that we had no available beds for an admission, so no place to put the patient. :stone Nursing homes tell this little white lie to the discharge coordinators at hospitals all the time as a stalling tactic, especially when there is a particular patient they don't want in their facility. I worked for one facility that sent a nurse immediately to visit the potential patient at the hospital to evaluate the patient's condition to help decide if they wanted to take the patient or not. They can do this with private paying patients. The hospital can hold the patient until the morning when the social service people and discharge coordinators can get on the phone with the administrative staff at your LTC and duke this thing out. There may be some problems going on between this patient's family and the LTC administration staff that has to be worked out. My guess is it's either financial or the patient or patient's family has been a source of problems for the institution. You may never know what is really going on. Our part as nurses on the night shift is to just stall the admission process until regular business hours. Didn't know you also became a receptionist and secretary when you took this job, did you? :chuckle Welcome to long term care!

babynurselsa, RN · Oct 6, 2005

I would have refused to give out her home #. I would have called her myself and relayed the info and given her the name of the hospital nurse and the extension to call.

I agree Iwould never give out any employee's number to anyone outside of my facility. I have seen too many instances of people mis-representing who they were. This could have just as easily have been a family member impersonating hospital staff.

CoffeeRTC, BSN, RN · Oct 6, 2005

:yeahthat: Next time, be firm with the hospital, take their number and call the DNS yourself.

As far as not taking back the resident, I'm curious as to the legality behind it. Was the family asked if they wanted to do a bedhold? Has the pt officially discharged?

estrogen · Oct 6, 2005

I guess I dropped the ball on that one. :uhoh21:

I don't really want to go into detail as to why we didn't want to re-admit the pt because it would be too pt. specific info... Ya know... don't want to get into any more trouble... :)

Daytonite, BSN, RN · Oct 7, 2005

As far as not taking back the resident, I'm curious as to the legality behind it. Was the family asked if they wanted to do a bedhold? Has the pt officially discharged?

This is exactly why as a nurse we can only be in a position of doing what we have been told. The business end of things is complicated and not ours to interfere with. It's quite possible that Estrogen will never know why she was told not to take the patient back. It is quite possible that the DNS never anticipated that the hospital would try to send the patient back in the middle of the night. It's possible that the family was told that the patient could not come back. There are any number of things going on here. If your boss tells the staff not to re-admit the patient, the correct thing to do is as the poster did--turf this problem off to the DNS even if it's the middle of the night. I'm sure when the DNS got in to work yesterday morning she was in with the administrator discussing what went awry with this patient's disposition and this poster who was the night shift charge nurse didn't do anything wrong with regard to the patient. She, like all of us, owe that duty to follow the instructions we are given by our bosses. This patient was in no jeopardy. Someone from an acute hospital telling a charge nurse at a nursing home "Do you know that you are obligated, since he's your resident.... Do you know that you are liable.... Do you know that you will be reported... Are you willing to take the risk etc..." is very inappropriate and very intimidating. This is ultimately an administrative problem. If Estrogen had given in to whoever had been trying to push her into accepting this patient, her job would have been in jeopardy. As long as the patient was already at an acute hospital, he/she is safe and being care for. This is the first concern of all. The hospitals have to deal with dispositions of patients all the time. Nursing homes refusing to take back patients happens as well as families who refuse to let one of their family members come back home from an ER visit. This stuff happens and someone in that hospital should have known how to deal with it, especially in the middle of the night. Hospital personnel threatening and trying to get into an argument with a charge nurse in another facility is way off base.

I guess I dropped the ball on that one.[/Quote]You did fine insofar as the patient was concerned. I'm sure you'll never give the DNSs home number to anyone ever again! In nursing homes, especially during the nighttime, there is someone from administration who is supposed to be on call at all times to handle just these kinds of situations. Unless you have a specific list of who is on call it is totally appropriate to start by calling the DNS. The on call person serves the similar function of a nursing supervisor as in an acute hospital. Review with your DNS what you are to do in a situation like this again. Also, since you are the only nurse on duty at night (I thought I read that in one of your other posts) it is necessary for you to know who to call in the middle of the night for advice and consultation. As well as being the charge nurse, you are also the highest ranking employee on the premises and need to know this information for the safety and well-being of both the employees and the patients.

joyflnoyz, LPN · Oct 7, 2005

It sounds as if this patient was sent out, and returned the same day. Didn't spend any time in the hospital other than in the ER, and wasn't gone 24 hours. In our facility, they have to be gone 24 hours to actually be discharged and thus, a "re-admit". (and yes, the 3 hours of paperwork that goes with it)>

As far as giving out the phone #, I'd say that's a no go. When someone calls wanting to admit during "off hours", my response is "I do not have the

authority to do that. May I have your name and phone number, and I'll pass that on to the administrator" and she will call you back. "I need to check with or and someone will get back to you." works too.

We have a "Companion Services" section. supposed to 'assist' those in INDEPENDENT living with certain things..(most times the person shouldn't be left alone d/t dementia, but then WHY on earth are they in independent living?? duh..sorry, I digress). Anyway, family members who use companion service have the director of CS phone #. Poor guy was hounded day and night. Just wuit to go to another place. I considered the job for about 5 seconds and decided no way ..I couldn't put up with that...I liked the other side of the job...wellness nurse> I continue to digress, and I'm so tired I think I'm rambling and not making sense..forgive me please.

Anyways...NO on handing outhome/cell phone numbers...that is private information. YES on calling DON at any hour for a situation.

angelbsn · Oct 7, 2005

In our ED, if a NH refuses to take a pt back after an ED visit, it's a big no-no...too many legalities around NH "dumps" (which we get often). Our ED docs are great at calling the pt's doc to straighten things out on both ends. The pt goes back, & it's up to the doc to speak with the family during more normal hours to arrange alternate care.

On a side note...while I'm sure there are many good NH out there with qualified, caring staff, it's rare that we receive a pt from one of these facilities. Most of our NH pt's truly are "dumps" in deplorable conditions. Makes me furious :angryfire to have a pt come in unkempt, with dried you-know-what everywhere, decubitus everywhere, gravy in the foley, with no one whatsoever involved in any aspect of their poor lives.

CoffeeRTC, BSN, RN · Oct 7, 2005

Heck yah you can call the DON any time of day or night.

What I really don't get is where the hosp nurse got off threatening you. Or was this a social work person?

There are rules/ regs about this. Is anyone up on them?

button2cute · Oct 7, 2005

OK, the situation was as follows:
We had a pt. who was Yesterday on day shift sent to the hospital. When I came on to night shift last night, I was informed by eve nurse, that per our DNS we are not to re-admit him to our facility. During the night (around three in am) the hospital called telling me that they want to send him back. I told the person on the phone that I have instructions not to re-admit him. She started saying: "Do you know that you are obligated, since he's your resident.... Do you know that you are liable.... Do you know that you will be reported... Are you willing to take the risk etc..." She sounded very demanding and threatening and argumentative. I told her calmly, that again, these are my instructions which I will follow and that I cannot comment on any legal issues. She demanded to speak to our DNS and wanted her phone number.
I gave it to her, since I figured that I'll have to call her anyway with all this information and check with her what to do and that she'd have to call this person anyway. I was affraid to get into trouble, if I do the wrong thing... I could just imagine, the facility being slammed with some legal measures and them blaming me for it.... Oh my goodness, that's the last thing I need.
In the morning the DNS came in and was angry with me. "Did you give my number to the hospital? DON'T EVER DO THAT!" she said... "The instructions were clear. It's the same as giving it to family members. Even I am entitled to some privacy." I appologized three times and I asked if I could have called her if I had a question or problem with this issue. She said "ABSOLUTELY! I am here for you guys any time but don't give my number to any third party."
I just don't understand it! How is it the same as giving it to family members? Does she assume that the hospital will pass it on to the pt's family members? I can't really imagine that to happen. Can you?
I'm affraid that I'm being stupid here, but I just don't seem to understand the difference. I know that some people are really protective of their phone numbers, but I guess I don't understand the concept. My work calls me all the time at any given hour too, to ask if I would come in to cover for someone (they pulled me out of bed more than once). My husband's work, co-workers, different contractors call all the time and at all hours to. It annoys me, when they call at 7 am on sunday morning but I just kind of accept it as a part of life. Then if she said, that she's available to us at any time for any questions we might have, and then there's a potentially legally dangerous situation emerging, and she would have most likely had to make a second phone call to the hospital anyway, after she talked to me, why was it a mistake to give this person (I'm not sure unfortunately, but she was either the nurse or the social worker) her phone number?
Am I missing something here??? I guess I must be...

Hello, Everyone

Estrogen......

Do not ever give out anyone's number at work. It is a safety as well as a private. You assume it was a nurse and no harm was noticed byyou. Well, there are horrible stories about nurses giving out personal information to people on the telephone. It was a learning lesson, it breaks the rules of confindentiality and safety.

Stand up to anyone that tries to use the verbal force and verbally threat. Always get the caller's name, position and the purpose of the call. Write the conversation down.

If you need to call the DON than you call her and no one else. unless, someone else in the your facility.

Therefore, over all you handle the situation fine. I am not sure if you fear the peron on the phone; clinical skills where intact and a lesson well learn.

Friends,

Buttons

Antikigirl, ASN, RN · Oct 7, 2005

I would have refused to give out her home #. I would have called her myself and relayed the info and given her the name of the hospital nurse and the extension to call.
I agree Iwould never give out any employee's number to anyone outside of my facility. I have seen too many instances of people mis-representing who they were. This could have just as easily have been a family member impersonating hospital staff.

Exactly! I have had to do this! My facility also encourages no re-admits after a certain hour or day, but if the hospital discharges them...we have no choice, we must take them in (ohhhh and usually with no clear orders, all sorts of things to clarify, and always on a weekend..LOL! Murphy's law I think!).

Peoples home numbers are what I considered "classified" information. My employer may call me in cases of emergencies and such, but to never give out mine to anyone (they will call me with the return phone number, and that is okay with me). I would have been very upset if someone had given my number out, but I wouldn't have chewed someone out for it, just reminded them why this isn't done (why chew someone out and get them scared when a simple explanation to the whys is so much more helpful and benificial!).

BabyRN2Be · Oct 7, 2005

Estrogen, maybe you think you dropped the ball but the only mistake you made was giving out the DNS phone number at night. Chalk it up to a lesson learned. The hospital was just trying to harass someone into taking back this pt and it happened to be you. I don't believe that *you* can be legally held responsible for this. Next time it happens, if ever again, just don't back down. Tell the caller that you'll call the DNS and get back to them. It's just a minor mistake... you've learned it looks like. :)