"Nurse call on line 1"

aussie oi oi oi · Mar 1, 2002

We continually have dc pts call our unit asking for advice about their meds, wound pain etc, I am always hesitant to answer their queries with advice as quite often they will not give you all the facts and it is hard to make a decison without all the clinical facts, I usually tell them to come to ED or put one of doc on the line as I don't want to be responsible for misdiagnosing ischaemic chest pain for wound pain. Although Ed units are always busy and understaffed, I beleive that I don't have the knowledge base to fully issue some advice. There are hospitals that have nurse lines but from what I have heard, it is usally clinical nurses that run this sytem and their repsonsability is the phone, but they have other resources within their reach and it is only an advice line and not a treatment advice as such. Phone calls are always tricky as you can misunderstand what they are saying or can't hear them properly. Not to mention the legal issues, if the pt has chest pain and they say that the nurse told them not to come to hosp, but you know that you told them to go to ED then it is one word against another, no thanks.

MitziK · Mar 1, 2002

Our response is: I really can't give you any advice over the phone but you are welcome to come to the ER where we have an MD on staff to evaluate your condition.

"But I'm not sure if it warrants coming to the ER" I understand (maam or sir) however without assessing you we can't tell you that either.

hoolahan, ASN, RN · Mar 1, 2002

Yup, agree with you Mitzi. I did HH supervision and had to triage calls from our clients. So and so is having trouble breathing, can you send a nurse? I could send a nurse, but she would only come out and say, yes, he's having trouble breathing, he needs to be seen in a hospital! Or, yes, that is indeed blood coming from the rectum! We aren't traveling surgeons! No colonoscoipe in my bag, forgot it at the office today! :chuckle.

I am comfortable with trying to help them on the phone first, ie, bretahing problem, have they had this problem before? What did you do about it then? Do yu have any inhalers, nebs? What is the name of the medicine? Stuff like that, but frankly, we never had the staff to just say, OK I'll send out a nurse to every single person.

I think you are wise if you are not comfortable with it, not to do it. And I don't know how the he!! you can squeeze that in while working in a busy ER! The nurse should be dedicated to a phone line if that is the case. Telling them to come to the ER will never hurt them, and you are so right about not getting the full story.

Jas honey · Mar 1, 2002

I think this is why the docs make big money, so THEY can take care of the medical problems. I only play a doctor on TV, is what I usually say, and then advise them to call their PCP, cardiologist, gastroenterologist, whomever, and explain the problem to them. If it seems an emergency, I advise them to hang up, call 911, and go from there. I will usually call back in a few minutes and stay on the phone with them until the medics arrive. Sheesh...we nurses have to do it all, and be worried all the time about legal etc consequences...I say let the big boys use their toys and do what they are paid to do.

Jay Levan · Mar 1, 2002

Phone Triage, Yuk Phooey! Most Hospitals I work at, have very strict Guidelines that must be followed. Trouble is, Hospital Policy does nothing to actually protect the individual, who gets stuck answering the call. For "Hotlips" are you aware that nurses have been sued, for telling people to come to the E.R. but not telling them to use 911 to activate EMS?? I do not know the actual details, or the outcome of that occurrence, but it does show that there is indeed Danger, in telling someone to come to the hospital. One scripted response I work with(per Hospital Policy) states, "I'm sorry Sir/Madam, but we cannot give medical advise over the telephone, would you like us to send an ambulance? This invariably leads to frustration, on the part of the caller, and has to be repeated several times. All to often their next question is "How long will we have to wait, if we come there?" When you tell them that you cannot estimate the time factor, without assessing the patient, the next sound we hear is a click followed by a dial tone. Even if you try to help as much as possible, with the proper responses, they may deny you gave those responses, and state to an administrator or Hospital Representative, that the nurse on the phone was Rude to them, because they wouldn't answer their questions! Bottom line, there is no absolute, sure-fire, way to handle telephone calls, no matter what you do, someone will surely take exception to your responses because you didn't tell them what they wanted to hear. I would be interested to hear from, a telephone triage nurse from Kaiser Permanente, or any other Insurance company nurses that do this type work daily. Any help they might offer would be beneficial, to this discussion.

NicuGal, MSN, RN · Mar 1, 2002

We have a nurseline. In our unit we are not allowed to take calls for legal reason, we always refer them to the nurse line or one of the fellows. The nurseline records the calls so no one can come back and say...well you told me this, or you told me that.

deespoohbear · Mar 1, 2002

Our policy in ER is that we do not give out advice over the phone. We have two family physicians on call in after office hours. The hospital operator will page one of the physicians on call for the patient. The only information we give is how much Tylenol to give a child depending on the child's weight. We don't tell them to give the Tylenol, we just tell them what the dosage is based on weight.

One time we had a person call the hospital operator and wanted her mother's family physician paged because her Mom had taken 7 nitro and was still having chest pain. The operator asked me what I thought about paging the doctor. I told the operator to tell the person on the phone to hang up and call 911 because that is what the doctor was going to tell them. People never fail to amaze me!!!