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Ghosts of the ER (Clerks)

Professionalism   (1,442 Views | 36 Replies)
by Cody1991 Cody1991 (New) New Pre-Student

Cody1991 has 7 years experience and specializes in Registration / Insurance.

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You are reading page 2 of Ghosts of the ER (Clerks). If you want to start from the beginning Go to First Page.

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2 minutes ago, Cody1991 said:

The 10-minute thing is sort of producing a toxic work environment.

And, for nearly all intents and purposes, it is completely unnecessary. You can also use the word "arbitrary." How did they come up with that number, you know? No patient has a 10 minute visit, whether they should or not 😉 so the actual truth is that you have more time than that to get in there without missing patients.

There is just so much going on at your place @Cody1991. Sorry about that. Another head-scratcher is why they have you running KASPER on everyone. They should be focused on only giving out essential and reasonable controlled-substances, which would mean that MOST patients will have no need to have KASPER checked.

Secondly, I would look into this KASPER thing a bit more as far as registration staff is concerned. As far as I know (and someone please chime in if it is different elsewhere), hospitals are not authorized to run these types of reports. Specifically, pharmacists and several different types of practitioners/prescribers are authorized, and pharmacists and practitioners may directly delegate each occurrence of this task directly to an employee of theirs who is under their direction. I am quite skeptical about whether a general hospital employee meets this qualification. Where I work nurses don't even get involved in obtaining such reports (and yes, this will vary state to state and workplace to workplace somewhat).

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Cody1991 has 7 years experience and specializes in Registration / Insurance.

10 Posts; 139 Profile Views

21 minutes ago, JKL33 said:

And, for nearly all intents and purposes, it is completely unnecessary. You can also use the word "arbitrary." How did they come up with that number, you know? No patient has a 10 minute visit, whether they should or not 😉 so the actual truth is that you have more time than that to get in there without missing patients.

There is just so much going on at your place @Cody1991. Sorry about that. Another head-scratcher is why they have you running KASPER on everyone. They should be focused on only giving out essential and reasonable controlled-substances, which would mean that MOST patients will have no need to have KASPER checked.

Secondly, I would look into this KASPER thing a bit more as far as registration staff is concerned. As far as I know (and someone please chime in if it is different elsewhere), hospitals are not authorized to run these types of reports. Specifically, pharmacists and several different types of practitioners/prescribers are authorized, and pharmacists and practitioners may directly delegate each occurrence of this task directly to an employee of theirs who is under their direction. I am quite skeptical about whether a general hospital employee meets this qualification. Where I work nurses don't even get involved in obtaining such reports (and yes, this will vary state to state and workplace to workplace somewhat).

 

Edited by Cody1991

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3 minutes ago, Cody1991 said:

Our doctors select patients charts electronically which moves them into “treatment in progress” from "waiting to be seen/triage" after they meet them and sign onto their chart.

No, I got you. That's exactly how it works in a lot of places; I'm familiar. I'm just saying that EMTALA basically does allow you to go in at that juncture unless you would be delaying or obstructing emergent care.

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Quote

 

Who may request a KASPER report?

A practitioner or pharmacist, or employee of the practitioner’s or pharmacist’s practice acting under the specific direction of the practitioner or pharmacist, for medical or pharmaceutical treatment of a current or prospective patient; Kentucky Commonwealth’s attorneys and assistant Commonwealth’s attorney’s; Kentucky county attorneys and assistant county attorneys; a law enforcement officer with an active investigation; a licensure board for a licensee; Medicaid for a Medicaid member or provider; a grand jury by subpoena; a medical examiner engaged in a death investigation; and a judge, probation or parole officer administering a drug diversion or probation program.

Top of Page

 

Source: https://ekasper.chfs.ky.gov/FAQ/FAQ.htm#q2.

So I'm curious now. Do you sign up under your own name or under some qualification that the hospital has?

Edited by JKL33

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Cody1991 has 7 years experience and specializes in Registration / Insurance.

10 Posts; 139 Profile Views

9 minutes ago, JKL33 said:

And, for nearly all intents and purposes, it is completely unnecessary. You can also use the word "arbitrary." How did they come up with that number, you know? No patient has a 10 minute visit, whether they should or not 😉 so the actual truth is that you have more time than that to get in there without missing patients.

There is just so much going on at your place @Cody1991. Sorry about that. Another head-scratcher is why they have you running KASPER on everyone. They should be focused on only giving out essential and reasonable controlled-substances, which would mean that MOST patients will have no need to have KASPER checked.

Secondly, I would look into this KASPER thing a bit more as far as registration staff is concerned. As far as I know (and someone please chime in if it is different elsewhere), hospitals are not authorized to run these types of reports. Specifically, pharmacists and several different types of practitioners/prescribers are authorized, and pharmacists and practitioners may directly delegate each occurrence of this task directly to an employee of theirs who is under their direction. I am quite skeptical about whether a general hospital employee meets this qualification. Where I work nurses don't even get involved in obtaining such reports (and yes, this will vary state to state and workplace to workplace somewhat).

Rumor has it that management worked registration for a few hours during two whole shifts (!) on the computer on wheels and came up with that number. 6 patients per hour (10 minutes.) One of the supervisors fought for 20 minutes but then the new manger hot-wheeled the computer around in 10 and got the rule going.

A lot of the seasoned clerks said, yes but they chose to do it during the slowest part of the day and in PEDS where most of the patients had been seen before and were Medicaid and so quicker to do.

I work 3p-11p so it’s insansesville.

 

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Cody1991 has 7 years experience and specializes in Registration / Insurance.

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5 minutes ago, JKL33 said:

Source: https://ekasper.chfs.ky.gov/FAQ/FAQ.htm#q2.

So I'm curious now. Do you sign up under your own name or under some qualification that the hospital has?

We use our hospital login username.

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You know, here's a suggestion for them: If they want their 10-minute thing, FINE, yes you should take less than 10 minutes in the room, for sure. In doing so, you will easily see 6 pph.

The part that's wrong is the "you have 10 minutes to get in there." As soon as the provider leaves the room/orders are entered that is the busiest time in that room barring initial settling of the patient and any emergencies that might arise. Those 10-20 minutes when the provider is in the room and then subsequently leaves is when the nurses are going to be hopping to initiate and/or complete all the initial orders.

They are setting you up for the exact hostilities that are arising by sending you in there on a mission the minute the nurses are trying to implement orders.

I will never understand why "this" (what you are going through) is more preferable than just getting rid of individual lazy employees or those who can't/won't perform the role adequately.

Edited by JKL33

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Cody1991 has 7 years experience and specializes in Registration / Insurance.

10 Posts; 139 Profile Views

11 hours ago, JKL33 said:

You know, here's a suggestion for them: If they want their 10-minute thing, FINE, yes you should take less than 10 minutes in the room, for sure. In doing so, you will easily see 6 pph.

The part that's wrong is the "you have 10 minutes to get in there." As soon as the provider leaves the room/orders are entered that is the busiest time in that room barring initial settling of the patient and any emergencies that might arise. Those 10-20 minutes when the provider is in the room and then subsequently leaves is when the nurses are going to be hopping to initiate and/or complete all the initial orders.

They are setting you up for the exact hostilities that are arising by sending you in there on a mission the minute the nurses are trying to implement orders.

I will never understand why "this" (what you are going through) is more preferable than just getting rid of individual lazy employees or those who can't/won't perform the role adequately.

I tried something different tonight. When I was approaching whatever area I was going to, I’d find the nurse and ask if it was OK to update them now.

My script was “Hey ____ (their name), is it cool to update 138 now?”

They would tell me, “Sure”, “absolutely” or “can you come back in a little while we’re about to do a procedure.” No one was exactly nicer to me but they did seem more appreciative and less intrusive. A few seemed stunned that I actually spoke to them, lol.

 Each time I couldn’t go in, I’d drop the patient back so that my timer didn’t keep counting. Management sent no messages over chat so I guess it worked out. The only time one came in was just to ask a question to the patient and they walked back out.

Thanks all for help. I’ll see how it goes.

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Excellent!!

If you get a couple of good shifts in like this you will at least have some experimental data to present to your manager.

And we'll all just hope your nursing colleagues shape up. You're already working on those inroads, though!

Solid work. Sending good vibes that you don't get any nastygrams for your efforts.

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Cody1991 has 7 years experience and specializes in Registration / Insurance.

10 Posts; 139 Profile Views

11 minutes ago, JKL33 said:

Excellent!!

If you get a couple of good shifts in like this you will at least have some experimental data to present to your manager.

And we'll all just hope your nursing colleagues shape up. You're already working on those inroads, though!

Solid work. Sending good vibes that you don't get any nastygrams for your efforts.

Since I came in to discover we’ve had three resignations in one day (!), I think they’re getting hip to it. Lol. (Or I hope, at least)

Part of my problem may be that I’m quite shy so I hadn’t really ever even tried to talk to the nurses before. I was just trying to get my job done AROUND THEM or sat in silence at the station among them. Now I don’t want to be BFF but I guess I can bend some. I think I was guilty of playing into the power game. 

While it’s not A+ comfortable approaching them and talking to them directly – it did make the night go much much much smoother and every time I got the OK, I was never interrupted. And I technically got more accounts done than normal, so I think it was a kind of success!

I guess that old communication thing isn't just a myth. 😉 

Edited by Cody1991

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Just me. has 20 years experience.

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I work in an ED, and have a good relationship with registration.  We do annoy each other at times.   And yes, they do collect co-pays and give the option to pay now or later.

Overall, basically my goal in life is to get to the patient before registration! 

That is especially true if they have never been to the hospital before.  And if registration is with a patient, I will let them finish before interrupting.  I will ask if registration is almost done, especially if the pt needs a stat ekg, etc (they are to be done in a timely fashion).    There are a few times I have spoken up and needed to interrupt.  But in most cases, if the patient is in acute distress registration will usually recognize the timing is not good.

That being said there are times the Doctor or PA is ready to see a patient, literally standing in the doorway.  Most of the registrars will acknowledge the provider and mention I'm almost done, is that okay?  Others make us them wait, like they are not even there.  And I will say, some doctors are just rude about it, some nurses too.

And there are times, I'm having a private conversation with a patient and registration is hovering.  I have asked them to give us a moment.

I understand no work situation is perfect!  And I have no doubt there are some very toxic people, believe me....  Take a deep breath and be the bigger person.  If someone really does offend you I would approach them privately and talk it out.  And if that doesn't work, talk with your supervisor and she can speak to the unit manager and give reminders about what registration needs to do.

It sounds like you are doing some solid things to make things work better!!!

Edited by Just me.

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Your co-workers are jerks. One is not required to be friends with everyone at work (and frankly sometimes it better not to since it can bring unnecessary drama) but everyone should be treating all of their co-workers with a basic courtesy and respect. And unless it is an true emergency (which will happen more often than in other settings given it is the ER), the medical and nursing staff can wait for you to finish your transaction with the patient before busting in like that. I don't walk in and interrupt the RN or MD who is speaking to a patient or doing a procedure  in order to examine a patient just because I am an NP. I politely wait for them to finish and my expectation would be that they do the same.  Their frustration with the registration process does not given them a pass to be rude to their co-workers. And they most certainly should not be tossing other people's possessions on the floor, repeatedly bumping into co-workers, refusing to make eye contact or talking about registration staff as if they are not present under any circumstances. 

Ultimately though, every job has it's hang ups and issues. You seem to like the job overall and it has the best pay and benefits so far so this may just be an annoying part of the job. You can also see if there is a lateral move to another department or shift but the grass isn't always greener. 

It's unfortunate in healthcare that we frequently don't treat each other as humans given that the vast majority of us went into the field to help others. We tear each other apart over conditions created by employers.

Edited by egg122 NP

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