Is my assumption correct??

Five&Two Will Do · May 14, 2011

I think it is good that you try to educate non nurses about the difference between NP and MD. I do not think that the MD could get into trouble for the operators answering the phone inappropriately. Unless of course NP made it that way. Good luck with school

merlee · May 14, 2011

Unless the NP has a PhD, they should not be saying "Dr so-and-so's office". Someone should contact the NP and ask how she would like you to answer her line.

If a patient or family member calls the Dr's office, the message needs to get to the doctor. Unless the doc specifies how the calls are to be screened, then the calls don't get screened. Get the messages through. The doc may decide which calls will be returned directly, and which calls can wait.

Yes, HIPAA is a very big deal. Your company should have a written policy about HIPAA and patient privacy. And all gossip should be avoided. Violating HIPAA protocols is grounds for immediate termination in most places.

You are obviously a very conscientious person, and you are to be commended for your efforts.

Best wishes!

CrazziiRN913, ADN, BSN · May 14, 2011

Unless the NP has her DNP or PhD she so not be called Dr. Anyone. Because she is not a dr lol your co-worker are in error presenting her as one.

Whispera, MSN, RN · May 14, 2011

1. NPs shouldn't be called "Doctor", by anyone, unless they have their doctorate. In addition to that, NPs without doctorates don't WANT to be called "Doctor." They aren't doctors, they do things differently than they do, and they are proud of how they do things (as they should be!). I don't think it could turn into a problem for anyone but the person doing the mis-labelling. It's a simple matter for them to change their behavior, and what they're doing is incorrect, they should correct themselves.

2. Calls to the doctor's or NP's office should be transferred or messages relayed immediately. Maybe family members are disregarding the patient's nurse inappropriately, but maybe they aren't. It could be that the doctor has told the callers to call him/her as needed, too. You don't know the whole story when someone calls. It's not up to you to screen the calls.

3. I think you need to have some sort of inservice about confidentiality with your staff...even if it's just a few minutes at the beginning of a day when everyone is there. It's not ok to talk about patients in a gossipy way. It's against confidentiality laws and also is pretty immoral in my opinion. To use patients' personal issues as entertainment is never ok. I bet these women talk about callers at home too.

How is it possible for them to listen to calls between caregivers and callers? Aren't they supposed to hang up once the caregiver is reached? It is NOT ok for them to eavesdrop on callers' personal concerns.

Are you new to the mix and the others have been there awhile? Are you reluctant to make waves in a tight-knit clique? I think you need to make some waves. If you don't do anything about problems, you can be seen as part of the problem. It's part of being a patient advocate and that's one of the most important roles a nurse has...

TDCHIM · May 14, 2011

I cannot comment on the other parts of your post, but as for the operators listening in on phone conversations between patients and their healthcare providers and then gossiping about them - wow. Yes, what they're doing violates HIPAA. One way to present it might be to use the "need-to-know" line. HIPAA dictates that you access only the information you require to provide care or otherwise fulfill your role in the healthcare chain. So if you don't need that information to do your job (direct care, coding, billing, whatever), you should not access it. Those operators clearly do not need to listen in on confidential phone calls between patient and provider to do their jobs. While I could understand the need to track basic details (i.e. patient name/contact info, brief description of the issue prompting the call, etc.) the conversations themselves are emphatically not any of the operators' business and are not meant for their idle consumption!

If your organization has a privacy compliance officer, I'd report the problems to that person. If not, try contacting your health information management or legal department. The people you're supervising are obviously in need of some extremely thorough privacy (re?)training, which I hope will include details about the possible punishments for breaches of HIPAA and recent cases in which unscrupulous individuals have been given substantial fines and jail time for flagrant HIPAA violations. If the operators think it's acceptable to listen in to what should be private conversations between providers and patients and gossip about them afterwards, heaven only knows what they're saying about those conversations outside the office and/or online. Your instincts are right - this problem needs to be addressed quickly!

hannahmaepunk · May 15, 2011

Good job for upholding your professional conscience!

Salute and two thumbs up!

Truly_Blessed · May 15, 2011

1. NPs shouldn't be called "Doctor", by anyone, unless they have their doctorate. In addition to that, NPs without doctorates don't WANT to be called "Doctor." They aren't doctors, they do things differently than they do, and they are proud of how they do things (as they should be!). I don't think it could turn into a problem for anyone but the person doing the mis-labelling. It's a simple matter for them to change their behavior, and what they're doing is incorrect, they should correct themselves.
2. Calls to the doctor's or NP's office should be transferred or messages relayed immediately. Maybe family members are disregarding the patient's nurse inappropriately, but maybe they aren't. It could be that the doctor has told the callers to call him/her as needed, too. You don't know the whole story when someone calls. It's not up to you to screen the calls.
3. I think you need to have some sort of inservice about confidentiality with your staff...even if it's just a few minutes at the beginning of a day when everyone is there. It's not ok to talk about patients in a gossipy way. It's against confidentiality laws and also is pretty immoral in my opinion. To use patients' personal issues as entertainment is never ok. I bet these women talk about callers at home too.
How is it possible for them to listen to calls between caregivers and callers? Aren't they supposed to hang up once the caregiver is reached? It is NOT ok for them to eavesdrop on callers' personal concerns.
Are you new to the mix and the others have been there awhile? Are you reluctant to make waves in a tight-knit clique? I think you need to make some waves. If you don't do anything about problems, you can be seen as part of the problem. It's part of being a patient advocate and that's one of the most important roles a nurse has...

I should have clarified what I meant by telling the patient to have their nurse call. A lot of the doctors do want their calls screened.....they only want "emergencies" BUT, how are these operators supposed to know what qualifies as a real emergency? I've often wondered this....I'm usually the go to gal when someone wants to know if something is an emergency. Uh, no....some a&p, psychology classes; and a semester in an lvn program does not make me qualified me to figure anything out....I don't have a scope of practice. I answer phones. The problem that arises is that I get yelled at by physicians after the patient is put through for one of two reasons: Why are you putting calls through if they are in the hospital? I've actually been told..."Use some common sense." by a doctor. lol The other reason, after the patient is connected...not even 5 minute later their nurse is calling. So, that call is connected..and oh joy, 5 minutes after that the doctor is calling back having a fit because he's just been connected for the same thing twice!!! Oh em gee, I forgot "psychic abilities" was part of my job description. Perhaps it's one of those darned if you do darned if you don't situations. Good thing....this is allowing me to become acquainted with the fussy docs and that might be helpful later when I actually have a nursing career.

The operators can listen because when they are connecting patient to nurse or doctor it works like a 3 way call, but after the call is connected we are supposed to hang up and leave the other two parties on. The operators simply hit a mute button on the console and sit and listen to the entire call. They do this with hospice calls (we do have hospice and funeral home accounts); actual death calls, OBGYN calls, you name it they will listen to it.

I'm not new, actually been there for a couple of years but just took a supervisor position...there is a high turnover rate there and I believe this is part of the problem. People are not being trained correctly nor are they required to become HIPPA certified. I am definitely not afraid of making waves. I don't go to work to make friends, I'm there to do my job...if I make friends along the way it's a bonus. Me coming here is basically the beginning of doing some research and I pretty much want to make a presentation to my bosses. I think educating the operators is the best bet and HIPPA certification is the way to go. It's just a matter of justifying the cost to pay for certifications. I would think telling them that they could possibly lose the majority of their customers if one doctor finds out which means no more business, no more $$$ for them, etc. would be enough justifying. I know of one answering service who requires their operators to be certified and management says they have no problems. Yeah I called around to see if there were any other places who took physicians calls, lol I'm relentless at times. So yes...I will be ruffling feathers soon and I'll get my way because...well, it's the right thing to do. I feel so gross and unprofessional working in a place that isn't serious about the service they provide. It's embarrassing.

Truly_Blessed · May 15, 2011

I cannot comment on the other parts of your post, but as for the operators listening in on phone conversations between patients and their healthcare providers and then gossiping about them - wow. Yes, what they're doing violates HIPAA. One way to present it might be to use the "need-to-know" line. HIPAA dictates that you access only the information you require to provide care or otherwise fulfill your role in the healthcare chain. So if you don't need that information to do your job (direct care, coding, billing, whatever), you should not access it. Those operators clearly do not need to listen in on confidential phone calls between patient and provider to do their jobs. While I could understand the need to track basic details (i.e. patient name/contact info, brief description of the issue prompting the call, etc.) the conversations themselves are emphatically not any of the operators' business and are not meant for their idle consumption!
If your organization has a privacy compliance officer, I'd report the problems to that person. If not, try contacting your health information management or legal department. The people you're supervising are obviously in need of some extremely thorough privacy (re?)training, which I hope will include details about the possible punishments for breaches of HIPAA and recent cases in which unscrupulous individuals have been given substantial fines and jail time for flagrant HIPAA violations. If the operators think it's acceptable to listen in to what should be private conversations between providers and patients and gossip about them afterwards, heaven only knows what they're saying about those conversations outside the office and/or online. Your instincts are right - this problem needs to be addressed quickly!

I am going to print out a couple of these responses you guys are giving as they will help me.

Nooooo, we don't have a privacy compliance officer. It's not a huge company it's small, locally owned and employs 30 to 45 employees at a time. There is no privacy compliance anything!!!! From what I'm seeing supervisors are on their own so it's up to them to set the standard for their shift. Bleh. It should be a cohesive company standard but whatever.

Whispera, MSN, RN · May 16, 2011

You're being a good patient advocate. Sometimes that's a difficult job but we need to do it anyway. You deserve a pat on the back for it, Truly!

The eavesdropping and gossiping really bothers me. I'm glad you're going to do something about it.

As far as calling the doctor when you're not sure you should or not...I say err on the side of doing it rather than not doing it...docs get angry but we still need to do what we need to do.