Job Hinderance vs. Just Annoying?

[unbalanced]

I am a triage nurse at a busy inner city community health center. The way the job works is: a patient calls the practice and a secretary takes a message and forwards the message to the nurse to be addressed. Based on acuity of the situation the nurse calls the messages back. If it is a true emergency (airway, breathing, circulation, chest pain etc.) the secretary will come and get the triage nurse directly.

Sometimes I call a patient back but they do not answer. I typically leave a message and move on. Naturally, they call right back but I am already on another call. Instead of taking a message the secretary will stand either in the doorway trying to get my attention or they will watch me and wait until I am done with my phone call before telling me the patient I just called is on the phone. I find this very distracting. Also, at the end of my call I need to thoroughly document the conversation and advise given and I cannot take another call until I have done so.

I do not think it is good nursing practice to keep more than one triage/chart open at the same time. I would rather finish the write up and then call the other person back.

I have voiced my opinions just as I have above, "I am finishing my documentation and I can call them back when I am finished." I just feel like the secretaries get annoyed when I say this. I hear them sigh and make comments amongst themselves about not taking the call right away when the patient called back. I wish they knew what was involved in making telephone triage calls. I am not looking at the patient. I cannot see what is going on and critical thinking skills and undivided attention are imperative.

I have thought about going to my supervisor about my concerns. I don't want to get anyone in trouble but I need to be able to do my job safely. In all honesty, I cannot tell if this is hindering my work or if I am just plane annoyed that they do this! I don't like to make hasty decisions either. Please let me know what you think?

[HouTx, BSN, MSN, EdD]

It appears that you and the secretary(ies) have the same goal.... good patient care. But they don't understand enough about your work to understand why you just can't drop everything and talk to them. IMO, this is a perfect opportunity for some education for the secretaries. Is it possible for you to facilitate this in the guise of a QI project? You all have to work together to ensure that patients receive the services they need. A team approach seems to be needed to make sure that everyone understands the process & everyone's roles and responsibilities.

[dudette10, MSN, RN]

I agree with HouTX. Both you and the secretaries want the best patient care, but there are different perspectives and priorities at play because of the different roles. You can work with them to determine their concerns/priorities and also let them know your concerns/priorities. Who knows? Maybe an innovative solution will come out of it!

Good luck!

[canned_bread]

Perhaps you could ask the secretary to tell the patient on the phone that they are to wait by the phone. If they do not pick up the office is to assume that they have taken themselves off to hospital or something.

Alternatively say to the secretary after one of these incidents "I hope you don't think I am rude when I do this, I am doing this because of blah blah. I know you have things to do and can't just wait for me! So how about you pop the memo of the called back patients phone line on the door, and then tell the patient I will get back to them when I am finished with this call? Would that work for you?"

[Gooselady, BSN, RN]

Don't forget that the secretaries are taking the brunt of angry and/or very anxious patients. They have the initial contact, and as you well know, every person calling a triage line is anxious and these days, 'ready' to be fluffed off and called much later than they want to be called! So there's this edge of anger along with the already anxious person calling a triage line for some scary, upsetting health concern.

The secretaries need support, IMO. They need training to cope with the 'hard sell' the patients calling are undoubtedly delivering. Like was said earlier, they, just like you, want the best care for the patients, and it's likely, just being secretaries, they may be getting overwhelmed by all the emotion.

So, two things; secretaries need training and support on how to handle the patient's calls. And then, the secretaries need to know YOU have their backs, that you understand what they are putting up with being on the 'front lines' of the battle. It makes a huge difference in people when they know you are concerned about what they are going through.

It could be the secretaries are feeling pressured by the patients and then stone-walled by you! Of course you aren't deliberately stone walling anyone . . . but we are talking about their perspective here, and this can be remedied by you expressing to them you respect and are concerned about the pressure they are under.

Nurses, even fairly new-ish ones with a few years of experience, have long ago learned how to distance themselves from a patient who is freaked out over an inflamed hang nail . The secretaries? Nope. They need your help as much as you need theirs :) You could form a very resilient team with the secretaries if you regard yourselves as 'all in this together'. Good luck :)