Texting in nursing

[kimbagirl]

There must be something wrong with me or Im just too old and not "with the times" as has been pointed out to me. Nurses today, staff and management , dont see a problem with texting doctors. Did not get a job today because I frowned upon doing such, on my personal phone no less. I stated that I call doctors and mentioned HIPPA and she (RN!) stated to me that doctors dont have time to answer their phone. I have worked with others who see no need to write their title after their name in the narc book, and even others who dont know how to write a hard copy! doctors order. No name who wrote it,no date dosage, etc. Everything is sooooo impersonal and computerized and no one cares. My husband says...why cant you just text like everyone else does?!Grrrrrrrrrrrrr

[Wuzzie]

It was sure not my desire to offend anyone. I only posted to get some sort of feedback regarding texting. Nursing sure has changed but the backbiting and nasty behavior has not. I am truly sorry if my words were offensive. I just wanted to know what other nurses thought.

Well what this nurse thinks is that any piece of technology that allows me to do my job more efficiently and accurately is a good thing. If it gives me more time to spend with my patients practicing the art of nursing all the better. For me and my physician colleagues it has nothing to do with being lazy. I can get a question answered immediately by a quick text while they are rounding or wait two hours for them to finish so they have time to call. I prefer the former. That way we can both keep moving forward in our day rather than playing phone tag. I'm happy, they're happy but, most importantly, the patients are happy.

[caliotter3]

Well, I have had doctors (and their office staff) in home health that refuse, neglect, choose, whatever, to return phone calls, so phone use is not necessarily better as I see it. However, text or verbal conversation, I don't really appreciate being required to use the cell phone that I pay for, in my everyday work. And as unreliable as I have found cell phone service to be, I don't rely on it to preserve texts any more than I would rely on it to preserve records of dates/times/existence of phone calls made. Technology is not as perfect as attempts to portray it. You should not be so vocal when expressing your dissatisfaction though. If I had wanted the mentioned job badly enough, I might say that I don't like the idea but that I would be willing to comply with the company policy.

[ComeTogether, LPN]

Its called evolution. You simply use initials and room numbers or an encrypted texting service. (they are common and legal).

If you don't text well most phones allow you to speak the message, if that helps at all.

You have to understand that doctors now days have far more patients than they used to and they get far less time with them.

Not only that, but then you have proof that you got an order, etc. and the doc has a reminder right there in writing of what he needs to address.

How would a nurse know how to write a hand written order if he or she hasn't had to do it? Most facilities don't do T.O.'s, as everything is computerized.

Sorry you feel this way, I think you should keep your mind open and embrace it.

[ComeTogether, LPN]

I've been a nurse for 24 years, so I've seen many changes. This is just one of the changes that people seem to be misinformed about.

Bottom line, regardless of my personal opinion (I hate texting, btw): texting is a non-secure way of communicating personal health information, and therefore ILLEGAL. Our company requires that we use an encrypted and secure system (for example, FORCURA). Cell phones are NOT secure. Don't do it.

I had a doctor ask me one time to text him a photo of a patient's wound. Um...NO! I politely refused and cited the legality of doing that. He understood.

Heres the problem with many nurses, IMO. Because there is a "law" and something is percieved as "a violation" the answer to many is black or white. I see grey.

Using an encrypted app especially wouldn't concern me, but even if it's not encrypted, is it really a violation to text a photo of JUST a wound with no other identifying information?

I try to simply do what is in the best interest of my patient, whether or not it's a grey area. Some may say I'm wrong, but I find that in this convoluted, broken system we call healthcare I have to do things sometimes that may not be completely "kosher".

If I have to live in the land of grey in order to get my patient the best overall outcome, thats what I'm going to do. I am their advocate, I get things done for them and speak on their behalf when I need to. If I have to text a picture of a wound (and just a wound, without more in the photo) without identifying information in order for my patent to get a needed antibiotic or treatment NOW rather than having to wait until the next day or even longer, I'm going to do it.

[kimbagirl]

I too have worked in the land of grey for my patients, but never outside the law. There is black and white regarding laws and are in place for a reason. My patients will always come first, but I will not work outside the law or the scope of my practice. I thank all who have responded.

[hawaiicarl, BSN, RN]

Texting is slowly becoming the new norm no matter how old people, and administration fight it. There was a good lecture at last year's NTI about it available on the AACN website if anyone is interested. At work we had HIPAA concerns, and our hospital got encrypted Tiger Text to address the HIPAA concerns. Any pt identifiers can not be in plain text, and must go through the encryption service.

Cheers

[CBlover, BSN, RN]

This. Plus, it also provides an electronic record of the fact that you did, indeed, attempt to contact the physician' something the paging system at my facility doesn't do.

YES YES and so much YES. I hated it when I used to page MDs like 3 times and never get a response and then they'd be like "Oh I didn't get any pages" - now I'm and ER nurse and the doctor is right here for me to pester as much as I please!!

[trytounderstand]

As a person who has seen the world of computers change from a whole roomful of machines and blinking lights to perform a task to a simple little box on my desk, I know how much everything has changed and will keep changing. Texting is handy and it is quicker to answer than a phone call. It might even prevent a patient from having to wait for a needed medication or order.

My only concern in that allowing or requiring personal cell phones to be used to transmit patient information there is always a chance that the information could fall into the wrong hands. As long as the hospitals and medical offices are using encrypted phones and computers that patient's information is in a much more protected state. Also if the nurses and doctors are required to return the cell phone there is no chance that someone might accidently pick up the phone and find information that could put someone's privacy at risk.

In my own case I would not want to use my own cell phone from the standpoint of infection and germ control. For instance my cell has been used after I have petted my dog, after I have treated infected hot spots and given medication to the same dog, my children have played games on it while they were ill, it has been put on the ground while I was sitting outside, it has been used to take pics of that nasty hotspot to show the vet, I have used it while I was ill and had a fever, I have carried it in my pocket and placed it in my shoe while swimming. Do I ever wipe it down with Lysol wipes probably not. How many people in general make a habit of sanitizing their cell phone? If the hospital or office provided cell phones to be used during each shift and they were turned in as nurses or doctors are signing out then they could at least be wiped down and the patients and staff would not be exposed to additional germs. If they are on an encrypted system and can only be used to contact staff or a limited outside phone numbers such as specialists that need to be contacted, the patients would feel much more comfortable in seeing them in use as well.

[cyc0sys]

I think you're confusing impersonal with increased volume and the need for efficient timely information. As others have pointed out, the patient load, available resources, and costs are all driving the train toward "productivity". I still put in face to face time with staff and patients but it's short and concise, unless they're actively dying.

Personally, I welcome any technological advancement provided that works and results in time saving. Who in the hell misses paper charting, right?

I like the fact I can get a texted telephone order from the Doc. I have preformatted texts save for various situations and simply fill in the blanks to save time. Course you also have a record of the all the conversations and a time stamp.

As far as encryption is concerned, if both the sender and receiver of a text message have an I-Phone and are using Imessage. The text is automatically encrypted which meets HIPAA and FIPS compliance.

Apple Explains Exactly How Secure iMessage Really Is – TechCrunch

It can also be done via PC if both parties have Iphones:

https://www.digitaltrends.com/computing/how-to-send-free-text-messages-online/

[RLtinker, LPN]

There seems to be a preference for texting over calling. With the doctors we have a web portal that sends the information in the form of a text to their phones. Honestly, it makes it harder to make a mistake writing a TO/VO when it is actually written out on the screen. It is also a lot faster, we used to use a paging system and it could take an hour for the doctor to call back and if someone is not by the phone the doctor would then have to wait for someone to pick up the phone and someone would have to search the building for the nurse that made the call. With the ED, DON, and Unit managers it is not unusual to text quick information like so and so had a fall or Mr Doe has a new open area, anything more complicated I will probably be calling. The thing is they don't like being called in the middle of the night, but have to be notified.

[TheMB, ASN]

At my job 99 percent of the orders that I request for my pts are done thru our secure emails and the other one percent are done thru TVOs it makes things so much easier.

[Night__Owl, BSN, RN]

We have a new intensivist who prefers we text him. New to me, but so far it's been fine. However, it's more of a "text me rather than page me." He'll still call back to get the specifics, there is no text ordering going on. I wouldnt be comfortable with that unless there was a specific hospital application to go through (although I wish there was!)

If I needed him stat, I would still call. But I have no problem texting him ,"Hi, I have a critical value I need to report to you, (unit phone #)." Or "I have a medication question about one of my patients, (unit phone #)." Nothing approaching HIPAA protected info. Lots of things are not "next minute" important so much as "next 30 mins to an hour" important, so if I'm going to interrupt another person's shower, shave, or morning bowel movement I'd rather it be a true emergency.