non-emergencies

vampiregirl, BSN, RN · May 25, 2016

Sometimes it's the families needing support/ education/ empowerment and sometimes it's a customer service thing.

It can be challenging when other people's "emergencies" aren't in our books, but it doesn't mean it's not an emergency to them.

Sometimes this can be a situation where IDT support can also come in handy to address family needs. Occasionally "emergency" visits are not really about whatever the family called about but more of a cry for help. So many people are just plain overwhelmed at the time of hospice admission, so everything seems like an emergency.

It can be a pain to figure out how to schedule these in sometimes, but it's part of being a hospice nurse:) Often the families are so appreciate of the support and the visit being made.

Try talking to other seasoned hospice nurses at your agency and find out how they handle these visit requests. There may be some tricks that you would find helpful.

Welcome to hospice! It's really an amazing field of nursing.

nutella, MSN, RN · May 26, 2016

New hospice RN here. I am really starting to wonder about a couple of our office nurses. I've been called out for "emergency" visits this week for: a nosebleed (pt on o2 with dry sinuses- caregiver did not use moisturizer as instructed), trembling hands, and a patient who coughed while eating but then stopped coughing and was fine for the remainder of the day.
This is in addition to the prn's when family members call and state they "would just feel better" if the patient had two visits this week versus the one. It's getting to the point where I would rather give the family my cell number and have them call me directly so I can talk them through it instead of being called out for these non-emergencies when my schedule is already full.
Are these people fricking kidding me? These are experienced hospice nurses, and they don't know from a small nosebleed?

Sorry but you need an attitude adjustment.

Hospice is not like traditional home care. It is all about the family and the patient. Families and pat can get nervous about things you may perceive as "small". Hospice is like a primary care provider for those patients. You do not want a family to call 911 because they are nervous about some nose bleed, cough or mysterious symptoms. I worked in home hospice and did my fair share of "emergency calls" but I think the understanding is that those are most often not real emergencies in the medical sense. I would say a better term is "unplanned visits".

I got called once to "really really come quickly" and it turned out that the family got nervous about the patient who was coughing and "choking" on think liquids. They needed the education and re-assurance. It was a big deal to them and caused a lot of worries.

Another time somebody called for a "rash" and I was somewhat annoyed because it was close towards the end of my shift. When I got there, it turned out that the patient had shingles in the face and neck, very close to the eye and pain. I was glad that I went out right away.

The problem is when you have already 5 scheduled visits and in addition 2 or 3 more unplanned ones on top. That can cause overload, burnout, dissatisfaction....

PurpleDaisyðŸŒ¸ · May 28, 2016

Can you call the home before going and do some trouble shooting/instruction and then determine if a visit is still needed? Sometimes just that phone call can be enough...

BerryhappyRN, MSN, RN · May 30, 2016

I understand you frustration, but please don't give your patient's your direct number. You are opening yourself to providing 24/7 care, and the patient will also suffer if your phone is turned off and they don't think to dial your company's number when there really is an emergency.

Your issues are par for the course as far as home care hospice nursing. You sound very frustrated and might be becoming burnt out, it's understandable. You want to provide true hospice care but start to feel like a personal home health nurse sometimes? I get it. If you truly have a hospice heart, maybe consider becoming a facility hospice nurse? I provide hospice care to patients in facilities which means the facility nurse handles all the nosebleeds, rashes, pink eye, ear aches, ingrown nails, etc. I primarily handle the terminal diagnosis issues, family education, pain and pressure ulcers. God bless those facility nurses, and they really appreciate my handling the touch stuff!

Good luck!

jeannepaul, BSN · Jun 21, 2016

I've been an on call nurse for about 10 years, case manager 4years. I used to be called out for sob, pain, dying patients. Lot of teaching about end of life, I loved it. Now, I get called because someone has a blister, constipated on day 2' itch, cough. They act like I should be at their beck and call for anything. I was called last night for stinky burps and at 1030 pm wanted me to drive 50 miles one way to do what? Smell it? And yes, I probably do need a break, but I think the culture has changed also. The Free mentality has seeped in and they want more and more and want it now. Sometimes I want to ask them if they would go to ER for that , esp. If they had to pay for it? Ok, sorry for my rant, I'm tired and need a vacation! I do love my job and even when im called out for non emergency, I smile, and take care of them.

TammyG · Jun 23, 2016

I worked on call for several years for a large hospice that had a good triage desk. RNs would take the calls and walk the patient through whatever the problem was. Only if the triage RN really thought that the patient needed a visit, would I get the visit request. Still, about 10% of the visits that I did really didn't need to be done.

In my current hospice the nurses take the calls directly and do their own triage, so they can decide themselves whether the problem deserves a visit. But as was mentioned by a few posters, hospice families often just need some assurances and comforting.

LindaRossmanWilliams · Jun 25, 2016

AMEN. It's hard. I want to help people. I do. And it's true-it may not be an emergency to me, but it's an emergency to the family. It's difficult to remember this when asked to drive 50 miles for a malodorous burp.

toomuchbaloney · Jun 29, 2016

It can be annoying to get called repeatedly for inconsequential things.

When I call the patient/family back I find several things to be helpful;

1)Listen FIRST to what they have to say in their own words and without any coaching. Pay attention to their tone, and what you hear in the background. ASSESS them while you are assessing what they are saying to you.

2)Validate what they are feeling.

3) Collaborate with them to discover the best and most immediate resolution for the caller.

When we listen, hear, and validate the speaker we create a relationship (often) where we can guide the individual through a mutually beneficial algorithm.