Nurse Concierge - any experiences?

I see a ton of legal issues with this. RN's are not allowed to diagnose medical problems in their scope of practice. Nor can they adjust medications without the inout of a physician. Unless you are an advanced practice nurse, I believe that you need to work under the supervision of a physician.

You would also need very, very good insurance, as there is huge liability associated with this. What if a patient has a serious issue that you don't pick up over the phone, and ends up dying because they don't seek medical attention. The family will claim, "But 'A Nurse in the Family' told us he didn't need to do to the ER!" And all of a sudden you find yourself in the middle of a huge lawsuit.

I highly doubt that this idea is legal, as you have presented it. You really need to contact a lawyer, read your state's Nurse Practice Act, and consult with the BON to learn whether this idea is even possible.

It initially seemed interesting to me, but on second thought, there's a lot of issues with this plan. I applaud your innovation and thinking outside the box.

1. The people that would need a service like this the most would be the elderly and chronically ill. They're also the people least likely to be able to pay $100 per month.

2. I would think the liability for the phone support would be big. It's a fine line between offering medical advice a nurse can offer and what should be deferred to a physician or mid-leveler. It's personally have a very difficult time with advising people without assessing them in person, but I've never worked in a telephone triage type setting.

3. I think the accompanying on admissions/ER visits is a great idea, but I'm not sure that the providers in the hospital would be willing to provide much information to you, not being family members and such. Depending on the state of the patient, obtaining a HIPAA release could be problematic. Further, what about people that end up admitted for long periods of time?

I wish you luck with trying to find a way to use your energy and compassion, and perhaps this could work out, I just see a lot of kinks to work through.

Thanks for your input, Ashley. I do plan to call the BON. As I mentioned, we'd be a "knowledgeable go-between" for pts and MD's - I'd never adjust medications without an order. It's certainly within our scope of practice to assess and triage - just don't know under what umbrella. It obviously requires more research - just wondering if there are people who have done this, as it seems to be a "thing".

Thanks, Blondy. Good points!

At first light, I thought this was an interesting idea, although I did see many of issues that others posted. I think there is something called Life Care Managers (?) that are independent providers and they offer some of the services you mention. I googled it some time ago. There is a need for senior services like it. Good luck with your endeavors.

I've been thinking about something like this for a long time, though exclusively on the ED/inpatient side... a professional advocate.

The thing which has primarily held me up (besides working like a dog) is my inability to come up with a sustainable business model and finding enough people with enough money who would value such a service.

My major issue with your business model is the old insurance bugaboo about self selection. The ones who really need it and employ you will not be profitable as they will overuse you.

My insurance company offers nurse advice by phone for free. So your idea is timely, just going to be hard to implement privately without riding on an organization's coattails.

Subcontracting a proven support company to an insurance company on the other hand... But that is the old horse and cart thing.

We have a "nurse navigator" program where I work. These nurses keep track of scheduled appointments and accompany patients to all appointments and procedures. They are available as liaisons when the patient is hospitalized. For all intents and purposes they are a big pain in my butt. The patients who get them are the "squeaky wheels" the whiners, the complainers and the over-reactors. My primary job is accessing and caring for VAD's, as well as starting IV's and doing difficult peripheral sticks. As a rule I do not allow family members in the room with the patient unless they are children, DD or have severe dementia that cannot be overcome with sweet talk. I am not being mean but after the third time a family member, who assured me blood doesn't bother them, passed out as well as concern for infection control and privacy I put a stop to the peanut gallery. Well the last 2 patients who had a navigator with them insisted that she be allowed in the lab where she promptly contaminated my sterile field, got in the way and generally made a nuisance of herself by questioning (in front of the patient) every little thing I was doing. The kicker was both times the patient (females in their 50's) acted like cranky 2 year olds and actually screamed when I put their IV's in. I mean blood-curdling shrieking even though the entire procedure took about 3 SECONDS. I firmly believe they did it simply because they had a sympathetic audience who loudly stated "YOU'RE HURTING HER"! Well what the h##l did she thing me sticking a needle in her patient was going to feel like. It was a blooming #22 not even a big one and I am an excellent stick. The sucker went right in. I know IV's hurt (I got stuck 23 times once). I get it, but I've had 3 year olds behave better than these grown adults. I think the navigator program would be excellent if it wasn't used to mollify hostile, nasty patients but instead was used for it's original intent which was to help guide scared, sick people through the maze that is our health care system. Needless to say, no more navigators in my lab...ever!

I had this very idea about 8 yrs ago. I say go for it. We need more advocates for our patients. I would dump the telephone bit, but that is just me. Visit them once a wk and go to ER with them and be able to tell out of town kids the scoop, either get on the next thing burning or sit tight.

OP, check out a company called Accolade, Inc. Essentially, they are nurse concierges, but apparently a lot more too! The RN position is titled Clinical Health Assistant.

What do you think about an FNP doing this?