Phone, cell, beeper and texting.

[imintrouble]

Nurses are texting MDs. Cell phones instead of home phones. Beepers are obsolete.

What's the world coming to?

Change comes slowly to my area of the country. Texting for orders instead of talking, is slowly making its way to my hospital. Apparently it happens more often than I thought.

The last 4 new MDs to the area only provide cell numbers. No home phone or beeper. We have to leave voice messages when the cell is not answered.

The old MDs still answer their home phones after office hours, day and night. We also page them, and for the most part you can expect a return call within 15 minutes. They don't know if I'm calling for an MI, or for Zofran for nausea. There is no hierarchy of needs. There's no screen. I call, they answer.

I don't want to appear resistant to change. However, it feels wrong to leave personal pt info on voice mail. Then the new MDs basically screen the calls, because sometimes they call back and sometimes they don't. Is this the way bigger facilities' nurses contact MDs? How many times do you call the cell and leave a message?

Larger hospitals in the area have hospitalists around the clock, and the middle of the night phone calls to PCPs are a thing of the past. We'll probably get the hospitalist program too, but as in all things, a little later than everybody else.

What do the rest of you do when you need orders from an MD?

Do you think it's inappropriate to leave personal pt info on a cell phone voice mail?

Is it harmless, a sign of the times, and I just need to get with the program?

[imintrouble, BSN, RN]

It seems I might have to learn some new tricks as far as communicating with MDs.

I've been giving it some thought, because I really oppose the new way. Texting, and leaving messages on cell phones.

When I say texting, I mean nurses are using their personal cell phones. Not hospital equipment.

Right now personal cell phones are the only way a nurse can text an MD. We are really low tech here in rural USA.

Clarification: I have never used my personal cell to text MDs.

It seems around here, there's a fundamental shift in how new MDs view their pts.

More than ever pts are just a business. We don't have access to new MDs home phones, they don't want to be bothered. There is almost nothing that can't wait til morning. Leaving a message on a cell, allows the MD to hear it, then decide if they need to wake up enough to address the issue.

We have no policy regarding the MD not returning a call. He can listen to the message, decide it does not need to be addressed, but not share that thought with me by returning my call. It's disrespectful, to me and the pt.

And then there's the whole HIPAA thing. Leaving personal infromation on a cell phone voice mail just goes against decades of ingrained nursing beliefs.

[mclennan, BSN, RN]

Our texting is also done through an online system. If they deny getting a page, they can all easily be traced - and yes, we've had to do it.

It is also our policy that docs are required to respond to a page within 5 minutes.

Same here. You all talk as though your facilities have NO policies about this stuff! Really? We almost ONLY text MDs/NPs any more, through our online system. They usually respond by entering orders into the online chart. Rarely do they actually call back and we have an actual person-to-person phone exchange. They must respond to any text/page/request from us within 15 mins. This policy is ENFORCED, any response over 15 mins gets logged & dealt with by their Medical Director.

And THANK GOD! This means two positive things: 1) ALL information being exchanged is IN WRITING and recorded in the online system (no "he said/she said" arguments about a phone conversation later) and 2) it encourages nurses to make requests and write texts that are CRYSTAL CLEAR and well-articulated, because if they aren't, guess what? The DREADED phone call. The MD will call you & you'll actually have to TALK to them to clarify, and it's SUCH a huge interruption in your busy day!!!! Trying to understand their thick accents and jibber jabber is such a pain! Then you gotta document the stupid phone call and every word said. God, just read the text, review the chart & my notes in the system, enter orders for me to carry out, and leave me ALONE! We also have 24-hour coverage of MDs that are always reachable by text page who also have access to all charts via the Web.

I trust computers and robots and machines FAR MORE than I've ever trusted, or will EVER trust actual human beings. I think health care's increasing reliance on this kind of technology is more a sign of how UNRELIABLE and IDIOTIC "people" have become than some sign of impending doom about the apocalypse. I thank my lucky stars I work for an employer that has a way to trace and document and record everything in writing, is computer savvy, and DISCOURAGES verbal info exchange!

Also I don't know a single soul who has a land line home phone any more. Not even my 70 year old mother in rural Minnesota.

Viva technology! All of this is about 30 years behind. I'm excited to see health care finally starting to catch up to the future. Embrace it, or you'll get left behind.

[RNinCLE, ADN, BSN]

In my previous posts, I talked about text-paging docs. But that's also from within a huge medical system where I am text paging from a computer, using an internal tool designed for this specific purpose. And there is no way for the doctor to respond to me other than to call me on the phone, or put an order in the computer.

In the situation you describe, I completely agree with you. There is no way I would use my personal cellphone to text an MD. That is bad practice. And no one should be texting orders to a nurse's personal cellphone. There are just so many ways that could end badly.

Personally, I don't think you need to learn "new tricks". I'm not sure what type of facility you're working in, but I think I would work/discuss with management re: putting some protocols in place on what is appropriate and what is not. I would have serious issues with working in the way you've described.

[Rexie]

I would be very uncomfortable using my own cell phone to text a physician. Our hospital has one of those systems in which we can send a text to their beeper, which can be tracked. They recently changed what we are allowed to text due to HIPAA. Basically, we're limited to something like "Pt concern, please call." I liked it better when we could give them a little more information. However, I do recall my preceptor at a different hospital advising me to keep texts vague so that the physician would call back.

[imintrouble, BSN, RN]

I love AN, but there is such a disparity in our working conditions it's hard for me to imagine some of the things I read here as far as technology goes. I know it's hard for some of you to imagine just how bare technology is in some parts of the country.

The new MDs we have are no doubt used to giving and receiving info the hi-tech way. Computers. We can't do that, but the new MDs still want to limit our ability to contact them.

There are some nights I wish I could call old Dr Smith who routinely yelled and ranted, but listened and gave me orders that I could hear.

Instead of new Dr Smith who doesn't want to be bothered after 0000, and will not answer his cell, and won't return the call unless I leave a message first.

[imintrouble, BSN, RN]

Same here. You all talk as though your facilities have NO policies about this stuff! Really? We almost ONLY text MDs/NPs any more, through our online system. They usually respond by entering orders into the online chart. Rarely do they actually call back and we have an actual person-to-person phone exchange. They must respond to any text/page/request from us within 15 mins. This policy is ENFORCED, any response over 15 mins gets logged & dealt with by their Medical Director.

And THANK GOD! This means two positive things: 1) ALL information being exchanged is IN WRITING and recorded in the online system (no "he said/she said" arguments about a phone conversation later) and 2) it encourages nurses to make requests and write texts that are CRYSTAL CLEAR and well-articulated, because if they aren't, guess what? The DREADED phone call. The MD will call you & you'll actually have to TALK to them to clarify, and it's SUCH a huge interruption in your busy day!!!! Trying to understand their thick accents and jibber jabber is such a pain! Then you gotta document the stupid phone call and every word said. God, just read the text, review the chart & my notes in the system, enter orders for me to carry out, and leave me ALONE! We also have 24-hour coverage of MDs that are always reachable by text page who also have access to all charts via the Web.

I trust computers and robots and machines FAR MORE than I've ever trusted, or will EVER trust actual human beings. I think health care's increasing reliance on this kind of technology is more a sign of how UNRELIABLE and IDIOTIC "people" have become than some sign of impending doom about the apocalypse. I thank my lucky stars I work for an employer that has a way to trace and document and record everything in writing, is computer savvy, and DISCOURAGES verbal info exchange!

Also I don't know a single soul who has a land line home phone any more. Not even my 70 year old mother in rural Minnesota.

Viva technology! All of this is about 30 years behind. I'm excited to see health care finally starting to catch up to the future. Embrace it, or you'll get left behind.

You have no idea:) Wouldn't it be cool if you could drop into my hospital and I could drop into yours for a day? We'd both be equally shocked. Me pleasantly, you ...not so much.

[tewdles, RN]

We text the MD and ask him to call us regarding patient need.

We don't put patient identifiers in text messages.

We obtain our MD orders voice to voice.

We don't leave specific patient information in voice mail messages.

New technology is great, but we have to be careful that we are not putting patient privacy at risk. Cell phones are NOT secure in any way so be cautious.

[BrandonLPN, LPN]

We text the MD and ask him to call us regarding patient need.We don't put patient identifiers in text messages.We obtain our MD orders voice to voice.We don't leave specific patientinformation in voice mail messages.New technology is great, but we have to be careful that we are not putting patient privacy at risk. Cell phones are NOT secure in any wayso be cautious.

Ok, this is going to sound dense, but if you're texting the doctor to get him to call you and then take the order voice to voice...... isn't that almost the exact same thing as good old fashioned paging in order to obtain a telephone order?

[anotherone, BSN, RN]

we dont have any cell or home phone numbers of any drs. all communication is done by their work beeper. you must text page . you can text what you want, i guess .although official policy states you must include your name, pts name ,reason for page, and call back number. this allows them to screen calls and prioritize. i have been with drs in a pts room and pager goes off 10 times in 5 minutes. this is a teaching hospital where one night float may cover tons of pts. i like it because you can text something like, "455 Smith, back from Abd us , requesting diet. please advise. mary jones, rn phone number" most drs will put in an order without calling you. and for stuff like this you arent confined to waiting by the phone for 15 mins. all pages are recorded and will be pulled up by IT when needed

[tewdles, RN]

Ok this is going to sound dense, but if you're texting the doctor to get him to call you and then take the order voice to voice...... isn't that almost the exact same thing as good old fashioned paging in order to obtain a telephone order?[/quote']

Yes it is...but our MD doesn't carry a pager

[HyperSaurus, RN, BSN]

We have text paging during the day--text with concern and physician calls back with orders. At night, we have an on-call hospitalist and resident who we just page.

[wooh, BSN, RN]

Some of our docs prefer text pages. I like them. I can tell them what's up, give them some info, they can look it up and either put in an order without me having to talk to them, or can call me to discuss further or say they aren't worried. I like it because I don't have to sit on the phone twiddling my thumbs while they look up the patient, think about it, etc.

If I think we need to have a conversation, I just text them to CALL ME. And we have a conversation.

More options. It's great!

I do think there's a difference between that and GETTING THE ORDER via text. That I'm not a fan of.