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

[Julius Seizure]

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.

And if contacting them IS going to interrupt their bathroom time, I would rather it be via text rather than having to hear them over the phone line!

[nursej22, MSN, RN]

Patient arrives to floor with an order to notify MD on arrival. MD paged. Nurse is called to a room. Her facility phone rings, but she chooses not to answer because she is consoling a grieving family. She leaves the room, to discover that MD returned her call. So now, 2 calls have been made, MD still doesn't know why he/she was paged. Do this 3 more times, until they actually can speak.

Now, try this with an encrypted system with a text that says " Letting you know that Mrs. S has arrived to the floor in room 1511."

[Ddestiny, BSN, RN]

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.

I think there have been a lot of great examples of how texting can be used without having the HIPAA police at your door. It's different and it's fine to not be comfortable with it but that doesn't mean that those that do utilize it are breaking the law. If whole hospital systems are encouraging it (by disseminating an encrypted app to staff) then it can't be all bad, right?

[canoehead, BSN, RN]

I am not pleased about facilities wanting to use our personal cell for texts, they should be providing secure ones. I don't want to be going home with all that available on my phone. And I don't want to pay for cell service they use, I'm petty like that. But if it was private and approved by the hospital, sure. I'd love having a record of how often I texted and what was said.

[JKL33]

There are plenty of ways to text within patient care while still accounting for HIPAA, as noted by quite a few responders on this thread.

Using one's personal unencrypted phone on an open network does not meet any official government guidelines for security I've ever read.

The OP discussed a general dislike of texting in healthcare, true, but the specific example in the post was an expectation of personal phone use for patient care texting.

In addition to the fact that the law is what it is and it requires security measures, my cell phone is not a free perk of which corporations can avail themselves.

[PCnurse88]

Hi! I have an auditory processing disorder. I'm not hearing impaired by any means, I have EXCELLENT hearing, but my brain does not filter out background noise like most peoples. This makes talking on the phone nearly impossible for me. I have to be in a quiet room with no other sounds, phone on speaker, with it pressed right up against my ear (or wearing earphones). The few times I do have to use a phone at work, whether to talk to a doc or family member or another nurse, is torture. It's 10 minutes of me struggling to hold the phone to one ear, use my hand to block the noise in my free ear, and somehow find another hand to write down what I'm being told. I have had to tell doctors that I can't take a verbal order over the phone simply because I can never be 100% sure what they've said. Back when we had to call doctors for everything, I literally used to carry around earplugs and scope out the quietest corners of the unit. When getting report I am all up in the previous nurse's personal space because all the talking, movement, and beeping on the floor aren't being filtered out. I'm That Nurse that mutes the patient's TV when I walk in the room to talk to them.

Now I don't have that problem because 90% of my communication at work is texting! It's via a secure app and all disciplines have it- PT, OT, speech, nursing, doctors, CNAs, RT, you name it and they're on it! I've taught myself many tricks to help with situations where there's a lot of other noises- RRTs and codes, for instance- and can function safely. I know how to judge acoustics in a room and place myself in the best possible place. But texting has been such a lifesaver.

[FurBabyMom, MSN, 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.

Our paging system records everything. I can't remember how long ISD/communications retains it for, but they do save it to multiple places (just like our EMR). I always remind our new hires - if you wouldn't want to justify what you wrote to your manager/director/etc and/or to either the communications staff, legal/risk, etc, then just be mindful.

Also...some of the places we call within our system/hospital are recorded lines. I suspect they're able to record all calls, but most likely don't. That suspicion comes from years working in a call center where a certain number of calls were audited which meant that they did record most calls.

[FurBabyMom, MSN, RN]

I'm okay with texting providers. We have a secure/encrypted system that we can use.

With that said, I have texted providers without using the system. Usually though, it's something like "Non-urgent, but have a question about (day of week) schedule. (best phone number to reach me at)." Or, other times "please call (phone number)." Nothing about a patient at all... Other times it's "Covering for (name of manager). Question about cases this week."

I have never been a fan of putting too many details in a page - think about how easily pagers might get switched, or lost... I've seen them switched so many times, though all of them look alike when they're sitting on the shelf on the pager farm in the OR. I've only asked someone call back NOW or return NOW in a handful of instances.

Our providers are increasingly having their pagers forwarded to their cell phones. The responsibility for encryption is on them and we have a policy for it - they have to comply before Communications will allow the request.

[Wuzzie]

I am not pleased about facilities wanting to use our personal cell for texts, they should be providing secure ones. I don't want to be going home with all that available on my phone. And I don't want to pay for cell service they use, I'm petty like that. But if it was private and approved by the hospital, sure. I'd love having a record of how often I texted and what was said.

Our encrypted text system can be used on the computer as well so if you don't want to use your personal cell phone you don't have to. I don't mind using my phone because it doesn't use any of my data, the texts are saved in the system, I don't want to carry yet another phone and I scrub my texts at the end of my shift.

[Nurse Beth, MSN]

You can get into some slippery areas with texting, because orders cannot be taken through texting. That requires transcription by the nurse into CPOE, and the provider needs to enter their own orders.

Texting of orders is prohibited by CMS

https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-18-10.pdf

[Rose_Queen, BSN, MSN, RN]

I am not pleased about facilities wanting to use our personal cell for texts, they should be providing secure ones. I don't want to be going home with all that available on my phone. And I don't want to pay for cell service they use, I'm petty like that. But if it was private and approved by the hospital, sure. I'd love having a record of how often I texted and what was said.

That's what my facility has done. Instead of portable phones for each staff member, there is now an iPhone. It is signed out and beginning of shift and signed in at end of shift. Being connected to our EMR also automatically populates the phone number in the care team if the nurse assigned him or herself to their patients.

[/username, BSN, RN]

You can get into some slippery areas with texting, because orders cannot be taken through texting. That requires transcription by the nurse into CPOE, and the provider needs to enter their own orders.

Texting of orders is prohibited by CMS

https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-18-10.pdf

That guidance says should. There's nothing saying that texting orders is prohibited, nor that a third party cannot enter the orders. In fact, it seems to even encourage it as long as the hospital has a secure system set up...

"In order to be compliant with the CoPs or CfCs, all providers must utilize and maintain

systems/platforms that are secure, encrypted, and minimize the risks to patient privacy and

confidentiality as per HIPAA regulations and the CoPs or CfCs. It is expected that

providers/organizations will implement procedures/processes that routinely assess the security

and integrity of the texting systems/platforms that are being utilized, in order to avoid negative

outcomes that could compromise the care of patients."