That is not how you address one on the telephone.. *vent*

[Forever Sunshine]

One of my residents was sent out to the hospital today. This evening I called over to the ER to check on how he was doing. I had to explain why I was calling about 4 different times to 4 different people.. and not one of them was polite. I was literally treated like a telemarketer.

I mean even when I'm having the worst of days.. I still manage to dig deep down and find a smidgeon of a good mood to at least smile and act humane to the person on the telephone.

Don't think thats asking for too much. My job is busy too.

[Forever Sunshine, ASN, RN]

Sorry, I didn't mean to imply a "who's busier" aspect. I only meant to suggest that calling and immediately asking to leave a message, rather than repeating your request to four people, might be more convenient for all concerned.

I didn't have a chance to even get a word in... "Hold on.. " *Click*

[allthesmallthings]

One of my residents was sent out to the hospital today. This evening I called over to the ER to check on how he was doing. I had to explain why I was calling about 4 different times to 4 different people.. and not one of them was polite. I was literally treated like a telemarketer.

I mean even when I'm having the worst of days.. I still manage to dig deep down and find a smidgeon of a good mood to at least smile and act humane to the person on the telephone.

Don't think thats asking for too much. My job is busy too.

:) You sound like someone I would like to work with. Keep the light burning, dajulieness!

[mazy]

I think the continuity of care piece only works for the discharging facility to the admitting facility since they are going to need the PHI to provide care.

But I'm also seeing that the whole HIPAA component of this is really very complicated.

In the facilities I've worked in we do a bed hold for 72 hours, after that the patient is a whole new admission.

I also agree that we, as the nurses doing the discharging, can't see what the ER nurses are dealing with at their end and we may be getting someone on the phone who is completely frazzled and may think that a call about a discharged patient is not on top of their list of priorities.

But it's not OK to be rude, we really do need to treat each other with professional respect.

If I need to call the ER I just say "hello I'm X, I'm a nurse at Y, can I speak to the charge nurse." But again, if several hours have passed since discharge I usually do call the main line first just to find out if the patient has been admitted so I can talk to the nurse of that unit, where things are a lot calmer.

The main line can usually tell me if the patient is on a unit or still in the ER. That eliminates the part were you're on hold with a half a dozen people while they try to figure out what to do with you.

What I don't understand is why a LTC facility would need to know the admission information immediatey, and why the nurse doing the discharge would be expected to follow up so soon -- what if the patient is d/c at change of shift? What if the patient ends up languishing in the ER for hours and has no admitting diagnosis at time of call?

Since there is a three day bed hold, why can't someone follow up the next day? It would seem like social services would be better suited to that.

I just think that it is unreasonable for the LTC to be expecting the nurse to get that information so urgently. That's the part I don't understand.

[Forever Sunshine, ASN, RN]

I think the continuity of care piece only works for the discharging facility to the admitting facility since they are going to need the PHI to provide care.

But I'm also seeing that the whole HIPAA component of this is really very complicated.

In the facilities I've worked in we do a bed hold for 72 hours, after that the patient is a whole new admission.

I also agree that we, as the nurses doing the discharging, can't see what the ER nurses are dealing with at their end and we may be getting someone on the phone who is completely frazzled and may think that a call about a discharged patient is not on top of their list of priorities.

But it's not OK to be rude, we really do need to treat each other with professional respect.

If I need to call the ER I just say "hello I'm X, I'm a nurse at Y, can I speak to the charge nurse." But again, if several hours have passed since discharge I usually do call the main line first just to find out if the patient has been admitted so I can talk to the nurse of that unit, where things are a lot calmer.

The main line can usually tell me if the patient is on a unit or still in the ER. That eliminates the part were you're on hold with a half a dozen people while they try to figure out what to do with you.

What I don't understand is why a LTC facility would need to know the admission information immediatey, and why the nurse doing the discharge would be expected to follow up so soon -- what if the patient is d/c at change of shift? What if the patient ends up languishing in the ER for hours and has no admitting diagnosis at time of call?

Since there is a three day bed hold, why can't someone follow up the next day? It would seem like social services would be better suited to that.

I just think that it is unreasonable for the LTC to be expecting the nurse to get that information so urgently. That's the part I don't understand.

This is 6-7 hours after the resident was sent out. Immediately would be calling at 4PM if they were sent out at 2:30pm. They usually are admitted or sent back 6 hours later.. If they don't have any information yet.. I let the next oncoming nurse know and move on.

[cherrybreeze, ADN, RN]

The patients are residents at these LTC facilities. Don't the nurses and staff have a right to know what is going on with the resident, when they might be coming back, should they hold the bed or give it away? They are still residents of the facility and the facility has a right to know. In fact I think we as ER nurses really should be calling to give a report to the LTC nurse as far as the dispo. Are the coming home, being admitted, ect.

Besides anyone in the world can call a hospital and ask if a pt is admitted and it's not a violation of HIPAA. It's public record unless the patient asks it not to be.

Well, sure, they can ask. The answer to that question ("if a pt is admitted") is "yes." Asking "if" is not the same as asking "why" or "when."

[tryingtohaveitall]

I agree that I hate poor phone etiquette, most of all, "hold on." Ugh, sets my teeth on edge. I'm sorry you were treated poorly over and over.

Re: the HIPAA aspect, in the ICU where I work, we are absolutely not allowed to give out diagnosis to anyone over the phone besides the parents/guardians. Even if their personal physician calls, we can't give out this info. The hospital chiefs have even gotten on staff from units calling and checking up on patients after they've been transferred to another unit, which I think is ridiculous.

[steelydanfan]

Actually the admitting dx can be quite different from what you sent them there for..

I sent a man who had fallen in our facility earlier in the day and was complaining of backache and running a temp and vomited once. Sent out for r/o brain bleed/head trauma. Admitting DX: myocardial infarction.

Lady sent out trouble breathing and chest xray with infiltrates present.Sent out possible pneumonia. Admitting DX: CHF and anemia

Man unresponsive on toilet, O2 sat 76%..Sent out for COPD exacerbation. Admitting DX: syncope.

Sometimes you think you know what is wrong with your resident.but thats why we are not doctors.

Gotcha, but as I posted previously, it HELPS enormously if you have some facts about the resident at your fingertips and don't come off just asking for info. You will simply be treated more professionally.

[Forever Sunshine, ASN, RN]

Gotcha, but as I posted previously, it HELPS enormously if you have some facts about the resident at your fingertips and don't come off just asking for info. You will simply be treated more professionally.

All I need is an admitting diagnosis and a time. If they already have facts about the resident in a report earlier.. why do they need it again to answer my questions.

What I said was this, its sufficient enough.

"Hi this is Dajulieness from XYZ healthcare facility. I'm calling about a resident, Mary Jones, that we sent over there to the ER around 2pm this afternoon. I would like to know if she has been admitted or evaluated yet."

"Hold on, *click* "

repeat that 4 times.

The 4th answerer finally informs me that she was admitted for something a bit different than what we went her out for.

Me- "Ok thank you. Would you also be able to tell me the time she was admitted to the hospital."

Her- " Uhm the time? "

Me- "Yes please"

Her - "Rude Silence for about 5-10 seconds"... 2036.

Me- Ok thank you very much for your help and have a great night!

Her- *click*

Now whos the one not bring professional here?

[southernbeegirl, BSN, RN]

Wow. some of the egos in nursing are HUGE.

[Roy Fokker, BSN, RN]

Rudeness sucks. Sorry it happened to you.

To be honest my usual "phone pick up line is": "ER. This is Roy. How can I help you?" [sometimes I do that when answering the phone at home! ]

I'll admit - sometimes I don't have a "smile" in my voice when I answer the phone. I may even be curt.

But I doubt I'm ever rude. Maybe my "curtness" comes across as rude?

Her- " Uhm the time? "

Me- "Yes please"

Her - "Rude Silence for about 5-10 seconds"... 2036.

Just to give a slightly different perspective here:

That 'rude silence' could well just be that RN actually pulling up the patient chart/screen and digging through to find out the admit time.

That patient may not even have been hers. Maybe not even on her pod.

I may see upwards of 5 new patients (more if I'm working track) every hour.

In all my years as an ER nurse, I've never once cared to look/notice what time a patient was "admitted"; because that little detail is insignificant in the grand scheme of ER throughput.

It's usually: Admit or discharge?

If admit: Do they have a bed? Do they have orders? Yes to both? NEXT!

But having never worked LTC, I'm curious - why does the admit diagnosis and time matter at your end? Why does management make it such an issue to have those details by XYZ time?

Again, not excusing rude behavior. Sorry you had it happen to you.

cheers,

[Forever Sunshine, ASN, RN]

Rudeness sucks. Sorry it happened to you.

To be honest my usual "phone pick up line is": "ER. This is Roy. How can I help you?" [sometimes I do that when answering the phone at home! ]

I'll admit - sometimes I don't have a "smile" in my voice when I answer the phone. I may even be curt.

But I doubt I'm ever rude. Maybe my "curtness" comes across as rude?

Just to give a slightly different perspective here:

That 'rude silence' could well just be that RN actually pulling up the patient chart/screen and digging through to find out the admit time.

That patient may not even have been hers. Maybe not even on her pod.

I may see upwards of 5 new patients (more if I'm working track) every hour.

In all my years as an ER nurse, I've never once cared to look/notice what time a patient was "admitted"; because that little detail is insignificant in the grand scheme of ER throughput.

It's usually: Admit or discharge?

If admit: Do they have a bed? Do they have orders? Yes to both? NEXT!

But having never worked LTC, I'm curious - why does the admit diagnosis and time matter at your end? Why does management make it such an issue to have those details by XYZ time?

Again, not excusing rude behavior. Sorry you had it happen to you.

cheers,

We, (LTC floor nurses) don't make the ridiculous policies.