Thoughts?

[NRNPH]

Quick background - we have certain patients that don't have hospitalist teams to text page because they are patients of MD's who have separate offices within the hospital so we have to call the answering service and speak with whoever is on call. Whoever is on call for the MD's (always PA's or NP's) stay at home and are on call and answer when needed by RN's.

I had an elderly patient and due to some miscommunications from the MD and RN's the patients SO drove almost 2 hours to get here to pick them up. They were understandably upset when no discharge orders were in, they insisted that they were told by the MD that they would go home (they had no reason to stay. medically stable, could have discharged day before) and I told them that the MD's try to round early in the AM or as soon as their surgical schedule allows them time. This answer wasn't good enough, patient's SO stating they can't wait long and its a long drive. Understandable. 2 hour drives for elderly couples is so taxing. So since its close to 7 AM, I got on the phone NP to see if there were any notes or any indication for discharge so I could soothe the patient's irritation and anger by giving them something other than I don't know and not do anything about it. It wasn't like it was in the middle of the night. Granted, I should have talked to the CN first (I ALWAYS do before I call except this one time) but they were at report and you don't call them unless its an emergency cause they don't want interruptions. I figured its close to the morning about 0630 (day shift calls right in the morning for patients anyways for needs when its 0700) and it seems appropriate enough as they kept saying they could not wait long and needed to get back. Hospital is all about patient satisfaction to get those satisfaction scores so I took that extra step.

The provider did not let me get a word in. Rude, condescending, they always talk like this to any RN that calls. They have access to patient's charts and MD's notes from their home. Didn't give me one piece of information. I explained the patient's circumstances and the miscommunications going on and in order to get the patient an answer they can be okay with so that they don't take it out on the next person or the MD. Why pass on an angry patient and make someone else deal with that blow back when you could possibly solve it. NP calls my charge mad. My charge said it was fine but that the provider did the same thing to her and would not let her get a word in and "yelled" and I filed a grievance report because this is not the first time having to deal with this NP being disrespectful. I don't mind calling out disrespectful behavior to any staff regardless of your temper. I get you're irritated from being woken up but keep the professionalism will you? All I get back from the Manager is that moving forward it is mandatory to talk with CN before contacting MD (yes already knew this but I thought I was making an okay call due to it being 0630 and the circumstance of the patient and SO). Nothing regarding MD's behavior.

What is really bugging me is the fact that MD's on call get upset when they are called. In my head its the same as if I am on call. I assume I am to be called at any moment to come in and I don't get upset. They get on call pay and they are sleeping at home and get the occasional phone call (I know this because they are only MD's for my floor so they get 1 call maybe in the middle of the night for must haves). If you're on call, you're on call. You're being paid, its your job so why get upset when you are called and asked to do your job as a provider? I always try to respect the provider's time and expect them to respect that. I don't work FOR them, I work WITH them. Apparently here that's still not quite getting through. I guess being called in the AM when every MD is awake and getting ready for rounds was unacceptable and this provider got mad. The patient and SO were actually super grateful and after knowing I called to get an answer but there was nothing in any notes, they were more than willing to wait for whenever the MD rounded and now I would be passing on a happy patient to the MD rounding and the oncoming Nurse instead of a disgruntled patient and SO. Am I wrong for feeling irked? Am I wrong for being frustrated with some providers here that get upset but their job is to be on call? I'm doing my job, its time to do yours. Am I wrong for seeing it this way? Am I wrong feeling irked that my Manager didn't even address the provider's demeanor towards me and my CN?

[MJB2010]

The only way to spark change would be for multiple people to write written complaints about this providers behavior. It has to be a pattern. So if it is just you that has an issue they will blame you. If they get multiple complaints from nurses about that office, they will be forced to address it. So if it happens again to someone else, encourage them to report it. If you have to call again, and the charge nurse ok's it, maybe do the call on speaker phone (in a private office) with the charge as a witness just in case of more bad behavior.

[Swellz]

You're definitely doing the right thing by writing the provider up for their behavior. Your charge nurse should do it as well. I have worked with a lot of clinicians who are just rude to everyone if they get called after 9pm. They do it because they can get away with it. In theory, if enough people write them up, it will be addressed in some way. In theory.

That being said, as angry as the patient's family was, I'd have explained that the person on overnight is not the regular provider and wouldn't be able to discharge them. I would have waited until 0700 and called the doctor myself, during/after shift change.

[Oldmahubbard]

I see nothing has changed in 30 years. You are forced to call during off hours. I say forced, because you are not calling for your own pleasure.

You correctly anticipate that the person you connect with will be, at the very least, incivil. More likely, rude, unprofessional, and downright ugly. Although it is their job.

A nurse would be out of a job, but we put up with this nonsense.

[NRNPH]

11 hours ago, Swellz said:

That being said, as angry as the patient's family was, I'd have explained that the person on overnight is not the regular provider and wouldn't be able to discharge them. I would have waited until 0700 and called the doctor myself, during/after shift change.

Even though it is not their attending the NP's and PA's discharge for them and have access to their notes. Its hard to tell when they will round depending on their surgical schedules and when you call in the morning, you get the same NP or the PA either way. They have access to charts and notes indicating possible discharges, etc. The NP did say they would pass onto the rounding team this information finally at the end. The only reason this is an issue because they complained they were woken up. In my mind, its 0630-ish, closer to 0700 and you are getting paid to be on call until 0730 so if someone calls, it is still your job to answer.

[JKL33]

On 6/13/2019 at 7:57 AM, NRNPH said:

Granted, I should have talked to the CN first (I ALWAYS do before I call except this one time)

On 6/13/2019 at 7:57 AM, NRNPH said:

All I get back from the Manager is that moving forward it is mandatory to talk with CN before contacting MD

See I don't like this, and this is why. If you are an RN you are the primary person responsible for advancing your patient's needs and concerns. But beyond that, this "middle man (woman)" process means that when there is an issue with a phone call it is solved by chastising people for not using it, rather than reviewing situations and supporting and training people [on things that every RN should learn to do, mind you].

It also discourages the normal process of RNs refining their own trouble-shooting skills and is a drag on confidence-building. Then when the situation rolls around that the RN has to make an independent decision (one that is totally within a normal RN scope!!), s/he has little history of doing that and the chances are lower that "the best" decisions will be made...so the decision is criticized and someone says, "see, this is why you have to talk to the charge nurse first." What a set-up! ?

To the spouse who has driven two hours and arrives at 0630, I would have said, "I apologize if we did not communicate very well about the way this usually works: The staff who is going to help get everything set up for you will be coming around this morning; I will let them know you are here." I'm sure a little bit of discussion would ensue, and I would provide the usual (validation/reassurance, etc.), then I would do a little concierge (Get a cup of coffee while he waits, etc.).

If it's true that there is no provider-on-call shift change at 0700, then I would have called. If I knew they would be changing over at 0700, I would have waited and called before I left, after the new person was on call. Either way they just need a brief synopsis of the situation. They don't need to hear play-by-plays...they just need to know that the spouse has arrived and is very stressed about getting back home.

On 6/13/2019 at 7:57 AM, NRNPH said:

Am I wrong for being frustrated with some providers here that get upset but their job is to be on call?

The NP to whom you spoke should have maintained his/her professionalism. But there is a sweet spot as far as: yes, they are on-call so they should take the calls pleasantly...vs. the idea that we don't need to call them for things we can reasonably troubleshoot.

[Swellz]

6 hours ago, NRNPH said:

Even though it is not their attending the NP's and PA's discharge for them and have access to their notes. Its hard to tell when they will round depending on their surgical schedules and when you call in the morning, you get the same NP or the PA either way. They have access to charts and notes indicating possible discharges, etc. The NP did say they would pass onto the rounding team this information finally at the end. The only reason this is an issue because they complained they were woken up. In my mind, its 0630-ish, closer to 0700 and you are getting paid to be on call until 0730 so if someone calls, it is still your job to answer.

I hear you that they are on call and are expected to respond and be professional. I appreciate that you were trying to resolve something for a patient. My thoughts are that this is something that could have waited; it would have inconvenienced your patient and their spouse, but it would not have hurt them.

[NRNPH]

Thank you all for the input! I wish my unit could explain and talk to each other in such a supportive and learning way. Its a practice, always things to learn and a different perspective to see.