Unspoken rules? Receiving calls at home?

[RRRNNN]

Hi

I'm new to home health nursing, have only been doing it a couple of months. I live in a very rural area. I have eleven years of hospital nursing experience. I really don't understand how things work in home health. It's very frustrating. There are all sorts of weird rules and I don't know how I can do my job right.

The agency I work for is privately-owned and spread out over several counties. The county I'm working in only has a few patients so there are two RNs and a few care aides working here without an office. I have a so-called "home office" and only travel to the main branch once a week or so. Each staff person at the main branch has several different jobs and they all kind of overlap. A clerk is not just a clerk but also a scheduler, and they all seem to know everything.

Weird situation #1: It's hard for the care aides in our county to get their supplies because they only make it to the main office every 3 months or so and the girl that's supposed to send their supplies to them keeps forgetting. So I gave my # to one of the care aides so she could call me to pick up supplies for her when I go in. One evening when I wasn't on call the care aide called me to report a problem with one of the patients. I directed her to the nurse on call. When my boss at the main office heard I had received a call from the aide, she questioned me about why the aide had called me and why the aide had my home phone #. Why wouldn't I? Is there anything wrong with her having my #?

Wierd situation #2: Today I was off at 1:30. After I was off, a clerk at the office called to tell me that she had changed my schedule because one of my patients was sick and wanted me to go see her tomorrow. I asked the clerk what symptoms the patient was having and she related them to me second-hand. I said it sounded like a nurse should talk to her and asked the clerk if she thought it would be OK if I gave the patient's daughter a call from my home phone to get more details. She said she thought that would be fine so I called and the patient's symptoms are potentially life-threatening but she has chosen to wait to go to the ER. I called my boss, who was the supervisor on call, to fill her in on the patient's symptoms and history in case the RN on call gets a call tonight. She asked me how I knew the patient was sick when I wasn't the RN on call and wanted to know why I had called the patient. What was I supposed to do? I've been the only nurse to see the woman for the past two months, I'm the only one who has seen what her baseline status is, and I was made aware that she was sick when the clerk called to change my schedule. I had to call her to let her know what symptoms to look out for, etc.

I wish my boss would jsut come out and tell me what it is that she is concerned about instead of constantly asking "why does so and so have your #? Why are you calling this person?"

When there's not a nurse physically at the office, the only way for us to call the patients is from our home phones. When there's not an office, the only way for the staff out here to talk to each other is on the phone. If we can't call each other we can't communicate and if we can't communicate we can't do our jobs effectively.

What am I missing? I don't get it.

[caliotter3]

Sounds as if this boss has some quirks that obviously must make some people uncomfortable in their jobs. I don't know how she expects things to get done without basic communication. She ought to pony up for company cell phones for everyone if she doesn't want you to give out your number or to call from home. That would solve that problem.

[txredheadnurse, BSN, RN]

Possibly she is concerned that by calling you when you are not on call there might be lapses in communication to the on call nurse. Imagine if the initial phone call/contact was to you but then the patient calls the on call nurse for further instructions, to update, request a weekend visit, etc. The on call nurse is totally unaware of what is happening. That in turn could lead to possible further break down in communications and/or a lot of repetition of info etc.

As to why she might be concerned about the HHAs or patients calling you directly I wouldn't be surprised if she is trying to protect your privacy and also avoid having to pay possible overtime for you handling the phone calls.

I do believe they should be supplying you with a work cell and there should be some kind of written guidelines as to how the chain of communication is to be used. Personally I would be very selective about which employees have my personal phone number(s). If it is a work related communication then it should be done used work phones and following the company policies on chain of communication. Doing so protects everybody in the long run and eliminates a lot of needless detours in clear communication.

[Isabelle49]

Sounds like a micromanagement problem to me. I think I would look for another job. I am going to be responsible for the patients I see. They have my cell phone number and can call me at any time - I would much prefer to know about a problem first hand than hear about it 3 days later cause the nurse who handled it didn't let me know about it. When I call a doc about a problem, I ask for a return call to my cell phone (our office doesn't like this) as I think it is better that I speak to them first hand in case they have other questions and if there are orders, I want to be the first to know. I am OCD in some things, but not many. I want to be in control of my patients' care and will be as long as I am responsible for them. I have not had any patients abuse my by calling for trivial things.

[systoly]

You received calls at home, because someone at the office didn't do their job right or didn't do it at all. The boss is in charge of that, no?