What was she thinking?!

Updated:   Published

Many of us are unaware that there are significant differences between post acute care/snf hospitals and acute care hospitals in terms of staffing, especially during the evening hours. SNFs do not have a receptionist after 6pm, which means the responsibility for buzzing visitors in and out falls on the nurse or CNA while they are still engaged in their primary duties. SNFs don't have a unit secretary in the evening so the phones may not be answered if the nurses and CNAs are tending to patients and not currently at the nurses' station.

I work the evening shift at a skilled nursing facility, and yesterday morning my patient was taken to the emergency room, and he was discharged last night. I noticed a PIV in the patient's left forearm while doing my assessment and told him that I would be removing it once med pass is completed.

Two police officers show up about an hour later at the facility to do a welfare check on my patient at the request of someone from the ER.

When I try to obtain details from the officers, they are also confused, but they do believe it has something to do with the PIV, but they do not have specific information. They leave without ever seeing my patient. As a result, I contact the hospital's emergency department.

This is what the charge nurse said to me.

During shift change, the ER nurse assigned to my patient realized she had not removed his PIV. Several attempts were made by her to speak to someone at the facility for no other reason than to inform them that she forgot to remove the PIV. When she was unsuccessful in reaching someone, a colleague of hers suggested she contact the police and request a welfare check be done. She took their advice and the rest is history.

I'm still trying to wrap my heard around this one.

toomuchbaloney said:

Because the owners don't pay someone to prioritize answering phones over patient care.  

Agree....but that is the fact of the matter. I agree with what I think is the previous poser's sentiment -- I.e. the fact that messages cannot be received is certainly more troubling than the idea that someone took steps to try to deliver a message.

Specializes in ER.
JKL33 said:

Agree....but that is the fact of the matter. I agree with what I think is the previous poser's sentiment -- I.e. the fact that messages cannot be received is certainly more troubling than the idea that someone took steps to try to deliver a message.

I don't see why the nurses then don't carry phones. In this day and age it's ridiculous to skimp on technology that is pretty inexpensive. Also, texting is underutilized in the medical world. With privacy features, I'm sure HIPAA can be maintained. The advantage of texting is that one has a record that can be reviewed.

Specializes in NICU, PICU, Transport, L&D, Hospice.
Emergent said:

I don't see why the nurses then don't carry phones. In this day and age it's ridiculous to skimp on technology that is pretty inexpensive. Also, texting is underutilized in the medical world. With privacy features, I'm sure HIPAA can be maintained. The advantage of texting is that one has a record that can be reviewed.

I think that cutting support staff who answer phones only to then require nurses to answer phones and text messages instead of provide nursing care of the patients and residents is a symptom of the foundational problem with for profit health businesses and our unsustainable and dangerous system.  

Emergent said:

I don't see why the nurses then don't carry phones. In this day and age it's ridiculous to skimp on technology that is pretty inexpensive. Also, texting is underutilized in the medical world. With privacy features, I'm sure HIPAA can be maintained. The advantage of texting is that one has a record that can be reviewed.

Carrying phones has pros and cons, both are usually in play IMO. I think it is inappropriate to expect nurses to carry phones and actively field calls and messages in real time, which can be fairly incessant and coming from anywhere and everywhere, while caring for patients. That is not the type of constantly distracted and interrupted care I would want to receive as a patient. I especially think it's inappropriate if the reason for doing it (possibly in play w/ the OP scenario) is because we don't want to pay someone to manage basic day-to-day functions of a place of business.

Specializes in ER.

Maybe the nurses could carry phones that would be for only vital communications. The company could subcontract to an answering service, similar to what doctors offices do for off hours calls. There are triage nurses who work those jobs. There's other answering services that are just merely for other types of businesses off hours. They handle several accounts at the same time, which is more cost efficient.

A lot of companies are using artificial intelligence based resources for some things. There has been a human resources shortage in United States since the pandemic. It's hard to hire people for $16 an hour anymore. There is a lack of mentally and physically able workers in the United States right now.

Specializes in NICU, PICU, Transport, L&D, Hospice.
Emergent said:

Maybe the nurses could carry phones that would be for only vital communications. The company could subcontract to an answering service, similar to what doctors offices do for off hours calls. There are triage nurses who work those jobs. There's other answering services that are just merely for other types of businesses off hours. They handle several accounts at the same time, which is more cost efficient.

A lot of companies are using artificial intelligence based resources for some things. There has been a human resources shortage in United States since the pandemic. It's hard to hire people for $16 an hour anymore. There is a lack of mentally and physically able workers in the United States right now.

Hiring an answering service was an option when the company decided to cut staff and let the phones ring.  

Specializes in ER.
toomuchbaloney said:

Hiring an answering service was an option when the company decided to cut staff and let the phones ring.  

I'm just throwing some ideas out there. I personally think the nursing home business is pretty atrocious.

Specializes in NICU, PICU, Transport, L&D, Hospice.
Emergent said:

I'm just throwing some ideas out there. I personally think the nursing home business is pretty atrocious.

Lots of the US for-profit health system is pretty atrocious.  

Specializes in Dialysis.
offlabel said:

The person in charge carrying a cordless handset off of the facility land line is not a big deal. 

Not every facility has a cordless. Some less desirable facilities act like staff should wear roller skates and roll non stop between patients and phone and visitors, etc

In many areas, lack of staff at night and weekends are the norm at skilled nursing facilities. Smaller SNF's don't even have a receptionist to answer the phone. Answering the phone is just not a priority when  you have 30+ patients and lack of staff.

And, licensed nurses work at skilled nursing facilities, I.V.'s can be removed if not needed. 

 

Specializes in Geriatrics, Dialysis.
offlabel said:

The person in charge carrying a cordless handset off of the facility land line is not a big deal. 

Actually it is kind of a big deal. If I had been expected to carry a phone, answer every call and also page the correct person or worse yet  run around the building to find the correct person to take the call after the quiet hours when pages are no longer allowed had started on top of doing my already overwhelming job I would have left the SNF much sooner than I did. 

Specializes in MedSurg, phone triage.

I think calling it a "welfare check" was the mistake. I wonder if the ED nurse knew the patient was returning to a SNF. Was it by SNF/EMT transport or did a personal vehicle transport them there. Where I work, anytime a patient leaves before the nurse removes the IV we are supposed to call police to find the person if we are unable to contact the person. I was told this is due to potential for IV drug abuse. Obv this makes more sense for a high risk person who leaves AMA to home... but that's my guess as to what happened. 

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