Better ways for residents to get in contact with nurses on the floor

[kaizenakira]

Just wondering if anybody had suggestions for better ways to residents to get in phone contact with nurses on the floor.

Our current system: Resident receives a page. Resident calls ward clerk, who sends an overhead page to floor saying that Dr. John Doe is on the line and needs to speak with so and so. Half the time, nurse does not hear overhead page and resident is left waiting on line wasting time for many minutes. Nurse then gets pissed off that resident never returned page, and the cycle continues.

We do not have enough spectralinks phones for every nurse to have one.

Another possibility would be voceras but we do not have those either.

Any suggestions would be greatly appreciated.

---

Members don't see this ad.

 

[DrBowtie]

Just wondering if anybody had suggestions for better ways to residents to get in phone contact with nurses on the floor.

Our current system: Resident receives a page. Resident calls ward clerk, who sends an overhead page to floor saying that Dr. John Doe is on the line and needs to speak with so and so. Half the time, nurse does not hear overhead page and resident is left waiting on line wasting time for many minutes. Nurse then gets pissed off that resident never returned page, and the cycle continues.

We do not have enough spectralinks phones for every nurse to have one.

Another possibility would be voceras but we do not have those either.

Any suggestions would be greatly appreciated.

Have the nurse page to a specific phone number that they will answer, not the ward clerk.

Have the nurse page with the patient name or room number tagged for ease of figuring out who paged and you can get an idea about what to do if cross covering.

 

[gutonc]

There are literally 100s of different ways to do this better than the one your hospital has implemented.

 

[DrBowtie]

There are literally 100s of different ways to do this better than the one your hospital has implemented.

Agree. Can't help but think this is a greater systemic issue above the pay grade of a resident.

 

[kaizenakira]

The problem with having the nurse page to a specific phone number, is that specific phone number would be a phone at a fixed position at the nursing station and nurses are not willing to sit at the nursing station at the phone and wait for the page to be returned.

The nurses usually do send their name and room number with the page, then we call back to the ward clerk and ask for Nurse Ashley to be put on the line, then the ward clerk pages overhead "Nurse Ashley pick up on line 54" then Nurse Ashley never hears the overhead page, and thus the cycle repeats over and over again.

I agree, that this is a terrible way to have this done at the hospital. Such a freaking inefficient waste of time. My medical school had every nurse have their own spectralink but our hospital cannot afford this.

 

[DrBowtie]

The problem with having the nurse page to a specific phone number, is that specific phone number would be a phone at a fixed position at the nursing station and nurses are not willing to sit at the nursing station at the phone and wait for the page to be returned.

The nurses usually do send their name and room number with the page, then we call back to the ward clerk and ask for Nurse Ashley to be put on the line, then the ward clerk pages overhead "Nurse Ashley pick up on line 54" then Nurse Ashley never hears the overhead page, and thus the cycle repeats over and over again.

I agree, that this is a terrible way to have this done at the hospital. Such a freaking inefficient waste of time. My medical school had every nurse have their own spectralink but our hospital cannot afford this.

Your first paragraph is a serious problem. Culture of the hospital seems dysfunctional.

 

[gutonc]

The problem with having the nurse page to a specific phone number, is that specific phone number would be a phone at a fixed position at the nursing station and nurses are not willing to sit at the nursing station at the phone and wait for the page to be returned.

How f***ing long does it take to return a page? If the nurse can't sit there for 3-5 minutes (which is how long it should take to respond to a typical page) then it either wasn't that important, or the patient (or some other patient) is coding and the code or rapid response team is at the bedside and your input is no longer relevant.

And honestly, the vast majority of pages don't require actual RN/MD communication if done right. You get the page telling you that Ms. Jones in 731 has a K of 2.9. You put in orders for K replacement...that should really be the end of it. If you want to call the unit clerk and tell him/her to pass that on to the RN, that's fine, but it's not a huge deal most of the time.

But I agree that it sounds like a systemic hospital issue that you won't be able to fix. If it makes you feel better (and it might not since you're in Peds and Peds RNs are the absolute worst), once you get out in the real world, your page volume will decrease by about 110% as long as you're not a surgeon.

 

[Mass Effect]

How f***ing long does it take to return a page? If the nurse can't sit there for 3-5 minutes (which is how long it should take to respond to a typical page) then it either wasn't that important, or the patient (or some other patient) is coding and the code or rapid response team is at the bedside and your input is no longer relevant.

And honestly, the vast majority of pages don't require actual RN/MD communication if done right. You get the page telling you that Ms. Jones in 731 has a K of 2.9. You put in orders for K replacement...that should really be the end of it. If you want to call the unit clerk and tell him/her to pass that on to the RN, that's fine, but it's not a huge deal most of the time.

But I agree that it sounds like a systemic hospital issue that you won't be able to fix. If it makes you feel better (and it might not since you're in Peds and Peds RNs are the absolute worst), once you get out in the real world, your page volume will decrease by about 110% as long as you're not a surgeon.

If they actually text page you, that is. I don't know about the OP, but I can't tell you how many times I've been paged with a number, called the nurse's station (nurse is often there, but sometimes wanders away, even though I call back immediately) only to have the nurse tell me so and so's K is 3.2 in case I didn't see the labs or so and so's BP is in the 150s or so and so is refusing meds.

 

[kaizenakira]

Yeah usually the nurses do not text page, because it is far easier to hit 77-pager# then to pull up a computer and type in a page and response.

 

[FutureInternist]

And honestly, the vast majority of pages don't require actual RN/MD communication if done right. You get the page telling you that Ms. Jones in 731 has a K of 2.9. You put in orders for K replacement...that should really be the end of it. If you want to call the unit clerk and tell him/her to pass that on to the RN, that's fine, but it's not a huge deal most of the time.

I HATE text pages.
There have been plenty of times when the nurses have paged the wrong person or incomplete info & then they do the passive aggressive nurse thing i.e put in the notes "Paged FI 3 times, no response", even though I was off that day

The problem w/ text pages is that if the intended person doesn't get it, then there is no way to know

 

[Raryn]

Text pages are good if they are intended to get a callback (i.e. provides you some context for the call).

Text pages are bad if the nurses treat them like it's a text message and try to convey all the information and act like merely sending you the text is an adequate action on their part.

I'd much rather get text paged "The restraints for room XYZ are about to expire" or "Room ABC has a potassium of 3.2" with no expectation for callback than the alternative. It's pretty clear if I receive it or not... given that I put in an order to rectify the issue pretty much immediately. Obviously, if that doesn't happen within say, 15 minutes, they need to figure out where the broken link in the chain is.

That said, the passive aggressive nurse charting BS when she pages the wrong person is definitely annoying.

One of the only good things about the VA computers all being locked/you having to log in is the Lync system. It's a hospital-wide (system-wide actually) instant messaging system similar to old-school AIM where the nurses can just quickly send a message. If I'm at the computer, I can send one back and just take care of the issue. Some of my colleagues don't like it, but I encourage all the nurses for my patients to please Lync rather than page.

 

[Winged Scapula]

That said, the passive aggressive nurse charting BS when she pages the wrong person is definitely annoying.

That used to (and still does) annoy me immensely.

I just play the passive aggressive thing back and would write (when we had paper charts) "at the time RN X documented she paged me I was out of the country/not on call/etc"; Dr X was on call and this was clearly documented by the hospital operator and the call schedule provided to all units". 😛

 

[alberrito]

The use of pagers is surprising to me especially considering that the US is the leader of advanced health care (in most hospitals, anyway). I would expect the hospitals to have a good system for communications between hospital personnels and doctors. Where I work in Asia, all doctors (including residents and interns) have a phone which allows immediate communication when situations arise. No one uses pagers anymore...hard to believe that US hospitals still use them. No disrespect or anything, but I believe this is one aspect that US hospitals should improve on. Sorry my comment ain't of much help

 

[Siggy]

I HATE text pages.
There have been plenty of times when the nurses have paged the wrong person or incomplete info & then they do the passive aggressive nurse thing i.e put in the notes "Paged FI 3 times, no response", even though I was off that day

The problem w/ text pages is that if the intended person doesn't get it, then there is no way to know

I always want to be able to document, "Nursing staff refused to give X medication, and did not notify MD" or "Patient hypotensive and septic, no nursing action given" (true story, found out my patient was hypotensive through the EMR... fun times), but then I realize that someone in the hospital actually has to be an adult and act their age.

 

[Raryn]

I always want to be able to document, "Nursing staff refused to give X medication, and did not notify MD" or "Patient hypotensive and septic, no nursing action given" (true story, found out my patient was hypotensive through the EMR... fun times), but then I realize that someone in the hospital actually has to be an adult and act their age.

I have a coresident that would do this sort of thing. Not worth it IMO. The nurses have a lot more time on their hands than we do, and can start paging for ever more stupid reasons if we annoy them.

 

[mmmcdowe]

Pickle phones. Not a pickle shaped phone that is, but a system of phones that function like walky talkies. Each nurse on the unit has one, each resident has one for their assigned position (Trauma senior, trauma intern, etc).

 

[colbgw02]

The problem with having the nurse page to a specific phone number, is that specific phone number would be a phone at a fixed position at the nursing station and nurses are not willing to sit at the nursing station at the phone and wait for the page to be returned.

It sounds like the nurses don't understand how paging works.

 

[colbgw02]

The use of pagers is surprising to me especially considering that the US is the leader of advanced health care (in most hospitals, anyway). I would expect the hospitals to have a good system for communications between hospital personnels and doctors. Where I work in Asia, all doctors (including residents and interns) have a phone which allows immediate communication when situations arise. No one uses pagers anymore...hard to believe that US hospitals still use them. No disrespect or anything, but I believe this is one aspect that US hospitals should improve on. Sorry my comment ain't of much help

If phones were always the superior mode of communication, then our mobile phones wouldn't have text messaging and email capabilities. I think paging fills a niche quite nicely because it's like saying, "hey, I need you, but feel free to shake that last little bit of pee off your schlong first." Phones don't permit that. You either stop whatever you're doing or you don't, in which case the exchange never takes place.

 

[Doctor Bob]

If phones were always the superior mode of communication, then our mobile phones wouldn't have text messaging and email capabilities. I think paging fills a niche quite nicely because it's like saying, "hey, I need you, but feel free to shake that last little bit of pee off your schlong first." Phones don't permit that. You either stop whatever you're doing or you don't, in which case the exchange never takes place.

Sure phones do that. As mentioned... text messages.

We are all assigned a phone based on our position and it's either an iPhone or a kyocera blackberry knockoff.
In an emergency you call the person. In a non-emergency, you get a text message.

The downside to this system is its expensive to implement and if someone misplaces their phone it's costlier to replace than a pager.

 

[colbgw02]

It might have been implied that by saying phones that I meant a traditional phone, as in the kind described in the post to which I replied or the non-smart cordless phones that are typical in many U.S. hospitals.

 

[j4pac]

My nurses stay near the phone after paging me. Problem solved.

 

[styphon]

My last hospital the floor nurses carried cell phones connected to the hospital system, when I would call their extension - it would reach them directly.

 

[Siggy]

At my hospital, all the nurses carry a spectralink (unfortunately, not the same, but it's easy enough to call the unit clerk), all of the residents carry a pager, and then specific residents carry a spectralink as well (1 spectralink for each of the medicine teams plus one for the on-call senior, etc).

 

[kaizenakira]

Thanks for all the advice. I really like the idea of cell phones connected into the hospital network but that would probably be costly as anything to buy every nurse a cell phone.

 

[Armadillos]

The concept of giving a hospital issued phone that can get texts seems awesome to me. Probably would be best to design system so the texts from nursing have to be sent by computer, so its harder to become a long back and forth text conversation. Also every MD having a phone eliminates the intern's pain of having to stalk a phone waiting for the consultant to call or whatever.

I could see patients getting pissed if it looked like you were answering a personal phone or something, so probably would be good to makes all the phone cases some random color w/ a huge hospital logo or something.