Issue link: https://nnumagazine.uberflip.com/i/956820
like, 'Didn't you hear me? I want an appointment.' It's a waste of time." Patients don't understand that Kaiser requires the TSR to ask these questions because it is trying to direct them to these options instead of an in-person appointment. Because of job stress and working conditions, David reports that "90 percent of TSRs are not happy there. The morale is very low. A lot of people use the term 'prison.'" * * * It was after midnight on a Friday night when Mary Roth picked up the call. Her computer monitor is telling her the patient in ques- tion is a newborn and the quavering, teary voice on the other end of the line is the new, young mom. "I am calling about my baby. I don't know what's wrong, my baby won't stop crying." Over the next minutes, Roth becomes the ultimate multitasking nurse detective: using her powerful conversational skills to establish trust and rapport with the new mother as well as reassure her and calm her down, listening carefully through her headset to not only the mom, but the sounds the baby is making and other background noises, scrolling through the patient's medical record to glean as much information and history as possible, and drawing upon her decades of nursing experience and knowledge to pull everything together into a treatment plan for this woman. Even though it was harder to hear the mom while the baby was crying, Roth senses the importance of the mother-baby bond at that moment and does not ask the mom to put the baby down—something a less experienced RN might have done. The upshot? Roth not only educated the new mom about the causes and solutions of crying babies and determined this particular baby was fine, but assessed that the mom likely had mastitis and was able to arrange a prescription for her. She further taught the mom about breast infections and how to avoid them in the future, as well as offering the mom additional resources about breastfeeding and postpartum depression and emotional changes. The call ended with a grateful and more empowered patient on the road to health and a nurse who felt confident that mother and baby had received the best possible care. These types of stories are why Roth is a call center advice nurse. "All calls require us to use our critical thinking skills, employ the nursing process, use the resources provided judiciously, and practice as professionals within our scope as described in the nursing prac- tice act," wrote Roth in this exemplar on her work. "As registered nurses we are required to consistently advocate for the safest out- come for our patients and it is gratifying when all the components come together to make that possible." If it were up to Kaiser, Roth might never have taken the time to triage the mother (in order to keep the call time short) or been expe- rienced enough to consider the mother-baby pair, which could have led to call backs and a delay of treatment for the mother. "It is impor- tant to manage each call thoroughly and completely," wrote Roth. Sadly, Kaiser AACC nurses report that management does not provide them the conditions they need to do their best work; RNs are struggling to provide the kind of quality care Roth describes in her scenario despite Kaiser, not because of Kaiser. Like the TSRs, the Kaiser nurses' main complaint is that Kaiser management believes that minimizing the call handle time and maximizing the volume of calls trump all other concerns, including patient safety and the well-being of the registered nurse. "In the call center, the pressure is to move faster with taking care of the patients, but we're not having the proper tools and not having the staffing," said Berry. "There is high surveillance and micromanaging of any and everything we do. The encouragement is to speed up instead of spending the appropriate amount of time at that moment to proper- ly assess that patient." The call center nurses describe management that treats them like automatons undeserving of respect, down time, and adequate bath- room breaks, and working conditions that cause undue emotional and psychological stress and physical injury. Sometimes nurses show up for work and don't even have an assigned desk because the staffing software wrongly calculated two 0.5 full time employees as only one person! Nurses are timed and judged on every aspect of their call by customer service standards developed for the retail, banking, and hospitality industries—even though they are literally handling matters of life and death. "There is a general sense among nurses that Kaiser has no respect for our practice," said Billings. Every month, nurses are scored according to the AACC "Quality Listening Key," a 30-page document that details Kaiser's expectations and guidelines for every aspect of each call, from triaging proficiency J A N U A R Y | F E B R U A R Y 2 0 1 8 W W W . N A T I O N A L N U R S E S U N I T E D . O R G N A T I O N A L N U R S E 29 "Here at the call center, we touch many lives every single day. It's the ultimate problem solving job because we get everything. And you can get right to the person that wants the help and fix it right there and then."