EXECUTIVE SUMMARY
Keeping PRN employees updated is difficult because of constant changes in the field of patient access. The following are good approaches to keep employees informed.
- Give employees who are leaving the department the option of becoming PRNs.
- Schedule a time to review important changes with PRN employees.
- Assess PRN employees’ ability to meet quality indicators.
Constant changes in patient access necessitate constant updates for all employees. But what about those who only work in the department occasionally?
“One of the biggest challenges is communicating to employees who work only on the weekends,” says Anne McCabe-Staub, director of training for patient financial services at Springfield, PA-based Crozer-Keystone Health System. About 10-15% of the department’s patient access employees are PRN, meaning they work only as needed.
“PRNs need to be alerted about insurance plan code changes, changes to desk procedures, and new work flows, to name a few,” says McCabe-Staub. “They are constantly getting information from us.”
Below are some ways the department keeps PRNs updated.
- All patient access employees, including PRNs, are required to check their email for updates at least once a shift.
For important communications, managers ask that employees confirm that they reviewed the email.
- Meetings are held during multiple shifts.
PRNs simply are not physically present often enough to attend all monthly staff meetings. However, holding two meetings — one in the afternoon and one in the evening — makes it more likely. Allowing them to dial in and attend remotely is another option. “PRN staff may call in rather than physically come to the meeting,” says McCabe-Staub.
- PRNs work a minimum of every other weekend.
“We don’t have them work less frequently than that because they can’t keep up their skills,” says McCabe-Staub.
- PRNs are encouraged to try for part-time or full-time positions.
Turnover with PRNs is a continual challenge. “If we’re lucky, they stay two to four years, but they usually don’t stay longer than that — at least as a PRN status.” Some PRNs move to part-time or full-time positions in the department, which is better than losing them altogether.
- An experienced patient access employee always works alongside the PRN.
“It’s not a good idea to have a bunch of PRNs working together,” notes McCabe-Staub.
- Patient access leaders assess the quality of PRNs’ work, just as they do with other employees.
A consent form was recently revised, to include documentation that the registrar offered the Patient Bill of Rights and Notice of Privacy Practices. “Managers and trainers instructed employees on the proper way to complete the forms,” says McCabe-Staub. Sign off sheets were used to document that employees attended onsite training.
“Audits were completed to ensure that employees were using the new consent forms and checking appropriate boxes on the new form,” says McCabe-Staub. Any staff, including PRNs, who were having difficulty were sent for additional training. “It’s challenging if somebody is attending school or has another job, but that’s the condition for their employment,” says McCabe-Staub. “They have to keep up with it.”
Same Quality Standard
Eight PRNs do ED registration at Knoxville-based University of Tennessee Medical Center. “I use email a lot for communication,” says patient access manager Michelle Reno. All PRNs also have their own folders with information to view during their shift. “We print any communication that is sent out via email, and add it to the team members’ folders,” says Reno. “Any updated policies are also printed and put in folders.”
At Albany (NY) Medical Center Hospital, PRNs are not used as much as they were in the past. “This is due to the concerns of ensuring competencies are maintained,” says patient access director Catherine M. Pallozzi, CHAM, CCS.
The department offers part-time and full-time employees who completed school and are leaving for a position in their field of study the opportunity to remain as PRNs. “This is a huge benefit, as training and expectations are known!” says Pallozzi.
Since PRNs usually are absent from staff meetings, they are not up-to-date with changes in the department, the hospital, or the field in general. To address this, Pallozzi recommends several strategies.
- Schedule a time when the PRN employee is at work to review changes to policies.
Supervisors keep track of PRNs who are not at staff meeting or important training sessions. On the employee’s next shift, they make sure to review the new information. “We have very few shifts not covered by a supervisor, manager, or staff lead, so reviewing with a per diem is not an issue,” says Pallozzi.
All staff, regardless of status, are responsible to review emails for any updates. “This includes managers’ weekly updates on changes to policies, areas needing improvement, or celebrating of successes,” says Pallozzi.
- Have a senior patient access employee or trainer determine if the PRN employee is meeting the required quality indicators.
“Per diem staff are held to the same quality standard as full-time staff,” says Pallozzi.
- Anne McCabe-Staub, CHAM, Director, Training, Patient Financial Services, Crozer-Keystone Health System, Springfield, PA. Phone: (610) 447-6380. Email: [email protected].
- Catherine M. Pallozzi, CHAM, CCS, Director, Patient Access, Albany (NY) Medical Center Hospital. Phone: (518) 262-3644. Email: [email protected].
- Michelle Reno, Patient Access Manager, Emergency Department, The University of Tennessee Medical Center, Knoxville. Phone: (865) 305-6971. Email: [email protected].
