A key priority for any district nurse is ensuring the safety of their team members, especially in settings in which these individuals work autonomously. This is particularly relevant in the present climate in which assaults and incidents affecting lone-working nurses are continually increasing (Primary Health Care, 2018). The main source of communication used among district nursing team members while they visit patients is by direct telephone calls, as text messaging often increases costs for the employer. Therefore, this is often discouraged or disallowed in many areas. Telephoning staff frequently through the day can pose challenges for both team leaders and staff members, as often staff are busy with patients or commuting. It has been the author's experience that over the course of the working day, many phone calls are made and received for non-confidential discussions, which could potentially be avoided with a more efficient communication system.
This article explores the use of an encrypted instant messaging (IM) application for non-patient-specific communication throughout the working day, as well as the use of a ‘check-in’ system, through which staff can efficiently report to their team leader at the start and end of their shifts.
Background
The author is the team leader who triages referrals and is responsible for ensuring the safety and wellbeing of staff on shift. It often became frustrating when staff did not answer calls, if mobile phones were left switched off accidentally or, occasionally, if there were connectivity issues. Despite best efforts, if a member of staff had not returned a call made to check they had started their shift after a short period, the author often became inundated with the daily duties of the role. At times, if the author was visiting complex patients or otherwise busy, they would not speak to team members for over 3 hours from the start of the shift. The author felt it vital to adopt appropriate safety interventions to protect lone-working staff members in the community (Primary Health Care, 2018).
Introduction of the system
The author proposed an idea to the team where they would use their personal mobile phones as a way of communicating among each other throughout the day, using the application WhatsApp. WhatsApp is as an alternative to IM, but is significantly more secure due to the end-to-end encryption level used (WhatsApp, 2019). The mobile phones issued by the author's workplace do not have the capability to use this application.
As with any change, the engagement and ‘buy-in’ of the team is paramount (Mathews and Crocker, 2016); however, the team members were all very keen to encourage this change, as receiving several inconvenient phone calls during the day often caused them some anxiety. Most of the team were familiar with WhatsApp, and those who were not received a demonstration into its use. When initiating the change, ground rules were agreed among the team members and potential implications were discussed. Staff members were advised that since WhatsApp requires internet connectivity, this would impact on their data usage and have cost implications. Although the application is encrypted, it was agreed that no patient information would be discussed.
At the start and end of the working shift, all staff had to message into the WhatsApp group to state that they were either starting or finishing work. When a patient- relevant discussion was required, staff could message each other in the group and ask to be called on their work mobile when convenient. This rule was instated in light of a recent report by CommonTime (2018), which stated that the inappropriate use of IM applications has led to staff disciplinaries, confidentiality violations and alleged incidents of malicious use.
The sole purpose of using WhatsApp was to create an efficient communication system among all staff members. However, extra benefits, such as improved lone worker support, became evident. This change received very positive feedback from colleagues, who were able to interact with all team members throughout the day and check on each other's progress without being disturbed by multiple phone calls. The author found WhatsApp to be a more efficient way of communicating with the team, as it allowed them to conveniently check in with the team members at any point. The team members were highly reliable in checking in and out at the start and finish of their shifts, which was very important, as the team leader would often not meet staff in the mornings and late afternoons due to the demand of early morning and late afternoon visits (often, patients with diabetes or those requiring palliative care).
There was a particular incident that reinforced the benefits of this new communication system. When the author's shift started at 09:00, they texted the group to make sure everyone had ‘checked in’ for their shift starting at 08:30. A junior staff nurse colleague who is highly reliable was the only staff member to have not checked in. This was unusual, as they were often the first team member to do so. The author called their work mobile multiple times but received no answer. This was becoming a concern, as the staff member had been allocated patients with diabetes who needed visits early that morning. The author then called the junior nurse on their personal mobile phone and learned that there had been some confusion with their time off, and they had believed it was their day off. Fellow team members visited patients on the junior nurse's caseload without delay; no patient visits were missed, and no patients were harmed.
Due to the ‘check in’ system initiated using the mobile application, the team leader was alerted in time to the fact that the staff member had not reported that they were at work. This system acted as a fail-safe, since if the staff member had not answered their phone, it would have been incorrectly assumed that they were visiting patients and therefore busy, especially with the team leader's shift starting slightly later than the junior nurse's. This would probably have prolonged the misunderstanding, potentially resulting in missed visits and/or a staff safety issue.
Conclusions
Primary care in recent years is adapting to the technological age, as identified by the Queen's Nursing Institute (2014), which found that up to 75% of community staff are using electronic systems. The initiation of a WhatsApp-based communication system in the author's workplace provided several benefits to the staff involved, in addition to creating an effective and efficient system that reduced anxiety and interruptions during the working day while the nurses visited patients and/or were commuting. Although the use of applications and technology in themselves can cause some anxiety, the use of technology to develop strategies for communication should be welcomed and encouraged where possible.
Targeted research and investment into the benefits of encrypted IM applications within lone-working settings would be well worth undertaking.