[Altra]

I'm with TiredMD on this one.

"Many people have family members or friends who have the time and savvy to shepherd them safely through their hospital trip — monitor their medications, review their treatment plan, know their detailed medical history, alert overworked nurses when vital signs go bad, battle for timely attention in a jammed ER, coordinate care as nurses and doctors change shifts, and look out for their comfort, hygiene and mobility."

Family members review treatment plans, monitor vital signs and "coordinate care"? Really?

...

"Norma Jean French's son is a UA-trained doctor. But when she had to go into the hospital twice last year for surgery and heart problems (once to St. Joseph's Hospital and once to University Medical Center), he immediately put the team at Patient Care Advocates — a nurse practitioner, a registered nurse, a physical therapist, an attorney and a physician medical director — on her case."

Interesting, that licensed professionals not employed by the hospital are working as "advocates" ... and possibly even performing direct hands-on patient care (i.e. monitoring vital signs, assisting w/hygiene and mobility, etc.)

[Michigan RN]

Originally Posted by MLOS

I'm with TiredMD on this one.

"Many people have family members or friends who have the time and savvy to shepherd them safely through their hospital trip — monitor their medications, review their treatment plan, know their detailed medical history, alert overworked nurses when vital signs go bad, battle for timely attention in a jammed ER, coordinate care as nurses and doctors change shifts, and look out for their comfort, hygiene and mobility."

Family members review treatment plans, monitor vital signs and "coordinate care"? Really?

...

"Norma Jean French's son is a UA-trained doctor. But when she had to go into the hospital twice last year for surgery and heart problems (once to St. Joseph's Hospital and once to University Medical Center), he immediately put the team at Patient Care Advocates — a nurse practitioner, a registered nurse, a physical therapist, an attorney and a physician medical director — on her case."

Interesting, that licensed professionals not employed by the hospital are working as "advocates" ... and possibly even performing direct hands-on patient care (i.e. monitoring vital signs, assisting w/hygiene and mobility, etc.)

How nice of them to "battle for timely ER" and to "alert the overworked RN" about bad vitals. Sounds like a bad idea to me.

[Michigan RN]

Opps sorry about the above post.

I don't think its appropriate for patient advocates to explain procedures, coordinate patient care, treatment plans. Isn't that what doctors and nurses are for? I don't need someone to tell me how to do my job. That's just irritating and as if I don't hear it from families already. Now I have to hear it from someone who may or may not be qualified. Whatever.

[jjjoy]

To be devil's advocate...

I actually think it's NOT the nurses professional role to be "a patient advocate." An advocate has no other responsibilities than to who they are advocating for. Nurses have MANY other responsibilities, primary of which is monitoring the patients, administering on-going care, preventing complications, and responding to medical emergencies.

OF COURSE, nurses should advocate in their patients' best interest if other professionals aren't considering the patient's perspective! But so should physicians and dieticians and all other health personnel!!! It's not professional nursing's unique domain to advocate for patients.

And nurses often have too many other responsibilities to be able to fully assess the patient's advocacy needs. Nurses can't do everything and its more important for the nurse to keep the patients alive, to get medications administered on time, to make sure tests get done, etc. RTs now do much of what was once squarely in nursing's domain. Why not advocacy as well?

[earle58]

Originally Posted by herring_RN

Seems to me that if staffing were what it should be the nurse could be the patients best advocate.
In acute care and, I hope, long term care as well

i agree w/herring...
it is almost a no brainer:
that in the absence of outrageous nurse/pt ratios and other unreasonable expectations, we should be our pts best advocates.

but then again, what nurses 'should' be and what they actually are, are often 2 different ballgames...
even w/the perfect pt load and working environment.
so, maybe this is a needed service.
but maybe it should be a nsg specialty, rather than having nonmedical people handle the affairs of the pts.

leslie

[tabt]

Being a nurse makes me even more terrified of the day that I will have to enter the hospital as a patient because even in the best hospitals, with the best nursing care, mistakes can and do happen. I have no family, and the two friends that I absolutely trust with my medical Power of Attorney now live thousands of miles away.

I don't think that non-medical people, whatever their title, should ever make medical decisions, yet insurance company employees get away with it every day. I am not familiar with exactly what every privately hired "Patient Advocate" does today. However, I'm old enough to remember when many good hospitals employed their own patient advocates. These people listened to complaints from patients and their families and facilitated communication between patients and staff. They actually helped us all. Then, when nursing budgets got cut to the bone, they just disappeared.

[RedZeppelinRN]

Originally Posted by herring_RN

Seems to me that if staffing were what it should be the nurse could be the patients best advocate.
In acute care and, I hope, long term care as well

Being an RN, I am an advocate for my patients, but it has cost me dearly. I was fired from a facility that ignored the neglect and injuries of the patients. I had to report this to the DHEA, the State. I filed a lawsuit and about a year later my attorney dismissed himself from the lawsuit leaving me to fend for my self. As a result, I was sanctioned by the defense for $1220, which I still have not found out for what. Now he say he will drop the sanction if I agree to the dismissal.

When he sent me the dismissal papers, I would not sign them because I would have to withdraw my statements to the DHEA which substantiated and validated my reports of injuries and neglect of patients. The facility was placed on the "National Watch List for actual harm."

Doesn't this seem criminal? That would allow the facility to not be responsible for the harm he has caused patients, and continue this practice of using the patients for money.

Also, in California you are obligated to file this type of injury and abuse to the State or you will be discipline.

I am having a hard time now trying to get another attorney to take it. If I lose my lawsuit acting as my own attorney, it would mean financial devastation for me.

I have just today written the Bar Association of CA, the CA BON, and CNA.

This is my reward for safely caring for my patients and advocating for them.


Red

[canoehead]

In nursing school I was taught my first responsibility was to the patient. I've learned that if I put the patient ahead of the facility I won't have a job. I think patient advocates are what nurses would be if they didn't have to put the needs of the hospital first.

[Chaya]

I did not know this was a bonifide independent position although I have seen ombudsman type patient advocates various places that were employed by the hospitals.
Based on recent experience accompanying a family member to various doctor appointments and spending much time with him during his hospital stay, I would say there is a crying need for the average person to have a dedicated advocate or guide with some basic medical knowledge to help "navigate" the healthcare system. My relatives are well educated and intelligent but, between the stress they were under at the time, their lack of knowledge in the relevent field and the hasty, incomplete explanations they received from harried and overworked doctors, nurses and tecnicians at every step along the way, they were lost. The average patient in my experience does not know what questions to ask and has very little concept of the progression of treatment/ options. I found myself assessing which areas the folks needed clarified and trying to anticipate what questions they would need answered in time to have these things addressed when the appropriate physician/ case manager, etc was accessible. I found myself explaining to them that the staff has little way of knowing exactly when your test or procedure is scheduled, and yes, it may well take most of the day for it to be performed and part of the next day before it is read. I had a better sense of what questions could be answered by the nurse and when and how to access the case manager or physical therapist. I had some sense of what decisions to anticipate, ie- inpatient rehab vs VNA at home in a timely enough fashion so it could be discussed beforehand and the folks could feel they had some meaningful input before it was a done deal. I was a go-between between them and hospital staff and I feel I kept frustrations at a minimum for the folks and interuptions at a minimum and more applicable for the staff. I was also able to prevent care "falling through the cracks" as can happen too often (ie: a request for clarification faxed by the pharmacy to the MD after office staff had left for the weekend which took a number of phone calls to appropriate covering personnel to resolve)
I don't think theirs was an atypical experience. I think members of the healthcare profession greatly overestimate the ability of the average patient to comprehend enough of the complex issues involved with their care and do so in a timely enough manner to keep pace with the rate at which crucial decisions directing their care need to be made.
(I remember thinking more than once "Hey! Maybe I should hire myself out!)