Let's Ban the Phrase "I'll Go Get Your Nurse"

[nynursey_]

I discovered something about myself this week: I hate the phrase "I'll go get your nurse." I also have a similar disdain for the phrase "I'll have your nurse take care of it." They're simple, innocent enough phrases, but their implications are loud and clear.

G, a co-worker and CM, stopped in to see my patient to discuss matters pertaining to discharge. While speaking to the patient and his daughter, the daughter requested that the patients' vital signs be re-checked as she's worried about his condition. V, my PCA, happened to be in that room, organizing supplies. G exits the patient's room, spends approximately 10 minutes (per her report) looking for me, and once she finally is able to spot me, says this: "Mr. __ 's daughter would like his vital signs re-checked. Can you do that when you have a minute?" ...

I pause for a minute and decide I have two ways to handle this: I can either endorse the theory that the nurse is *the* essential personnel and all issues/requests big and small (and tedious) ought be reported to her so she can carry out the request, or I can begin holding other members of the health care team accountable for the things which they are effectively able to delegate and/or take care of themselves. I choose the latter.

I say to G: "V is in the room organizing supplies. Could you please let her know?" G stares at me, stunned, and is unable to form a sentence for a minute. When she finally collects herself, she says, "Well, you're the nurse, why can't YOU do it?" I politely explain that a vital signs check is an appropriate task to delegate and at the moment I am taking care of a nursing responsibility that only I am able to complete. G stands there for a few more moments and then turns back around to finish her conversation with two other staff members, and I finally resign to the fact that my subtle message has fallen on deaf ears. I sign, find V, and ask her to please re-check the vital signs.

This, while a small and isolated issue, represents a larger problem. It is my belief that ancillary staff (those unlicensed) and other members of the health care team (including CM, SW, MD, RD, PT, and OT) should be able/willing to assist with requests presented to them that require a) little time to do, b) no nursing experience or license, and c) are appropriate to delegate to another person. I do realize that as an RN I represent the center of the patient's entire care experience, but I refute the idea that the nurse ought to be preoccupied with obtaining ginger ale's, extra pillows, changing the television station, or obtaining a telephone. As you're expecting me to carry out these menial, easily delegated tasks, I am often in the middle of more serious issues such as stabilizing a blood pressure, inserting a new IV, re-assessing a patient that has fallen, or being present with a physician to discuss end-of-life issues. Why has it become unacceptable to hold other staff members accountable for the things they are able to do?

It's the age old concept: nurses' can do everyone else's job (except portions of an MD's occupation), but not all staff can do a nurses' job. However, in the era of patient satisfaction surveys being tied to re-imbursement, nurses struggle day-to-day to provide safe, competent care while also balancing the needs (and often demands) for miscellaneous items that do not contribute to the overall picture. In nursing school, delegation is stressed to the maximum, as way to assist the patient in obtaining those "creature comforts," while also respecting the nurses' right to focus on the nursing care plan, perform interventions, re-evaluate those interventions, and document accordingly. While it seems as though I am suggesting that the nurses' time is more valuable than that of other ancillary staff, that is not the case. My point is simply that when an ASA receives a call over the call light system for an extra blanket, a box of tissues, and a magazine, he/she is capable of providing those items so that the nurse can carry out nursing-specific tasks that cannot be delegated.

As I step off my soapbox, I'm interested to hear the thoughts of others. Do you feel frustrated when pulled to perform tasks that are easily able to be performed by the person requesting your attention? How do you balance the demand to do all things related to the patient with ensuring the important nursing-only tasks are carried out? Is this isolated or does this happen in your environment as well?

[KatieMI, BSN, MSN, RN]

Yes, yes, YES!!!.... except for one little thing.

Depending on place and situation, person who says "I'll go tell your nurse" may or may not have any idea if the task can be delegated and what's realy up with it.

In the particular case you described, I would not delegate. The daughter's concern may be justified or not, but if your PCA finds her HR in 60th instead of "mom's always" 100 (1 hour after b-blocker, Afib finally converted, amio drip off and PO loading dose is in) and not able to explain that it is at goal and why, the daughter very well might freak out. It would take a whole lot more time to get her trust back, and, BTW, I might teach her about HR goals, pulse taking and orthostatic hypotension while I am still there.

I encountered innumerable situations when unlicensed (and licensed but not "fully clinical") personnel made crude mistakes simply because they had no idea of what they are dealing with. I had an X-ray tech who complained on patient being "hysterical" (claustrofobia in crowded room, panic attack, atypical NSTEMI with all the fun). These people do not know what they do not know, and do not even mention fluid restriction "issues".

Maybe I am a perfectionist of a sort, but I delegate only when I have absolutely no other choice, and only either totally "technical" or "customer service" tasks at that. And I better fluff that pillow one time more if it will be my chance to notice that the patient is in fact orthopneic again.

[nynursey_]

Yes, yes, YES!!!.... except for one little thing.

Depending on place and situation, person who says "I'll go tell your nurse" may or may not have any idea if the task can be delegated and what's realy up with it.

In the particular case you described, I would not delegate. The daughter's concern may be justified or not, but if your PCA finds her HR in 60th instead of "mom's always" 100 (1 hour after b-blocker, Afib finally converted, amio drip off and PO loading dose is in) and not able to explain that it is at goal and why, the daughter very well might freak out. It would take a whole lot more time to get her trust back, and, BTW, I might teach her about HR goals, pulse taking and orthostatic hypotension while I am still there.

I encountered innumerable situations when unlicensed (and licensed but not "fully clinical") personnel made crude mistakes simply because they had no idea of what they are dealing with. I had an X-ray tech who complained on patient being "hysterical" (claustrofobia in crowded room, panic attack, atypical NSTEMI with all the fun). These people do not know what they do not know, and do not even mention fluid restriction "issues".

Maybe I am a perfectionist of a sort, but I delegate only when I have absolutely no other choice, and only either totally "technical" or "customer service" tasks at that. And I better fluff that pillow one time more if it will be my chance to notice that the patient is in fact orthopneic again.

I'll clarify the vital signs request.

The patient's daughter happened to be an exceptionally anxious individual in spite of having reassurance that the patient was maintained on IVF, not receiving his antihypertensive medication, and on bedrest d/t orthostasis 2/2 activity. His blood pressure had been previously assessed approximately 45 minutes prior to this conversation by myself in her presence. My PCAs are given parameters by me during our huddle that need to be reported to me immediately. V was capable of taking this patient's vital signs a second time in an hour because I had previously assessed them to be WNL for the patient, and the patient was in a safe, secure environment, also monitored on remote telemetry. I used my nursing judgment and decided it was a safe task to be delegated, especially given that the daughter's concerns are often gut feelings unvalidated by objective data. Vital signs (routine or as assigned intermittently by the RN) are acceptable in my facility to delegate to a PCA because I am not delegating to them the responsibility to act on those vital signs, only to perform the procedure utilizing the DynaMap, which they are all trained to utilize during their orientation. The patient's daughter had been instructed about her father's orthostatic hypotension including etiology, the particular reason in his particular case, precautions to take, signs of hypotension, and the current treatment plan. I had done this all in the three days prior to this situation in the time I had spent with this patient. I utilized my 5 Rights of Delegation appropriately.

But ... assuming I hadn't.

Case Managers ARE RNs. They fully understand how to assess a patient for an immediate need for intervention or assessment as well as I do. As an RN not observing any signs or symptoms of distress, it would have been just as appropriate for her to delegate that to a PCA, as PCAs are taught to utilize the equipment and report immediately to the RN.

What I was more referring to is ancillary staff that can do the "run and fetch" portion or assist a patient with paying for television/phone access, etc. Or tending to visitor needs.

[Lunah, MSN, RN]

I literally had to push a doctor's chair aside to reach the phone that was right next to him so I could page the hospitalist per his request. After I hung up I asked him if his arms were broken. Lol. I was only half serious! He's a good friend but he has it in his head that if he pages his own consultants that somehow his job scope will creep further and further into apparently menial tasks that aren't worthy of his attention. Meanwhile another physician who has been an ED doc for 30+ years somehow manages to page all his specialists all by himself. Mind boggling!

[LM NY]

Something happened to me two weeks ago that still doesn't sit well with me. I was with a patient starting an IV or something of that nature and a medical student came just to tell me my other patient that he was just with needed to be cleaned.

I don't know why I froze and looked at him blankly and said "ok". Many scenarios played in my head and am still thinking till this day that I should approach him and ask why didn't he roll up his sleeves and help the patient himself.

I don't want to come off the wrong way like there is something wrong with cleaning a patient, because there isn't. It is just the way he said it to me like an immediate order. He is still a medical student and maybe doesn't know.

I agree with OP. I have been asked the most ridiculous things for my patients and wonder why I am being pulled away for such miniscule things.

[nynursey_]

Something happened to me two weeks ago that still doesn't sit well with me. I was with a patient starting an IV or something of that nature and a medical student came just to tell me my other patient that he was just with needed to be cleaned.

I don't know why I froze and looked at him blankly and said "ok". Many scenarios played in my head and am still thinking till this day that I should approach him and ask why didn't he roll up his sleeves and help the patient himself.

I don't want to come off the wrong way like there is something wrong with cleaning a patient, because there isn't. It is just the way he said it to me like an immediate order. He is still a medical student and maybe doesn't know.

I agree with OP. I have been asked the most ridiculous things for my patients and wonder why I am being pulled away for such miniscule things.

This is another example to illustrate my point. A medical student, an MD, a CM, a SW, ... anyone! If a patient calls out and needs to be toileted or cleaned, for the LOVE OF GOD TELL THE APPROPRIATE PERSON, and often times, it is not the nurse! Everyone on my floor is fully aware of a PCAs job responsibilities, including toileting patients or cleaning them after episodes of incontinence. If I'm in the middle of a CL dressing change, please do not interrupt me to tell me someone needs cleaning.

[nynursey_]

I literally had to push a doctor's chair aside to reach the phone that was right next to him so I could page the hospitalist per his request. After I hung up I asked him if his arms were broken. Lol. I was only half serious! He's a good friend but he has it in his head that if he pages his own consultants that somehow his job scope will creep further and further into apparently menial tasks that aren't worthy of his attention. Meanwhile another physician who has been an ED doc for 30+ years somehow manages to page all his specialists all by himself. Mind boggling!

I had the same experience. I had an order for a non-formulary medication that was written as a paper order. Upon seeing it, I faxed it (as that's my responsibility) to the pharmacy and awaited the order for the medication. Some several hours later, the pharmacist called me to clarify the order, as it is non-formulary, and stated that a physician would need to fill out a sheet that includes the medical necessity for the drug. I notified the pharmacist that the drug had come on the recommendation of another service (not the hospitalist) and advised he contact that resident. Rather than doing so, the pharmacist HOUNDED the MD, who then called the unit to request that he unit clerk notify me that I was to contact the recommending service to have THEM clarify the medication in order to get pharmacy to "quit bugging" him.

When I returned from lunch with that message, my jaw hit the floor. Why is a physician asking me to do HIS job? Services need to communicate between each other, ESPECIALLY including medications and their necessity/reason for prescription. Not only is that well outside of my scope of practice, but it is also not my responsibility.

Sheesh.

[RNdynamic]

CM? ASA? When will people learn how ignorant it is to use ambiguous acronyms that aren't immediately obvious to people on this forum..?

I'd rather we ban that instead of the phrase "I'll go get your nurse."

[LM NY]

CM? ASA? When will people learn how ignorant it is to use ambiguous acronyms that aren't immediately obvious to people on this forum..?

I'd rather we ban that instead of the phrase "I'll go get your nurse."

Haha! CM case manager, SW social worker. ASA?? Lol what is that? A strong athlete?

[Kitiger, RN]

Aspirin?

[Lunah, MSN, RN]

Haha! CM case manager, SW social worker. ASA?? Lol what is that? A strong athlete?

To me ASA = aspirin. Lol. Acetylsalicylic acid.

[nynursey_]

Administrative Support Assistant or Health Unit Clerk (HUC).

CM is not nearly as ambiguous in the nursing world. It's a Case Manager.