Nursing shortage, patient care

  1. I'm a journalist (not a nurse) who's working on a story about how older patients--and their family members and friends--can assess, in advance, the quality of nursing care at a hospital. I'd also like to offer some practical advice on what people can do to help the nursing staff and minimize the chances of medication mistakes or other problems during a hospital stay.

    I'd be grateful for your help.

    Merely as a discussion-starter, I offer an R.N.'s advice on improving a hospital stay, as reported in a recent issue of Consumer Reports: "My biggest piece of advice is to have someone with the patient to make those obnoxious demands."

    Many, many thanks.
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  2. 25 Comments

  3. by   purplemania
    I fail to see how being obnoxious makes anything better. My advice is to have someone there if the patient will be unconscious or is otherwise unable to attract attention. Ask questions about your care, but do not grill people. Intimidation is not effective. Make all your personal requests at one time so the staff does not have to re-enter your room 40 times for toothbrush, pillow, turn the heat up, turn the heat down, etc. Keep a pencil and paper for things to ask the doctor or nurse, names & numbers of people who call, etc. ABIDE BY THE RULES OF THE HOSPITAL. Yes, we know you are the exceptional patient, but the rules are there for a reason and it creates a strain between the staff and yourself. Do you want someone caring for you who is angry and resentful? Remember that nurses are people too and no one is taking care of us except each other. The Golden Rule is always in style.
  4. by   llg
    I agree wholeheartedly with purplemania. Making enemies and setting up a confrontational relationship is not a help. Work WITH the staff to help them provide good care for your loved one -- not AGAINST them.

    llg
  5. by   Disablednurse
    ditto purplemania, also: Nursing also knows that the patient has rights also. We strive to do our best to take care of each and every patient to the best of our ability. We ask that the paitent have patience as we take care of them. Yes, it is advisable to have someone stay with the patient if they are so sick or if they are so timid as to be unable to make their own requests.
  6. by   baseline
    I read the Consumer Reports aritcle, and I can assure you that being obnoxious as possible may get you attention, but not necessarily the best care.

    It is good advice to always have someone stay with you in the hospital if you are elderly, or unable to get out of bed. I personally, never complain about visitors as long as they are considerate of others, and are not there in droves.

    Know your medications, and bring the actual prescription bottles to the hospital with you. Keep a typed list in your wallet that your physician has looked at and approved. It helps the staff enormously. " A little white water pill" is not going to cut it......you shoud know WHAT you take and WHY you take it. YOU are YOUR responsibility. Be knowlegable about your health. Know your medical history and again, keep important information in your wallet.

    Know any allergies. Know your vaccination history.

    Participate in your care. This is not a cruise. The staff will do everything they can to make you comfortable, but their primary job is to keep help you recover and to keep you safe.

    Do whatever you can for yourself. Keeping active is a great way to keep from getting sicker. Move about as much as your doctor allows. Take deep breaths and cough. Wash your hands. Make sure your caregivers wash THEIR hands.( This includes your
    family and guests.)

    If you are having pain, don't wait until it is out of control. Ask for something.

    I am sure there is more, but I have to move on......
    Last edit by baseline on Apr 1, '03
  7. by   Sleepyeyes
    Originally posted by billhogan
    Merely as a discussion-starter, I offer an R.N.'s advice on improving a hospital stay, as reported in a recent issue of Consumer Reports: "My biggest piece of advice is to have someone with the patient to make those obnoxious demands."

    Many, many thanks.
    An RN said that???!!!! Totally with purplemania on that--- PLEASE don't antagonize the already overworked staff.

    Please remember we don't have an hour or more to spend with each patient. A lot more about patient care goes on behind the scenes than you'll ever realize. A lot of nursing is technical, scientific, and experiential stuff that I don't have time to give you a crash course on--I went to college for this stuff--but I'll briefly update you as much as possible as your condition evolves because it's part of our job to help you be proactive about your condition and treatment.

    Please realize that I may be behind the desk checking your lab levels, and if some are bad, trying to reach the doc for new orders. I don't need to tell you this; it might be hours before the doc calls back, and the doc may not wish to give orders. I might be charting important information so that the next couple of nurses have a clue as to what's going on with you. I might also be evaluating your overall picture and consulting with other nurses because we're in a gray area and need another expert opinion.

    Perhaps the best advice I can give any patient is: ASK!!

    This is where your advocate might come in handy, if you're too sick to really be proactive, as well as playing "gofer" when you have a problem. (Please inform your advocate that the nursing staff is not there to serve BOTH of you.)

    Are you being whisked away for a procedure? Get information: Where are you going? What does it do? Why is it indicated? (Sometimes the doctor really needs to be asked these questions, not the nurse, but we'll try to help you be as comfortable as we can.)

    Are you being given a pill or an IV medication? What is it? If it's a different dose, you might bring that to the attention of the nurse, saying, "Gee, I only take half of this pill at home; should I ask the Dr. why he ordered this dose?" or even "Are you sure this one's for me, Joe Schmoe? This is a new one; I don't recognize it." You wouldn't believe how many Stephen Kings there are in the world (and how they, oddly enough, all get sick around Halloween).

    Anyhow, that's enough to get you started. Remember-- the nurse is the patient ADVOCATE. Even if the doc doesn't give a flying fig, WE CARE. We don't have to "like" you to get you the proper medication or inform the doc about your changing condition. We're professionals.

    We're underpaid and overworked, but we love what we do---we teach, interpret, treat, diagnose, intervene and advocate at the appropriate times--to keep you, the patient, as comfortable and as safe as possible.

    Hope that helps.
  8. by   ktwlpn
    Originally posted by baseline
    I read the Consumer Reports aritcle, and I can assure you that being obnoxious as possible may get you attention, but not necessarily the best care.

    It is good advice to always have someone stay with you in the hospital if you are elderly, or unable to get out of bed. I personally, never complain about visitors as long as they are considerate of others, and are not there in droves.

    Know your medications, and bring the actual prescription bottles to the hospital with you. Keep a typed list in your wallet that your physician has looked at and approved. It helps the staff enormously. " A little white water pill" is not going to cut it......you shoud know WHAT you take and WHY you take it. YOU are YOUR responsibility. Be knowlegable about your health. Know your medical history and again, keep important information in your wallet.

    Know any allergies. Know your vaccination history.

    Participate in your care. This is not a cruise. The staff will do everything they can to make you comfortable, but their primary job is to keep help you recover and to keep you safe.

    Do whatever you can for yourself. Keeping active is a great way to keep from getting sicker. Move about as much as your doctor allows. Take deep breaths and cough. Wash your hands. Make sure your caregivers wash THEIR hands.( This includes your
    family and guests.)

    If you are having pain, don't wait until it is out of control. Ask for something.

    I am sure there is more, but I have to move on......
    great post,baseline..(I love the lines " This is not a cruise" and "YOU are your responsibility"
  9. by   BadBird
    Let me tell you that if you are obnoxious and many family members are it is the poor patient that suffers, we will only do what we have to, no extras, so we can avoid the obnoxious family members!!!! Please keep that in mind. The best advice I can give a family member is to keep a list of all : Allergies, Medications, past surgical history. Designate one family member as the contact person, that person would be updated and the rest of the family and friends can contact that person for information (providing the patients consents to any information being shared with family). Respect visiting hours, remember many sick patients do not feel up to visitors and are so worn out when they leave but don't want to tell the family for fear of hurting their feelings. If the nurse asks you to step out of the room so we can take care of the patient, do not give us a hard time, just leave quietly and quickly, you never know what needs to be done. Do not ask for lab results, x-ray results, or any other test results, from the nurse, ask the physician and only if the patient consents that you may hear the test results. Check with the nurse before bringing in food for the patient, they may be on a special diet or ordered nothing by mouth for a test or surgery planned. Do not bring children to the hospital and let them run around, hospitals are not sterile, they are extremely dirty and have many unseen germs that a child may pick up and bring home. Do not be offended if children are not allowed in ICU, these rooms are not child proof, sharps boxes, IV tubing, catheters, all pose a threat to the child and patient if the child pulls on it. Try to remember that we do our very best to take care of the patient, we advocate for the patient, not you. Many times patients do not want any information given to family or friends, do not yell at the nurses. Do not be bossy or pushy, it is not our fault you haven't visited Grandma in 20 years and are feeling guilty now that she is on her death bed, she may not even remember you.

    I hope my suggestions will be helpful to you.
  10. by   SmilingBluEyes
    Obnoxious behavior on the part of well-meaning friends and relatives will improve care eh? Not in MY care it does not. And, that is a hoot. That is not true, has never been true and never will...BETTER and more comprehensive nursing care will ONLY become that when our demands for respect, better pay and bennies improved nurse-patient ratios and safer working conditions are MET. More proof that the general public and EVEN ONE OR OUR OWN (an RN? likely not one at the bedside any longer) have NO clue what is going on in healthcare today. GRRRRRRRRRRRRRRRRRRRRRRr...i gotta leave cause I am getting really annoyed here.
  11. by   Zee_RN
    *sigh* Make "those obnoxious demands"? Just what obnoxious demands might those be? Any demand that's obnoxious is not gonna help anyone.

    There is a nursing crisis. Part of the reason is "obnoxious demands." Nurses are caught in the middle of it all. We get to listen and respond to the obnoxious demands of the patient, the patient's family, the patient's doctor and our own administration. We are not to "talk back" to any of these people. This all translates to a lack of respect for the profession. The general public and the medical staff. Why be a nurse?! Why tolerate the abuse (we've all been cursed at, smacked, kicked, spit on), the risk (exposure to HIV, hepatitis, SARS, TB), the physical toll (strained backs and bulging discs from lifting heavy patients, varicose veins from standing long shifts), the emotional turmoil (good people die), and more. For the pay?! Not. For the respect?! Nope, it's not there.

    Despite that, there are those of us who do it. Because I love nursing. Despite it all. I am nurse.

    However, lol, I did not answer your question, did I? See what you sparked by quoting "obnoxious demands"?

    Families and patients should ask administration what the RN:Patient ratios are on each unit. Be sure to specify **RN**:Patient ratio (don't let them quote "nursing staff" which will include unlicensed personnel). Ask also about the ancillary staff on the unit (are their nurses' aides? secretaries?). You want the best care; you want the hospital with the lowest number of patients per nurse.

    By the way, administration will most likely not WANT to give you this information. That's a bad sign.
  12. by   K O'Malley
    Good grief, don't be obnoxious! The nursing staff will avoid you like the plague. By all means have a family member who can ask questions in a polite manner. Don't ask for a soda and then when the nurse brings it from all the way down the hall then ask for crackers. We are not waitresses but are professionals who are coordinating care for some very ill patients, watching for signs/symptoms of complications, checking lab results, giving large numbers of complex medications. Don't bring in hoards of visitors, sit on clean or even dirty beds of discharged patients(Yes it happens). Just use good common sense and good old fashioned manners.
  13. by   baseline
    I read this article. billhogan is very effectively pushing some buttons. It's from the January 2003 Consumer Reports article, "How safe is your hospital". Some of it I agreed with, some I did not. But billhogan is not giving the whole story.

    "After 16 years in nursing Sylvia Steiger has plenty of ideas how to improve your hospital stay. 'My biggest piece of advice is to have someone with the patient to make those obnoxious demands',she says. another tip: Bring a complete list of medicatiosn with you including name, dose and administation schedule. But she says the main quaility variable is the one patients can't control:nurse to patient ratio."

    It is a long article and this is just a piece of it.
  14. by   billhogan
    Dear Baseline,

    I didn't really mean to be unfair in any way; I'd commend the CR piece to those who haven't read it in full. I'm just looking for some advice -- as well as some first-person examples and experiences -- that I might be able to use in the story I mentioned. This is my first time on this board; I'd be pleased to exchange e-mails with anyone who might be willing to talk with me.

    Thanks to you all.

    Best,

    Bill

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