Question about nursing care my sister received

  1. Okay ... first of all, I'm not a nurse. I'm one of the cross-lurkers who wandered in via the thread about the mom nursing her 8-year-old. I've poked around a little bit on the site because I find anecdotes about patients from a nurse's POV quite interesting.

    But, the stories on the "demanding patients" thread kept making me think a bit about my sister's experience in the hospital last fall.

    My sister is in her mid-20s, and last fall had a terrible car accident on her way in to work (caused, we think, by a tire blowout). She was wearing a seatbelt (if she hadn't been, she'd be dead). Her car went off the road at about 70 mph and rolled. She ended up with a broken (snapped in half) upper arm, a fractured wrist, and two fractured vertebrae (C2 and C7). One was badly fractured enough that it had to be fused; to allow the other to heal, she was put in a halo vest for three months. She also had miscellaneous minor injuries (a laceration that had to be stitched, lots of bruises) but no concussion, thank God.

    Of course, she was in the hospital for a while -- about a week and a half. My mother and I tried to spend a fair amount of time there with her, though I have a toddler and decided after one visit that I really couldn't come unless I could bring my husband or a friend to look after the toddler.

    Early on while she was there, she was really almost completely immobile, even after she was in the halo vest. She was in really terrible pain from her arm, and she couldn't move it herself. She couldn't adjust her position at all. Although Mom and I could help her with some stuff (we fed her when she was hungry, gave her sips of water, got her stuff, etc.) we couldn't adjust her position because, well, it often took two people, honestly, not because my sister is heavy (she's quite slender) but because she was so injured and so helpless (and in so much pain!)

    My question is this. Is there a reason I should know that the nursing staff so often didn't answer her call bell? On one occasion, my sister was in so much pain she was almost crying, and really, really wanted one of the nurses to come and reposition her arm. She rang the bell and no one came, so after about five minutes I went looking at the nurse's station. And there were three nurses who looked like they were just standing around and chatting. I politely asked if one of them had a minute to come help my sister, and they jumped and one of them rather apologetically came in to help her out. I know there were times when I wasn't there that my mother had to go looking, and other times I suspect that neither of us were there and my sister just had to suffer.

    It makes me really angry, honestly, and I feel bad about that because I am honestly very pro-nurse. I have been in the hospital twice (once as a teenager for an appendectomy, once as an adult when I had my daughter), and I had really EXCELLENT experiences with my nurses. When I have the opportunity of getting my health care from a nurse practitioner or CNM instead of an MD, I will choose the nurse every time (well, I suppose I'd choose the MD if I genuinely needed a specialist, but for pap smears and throat cultures and so on, give me a good nurse any day). Also, I do realize that nurses are incredibly overworked and often have multiple emergencies to tend to at once. And I certainly don't begrudge anyone the opportunity to stand around shooting the breeze with their coworkers, as long as there's nothing pressing. But I don't get how a helpless young woman in pain pressing her call button wouldn't be urgent enough to respond to. My sister called for trivial stuff only because she had absolutely no way at that point to do things for herself. She was always very polite and said "please" and "thank you."

    Anyway. If any of the nurses here could take the time to share some of their insight with me, I would appreciate it. I have to admit I'm still a little bitter about this, even though it's been close to a year. (I don't think my sister is -- but she wasn't the one wh saw the nurses standing around instead of answering her call button. I think she always assumed, when they didn't respond promptly, that they were dealing with some emergency. I certainly didn't tell her otherwise.)
    •  
  2. 10 Comments

  3. by   Sleepyeyes
    I would have several questions (and I have been there myself; recently 27-yo daughter had a fractured pelvis, etc in an MVA):
    Are you sure they were nurses? When I went to help care for my daughter, I couldn't tell, and I'm a nurse. Their badges were too small to read. They could've been doctors, respiratory therapists, pt. care techs, transporters, volunteers, unit secretaries, or even housekeepers. One or all of them could have just brought in a new patient from ER or from another unit.

    There IS a nursing shortage and nursing staff is stretched thin. But because you can't tell what everyone's title is--- you are less likely to notice that there may only be 3 nurses for 30 patients and 2 patient care techs.

    Nurses who look like they're standing around the desk may be waiting for a critical callback from a doc, may be waiting for labs to be faxed, may be getting report (which takes about 20 minutes at shift change), or they may be getting some feedback about giving a med, for instance.

    When I'm at work, I usually have at least 2 hours of charting to do per night, and I'm afraid to do it at the desk because of the number of people who think that because I'm sitting, I'm not doing anything for the patient. Yes, I can check dr. orders and carry on a conversation with another nurse seated nearby, so it looks to you like all we're doing is shooting the breeze, but there's usually way more to it than that.

    Sorry this is so long, but this is the shortest and best answer I can give you. When my daughter was in the hospital, I did a lot of her care myself, and still had no idea who her nurse was and who was the housekeeper or the transporter.

    I also would think that maybe she needed a pain med along with repositioning, in the scenario you described. I hope they gave her something.
  4. by   NurseAngie
    Hi,

    I certainly do not have an excuse for the nurses' delay in answering the call bell. I might, however, have an explanation. I can understand that it was difficult for you to see your sister in pain and of course nobody wants her to be uncomfortable. I just wanted to tell you that I appreciate that you are supportive of nurses. I genuinely believe that the nurses were not ignoring your sister and were going to tend to her needs ASAP. Sometimes it seems unfair to have to wait for the nurse's attention, but nurses are responsible for the care of MANY patients and must prioritize care in order to be effective and efficient. I hope you comforted by the fact that your sister was a PRIORITY to her nurses and they did their best. (just imagine that everyone expects the nurse to be right there when the call is placed...now imagine there are 30+ beds on the floor. The odds of one or more bell ringing at the same time are pretty good! )
    Your sister is very blessed to have such a caring and loving sister. I hope she is doing much better now. Take care.

    ~Angie
  5. by   Sami*RN
    First, I hope your sister has completely recovered and is doing well. I'm sorry her call light wasn't answered immediately. In a perfect world, we would answer call lights the minute they came on.., but unfortuntately we can't. I agree with the previous post that these people standing at the nurses station may not have been nurses. It's hard to say. They could have been waiting on important drugs to arrive for a patient. I hate to say it, but sometimes we're so used to hearing bells dinging, sometimes it's too easy "not to hear it." There's no good excuse. The nurse that was actually caring for your sister may have been caring for someone else. Sometimes nurses are hesitant to answer call lights when it's not their pt. Sometimes because they're lazy or because they have no idea what is going on with that patient. Maybe these all sound like excuses, and I hope you don't take them as such, because they're just "maybe's". It's very frustrating to see someone you love have to wait, even a minute, to get something they need. All I can say is, it's a shame we can't be everywhere at once.., but genetics and staffing don't allow for that!
  6. by   fedupnurse
    Hi Greenbead!
    Some of my thoughts may be repeats of the above posts.
    First let me say yur sister is very lucky to have had a C2 fracture and it sounds like she had no spinal cord involvement. She was also lucky to have only been in the hospital for a week and a half. I used to work Trauma ICU and we had people for months in the unit. That Halo brace must be a nightmare to have to wear.
    My next point was stated above. Are you sure that these people at the nurses station were nurses? In my facility they make us all dress alike so that the people visiting the facility get the illusion of more nursing staff. There is a sea of blue and white and very few are bedside nurses who actually work that particular unit. If they wee indeed nurses from that unit, there is no excuse to not answer a call light in a timely manner. Five minutes, I hate to say, is a short wait in most hospitals. I knw 5 minutes feels like 5 hours when you are in pain. You also stated that your sister rang for trivial things. The best analogy is the boy who cried wolf. If you call frequently for "fluff my pillow, bend my straw" type of things, people will be slower to respond. Not to be mean but because there are other issues that require attention first. Are you sure that they weren't discussing a pressing patient issue?
    Sounds like someone should have done more for pain management with your sister, if that was possible. Some people, unfortunately, don't respond to any pain meds. Makes for a difficult situation.
    I'd basically get over the anger you have regarding the situation because that could damage your health. Particularly in light of the fact that your sister doesn't seem to be harboring any ill feelings. Life is way to short to be mad about this kind of stuff.
    I hope your sister has made a full recovery and has o ill effects from her vertebral fractures.
  7. by   fedupnurse
    Also, when we are talking about difficult people, we are usually talking about people who really have no business being there. I have had visitors say to me "we've been best friends for 20 years" whe what they should say is "we were best friends 20 years ago, I haven't seen or spoken to him since but heard he was in the ICU and wanted to see what the deal was." These people proceed to stay the entire length of visiting hours even when we suggest the patient needs rest and also ask very personal questions about the patient that we are not permitted to answer due to confidentiality. The patients will say after the "intruder" finally leaves "I don't know why he showed up now. Haven't seen him in years and to come see me here of all places!" I have also had visitors of other patients come out of that patients room so they could sight see on another patient coding (CPR being done, etc). I have also frequently had situations where there are 10 or more visitors who come into other patients rooms to track you down for information we are, once again, not allowed to give them due to confidentiality reasons, and we have already explained the situation to the spokesperson. These are the difficult people we are talking about. We are treated as personal secretaries and waitresses by far to many people. I am not a nurse in an ICU to take messages for visitors or fetch water or food for visitors. All of those activities take me away from the critically ill people I am there to monitor and assess and intervene when a complication arises.
    So I wish every visitor to a hospital would observe the following:
    1. The patient's privacy. If the patient is awake and alert we are not permitted to tell anyone other than the patient about his condition unless we have that patients permission.
    2. Not have friends and other family members calling the unit. Again it takes us away from the bedside of sick patients.
    3. Not bring food or beverages into patient rooms, particularly when the patient is not allowed to eat or drink anything. And many also leave all their garbage around for us to clean up.
    4. Respect the time of the hospital staff by not coming out to the desk every 5 minutes to ask besically the same thing over and over again or to ask why the line on the monitor has changed.
    5. Obey the rules. We have 2 at a bedside so that if that patient goes into cardiac arrest we can intervene rapidly rather than having to climb over 10 visitors. Also, having been through 2 major fires over the past 14 years I can tell you, we do't do a head count on visitors. Our goal is to get the patient out safely and we can't do that when we have families trying to help but basically getting in the way and delaying the evacuation process.

    Not an attack here, just explaining why we come here to vent and why you may see many threads regarding obnoxious visitors.
    Oh, and you don't want to get me started on the doctors!!!!(HAHA)
    Take care!
    Last edit by fedupnurse on Jul 21, '02
  8. by   Fgr8Out
    It's already been posted here that there are plenty of "maybe's" to explain the response time and subsequent scene you witnessed upon going to the Desk to find someone to help your Sister. What strikes me is, having been there well over a week... how was it that more Staff (note. I'm not saying Nurses) were not familiar with you.... On our Unit, family is quickly oriented to what's available, how to call us, and I also let the patient and the family know that if I'm not there shortly after the call light is pressed. it's because I'm unavailable for some reason. But someone should be there to answer, even if I'm not.

    5 minutes seems like a long time for you and your sister, particularly if she was having pain. But again, even if we only had 2 patient's... if both turn on their lights at the same time, then someone has to wait. It's frustrating, yes, but reality.

    As for commenting that your Sister would ask for "Trivial things"... I don't think in her situation anything was trivial. It was quite simply something she wasn't able to do on her own. Patient's who might call for Nursing frequently generally do so because they are hurting, uncomfortable, scared or just not sure about their nurse. That's not always fair, and Nursing generally does a good job of making themselves available for a patient. I try early on to instill confidence of my care and abilities to my patient's, and I try very hard to be consistent in my care. It sounds as if consistency may have been the real issue... not actual Nursing care.

    Prayers for your Sister... I hope she's fully recovered from her injuries... and good for her to have worn her seatbelt!

    Peace
  9. by   GreenBead
    Thanks to all of your for your responses. Just to address a couple of the questions that were asked:

    Are you sure they were nurses? When I went to help care for my daughter, I couldn't tell, and I'm a nurse. Their badges were too small to read. They could've been doctors, respiratory therapists, pt. care techs, transporters, volunteers, unit secretaries, or even housekeepers. One or all of them could have just brought in a new patient from ER or from another unit.
    No, I'm not sure they were nurses. The only orientation we got to who was who was that there was a chalkboard on the wall by her bed, with the name of her nurse and her ... wow, it's been long enough that I can't remember. I think the board listed an RN and an LPN. I guess I didn't understand why someone at the desk didn't answer her, whether they were "her" nurse or not. Especially since it was someone from the desk who promptly followed me to help her reposition.

    I also would think that maybe she needed a pain med along with repositioning, in the scenario you described. I hope they gave her something.
    She was on one of those "push button for more drugs" systems, but it only gave her more drugs when it was time. I do think her pain was under-controlled, but obviously that wasn't the nurse's fault. The other odd problems she had while she was there -- she broke out in hives, and there was some concern that had been caused by the first painkiller (Vicodin, I think), so they switched her to another one. (We think it was actually a skin reaction to the detergents used to clean the sheets, or else just from being unable to move out of the wet spots from her sweat.) And apparently narcotics don't work for her as well as they work for most people.

    First let me say yur sister is very lucky to have had a C2 fracture and it sounds like she had no spinal cord involvement. She was also lucky to have only been in the hospital for a week and a half. I used to work Trauma ICU and we had people for months in the unit. That Halo brace must be a nightmare to have to wear.
    Yeah, she was AMAZINGLY lucky. Well, she was awfully unlucky to get in the car accident at all. But given that, she was very lucky not to be hurt worse. She actually crawled out of her smashed car because she thought she'd need to flag down someone to help her (she was in shock -- it was rush hour, and probably half the drivers on the road had dialed 911 on their cell phones as soon as they saw her go off the road). But, she had no spinal cord injury at all, just the fractures of the vertebrae.

    She was only briefly in the Neuro ICU, just after she had the surgery to do the fusion and put on the halo vest. I didn't visit her in the ICU; she only wanted Mom.

    And yes, halo vests are a pain in the butt! But they're preferable to the alternatives. Apparently before halo vests were available, patients had to stay in bed in the hospital while their fractures healed. That would have been a lot worse than the halo vest. My sister said the worst part about the halo vest were all the strangers who would come up and start conversations. She didn't mind the people who wanted to tell her about their halo vests. It was the people who wanted to tell her about how Jesus had saved them the night they drove their pickup truck drunk with no seatbelt and crashed it, and they walked away without a scratch -- those started to drive her really nuts.

    In my facility they make us all dress alike so that the people visiting the facility get the illusion of more nursing staff. There is a sea of blue and white and very few are bedside nurses who actually work that particular unit.
    That was definitely the case in this hospital. Sea of blue scrubs and white coats. I think they were all patient care staff of the non-MD-type, but I don't know if they were RNs, LPNs, nursing assistants, or buff men who are hired by the hospital to do the heavy patient lifting (I'm sure there's a technical term for those )...or something else entirely. I don't think they were the cleaning staff and they definitely weren't doctors.

    Five minutes, I hate to say, is a short wait in most hospitals. I knw 5 minutes feels like 5 hours when you are in pain.
    Yeah. When I was in the hospital after my appendectomy and after childbirth, a five-minute wait was no big deal at all. I was usually asking for something like another blanket. (In my defense, I'm always happy to get stuff like that for myself if I know where to find it! :chuckle My assumption has always been that the nurses would rather get me a blanket than have me go hunting through the closets on the unit...) But I've always assumed, I guess that (a) units with more critically injured patients have more staff, and (b) patients who are likely to need something genuinely urgent are responded to faster.

    You also stated that your sister rang for trivial things. The best analogy is the boy who cried wolf. If you call frequently for "fluff my pillow, bend my straw" type of things, people will be slower to respond.
    Well, and see, this I guess is one of the things that bugs me still. I couldn't help but wonder if my sister was being treated as the boy who cried wolf, because she'd call and ask to be moved, and then call three minutes later and ask to be moved again because she was actually hurting more instead of less. (She couldn't always tell right away whether a new position was going to be better or worse.) When I say "trivial," I mean "small." She was really helpless, so if she wanted a drink of water and my mother and I weren't there, she had to ring for a nurse to hold her up to her lips (and yeah, bend her straw for her!) She is not someone who likes to be dependent, or who would order a nurse around for fun.

    Not to be mean but because there are other issues that require attention first. Are you sure that they weren't discussing a pressing patient issue?
    No, I'm not. That's a good point. All of the information on legitimate things they might have been doing at the nurse's station are helpful. It's too bad they expect you guys to chart and so on while also taking care of your patients; I've worked in interruption-driven jobs (like answering the phone for a computer helpline) and it's darn near impossible to get anything else done.

    What strikes me is, having been there well over a week... how was it that more Staff (note. I'm not saying Nurses) were not familiar with you.... On our Unit, family is quickly oriented to what's available, how to call us, and I also let the patient and the family know that if I'm not there shortly after the call light is pressed. it's because I'm unavailable for some reason. But someone should be there to answer, even if I'm not.
    Well, my mother was there more than I was and became much more familiar with the different staff members. I mostly visited for an hour or two each evening. This incident was quite early on in her stay; as she healed, she got a lot more able to move around on her own. She still needed help getting in and out of bed, but she was able to reposition her own arm, feed herself, walk to the bathroom, etc.

    Anyway. Thanks to all of you for your thoughtful responses and your well-wishes for my sister. It's not like I obsess about this every day but I found myself thinking about it while reading through some of the threads (yes, yes, I know you come here to vent, I respect and affirm the right of EVERYONE to vent, especially those who deal with the Public on a daily basis, and particularly those who deal with a public in a high-stakes way on a daily basis ... but it still made me wonder if my sister's requests got vented about). I appreciate the comments, especially since I'm not a nurse and really shouldn't be poking through your site :chuckle My sister is really almost entirely recovered now. She does have a little lingering soreness when she overtires her arm, and she can't turn her neck as far to the side as she could before the fusion. Considering that she actually broke her neck less than a year ago, I'd say she doesn't have much to complain about (and she certainly doesn't complain).
  10. by   Dayray
    Id also like to point out that sometimes if you are not assigned to a particular patient you really have no idea what to do with them. Some patients take advantage of this they will ask for foods they cant eat or to be helped out of bed when they shouldn't. I'm often reluctant to answer a call light of a patient unless I know something about them or the request seems urgent. Id also like to point out that most nurses (although not all) are very quick to respond to requests for pain meds or repositioning.

    I also am amazed at the amount of people who see nurses at the nurse station and assume they are just shooting the breeze. A few days ago 2 other nurses and I were at the nursing station discussing how we were going to solve an issue one of my patients was having.

    A group of people walked up and said " wow I wish I had your job no wonder nurses are so fat" (none of us were at by the way) that really urks me!

    I have to watch my time so closely when I stop to catch up charting or to ask someone's opinion on one of my patients. I keep looking at my watch.

    Without fail each time I sit down to chart someone sees me and thinks I should be doing something for them.

    Another possibility I don't think was mentioned is that the people you saw at the nurses station could have arrived there after your sisters call light had gone off. Her nurse could have heard the light and gone off to do something she felt to be more of a priority, planning to visit your sister after she finished.

    There really isent a way to know what happened and I can imagine how seeing your sister in pain made you feel. Idont know if the nurses you mentioned were lazy or not only that we are very often acused of lazyness by visitors and rarely by our actual patients.
  11. by   penguin2
    .
    Last edit by penguin2 on May 13, '06
  12. by   DusktilDawn
    Hi Greenbread, I hope your sister is doing well.
    I will introduce myself to my patients when I meet them and tell them how long I will be there: Hi, I'm Dawn and I will be your nurse until 7 this morning.
    I find that at our facility patients and visitors are able to distinguish the nurses from the other staff because different areas wear different colors. My name badge is not turned around (not deliberately but it has happened) and I actually have to use my badge to gain access to the med alcove, so I need it handy.

    I do think that care on the unit I work on could be improved. Communication, coordination, organization, courtesy, initiative, and education are the areas that need to be worked on here. All of these issues are staff focused (not just nursing staff either), however issues regarding education and courtesy can also be applied to visitors and patients.

    I guess I didn't understand why someone at the desk didn't answer her, whether they were "her" nurse or not. Especially since it was someone from the desk who promptly followed me to help her reposition.
    Turning and positioning every 2 hours (at least) should have been a routine part of your sister's care. I don't doubt halo traction is uncomfortable (I'm sure that's mildly put). I'm not sure either why no one answered. Most call bell systems allow you to page into the room to talk to the patient. It's hard to speculate what was happening on this unit.
    And apparently narcotics don't work for her as well as they work for most people.
    You sister may also not have the right analgesic or combination of analgesics for her pain. The PCA (push button for more drugs) can also be programmed to give a continuous dose. Muscle relaxants could have been beneficial here. A lot of my patients are ordered phenergan for nausea, another use for this medication is as an adjunct to analgesics. I understand that when one is in pain or one is watching a loved one in pain 5 minutes seems much longer than it is. If it only takes 5 minutes from the time you request analgesic to the time that it is given that is really good, remember nurses also have to triple check and document what they give and also draw it up. I also find it helpful on my end when I tell patients when they are due for analgesics and educate them that if they call when they are due and they don't have their analgesic within a reasonable time (15-20 min), please call again, it can be a hectic and despite my best intentions I sometimes get overwhelmed.
    It was the people who wanted to tell her about how Jesus had saved them the night they drove their pickup truck drunk with no seatbelt and crashed it, and they walked away without a scratch -- those started to drive her really nuts.
    Once we had this problem with a visitor doing this, he was banned. I don't know if it was a visitor or another patient, however they should not have been allowed in your sister's room without her permission.
    sonny:In retrospect I can't really blame the staff, b/c it was obviously a management problem- "continuity of care" seems a thing of the past. The only nurse who really knew what was going on was a student - she knew his history, his meds-- she had obviously READ his chart- what a concept!!--
    That is exactly how I feel as a nurse in regards to continuity of care and knowing patient history. Often times I'm reveiwing my patient's history when I'm doing my charting, which tends to be a few hours into my shift. Review my patient's history at the beginning of my shift, WOW what a concept (I'm not slamming you Sonny, I agree with you). The other day 3 housekeepers arrived to clean a discharged patient's bed while I was doing exactly this, and then remarked snidely how "busy" the nurses looked specifically so I could hear. They were groussing because it is not in their job description to strip the linens off the bed, a task which takes less than 45 seconds. Having been a housekeeper in a hospital I know it doesn't take 3 housekeepers to clean a bed and it also doesn't take a great deal of education to strip linen. This is the kind of nonsense (this is only one example) that takes away the nurse's time from their patients.

    Continuity of care is also an issue where I work. There are numerous reasons why I think it is important. I've also had my assignment changed part way into my shift, not only is it not beneficial to the patients, it creates more work for the nurse. I agree that management plays an important role here. There is certainly alot that management can do at my facility to foster an environment that facilitates the nurse in providing care for their patients. Not all of these changes are necessarily big ones either. Sometimes I feel like the attitude with management is "How can we get the last drop of blood out of each nurse?"

close