Dear Patients

Rapheal · Dec 8, 2003

I totally understand this letter.

live4today, RN · Dec 8, 2003

I was hoping more nurses would write their own personal "Dear Patient" letter after the first post. Writing what we wish we could express on behalf of our patient population can be quite therapeutic for us as nurses. I think they truly need to know what keeps us from their bedside longer than it use to take when things were better in nursing.....long BEFORE the HMO's took over. :rolleyes:

Rapheal..what would you say if you had the chance to write to your patients? :nurse:

CCU NRS · Dec 8, 2003

Originally posted by cheerfuldoer
I was hoping more nurses would write their own personal "Dear Patient" letter after the first post. Writing what we wish we could express on behalf of our patient population can be quite therapeutic for us as nurses. I think they truly need to know what keeps us from their bedside longer than it use to take when things were better in nursing.....long BEFORE the HMO's took over.

Rapheal..what would you say if you had the chance to write to your patients?

I would use your with a few exceptions.

It's 0700 hour. I've just clocked in at work to begin my shift. I get report, pull up labs, check your charts for new or missed orders, pull your meds from the fridge and medicine bin, and before I can get through all of these things, I'm being bombarded with requests from other hospital staff, family members, and yourselves. I so want to help you, to be by your bedside to care for you when you call. I wish I could give you more personal attention while you are under my nursing care. It is never my desire to keep you waiting, to not have time to answer your needs or questions left unresolved by your physicians. I became a nurse to be your advocate when necessary, to tend to your needs while you recover from your illness and/or surgery.

I know when you are not feeling well, the last thing you want to consider is that all five or six of your nurse's patients have the same needs and wants, and I can only be in one place at one given time. Forgive me when you ask questions that I cannot answer right off the bat because nursing is such that we

"may know many things about many diseases, and a few things about any disease, we are always able to quickly research any subject and find the information you may need." change #1

Although you may only get to see me a few times (if that many) during my time as your nurse today, know that I am not ignoring you, but am working as hard as I can to get to you. Keep in mind that although there are five or six of you, there is only one of me. I thank you for your understanding and patience. change#2 end

I really liked the gracious parts. I know the cynicism is humor and the is LOL

I could see an even further toned down version of this as beneficial to floor Pts on med-surg, tele, etc. where census is high nurse to Pt ratio.

healingtouchRN · Dec 8, 2003

Dear patient (client),

It is 18:45 & I have begun to get report on all the entire department & make assignments, as this is my job as the one the charge. I will complete an 8 or 12 hour chart check prior to making rounds so that I may catch any orders missed by the busy 1st or 2nd shift. I hope to be into you room by 2030 which are visiting hours so that I may converse with your loved ones & update them & you on you plans of care & progress. This is not always the case with such a shortage of nurses, although I dislike telling you this since we both cannot control this problem tonight. I want to give you your medicines & snack & treatments timely, give your care unhurriedly, in a caring manner, but I oft come across in a no nonsense fashion, because I am stressed to my breaking point. I often do not get a meal break in my 12 + hours, because of trying to get off on time, taking yet another admission even though there are too few nurses & no techs to provide care for them....

Please know that I came into this calling, my profession as a critical care nurse, to care for the most ill, but sometimes I think it's a futile effort.

Sinclerely, Your Night Nurse.

ceecel.dee, MSN, RN · Dec 8, 2003

Dear Patient,

I am here at 0730 today. Be patient with me, because as you are having your breakfast and getting cleaned up for the day, I am trying to catch each and every doctor to monitor their thoughts and plans for each of their, and my patients. I will cruise through all the patient's charts for current labs, most current progress notes from PT, OT, and/or ST. I will search out when your IV antibiotic regimen began so that I may calculate the "best guess" senario regarding your discharge date, and beging that planning. I will read through your H&P, the nurse's data base information, and the nurse's progress notes, so that I can try to get a feeling for your functional status, and any possible needs you may have on discharge. I will try to get a feel for your family and home situation, and any possible financial barriers to assistance you may need.

I will try to get down to your room to meet you, and hopefully part of your family before lunch, but the phone keeps ringing, as I must also assist the charge nurse with a detox transfer from the ER, involving our county family service department, that does not know the meaning of returning a call ASAP, but also involving the county sheriff for transport, and they are giving me a hassle about their own staffing problems. The detox center has called me back repeatedly for the same information 3 times, and the fax machine is resisting the stack of sheets I'm trying to get through too quickly. I am also attempting to screen a couple of patients that the University Hospital is trying to send us as Skilled Swing Beds. These patients will be better placed as direct admits to the Nursing Home, as they will be needing rehab for weeks, but of course they want to come here instead. So I must coordinate these patient's cases with the admitting nurse at the NH, as well as call back the University, have an extensive conversation about the criteria we must insist on to reserve beds for acute care patients when census is high.

Since I double as a Nursing Supervisor, and today's shift was decimated by a nurse's sick call, I must relieve the ICU nurse and the ER nurse for coffee and lunch, and assist with any ER event that is more than minor, and any delivery that may occur today. If families appear at the nurse's station with questions or concerns, I will field those. If there is a difficult IV start, NG placement, foley placement, or other procedure that one of the newer nurses needs support with, I will assist them. If an orienting nurse has a question while passing meds, it is me she comes to. I will be called to view a wound, assist or do many of the dressing changes, so that I may monitor healing in wounds. If there are new admits, and the charge nurse is busy, I will admit those patients, make them comfortable, and get their orders started. I will need to spend time with discharges, so that the patients recieve adequate education and instructions prior to leaving.

I'm so sorry that I missed your husband this morning! I will call him this afternoon, after we have had a chance to visit. I'm so sorry that your nurse didn't get you into the tub until after 0930, and that your blanket has a frayed edge. And you got 2% milk on your tray? You're kidding! I'll fix that for you too! Now let's talk for a moment about your CHF. You've never heard that diagnosis before? Well, I'm so sorry about that! Yes, your doctor knows you have it, and has been treating it for the last 2 years now, but I'm sure it's just a misunderstanding. Dr. Oldways doesn't always call conditions by the same name I may use, but he does a great job! We are all on the same side here! So, let's back up and start at the beginning...

I'm sorry if the day seemed hectic to you, and that I had to disturb your rest with our conversation,but I was afraid I wouldn't be able to see you at all if I didn't come when I did. I'm sorry the nurses seemed to be in a rush, and that your doctor didn't tell you about as much about your condition as he should have. I feel personally responsible for letting you in on how to manage your CHF, and why your body signals you as it does. If you had to be readmitted right away because of something you should have known about, I would carry that weight with me.

Now I must start my charting for the day! Why, oh why can't I dictate all this, rather than writing it out in long hand, narratively? How can the doc's be territorial about something as inconsequencial as that? Why, oh why didn't we have an agency nurse on as an extra today? How is it beneficial to run everyone here into the ground every time there is a sick call?

So Sorry, dear patient, that I don't even remember your first name.

FranEMTnurse, CNA, LPN, EMT-I · Dec 8, 2003

Dear Patient,

It's 0700 hour. I've just clocked in at work to begin my shift. I get report, pull up labs, check your charts for new or missed orders, pull your meds from the fridge and medicine bin, (and by the way, we recently updated our patient charting system by replacing it with computerized charting. The original intent was to increase efficiency in charting so I would be able to spend more time with you, but unfortunately it has added more time to keeping me away from you due to additional paper work.)Change#2 in parentheses.

Before I can get through all of these things, I'm being bombarded with requests from other hospital staff, family members, and yourselves. I so want to help you, to be by your bedside to care for you when you call. I wish I could give you more personal attention while you are under my nursing care. It is never my desire to keep you waiting, to not have time to answer your needs or questions left unresolved by your physicians. I became a nurse to be your advocate when necessary, to tend to your needs while you recover from your illness and/or surgery.

I know when you are not feeling well, the last thing you want to consider is that all five or six of your nurse's patients have the same needs and wants, and I can only be in one place at one given time. Forgive me when you ask questions that I cannot answer right off the bat because nursing is such that we

"may know many things about many diseases, and a few things about any disease, we are always able to quickly research any subject and find the information you may need." change #1

Although you may only get to see me a few times (if that many) during my time as your nurse today, know that I am not ignoring you, but am working as hard as I can to get to you. Keep in mind that although there are five or six of you, there is only one of me. I thank you for your understanding and patience. change#3 end

live4today, RN · Dec 8, 2003

Wow! Those truths about nursing are exactly what every patient and their loved ones deserve to hear so they are prepared for what may be the nature of their hospital care...sort of like giving a surgical patient preop teaching, peri op teaching, and post op teaching...no guessing what to expect that way they can prepare for situations better. I think it helps to ease their stress level when they are admitted prepared for the long waits that often take place between their nurses first visit to see them during her/his shift and the next visits that follow. Much like going to the doctors office with a room filled with patients and only one doctor to see them. People get restless, some choose to reschedule their appointments instead of sit through the long wait, and some wait it out because they know from previous visits to their doctor that it takes longer due to the patient load.

I ache for the patients and their loved ones who have to wait so long for care. I was a patient about 20 times with several major surgeries before I became a nurse which is why I know both sides of the coin.....that of the patient........that of the nurse. :)

unknown99, BSN, RN · Dec 8, 2003

this is an absolutely wonderful thread!!! These dear patient letters speak volumes!!!They speak the truth. THANK you!!!

live4today, RN · Dec 8, 2003

Thanks sagarcia :kiss Feel free to post a letter of your own.

Also, if you work in healthcare in any capacity, feel free to post your own patient letter. We can learn a lot from one another this way, and I am very much into educating myself by life lessons that I obviously cannot live all by myself.

Long Term Care Columnist / Guide · Dec 8, 2003

Dear Patient:

It is now 1500 and I've just clocked in for my shift. In the next half hour, I have to get report on the five of you, count narcotics with the 0700-1500 nurse, check new orders, and take the new admit who just came up at shift change. In the next two hours, I will have to take five sets of vital signs, do three blood sugars and insulins (which I have to check with another nurse before I can give them), change 2 IV sites that have gone bad, give 1600 and 1700 meds, and serve dinner. And in the next four hours, I may have to take still another admission, or a fresh post-op (with Q 30 minute vitals and assessments for the first 2 hours), while juggling assessments, I&Os, and still more meds.

That's without having anyone "go bad", or a doctor coming in to write blood transfusion orders, or the elderly confused patient down the hall deciding to get out of bed and falling on his head.

If any one of the approximately 4,273,906 things that can possibly go wrong in a hospital does, all bets are off, and you may catch a glimpse of me as I fly by, apologizing for making you wait a few minutes longer for the pain pill I promised you half an hour ago.

Please understand that this is NOT what I went into nursing for. I became a nurse because I genuinely like people and want to help them, but since health care is about profits and not people nowadays, I'm punished for spending more than 2.7 minutes with any given patient in any given shift with no lunch break, no potty break, and getting yelled at if I stay longer than 5 minutes past the end of my shift.

Thank you for your understanding. If you like the service I've provided you, please tell my boss.......otherwise she thinks I'm just another expense she has to deal with.

Sincerely,

Your Evening Nurse

RN-PA, RN · Dec 8, 2003

Dear Patients,

It is 1515, and I've just received report about all 6 of you from the 7-3 shift nurse. We're down to one PCT (aide) this shift for the 28 patients on our med-surg unit because a confused gentleman requires 1:1 supervision and our other PCT from the floor must sit with him for the next 8 hours of my shift. So I'm sorry if your callbell is not answered in a timely manner. I will spend much of my shift apologizing: that I haven't had the time to get fresh icewater and that you haven't had it for the past 8 hours; that I couldn't get you your pain med on time, but I had to change an incontinent patient for the 3rd time in 2 hours; and I'm sorry your mother had an accident because we couldn't help her to the bedside commode in time; and I'm sorry-- I paged the doctor twice about your problem, and he hasn't returned my page-- or maybe I missed the call back because nobody was at the nurses' station to answer the phone (we're without a unit clerk today, too).

You may not see much of me so I'll rely on you to use your callbell to let me know of your needs. We receive a lot of post-ops, admissions, and transfers on this shift, and patients are still leaving the floor for tests and we have no transport team after 1700. If your family can help us by washing you up, taking you to the bathroom, getting you a blanket from the linen cart, or getting you fresh water, I would really appreciate it.

When I'm sitting at the desk, I'm not "taking a break" (although it feels good to sit down for a minute); I am checking orders or your labs and test results, waiting for a return call from pharmacy, respiratory therapy, or I may be charting. I may be trying to decipher a doctor's handwriting or awaiting a return call from a doctor because he/she forgot to write Coumadin, IV fluid or antibiotic renewal orders for the umpteenth time this week.

Many of your fellow patients are very sick and require a lot of care. My manager says that's why they recently changed the name of our unit from "med-surg" to "acute care". I asked her, "Then why would you increase the number of patients nurses have if the patients are so much more acute?" She didn't answer me.

I will also need to help my LPN co-workers with their patients. I will do their admission assessments, initiate care plans, do IV push medications, call doctors for their patients' needs, hang blood products, heparin drips, and TPN, all in addition to my own 6 patients.

I may look somewhat frazzled, dazed, and wild-eyed, but that may be because I haven't taken a break or eaten in 9 hours. It's not because I'm a martyr; it's just that there are so many needs and so little time to care for all of you properly. I'm on a hospital-wide Nurse Retention Committee, I've written letters to upper management and even met with them to try to change the ratios on our unit so you can get the care you deserve, but we're told there's no money.

You will likely be seeing even less of me in the next few months as we all adjust to computerized documentation that began hospital-wide today. You see, JCAHO has so many requirements, we must spend much of the time documenting our care when all we would like do is have the time and staffing to give better care to you. Most of us became nurses because we want to do our best for sick people, and we will continue to try to do the best we can, but there's only so much we can do anymore. Please write our CEO, your Senators and Congressmen about your experience in the hospital. We need help desperately.

And again, I'm sorry.

-Your 3-11 shift nurse