Nursing shortage, patient care - page 2

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... Read More

  1. by   Liann
    A patient "advocate"who is obnoxious is no advocate. Anyone who is hospitalized needs someone to coordinate information, ask questions, assist the patient with minor tasks, and keep an eye on things in general. Being confrontational or demanding is not usually necessary, and may actually upset the patient and worsen their condition.

    I agree with the bit about limiting visitors, esp children. In my hospital, I often see huge groups of people roaming the hall outside the surgical waiting room, usually pushing strollers and trailing toddlers. Really, couldnt ONE of those people stay home and care for the kiddos? The waiting room is not that large, and our OR schedule consists of about 20-30 patients a day. Use your head....keep unnecessary people OUT of the hospital.
  2. by   nurseandmom
    Well Bill, Since you ask then here is my list

    1. If it is at all possible find out the RNatient ratio in the hospital you are choosing. A good ratio is 4-5:1 on days and 6:1 on nights on a medical surgical floor.

    2. Bring in a list of medications as previously mentioned.

    3. Assign 1 person to speak for you if you are unable to speak for your self. A medical power of attorney or having a specific person in writing is best.

    4. Explain to family, visitors and neighbors that no info about you can be given to any one due to HIPPA regulations so don't get mad at the staff who won't give out information over the phone.

    5. Please obey visiting regulations and limit visiting for your own health. Please no children, there are all kinds of nasty germs in the hospital and children are carriers of some pretty nasty germs as well.

    6. Ask any personell who enter your room who they are and what they are there for if they are not wearing an ID ask someone else to verify them.

    7.Insist that all health care workers (including MD's) wash their hands before touching you.

    8.Ask about medications, procedures and reasons for tests.

    9. Know that you can refuse to have any procdure or test, it is your right to be completely informed.

    10. DO NOT BE OBNOXIOUS, i guess you figured that out by now.
  3. by   Good_Queen_Bess
    Totally agree with all of the above, esp SmilingBlu Debs!

    The way some people speak to nurses is appalling. Yes, not everything is perfect and if people have a genuine grievence, I will try and deal where possible. Yes, it is a stressful time for the relative, but that does not give them the right to speak to me like I am a piece of dirt. I am trying my best to resolve things, but I am neither psychic nor wonderwoman with 4 sets of hands.

    Relatives can also help by helping to feed their sick relative (if possible) at meal times when necessary, instead of having a look of disgust on their face expecting a busy nurse to do it when you're just sat their looking blank.
  4. by   RNKerry
    The best way to minimise medication errors is to remember you are one of many patients that the nurse has on her mind during the shift. DO NOT MAKE TRIVIAL REQUESTS when you can see that the nurse is trying to give either yours or someone else's medications. Be considerate and wait or, just say, I need your help once you have finished that PLEASE
  5. by   RNKerry
    P.S. Some hospitals even have aprons for nurses that say 'i am giving out medication please do not disturb me'
  6. by   fancynancy
    Consumers of the System need to know:
    How to communicate their needs.
    Learn the terminology. Delegate a family member as advocate. If a relative is ill and hospitalized know the diagnosis and treatment options and prognosis. Ask for a list of medications, one is usually given on discharge. Keep a file of test and treatments.
    Read the information pharmacists provide. Buy a good drug book.
    The computer can be a useful tool for information for caregivers, patients and family. Have family discussions about death and what are the wishes of the elderly person. And respect the wishes of the individual. Discuss these wishes with the family MD or the admission MD. Know what the terms DNR, Palliative care and prognosis mean.
    Know the providers of care: RN, LPN,CNA, RPN,PA,NP, SSA,MD,
    Most staff in my hospital wear scrubs: housekeepers and porters(SSA) EkG techs, XRay Techs, MD's.
    One patient complained in a rather obnoxious tone with family members gathered around the bed " There are eleven nurses at the nurses station all yacking and no one is helping me." I stated " We don't have eleven nurses on this shift". I went out to the desk and counted the uniforms,(scrubs) most people were housekeepers/ ward clerks/porters/ and one nurse was on the phone getting orders from a MD. The rest of the nurses were preparing meds or in rooms assessing, doing vital signs,treating acute problems ie chest pain events, congestive heart failure episodes, starting IV's, doing dressings, cleaning incontinent patients. People really do not know what we do.
    If they did know, they would not be so offensive, attacking,obnoxious, harmful to a part of their community who happened to choose nursing as a profession. People can be so nasty and cruel to nurses. Consumers minimize our responsibilities and knowledge.
    I have been a nurse for over twenty five years, you can pick out the nasty ones and the good ones. It takes one good comment to make up for so many nasty ones. My Favorite one is "Am I ever glad you are here." Thanks
    Last edit by fancynancy on Apr 4, '03
  7. by   gwenith
    I don't know about anyone else but I now am at the age where if I don't get a please and thankyou form my patients I remind them that they will get better care from me if they do. Obnoxious patients DO NOT get better care because the effort taken to deal with the unwelcome behaviour detracts from the real issues. They may get more attention but they do not get better care. We all know cases where the person has been a real PITA and we have started to avoid them only to have the person fall in a heap a little later because you were unable to accurately diagnose the real issue. This isn't poor medicine it is the old story about the boy who cried wolf!

    You want better care? Be nice. Say please and thank-you. Help us to help you. You want a good rule for how good the hospital is? Good nurse to patient ratio's are not the only issue they will not gaurantee good care they just ensure it is not poor care. I would tack on a committment to quality assurance, infection control and evidence based practice.
  8. by   rachel h
    Oh, I have just a *few* things to say:

    1. Please DO NOT be obnoxious. This will not get you better care but will make the nursing staff loathe entering your room.

    2. Please use your call light for the appropriate reasons. Do not put your call light on to ask the nurse to get you an extra blanket that is sitting across the room on a chair if you are perfectly capable of walking over and getting it. We are not your personal assistant- we are here to assist with your healing and encourage you to be as independent as possible.

    3. It does help us (and the docs) if you know what medications you take and the normal dosages. If you can, bring in the prescription bottles from home.

    4. Be honest with us about your health history, including drug and alcohol use. This will help us to care for you better. We are not here to judge you, but to help you.

    5. Family members, please don't be offended if we ask you to leave the room to perffom certain tasks. Some things are personal and your family member may have requested privacy in advance. They may have also requested that we not share certain information with you. We are just trying to maintain patient confidentiality- we are not trying to make you mad.

    6. Know who the nurse is. I often have patients tell me "This nurse that was just in here did this or that"... when in fact the person in the patient's room was a dietary aid or nursing assistant or housekeeper. It is important that you know who the nurse is so you can recieve accurate information about your care.

    7. Keep a list of questions you have for the nurse or doctor. You are responsible for your care.

    8. You have a right to know what treatments you are recieving and why. Ask questions if you are not comfortable with something or don't understand.

    9. Know that all of your medications, treatments and tests are ordered by the doctor. Please be aware that the nursing staff may not be directly communicated with by the doctor as to why a certain medication or test was ordered and we will have to do some hunting to figure it out. If you have any questions about a new medication or procedure, ask the doc whenever possible.

    10. Know that as an RN, I need a physician's order to administer a medication or certain treatments, or I could lose my license. Just because you normally take a certain medication at home every night before you go to bed does not mean the doctor has ordered it. It may take me some time to contact the physician and get an order... or they may not even give me an order. Realize that even over the counter meds (such as tylenol) require a doctor's order in the hospital.

    11. Please do not get upset when a nurse does not have time to give you a bed bath or shampoo your hair. A lot of this stuff is now primarily a nursing assistant function as nurses are responsible today for more than we ever have been before. Some of the patients we may have on a med/surg floor would have been in an ICU ten years ago. And we may have 5-6 (or more) of these patients at a time. It's more important to me that you live than have your hair shampooed.

    12. Please be patient with us! We really do care, otherwise we wouldn't be nurses! Know that there are many people involved in your care and we will do the best we can to explain everything to you and make you comfortable. We want you to get well!

    Whew... I think that about sums it up!
  9. by   -jt
    People can be as obnoxious as they want and make whatever demands they can think of. If there isnt anyone there to hear it or do it, whats it gonna get them? If you have one RN trying to take care of 10 or more sick people while she only has 2 hands, and has been on her feet for 12-16 hours already and has no support staff to help because of all the "cost-cutting", the only thing your obnoxious demands are going to get is a more stressed-out, frustrated, distracted, overwhelmed nurse who then becomes more vulnerable to making a mistake with your life. Not exactly achieving your goal of helping to reduce errors.

    Years ago, your visitor may have sat at your bedside all day & been treated as a guest by the staff but nowadays, we need them there to actually help you. Hospitals have reduced RN staffing to such that 1 RN has the workload that 3 used to have. And the patients are sicker. We cant be in all places at once and have to rely on the family to help with the pts care. If Im trying to administer a ton of meds to an unmanageable number of debilitated people at the right time without making a mistake, I dont have time to give you a back rub, fill your water pitcher, or get you another blanket - but your wife can. Its a sorry state of affairs that we have been brought to this point, but until the public demands better from the state legislature and your hospital administrations, thats the way its going to stay. So by all means, have a family member stay with you and help you - but make sure they have the phone number to the CEOs office & will make their demands there - namely that the CEO provide the amount of staff and services to properly and safely meet your needs.

    The New York State Nurses Assoc published a consumer guide and "survival kit" for hospitalized patients which NY state then adopted & distributed. Its got the answers youre looking for.
    New York State Nurses Association
    11 Cornell Road
    Latham, NY 12110
    Last edit by -jt on Apr 5, '03
  10. by   Edward,IL
    I agree with most of what was said above
    re tips that you can use to make your hospital stay better. I'd like to add:
    1) The patient and any family member coming into the hospitalization experience has to have a sertious frame of mind. Facing cancer, childbirth, death of a family member is not to be taken lightly. The nurse is not meant to replace the role of the family member, so don't abdicate your responsibiiities.
    2) Nursing is not a spectator sport where friends and family of the patient sit on the sidelines heckling the nurse.
    3) The Registered Nurse is a university -prepared professional licensed by the state and often times seen working in hospitals providing care to the sick. The nurse has earned and deserves to be shown respect. Work with the nurse to get better (role of the patient) and be supportive and helpful (role of the family member. Ask the nurse to go over the individualized patient care plan, discuss your nursing diagnoses, plan of interventions and antcipated goals or outcomes. This gets everyone working from the same page, speaking the same language and moving towards common goals.
    4) As for any obnoxious comments, complaints or behaviors: It is not within the scope of practice of the Registered Nurse to put up with crap from any idiot. Please save this for the MD. (They're to be talked to as though they're a mentally retarded child. MD's have special training in this.)
    Edward, IL
  11. by   Jaaaman
    Originally posted by Edward,IL

    4) As for any obnoxious comments, complaints or behaviors: It is not within the scope of practice of the Registered Nurse to put up with crap from any idiot. Please save this for the MD. (They're to be talked to as though they're a mentally retarded child. MD's have special training in this.)
    Edward, IL
  12. by   -jt
    <how can pts families and friends assess, in advance, the quality of nursing care at a hospital.>

    Some hospitals have report cards that you can review before choosing which hospital to go to. Some hospital report cards can even be found online. Most are pretty simple and dont tell you much though. The best way to assess the quality of a facility is to have state law that requires disclosure, and not many states do.

    NY state has legislation pending, written by the NY State Nurses Assoc, that would require hospitals and nursing homes to disclose and report RN-to-patient staffing ratios and the actual mix of licensed and unlicensed personnel. The bill also calls for facilities to disclose information indicating the quality of nursing care, such as the incidence of hospital-acquired infections, patient falls, and pressure ulcers (bed sores) so that public knowledge of staffing practices will help put "market pressure" on facilities to make improvements. Needless to say, the hospital assoc is lobbying hard against that bill (wonder why?).

    There is also a similar federal bill, put forth to Congress by the American Nurses Assoc, that would do the same on a national level - requiring this public disclosure of all states. The Patient Safety Act, (H.R.1804/S.863) would require health care institutions to make public specified information on RN staffing levels, staffing mix and patient outcomes. At a minimum, they would have to disclose to the public:

    the number of registered nurses providing direct care;

    numbers of unlicensed personnel utilized to provide direct patient care;

    average number of patients per registered nurse providing direct patient care;

    patient mortality (death) rate;

    incidence of adverse patient care incidents (complications);

    methods used for determining and adjusting staffing levels and patient care needs.

    In addition, health care institutions would have to make public data regarding all complaints filed with the state agency, the Health Care Financing Administration or an accrediting agency related to Medicare conditions of participation. The agency would then have to make public the results of any investigations or finding related to the complaint.

    Since recent studies have demonstrated a direct relationship between RN staffing levels and positive patient outcomes, this legislation is intended to allow consumers and researchers to have ready access to information on this issue and that would answer your question. But it should be of no surprise to know that this bill too is meeting strong resistance from the hospital assocs' lobbyists in DC.

    Anybody who might ever be a pt or have a loved one in the hospital should contact their Congressman & Senator and demand they support that bill & pass it into law.

    In the meantime, you can try calling the hospital and doctor and ask for their RN-to-pt staffing ratios, staffing mix, complication/infection rates, and all those other questions addressed in the bill. But if its not the law in your state that they have to disclose this info, you probably wont get a direct answer. This is not information hospitals want the public to be aware of.

    You also asked us for "first hand experiences". On which issue?
    Last edit by -jt on Apr 5, '03
  13. by   Zee_RN
    First hand experience. Ratio on med-surg unit: 1RN, 9 Patients (1 nursing assistant who covers my 9 patients and another RNs 9 patients too):

    Call bell ringsm, patient states: "Nurse, I'm having crushing chest pain!"

    RN runs to nursing station to get the appropriate medication (sublingual nitroglycerin):

    Family member of another patient standing in hall: "NURSE!!! NURSE!!!"

    RN pauses: "Yes?"

    Family member: "My mother needs more ice water now!"

    RN: "I'm sorry, I'm dealing with an emergency right now, I'll be back as soon as I can."

    Family member: "I don't care what you're dealing with, my mother deserves attention too!!"

    RN: "I'm sorry, I'm dealing with an emergency right now." and runs back to chest pain room.

    Family member files a complaint with management.