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?
- medical students/doctors usually have no idea how to toilet a patient. The only one exclusion is if they worked in different capacities before.
Just the same, docs only know who is doing what in the unit(s) they work often enough. Otherwise, they have no idea. They also hardly ever communicate with PCAs and, in fact, with anyone else except other doctors and nurses.
We can cry out loud all we want about doin' the same and about the same, but in fact medical and nursing services are in many senses are parallel universes. I do not even mention X-ray and other departments - people there know only one rule: if any problem, call the nurse. That's everything they know and ever will know. And they may be officially (yep, they too have gazillion of senseless policies guiding their every breath) not permitted to do anything, meaning nothing at all, ever, not pertaining to their direct responsibilities. And among them are just as many policy-kissers as among us. Many of them, of course, have enough common sense to figure things out, but they still may not feel comfortable with what we deem as totally menial tasks.
The problem is, the nurses' fight for everything that's good and great put them in position when a nurse became the central figure in patient's care, the one who is supposed to know everything and get all the things done. That would be cool if her other multiple responsibilities (for which nurses were primarily known since Florence Nightingale time) could be totally transferred to someone else's business. Partially, that's what happened - nurses do not cook, swipe floors and sew bandages anymore, thanks God. But part of us still cries out that "it is not beyond my honor as a Bachelor of Science to clean an ocean of C. Diff poop because I am a nurse, and I do care". Sure, it is not bad thing to care for people, but the truth is that there are only 60 minutes in every hour.
I wonder where it ends. Physicians, when they found themselves in precisely the same situation some 40 years ago, attempted to solve the problem by developing institute of mid-levels and thus shot themselves in one foot and then in another.
At another hospital I worked with, we had a HUC (secretary, in case you call them something else) who would answer the call bells and REGARDLESS of the request, she would say in this nasally tone of voice "I'll tell your NURSE", emphasis on the NURSE, perpetuating the patients' ideas that the nurse is the only one who can do anything for them.
At another hospital I worked with, we had a HUC (secretary, in case you call them something else) who would answer the call bells and REGARDLESS of the request, she would say in this nasally tone of voice "I'll tell your NURSE", emphasis on the NURSE, perpetuating the patients' ideas that the nurse is the only one who can do anything for them.
It used to drive me nuts!
This is exactly what I mean. Nurses are the center of patient care but they are certainly not the only people capable of providing everything and anything the patient needs.
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."
I wasn't going to give this response a second thought, but after I thought it over a bit, I'll leave you with this thought:
AllNurses, a nursing driven forum, is typically visited by nurses. The acronyms I used aren't that ambiguous in any setting. In fact, most of the nursing world commonly utilizes acronyms as short hand. CM, SW, PCA, and MD are VERY commonly used terms. Any term that wasn't clear could have been clarified by a simple question. Your reply was rather snarky and unnecessary, particularly since you made a poor attempt to be general by using the term "people," when you clearly meant me.
At another hospital I worked with, we had a HUC (secretary, in case you call them something else) who would answer the call bells and REGARDLESS of the request, she would say in this nasally tone of voice "I'll tell your NURSE", emphasis on the NURSE, perpetuating the patients' ideas that the nurse is the only one who can do anything for them.
It used to drive me nuts!
Same here
And when I once asked the guy why it was so, it turned out he had no knowledge of who was SUPPOSED to do what. He knew that it was PCAs job to bring trays in rooms, procedure sets, etc., so when the tray was there, he called them and not nurse. Everything else was a black hole. No idea except "he said he needs help, I am not a clinical person, I do not know, I am just doing my job".
If there is a phrase I would ban, it definitely would be this one. "iamjustdoingmyjob".
Same here, i was so annoyed this week, a social worker went to talk to a patient then later the social worker approached me and said "hey your patient on room blah blah needs help to tie his hospital gown" and I was like come on you're just going to tie the freakin' gown!
Specializes in Cardiology, Cardiothoracic Surgical.
You READ my mind! I have had two instances of this happen this week where I wanted to punch the other person right in the gullet:
1) I am in a contact room, literally right across from the linens cabinet. I am at the door and asked a white-coat RN standing 5 feet away at the desk, chit chatting with the unit clerk (I could hear their conversation, it was NOT work-related) if she could please pass me some linens from the cabinet. The aide and I were in the middle of a very messy C. diff cleaning. This "nurse" proceeds to go all the way down the hallway and ask my co-worker to bring me linens.
The house sup herself has wandered by and automatically pitched in for patient care, and you're acting like you're too good for it?
2) Palliative care nurse came out of a patient's room and asked me to re-position a patient after she had spent literally 30 minutes in there. I was walking another patient at the time with full post-surgical getup and a pole full of drips. I started at her for a full 10 seconds and asked her point blank "And YOU couldn't do that why?" This patient had no special equipment, drips or anything else attached to her. God forbid you actually TOUCH the patient.
I can see med students being clueless, because they are guests on a floor vs employees.
But regular staff? We all work closely enough that yes, PTs know what CNAs do. HUCs know what CNAs do. Same thing with housekeeping -- our HUC isn't going to call the RN to change the full trash cans.
The only issue I could *possibly* see with the scenario in the OP, is asking the CM to delegate the VS. But still, rather than getting huffy that you're not doing the VS, if she didn't want to delegate to the CNA (being outside the bedside nursing hierarchy) she could have said so.
But yes, it would make me crazy if a SW came and got me to tie a gown.
I used to work with a HUC who never had answers...I can't count how many times she responded with "I don't know, I'm not a nurse." For example, I ask: "Hey T, where do we keep med rec forms?" (This was in a SNF, and I was newly off a 5 day orientation.) T the HUC: "I don't know, I'm not a nurse." Uh....but you are the health unit coordinator. You've got cabinets of papers around your desk, and don't know what they are, but expect the RN to??
I think this, in a way, was what bothered me yesterday when the consulting doctor looked completely lost when she needed a translator to speak with a patients family. I coordinated it the best that I could to help her out, but the interpreter had been paged and hadn't arrived yet. She asked if there was a nurse on the unit that could translate for her, rather than having to use the telephone interpreter system because she "wasn't comfortable with it." Is dialing the phone only in my scope of practice?
I am not on a specific floor, in fact I see patients in all areas including ER, ICU, general floors and so on and forth.
The thing is that while I do not mind to help a patient to go to the bathroom or to get them some ice/water the problem is that in most cases I do not know how the patient ambulates, 1 or 2 assist. The same is true for NPO and such. The other day I talked to a patient who asked my to hand him the water cup with a straw that was visible in the room. I almost grabbed it but instead called the nurse - to ask if the patient was allowed po - turns out that the patient was NPO waiting for another procedure in IR... The patient swore to me that he was allowed water...
Another case - the patient insisted on being able to walk to the bathroom if I would help. I pressed the call light and waited until somebody came in - turned out the patient was totally unsteady and was a 2 person assist - which I was happy to help with.
So what I am trying to say is that in cases where staff is not the primary nurse, or does not even work much on the floor, it is often important to ask the nurse or CNA before helping.
Sure - I do go to a bedalarm when I pass a room and it goes off to prevent a fall but since I do not know the patient in most cases I have to wait for somebody else to figure out if the patient can get up or not. I get blankets and if the nurse allows I also get water or a snack.
When somebody is CMO I sometimes also reposition or provide mouth care.
But - there are many things I have to refer to the nurse or CNA .
Specializes in Med Surg, ICU, Infection, Home Health, and LTC.
I think I have another nurse "HERO" The OP said the truth and did it so eloquently! I so totally agree that I am jumping my big hiney up and down doing a Tom-Cruise-on-Oprah imitation.
.thumb.gif.557c5203bd6f06724ecab47703960500.gif){kind=small}
KatieMI, BSN, MSN, RN
1 Article; 2,675 Posts
Guys, I'm going to tell you a big secret:
- medical students/doctors usually have no idea how to toilet a patient. The only one exclusion is if they worked in different capacities before.
Just the same, docs only know who is doing what in the unit(s) they work often enough. Otherwise, they have no idea. They also hardly ever communicate with PCAs and, in fact, with anyone else except other doctors and nurses.
We can cry out loud all we want about doin' the same and about the same, but in fact medical and nursing services are in many senses are parallel universes. I do not even mention X-ray and other departments - people there know only one rule: if any problem, call the nurse. That's everything they know and ever will know. And they may be officially (yep, they too have gazillion of senseless policies guiding their every breath) not permitted to do anything, meaning nothing at all, ever, not pertaining to their direct responsibilities. And among them are just as many policy-kissers as among us. Many of them, of course, have enough common sense to figure things out, but they still may not feel comfortable with what we deem as totally menial tasks.
The problem is, the nurses' fight for everything that's good and great put them in position when a nurse became the central figure in patient's care, the one who is supposed to know everything and get all the things done. That would be cool if her other multiple responsibilities (for which nurses were primarily known since Florence Nightingale time) could be totally transferred to someone else's business. Partially, that's what happened - nurses do not cook, swipe floors and sew bandages anymore, thanks God. But part of us still cries out that "it is not beyond my honor as a Bachelor of Science to clean an ocean of C. Diff poop because I am a nurse, and I do care". Sure, it is not bad thing to care for people, but the truth is that there are only 60 minutes in every hour.
I wonder where it ends. Physicians, when they found themselves in precisely the same situation some 40 years ago, attempted to solve the problem by developing institute of mid-levels and thus shot themselves in one foot and then in another.