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?
