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?
The vast majority of the time I agree with this. I despise when people call me to do things they could do. Drives me batty. Or when doctors don't talk to each other and I am in the middle of conflicting orders.
But on note of hope. A lab tech helped to feed one of my little old patients the other day. Made me so glad to see her just being kind. (And before any one jumps down my throat, he was sitting up the tray was set up I had just been pages away. He could feed him self. Just too forgetful.
The vast majority of the time I agree with this. I despise when people call me to do things they could do. Drives me batty. Or when doctors don't talk to each other and I am in the middle of conflicting orders.
But on note of hope. A lab tech helped to feed one of my little old patients the other day. Made me so glad to see her just being kind. (And before any one jumps down my throat, he was sitting up the tray was set up I had just been pages away. He could feed him self. Just too forgetful.
Don't get me wrong, I don't mean to imply that everyone does this all of the time, but it happens often enough that I leave work late a few times a week because I have done everyone else's job AND mine.
I worked on a telemetry floor as one of 2 RN'S one night. No, I did NOT have time to put someone on a bedpan if they just rang out. I had to assess 18 patients (36 total on floor) & maintain their IV's. I worked with 4 LPN & another RN. We had one aide.
I did my own vital signs with the assessments. I did take them to the bathroom or put on bedpan IF I was there already. Teamwork....
I couldn't take 4 hours to do my mandated tasks. I had to repeat them every 4 hours....not excluding my more frequent circulation checks on my heart catheter patients....AND all the IV meds I had to give, strips to read every 4 hours....
We had a family who came out and said, "only the RN can give mother....do...for mother..." our HUC set them straight! Mama was only there waiting out her 3 days to go to the nursing home. We only had Mama because we had the only open bed when she came in & (gasp!) Mama was being moved to a non-monitored bed (on another floor) as soon as the orderly came.
I had had enough that night with pages for turning up/down heat, fluff pillow, move the pitcher, where's the call light, get me the TV remote, when's breakfast, when does "x" show come on?, what channel is ESPN on, call my wife (from the visitor!) From of THAT room. All they would say was, we need the RN right away. In about 30 minutes. My pager went off 5x DURING report! For that room....
I think I got 5 calls the rest of the night....total
Kooky, no hospital functions well without all levels of care...you are one cog in the wheel. It's not all about you.... or me. Please don't disrespect the aides....quite often they miss their breaks as well... and their work is far more strenuous and back breaking than yours or mine any day of the week. It takes a team working together. The sooner nurses get that message, change their attitude, and always respect all levels of the entire team, the better the outcome!
I agree with what many have said beforehand, the attitude of "I NEED THE NURSE" is often a pain and a waste of valuable time and effort. We are lucky to have a few HUCs (unit secretary) who are very proactive and IF the phones are not ringing off the hook they are happy to come find the nurse, check about the diet order, and bring a cup of ice/water/whatever. As for blanket adjustments and the million other little requests, of course I will help if I have time, but not always. If someone down the hall is having 10/10 uncontrolled postop pain, and down in another room an NG needs to placed for nausea/vomiting...I may (politely but briskly) ask you to put your call bell on and the nurse's aide will be able to help you quite soon. And I'm not above toileting people or going for a walk, but again it all depends on the time available and what's left on my to do list. If I just got a call about someone who is short of breath in another room, or even if I just have three TPN bags that still need to be hung...you may have to wait a few minutes. But agree with other posters that the best scenario is good teamwork. AND ADEQUATE STAFFING, WITH WHICH THIS WOULD BE A MOOT POINT MUCH OF THE TIME! :-)
I agree with what many have said beforehand, the attitude of "I NEED THE NURSE" is often a pain and a waste of valuable time and effort. We are lucky to have a few HUCs (unit secretary) who are very proactive and IF the phones are not ringing off the hook they are happy to come find the nurse, check about the diet order, and bring a cup of ice/water/whatever. As for blanket adjustments and the million other little requests, of course I will help if I have time, but not always. If someone down the hall is having 10/10 uncontrolled postop pain, and down in another room an NG needs to placed for nausea/vomiting...I may (politely but briskly) ask you to put your call bell on and the nurse's aide will be able to help you quite soon. And I'm not above toileting people or going for a walk, but again it all depends on the time available and what's left on my to do list. If I just got a call about someone who is short of breath in another room, or even if I just have three TPN bags that still need to be hung...you may have to wait a few minutes. But agree with other posters that the best scenario is good teamwork. AND ADEQUATE STAFFING, WITH WHICH THIS WOULD BE A MOOT POINT MUCH OF THE TIME! :-)
I sincerely believe this. I'm not sure why adequate staffing is such a foreign concept to hospital administration. More people to attend to the needs of the patients would equate to better survey scores, thus increasing reimbursement, and allowing more profit for the hospital to fix the cost of a surge in employees. But, sadly, the attitude remains "do more with less," and nurses happen to be on the receiving end of the assignment of new/more responsibilities. Perfect example: it used to be a physician's job to complete the medication reconciliation on admission as there are often times they are more familiar with certain medications and doses that may appear questionable to the bedside nurse. From there, they can simply sign the list and order all home medications at the time of admission. Starting two months ago, bedside nurses became responsible for obtaining all the patient's medication information and verifying a home pharmacy.
Yes, please. Let's just add another responsibility to the nurse who already faces many dilemmas when admitting a new patient and balancing her patient load.
IDK about BANNING THE PHRASE! lol but delegation is a VERY important skill in modern medicine.
And by skill, I really do mean skill. Its not as simple as telling others what to do. You need to to consider your own abilities and responsibilities (aka your states nurse practice act) as well as the laws and institutional policies regarding what those under you can and cant do.
CNAs are there for a reason and when the hospital makes staffing decisions, they are assuming that their RNs are delegating effectively. If that is not the case, then its no surprise when people become overwhelmed.
It really is a skill and on top of that, most poeple (including myself) are uncomfortable telling others what to do, especailly new grads working with CNA who have been on the unit since before they were born! Regardless, as an RN we have a right and responsibility to "order" CNA's to do certain things, and its our responsibility to know what those things are and make sure they actually get done. It makes it much easier to just do it ourselves, but I think learning to delegate properly is worth the effort and the frustration that comes with asking someone to do something and finding out they didnt do it right or on time.
Most important thing is to know what everyone's role and responsibility is. Its a lot easier said than done!
In my locale, hospitals are primary care throughout. Read: no CNAs. They save money on UAP but wonder why they have huge nurse turnover
In my locale, hospitals are primary care throughout. Read: no CNAs. They save money on UAP but wonder why they have huge nurse turnover
And doing that is just inappropriate. Unless you work in an ICU. I can see the need for possibly less PCAs relative to nurses because there are lower ratios and the nurses are usually accountable for more aspects of patient care as they pertain to assessments.
I'm a big fan of assigning an appropriate amount of staff for an appropriate bed number and acuity on a unit. Management not so much. It's a never-ending battle.
I never understood their thought process beyond thinking cost saving. Our manager said she worked hard to get us better staffing ratios because she read that more RN per patient ratio meant better outcomes. So, we eventually got an RN for everyou aide that quit or was fired. So that unit now has 1 aide on the unit of 36 step down patients. And 6 RN'S....so I left.
We had 6 patients BEFORE she got rid of aides. I don't see how she helped us. Especially since we had patients on ventilators (up to 2 of our 6).
One evening, we had call ins & each of us had 8 a piece. I had 4 vent patients & 4 not on vent. No charge & we had to share our secretary with another floor, 4 floors up. We & other floor were both told she was only to help the other floor with admits. Both were full with no planned discharge....we had 2 aides that night, "since you're short a nurse AND sharing a unit clerk. But you should be fine because the other unit has no empty beds and the clerk is only going to help them with their admits."
Yea, don't feed me that crock of crap & expect me to believe it. I don't get why that regular med-surg floor was crying about no clerk when they had 6 patients each (same total patients on floor), 3 aides....no vent patients, AND a charge nurse with NO patients.
That was straw that broke camel back. When I learned a unit that had less complex patients had better staffing than us & we couldn't keep a ward clerk, or get anymore help.
And house supervisor answered a call light said, "I'll find your nurse" when the patient asked for bedpan. She knew an aide could do that AND the 2 we had were standing at kitchen door getting drinks out.
We had their diet, activity level, I&O status, nurse and aide name listed on a marker board on Wall (single rooms). We got wrote up if it was found to be out of date 2 hours after we started our shift. We had to initial the paper on the board every hour. Don't have a code!!!
Specializes in Tele, Interventional Pain Management, OR.
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!
I know this is kind of a complex issue, and I completely agree that uninvolved folks can't automatically discern if a patient can have water or gauge the patient's ability to ambulate to the restroom.
But I laughed when I read this post because it reminds me of a unit clerk on my floor who answers ALL call lights with, "Ill let your nurse know" in the same sing-songy tone Every.Single.Time.
Need ice or a blanket? I'll let your nurse know. You want an applesauce and a ham sandwich? I'll let your nurse know. Random family member needs a place to change their squalling baby's diaper? I'll let your nurse know.
Meanwhile, the nurse is with another patient calling for a CRT--critical response team for those with different acronyms.
**Sorry for the snark, everyone. I've only been a nurse for nine weeks and it's been a rough three-night shift stretch. Being a new nurse is hard. END RANT**
P.S. For anyone who says they wouldn't "enjoy me as their nurse" for the sentiment expressed above--I love my job and every shift validates my decision to become a nurse. But some requests made of nurses are simply absurd! School didn't really prepare me for the disparity between "pt wants ice" and "pt just Houdini'd out of restraints, ripped out IV/Foley, and there's blood everywhere." OK, really end rant!
Zombiologist
34 Posts
The vast majority of the time I agree with this. I despise when people call me to do things they could do. Drives me batty. Or when doctors don't talk to each other and I am in the middle of conflicting orders.
But on note of hope. A lab tech helped to feed one of my little old patients the other day. Made me so glad to see her just being kind. (And before any one jumps down my throat, he was sitting up the tray was set up I had just been pages away. He could feed him self. Just too forgetful.