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?
I was a bedside nurse before transferring into the world of case management after the birth of my second child. I used to be so aggravated by ancillary staff using that phrase repeatedly. It gets incredibly frustrating, espeically when I'm gowned in an iso room knee deep in C. Diff-tainted stool.
When I moved to case management I made the shift from driving the bus to being a passenger, so to speak. I still enjoy the interactions I have with patients, albeit, short ones. But I learned something that I never knew before: As a CM, I'm NOT ALLOWED to touch patients. As in, I am not allowed or I can be seriously reprimanded (ie: Fired). I'm not covered under the same hospital insurance that used to cover me when I was a floor RN. The reasoning is if I help pull a patient up in bed and injury myself, I'm not covered under the hospital's work comp insurance because that's not in the current scope of my job description.
Yes, I'm still and RN and yes I remember how to assess, toilet, etc....but I literally cannot help you. I'll get a blanket or help the patient with the remote, but that's about it. I bet this is the same for RD, SW, etc. Now, of course, if a patient is falling out of bed or putting themselves in danger, I can jump in because patient safety is always more important. But if a patient asks me to help pull them up or walk them to the bathroom....guess what, I call you because I'd rather like to keep my job.
Where I work, the nurses will put us on point if we call them for frivolous things when working as the unit assistant (meaning, we sit at the front desk and answer the call light phone). Sometimes, though, our patients have no idea/do not care who the nurse is and when they are asking for them, they're really asking for the patient care assistant. And, then sometimes, our patients do not have the best command of English and they just ask for the nurse in general. When pressed for what type of need they have, they usually just repeat that they need the nurse (usually for pain medication).
So, unless I can hear a pump beeping in the background or their monitor indicates some kind of stress, I generally have no clear idea who I should send. I defer to the nurse because more frequently they are needed. Sometimes I'm wrong, though, and the nurse will remind me not to call them for things the patient care assistants should be doing. :shrug: It's all good. :)
I literally had to push a doctor's chair aside to reach the phone that was right next to him so I could page the hospitalist per his request. After I hung up I asked him if his arms were broken. Lol. I was only half serious! He's a good friend but he has it in his head that if he pages his own consultants that somehow his job scope will creep further and further into apparently menial tasks that aren't worthy of his attention. Meanwhile another physician who has been an ED doc for 30+ years somehow manages to page all his specialists all by himself. Mind boggling!
We have a doc who, when he's sitting at the desk doing notes and such, will answer our phone if we're all tied doing stuff as we don't have a dedicated unit secretary. If the person being asked for isn't in the room at the moment he'll take down messages or transfer calls and the whole enchilada. He's a better secretary than I was when I was one I think! And I don't mean that in a demeaning way.
I worked with one like that. He went in an told a lady she'd had a heart attack & would need to be transferred out for open heart surgery. She went into cardiac arrest!
He not only pressed Code Blue button but started CPR using the headboard of the bed!
I was at med cart 2 doors down. We brought her back & he helped us move her to the ICU! Wouldn't take no for an answer.
This has me almost to the point of crying. I am in a spot that I am still a "young enough" of a nurse to still attempt to be everywhere at once, but also getting yelled at for having to stay late to chart. Our NM is like G, and constantly comes and gets the nurse instead of grabbing said vitals...but will know how busy the nurse is because its also the middle of med pass...and she has created more issues with each room she has rounded on.
Trying not to get bitter and change professions when the nursing shortage is getting worse day by day...
Hang in there! Unfortunately we come across managers who know less about being a nurse every day. Shocking for someone with a license, right?
I had a manager who couldn't figure out how to make honey consistency water, so he got a rep from Thick It to do a mandatory inservice. Guess who was on vacation during our inservices? Our the manager who didn't know how to put someone on a bedpan? Yep....caused me & the tech who helped get the patient off the upside down (bowl inverted!) bedpan a mess. Whole bed, patient embarrassed & said we were never to send the student back in to help us!
I'm in management now (recent change) & pray I never forget the small stuff like how to put someone on a bedpan! You never know when you might need to pitch in....
....caused me & the tech who helped get the patient off the upside down (bowl inverted!)
....it was upside down?!? Are you serious?! ...what...I mean...how....why....how does that even happen?! I can understand getting it turned around as in from the head end from the foot end but upside down?!
I don't know....patient had limited mobility & we had to have 2 of us to put on or take off bedpan. I offered to do the lifting/rolling & wish I could've paid attention to how they put the bedpan in. Later said they thought it would be more comfortable since they had more area to sit on.
Wrench Party: Why did you assume it was a "too good to lower myself to that level" situation? And not to anger you, but did you not plan ahead and make sure you had linens with you before doing the poop cleaning? What if no one had been around? I always always and always, despite rules not to do so, kept extra linens, gowns, bowls, and so on in isolation rooms, just for times like this. That way I didn't have to ask anyone for anything and incur anybody's resentment. Just a thought.
Might the person have been afraid of getting roped into more than just handing you linens? Maybe she had a free moment but that was over now and she needed to move on to her next essential task? Maybe she saw the "coworker" goofing off, maybe she had to pee, maybe she'd had no break, who was this coworker - someone on your team or just a random someone?
Maybe the Palliative Care nurse does that type of care because of a bad back?
Maybe they're all shameless you-know-what's, maybe they all do see their jobs as other than hands-on, but maybe they have other reasons. And probably no one here who is complaining about them has ever really said anything to them and gotten to the bottom of their reasons - except you, Wrench Party, to the PC nurse.
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!!!
What did Sup/Staffing person say when you pointed out the staffing situation to them as you have stated it here?
They had only a unit clerk call out. You had 3 nurses call out and I've pulled everyone to your unit I can. Not all nurses can work your unit. Remember, everyone is short tonight, not just you.
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jamieann.rn
6 Posts
I was a bedside nurse before transferring into the world of case management after the birth of my second child. I used to be so aggravated by ancillary staff using that phrase repeatedly. It gets incredibly frustrating, espeically when I'm gowned in an iso room knee deep in C. Diff-tainted stool.
When I moved to case management I made the shift from driving the bus to being a passenger, so to speak. I still enjoy the interactions I have with patients, albeit, short ones. But I learned something that I never knew before: As a CM, I'm NOT ALLOWED to touch patients. As in, I am not allowed or I can be seriously reprimanded (ie: Fired). I'm not covered under the same hospital insurance that used to cover me when I was a floor RN. The reasoning is if I help pull a patient up in bed and injury myself, I'm not covered under the hospital's work comp insurance because that's not in the current scope of my job description.
Yes, I'm still and RN and yes I remember how to assess, toilet, etc....but I literally cannot help you. I'll get a blanket or help the patient with the remote, but that's about it. I bet this is the same for RD, SW, etc. Now, of course, if a patient is falling out of bed or putting themselves in danger, I can jump in because patient safety is always more important. But if a patient asks me to help pull them up or walk them to the bathroom....guess what, I call you because I'd rather like to keep my job.
Just food for thought.