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?
"Fetching a pitcher of water" was something I was perfectly willing and able to do, once I ascertained from the nurse that it was OK to do so. I didn't delegate that task to a PCA when I was willing and capable of doing so myself. As for the bedpan - I relayed those requests to the first person on the patient's team that was able to help them, whether it was the nurse or the aide. Assisting a patient onto a bedpan is not solely the role of a PCA, but surely you know that.
You're right. It isn't. However, rest assured, the nurse likely does not have the time to tend to that, and this is why ancillary staff and proper delegation exist.
You're right. It isn't. However, rest assured, the nurse likely does not have the time to tend to that, and this is why ancillary staff and proper delegation exist.
First, let me state that my initial post was in response to a specific poster, and was not in response to your general topic. My point was that it is appropriate, in some situations, for hospital personnel to tell a patient that they will get their nurse to help them. Period.
Second, I understand your general point in respect to notifying the appropriate staff member to help with specific patient needs. I am simply speaking from my own perspective. I work at a facility that takes a team approach to patient care on the units lucky enough to have aides, and not all do.
First, let me state that my initial post was in response to a specific poster, and was not in response to your general topic. My point was that it is appropriate, in some situations, for hospital personnel to tell a patient that they will get their nurse to help them. Period.
Second, I understand your general point in respect to notifying the appropriate staff member to help with specific patient needs. I am simply speaking from my own perspective. I work at a facility that takes a team approach to patient care on the units lucky enough to have aides, and not all do.
It matters very little what your post was in response to. My response was still relevant. It is appropriate to get the nurse in situations that require nursing judgement or assessment. Checking on the status of a patient obtaining water can be relayed to the aide. They know everyone's diet order in their assignment even when it includes thickened liquids or being NPO.
We also take a team approach. However, the team approach only works if every member of the team knows the other's capabilities, duties, and limitations and utilizes them effectively. Spending 10 minutes to find a nurse for a task or information that can be delegated or obtained elsewhere is not effective utilization of time OR teamwork. It results in delay of the need being met for the patient.
It matters very little what your post was in response to. My response was still relevant. It is appropriate to get the nurse in situations that require nursing judgement or assessment. Checking on the status of a patient obtaining water can be relayed to the aide. They know everyone's diet order in their assignment even when it includes thickened liquids or being NPO.
We also take a team approach. However, the team approach only works if every member of the team knows the other's capabilities, duties, and limitations and utilizes them effectively. Spending 10 minutes to find a nurse for a task or information that can be delegated or obtained elsewhere is not effective utilization of time OR teamwork. It results in delay of the need being met for the patient.
We are either not speaking the same language or I am not effectively communicating here, but either way, I agree that in a perfect world a patient's needs will be expeditiously fulfilled by the most appropriate team member without disturbing members of the team that have no need to become involved. I maintain that it is absolutely appropriate at times for the phrase "I'll go get your nurse" to be uttered. If every patient need could be fulfilled by non-nurses then there would be no need for nurses. Have a great day.
Request for pain medication are appropriate to request of the nurse.
Needing a bedpan is not. Surely you know this. And fetching a pitcher of water, if you're concerned for a patient, can also be delegated to the PCA. I suspect you also know this as well.
You and vanilla bean are both agreeing with each other, you know? And quite strongly. It takes a re-read to see it and unpick it but you are.
I didn't know whether to point this out as you are both having a conversation that seems private (for a public forum) but it seems a shame not to.
I dislike the phrase, too, especially when another nurse says it"I'll go get YOUR nurse" Myself I would rather assist the person to the BR, administer the pain med, or take the vital signs. Why spend ten minutes on looking for a person who is obviously busy rather then help the patient and your co-worker, too. After all there are times when I am busy and I sure do appreciate the help. Nursing is a 24/hours a day job all year long. Working together for the benefit of the patient and the unit seems to make things run more smoothly with less bickering and increased satisfaction in job performance, as evidence by healthy and happy patients.
I love this post. I can't tell you how many times I feel this way. Its because of things like this that have made me develop a distaste for nursing and influenced me to go to school for a different career. I remember when I was working in the ER, I had a pt come in with chest pain. I was drawing cardiac enzymes and inserting a IV when a resident asked me to get the vital signs for a pt in the next room. Mind you, this pt was already connect to a cardiac monitor. The HR and RR were already on continuous display. The most recent BP was 40 minutes ago and I had it scheduled for every hour. The cuff was on the arm. Literally all the resident needed to do is press a button to obtain another BP.
I hate the words "I'll go get your nurse". One time a pt asked for water and then the doctor came and told me the patient wants water. The nourishment area was like what 10 feet away from him? Like I'm sorry is it not in your scope to give a pt a freaking glass of water. I also HATE it when I am in the middle of a nursing task that I can't delegate to anyone and someone comes and tells me a pt needs to be changed. I hate it when an attending tells me that because they've worked in the ED for 15+ years and are fully aware that we have PCAs in the ER. But instead of telling them, you tell me when you clearly see that I a busy, and that the PCA is standing in a corner with anotheR PCA chit-chatting Ugh whatever rant over. But yes I definitely agree with you.
I don't have time to read all of the comments, but there may be a few saying that you're too impressed with yourself or something like that - but no, I agree with you, because the key thing for me on this is very simple: it's not that I'm 'too good' to do *anything* for anyone where I work - but I don't have the TIME to do 'just anything'. Some CNA's and med techs are willing to do whatever's needed, and they know you're busy, but there are some who get irritated when you ask them to do anything additional or outside of what they think they're supposed to do.
We have this 'policy' in our NICU- if you find the neonate dirty, you change him/her. Any of our Senior Registrars and Registrars (we don't have residents/interns/medical officers in our NICU- it's too highly specialised) will change the neonate if they find the neonate dirty during their examination. No 'IFS' no "BUTS'...
If a doctor is doing rounds and suddenly the patient asks for a bedpan or something time consuming, no 1) the doctor is doing rounds, they're busy as well. 2) a lot of residents don't have a clue on how to toilet a patient or other nursing tasks that seem easy. 3) have noticed doctors are a bit awkward when communicating with patients outside of discussing medical info, but nurses aren't, therefore we're the better person to handle these queries/tasks.
Also, at the end of the day, you the nurse, take full responsibility of care for that patient. What if the doctor did delegate to the CNA instead of you, and for some reason that CNA didn't do it, you would have no idea. If someone says I'll get your nurse, they know that you are the one responsible for the care and if you want to delegate the task, then fine, but still, you should be the one to direct queries to.
I think some nurses become a little sensitive when it appears they are 'taking orders from doctors'. Or I get the impression some nurses even think bed pans etc are beneath them and get annoyed when someone higher up delegates the task to them, and then they always delegate to the CNA.
With patients, all they know is that they have 1 nurse caring for them for that day. They know a CNA helps out, but they also know that that CNA isn't just 'their' CNA (ie, the CNAdoesn't have allocated patients, but the nurse does) and they aren't the ones who will be always answering call bells (the nurse will mostly).
There's also too many allied health professionals that we work with, in which patients may not even realise. And doctors, they don't really communicate with physio or the dietitian, but we the nurse do. So if a patient asks them something to do with their mobility, which is obviously a question for the physiotherapist, the resident probably has no idea who this person's PT is, how to contact them etc. So, ask the nurse/the person who bloody does know. And then guess what, we'll be the one's saying 'i'll let physio know/i'll pass it on to the dietitian".
Unfortunately, we are the middle man for a lot of things but it's kind of how it works.
Every day that I hear that phrase I am reminded on how silly it sounds. I am a nurse, not a waitress, not a maid. I just figure if I can do some small task, so can you. Don't be such a needy baby. Then again, there are people in my department who can't even throw away their own trash. Babies.
First, thanks to all the nurses for doing what you do. From my perspective nurses usually know more about a patient's condition and how to get them better than the doctors who breeze in and out taking only a superficial look.
One of my takeaways from this discussion is that the next time I am a patient I need to make an effort to understand who is the RN vs the CNA or any other medical staff member. I'm realizing that I never completely understood the delineation of the respective roles working with patients. I'm not one to ever ask for anything nor have I ever hit a call button so I'm guessing I never asked an RN to do anything that was the CNA's job, but my apologies if I did. My guess is that many patients don't understand who is who and what their roles are.
nynursey_
642 Posts
You're right. It isn't. However, rest assured, the nurse likely does not have the time to tend to that, and this is why ancillary staff and proper delegation exist.