I'm sorry, but I didn't realize I signed up to please the customer. While the nurses go around reminding the patients this is a hospital, not a hotel, we get notices that we SHOULD make these people feel like they're in a hotel. Or "even if you know they're wrong, you should apologize and let them know that they're right" THIS IS AN ACTUAL MEMO THAT APPEARED IN MY MAILBOX.
... oh but it gets worse.
I got tapped on the shoulder by the "hospital customer service rep" telling me this patient (customer) really really wants a milkshake and would really make her day if she could have a milkshake. And I tell this rep this patient just had a bowel resection yesterday and not only can she NOT have a milkshake, but she probably can't even have water, even ice, for the next couple days. I spend all day listening to this patient whine and complain, and now the hospital has provided her a rep to follow me out in the hallway to whine and complain. And neither of them can admit that although a milkshake would make the patient really happy for about 15 mins, going back to surgery and prolonging the recovery would not. I know there's a lot of things in the medical field that seem downright cruel. But if we go by "the customer is always right" keep the patient/customer happy, there will be consequences.
Should customer service be #1 priority? Or am I just being delusional believing that patient safety is more important than patient satisfaction?
I've been a nurse for awhile, and I agree with visiting hours. I disagree with families sleeping at the bedside, unless you're withdrawing care. I shouldn't have to climb over people sleeping, or get dirty looks from turning on the light to do my job.
Here's a question for everyone ? What if your patient crashes during your night shift, and you have the spouse to deal with while your patient is sinking fast ? The Dentist my grandkids see takes them WITHOUT PARENTS for their cleanings and such. It hasn't hurt them one little bit. I say bring back the restrictions on visitors and hours. Patients are in the hospital to recover, are they not ?
One of the other aspects of the nurses' role, is supporting physicians' decisions about patients' treatment, while questioning it. For example:(not sure when this started), but I became aware of a custom/ protocol of giving benadryl before transfusions are started. They say that it won't block a transfusion reaction, but I've researched that theory and found no basis for it.
Also, patients are discouraged from finding friendly "designated" transfusion donations, due to a 3-5 day "processing" time. While that's a "medical" decision, I've always been a patient advocate type of nurse who believes in the pledge to "first do no harm". If a patient is not hemorrhaging currently, but has a Hgb less than 8 from an earlier one, I see no reason for pouring 3 units into them while admitted to hospital, in quick succession, rather than 1 at the outset, when their Hgb was 6.8; and then giving the designated units as an outpatient, a day or so later, thus saving $$$ and available units of blood. To me, it was an obvious misuse of health care dollars.
So the above examples are seen as "medical" decisions, as well as many others, with no "nursing" input. I suspect with Dr. Mary Wakefield at a helm of the DHHS that should change, due to budget concerns, and greater use of mutual risk management. We'll see more mutual decision making, but it's not here yet. Let's work toward that.
Here's a question for everyone ? What if your patient crashes during your night shift, and you have the spouse to deal with while your patient is sinking fast ? The Dentist my grandkids see takes them WITHOUT PARENTS for their cleanings and such. It hasn't hurt them one little bit. I say bring back the restrictions on visitors and hours. Patients are in the hospital to recover, are they not ?
Recover from being with their parents?
In 1958, in Montreal Childrens' Hospital, beds were set up for parents to stay overnight with their children. Those kids were much happier than those without a parent there (evidenced by smiling and less crying) and the nurses had the parents' support carrying out procedures. I worked there for 3 months during a rotation while receiving my nursing education (hospital program), and throughout that time, it was never necessary to expel a parent from any child's presence. It appeared a humane, logical program, and more traditional parent deprivation inhumane. :yeah:
In 1968, my daughter at age 2 years was admitted to Toronto's Hospital for Sick Children and I was told that I could not accompany her to the ED enclosure where she was seen, or to her room when she was transferred. The line I was fed by the staff there, was "she'll never forgive you" (for being there when painful/scary things happened). Of course memory of occurrances while under 3 years of age is the exception rather than the rule!
I told them that I'd take her to another hospital if they took her away from my presence, taking her out AMA(unconscious from dehydration caused by a pediatrician who told me "2 year olds never become dehydrated due to D&V" when I told him that was my concern, earlier that day when I took her to his office).
From your post, it would seem that the pendulum is swinging again, and I warn everyone that it is not in any patient's interest to deprive them of their support system, while in hospital (unless there is a security issue). After all, regression is a known response to illness, which implies the need to have even negative folks there for them. I do make an exception if there are street drugs involved........ Their exclusion then is a legal and ethical issue. (I've smelled "pot" many times while visitors are with patients, and even seen drug paraphenalia left in the bathroom, which is of course contrary to the medical and nursing care plans.)
Continuity of care is our credo, which extends to family as well as professional coverage.
Specializes in psych, addictions, hospice, education.
I very much agree with lamazeteacher. How can we deprive patients of those they depend on for emotional support? That is dis-acknowledging their emotional health and not treating them like the holistic beings we humans are! I know visitors can be a problem, but the problems should be confronted and/or removed, not those that are lovingly caring for the patient in the way they feel is correct.
lamazeteacher...way to go for advocating for your child!
Specializes in Home Care, Primary care NP, QI, Nsg Adm.
Here in Saudi Arabia, it is the norm for a family member to stay if needed, especially in peds. A friend of mine whose 16 y/o daughter recently had a serious neuroglogical problem was hospitalized for several weeks and her mother stayed 24/7, providing much of her care. Of course, things are different from hospital to hospital and hospital system to another so, it is not just staying as a support system, it is to ensure the individual is safe. Here, the issue of quality in governemental hospitals is a big issue due to the huge presence (and necessity) for expatriate staff and unfortunately the education, skills, and experience of foreign staff varies widely.
Most private hospitals provide beds for a family member and if you want to go 'five star', an attached room. That's for cash payment.
But, like everything, there are and should be well defined limits that first provides a safe environment. Letting a patients room become a 'second-home' to friends and family is too much. Hospitals are not frat houses.
As far as dealing with a spouse of a 'sinking patient', if a patient begins going 'south', I would rather have a family member present, deal with him/her at the time kindly, remove them firmly, yet gently and be able to communicate directly, rather than making that terrible phone call to come to the hospital at 3 AM.
There is usually a middle path in most issues and we should seek to follow it without going to one extreme or another.
Maybe some of the issues about families staying in the room with the patient is a regional issue. We are in the south and I think it is pretty much expected that family will spend the night with severly ill patients. On our unit it is just as common as not for a family member to spend the night and frequently 24/7 with the patients. We have a lot of head injuries and the families are hoping and praying that there will be some sign of arousal. Sometimes this is absolutely tragic to watch and a few times pts have become responsive to family members long before we see any purposeful response, they tell us about it, we think....... wishful thinking and then surprise..... we see it and the pt sometimes continues to improve when noone thought they would. One such patient actually spoke to me one night after family had been saying for days that he was saying a word or two. That was a high point for me! I talk to my head injuries as I am doing their care and he said "you are so nice." I said what? He said "you are nice!" WOW! He went on to be able to communicate regularly and went on to rehab. I do hope he continues to improve and suspect he probably has.
Some of the patients would probably do so much better if they had someone who could stay with them. I really feel so sorry for those who are conscious and have few or no vistors. I have only had 2 family members who acted unreasonable with me and I have had many who were extremely helpful. One of the unreasonable ones was a sister who complained because I didn't hang all the patients iv's at the same time. She said I kept her sister awake all night. While I was in the room, hanging iv's and giving meds, this sister was loudly talking on the phone :rolleyes:each and every time and I had to hang about 6 different iv's. Another one was a patient's wife who would not allow me to put him on a bedpan when we were giving him golytely. She preferred he just go on the sheets and we could do a total bed change everytime on this poor guy in all sorts of braces.
Mostly I have family members who help turn patients, bath them and help to change them or get them on and off the bedpan. Many times the families of the head injury patients feel much better if you teach them how to do some of the care like rotating podus boots, suctioning and doing mouth care. I think they feel less helpless.
Sometimes I love open visiting hours, sometimes I hate them...depends on the patient and the visitors.
I too have gotten much flack from patients and families about NPO status. My favorites are those who are in with aspiration pneumonia, ST has evaled and stated that they need to be NPO and have alternate nutrition, and family still wants to feed them even though they are a full code. I've educated till I'm blue in the face sometimes, and although some people finally get it, it's to no avail with others. I got in trouble with my manager once b/c a family member felt I was being condescending by finally drawing a picture of what happens in aspiration and telling them "If you feed the patient, you may kill him. However, if the POA is willing to change his code status, we can certainly get an order for comfort feeding." Go figure, way to support your staff there.
I understand that there is a certain amount of customer service that needs to go on, and that a little butt kissing can go a long way, and that being willing to go along with little requests that are reasonable can help to build that relationship so that when you do have to say "no" it's not such a fight. But there's a line between customer satisfaction and acceptable outcome that seems to get crossed on a continuing basis, even if you give rationale and consequences. At which point I just have to sigh and document my butt off to cover said butt.
I have been known to say to patients/family members "If you want to engage in potentially life threatening behaviors, can you please wait until you go home and let us try to keep you alive while you're here? It's your right, but I'd prefer if you didn't do it while you're on my watch; it goes against everything I became a nurse for." Sometimes it's enough to make them stop and think.
in 1958, in montreal childrens' hospital, beds were set up for parents to stay overnight with their children. those kids were much happier than those without a parent there (evidenced by smiling and less crying) and the nurses had the parents' support carrying out procedures. i worked there for 3 months during a rotation while receiving my nursing education (hospital program), and throughout that time, it was never necessary to expel a parent from any child's presence. it appeared a humane, logical program, and more traditional parent deprivation inhumane. :yeah:
in 1968, my daughter at age 2 years was admitted to toronto's hospital for sick children and i was told that i could not accompany her to the ed enclosure where she was seen, or to her room when she was transferred. the line i was fed by the staff there, was "she'll never forgive you" (for being there when painful/scary things happened). of course memory of occurrances while under 3 years of age is the exception rather than the rule!
i told them that i'd take her to another hospital if they took her away from my presence, taking her out ama(unconscious from dehydration caused by a pediatrician who told me "2 year olds never become dehydrated due to d&v" when i told him that was my concern, earlier that day when i took her to his office).
from your post, it would seem that the pendulum is swinging again, and i warn everyone that it is not in any patient's interest to deprive them of their support system, while in hospital (unless there is a security issue). after all, regression is a known response to illness, which implies the need to have even negative folks there for them. i do make an exception if there are street drugs involved........ their exclusion then is a legal and ethical issue. (i've smelled "pot" many times while visitors are with patients, and even seen drug paraphenalia left in the bathroom, which is of course contrary to the medical and nursing care plans.)
continuity of care is our credo, which extends to family as well as professional coverage.
pendulum swinging? i highly doubt it - except maybe in this thread. most modern parents and family members will definitely stay with their child in the hospital for as long as they are able to. how in the world does any modern nurse expect a child to recover in a strange place with surly nurses? "surly" because any good nurse wouldn't resent having family members present.
i don't know how old the poster's grandchildren are but most parents do go to the dentist with their young children and if this dentist is refusing to allow parents in the room i'm surprised that s/he is still getting business.
I think it's ridiculous for peds patients parents to not help care for their kids as much as is appropriate for the kid's diagnosis. When my son was two months old, we spent three LONG days with him in the local peds hospital b/c of sepsis. He was on multiple IV abx/antivirals until the cultures came back (12 piggybacks every 24 hours). You can bet that I did all the care for him that I could, those poor nurses were in and out often enough just with the piggybacks! There's no excuse for "forgetting" how to be mom or dad just b/c there's a nurse there, not to mention that when you've got a sick little one on your hands they probably prefer mom or dad to do the care anyway.
I know when I made the comment about wanting visiting hours, I should clarify, I meant in an adult setting. I don't work Peds, it's a different situation. I'll make one more comment. Most of the family members I've dealt with camping out at the bedside are NOT helpful, in my experience.
I think it is sad that some nurses would place additional distress on the patient and family (by limiting their access to each other) for the nurse's sole benefit. Sure, it might make your job easier not to be tripping over family members, but think about what is best for the patient. Even if the relationships seem dysfunctional to you, the patient is the one who lives with these people, presumably by choice. To disallow them to be with their loved ones in what is probably the most stressful time of their lives is just cruel to me.
I was married very young and we moved from Louisiana to Texas shortly after we married. No family here, just the two of us. My husband became suddenly very ill and had to be hospitalized. He ended up having colon surgery and is fine now, but it was very scary and stressful for us. BTW, this was WAY before I even thought of becoming a nurse (and actually is the main reason I did go that route).
No, he was not in ICU. Simple med/surg, stable the whole time. Yes, I spent the night at the bedside, and as much time during the day as I could. We had never been apart in our marriage and not being from a medical background at that time we were both terrified. Had I been forced to adhere to strict visiting hours, I would have been an absolute WRECK and I know my husband would have as well. The nurses were so sweet to us, even bringing me a sandwich one night when my husband mentioned to them I was racing to get to the hospital before they locked the doors and I hadn't even had time to eat (neither of us asked for this). If I was a burden to them, I feel bad for that but I would not change what I did, as it was best for my husband and myself.
Try having some compassion and putting the focus back on the patient where it belongs, not on the nurse and what is easiest/less stressful for him/her.
:yeah:
emilee1978
64 Posts
I've been a nurse for awhile, and I agree with visiting hours. I disagree with families sleeping at the bedside, unless you're withdrawing care. I shouldn't have to climb over people sleeping, or get dirty looks from turning on the light to do my job.