code blog: tales of a nurse

This submission came in January (sorry!!) from "Mary" who states that she is the wife of a patient:

First, I want to say how much I am enjoying your site, and how much I appreciate your obvious dedication to your profession and your care for other humans. I've spent part of the afternoon reading healthcare-worker blogs that complain about patients, so you are a breath of fresh air.

I guess this isn't so much a story as an attempt to understand some of the problems in hospitals. I think I understand how difficult healthcare work can be... endless redundant forms to fill in, too many people to care for, very high stress, etc. But I've watched a lot of what goes on in one particular hospital and spoken to enough other "patients" and doctors to know that this hospital isn't unusual. This hospital has a very good reputation, by the way.

There is nothing... nothing... like a good nurse. You folks are in the trenches, and worth your weight in gold. But, for instance....

A resident? intern? med student? (just a first name on the nametags now, right? You don't even know who you're talking with.) comes into my husband's ward and discusses a plan for the next 24 hours with us, then leaves to write up orders based on that plan. Half an hour later another resident? intern? med student? comes into my husband's ward and discusses a plan for the next 24 hours, radically different from the first fellow's plan. Fine. We can go with the flow. The revised plan is to take my husband off a morphine drip and start him on oral percocet, with the option of a shot of morphine if the pain is too great. The night nurse comes on shift, and decides to pay no attention to the resident/intern/med-student's written orders, and to deny my husband any pain medication. We later find out that he does this to another patient in the same ward the same night.

So what do we do? Do we complain about him? When you complain in a hospital, you are "a complainer." We casually mention to his day nurse, who is wonderful, that he hasn't had any pain meds since the day before. We could tell she was appalled, although she didn't say so in words, but clearly not of a mind to pass the information along to anyone in authority. I can't blame her.

My big question is this... why is there not a nurse on hospital wards whose sole responsibility is to explain how the place works, find out from patients if all is going well. Another question... why are nurses given responsibility for more patients than they can handle in a day?

Ah, but there is! He/She is known as the Charge Nurse! The charge nurse for a given unit is supposed to take care of the problems for that unit during their shift. This includes dealing with family members who have issues with the nurse assigned to the patient. Did you ask to speak with the charge nurse? The chain of command goes higher... you can also speak with the unit manager, or if it's off-hours, you can ask to speak with the house supervisor. Your role as a family member to a patient is that of patient advocate! Nurses are taught that they are to act as patient advocates as well, but some of us are seriously misguided for whatever reason. I would like to know just why your nurse withheld pain medication all night long.

You could have asked to speak to the charge nurse that night or the next day. If you didn't feel as though you got satisfactory answers from them, you could have asked to speak to the house supervisor. Of course, I don't expect that you would know these terms... you could just ask to speak to "someone in charge."

As for the first names only on our nametags: The nametags should also include the person's title. It would be ridiculous not to include that little bit of information. You have every right to know the title of the person you are speaking to. They are in charge of your care, your health and sometimes your life. If you went to a teaching hospital, then yes, there are all kinds of med students, interns, residents, and attendings. Maybe the first medical person was the low guy on the totem pole, and as he presented the case to the higher-ups, the treatment plan was changed because the higher-ups have more experience. I hope that made sense.

Lastly, sometimes being a "complainer" is the only way to get things straightened out. As long as you aren't being a complete control freak, you have the right to question parts of your treatment that aren't working out. Well, I guess you still have the right to question parts of your treatment even if you are being a complete control freak, but then you become the boy who cried wolf. But "complaining" about valid things will not necessarily label you as a complainer. Not getting any pain medication all night is certainly a valid complaint. You also could have innocently asked whatever doctor/intern/med student that showed up about why he wasn't allowed to have pain medicine all night? Then they'd have to question the nurse.

Anyway, thank you for the kind things you said in your email, and I hope this answered some of your questions/concerns.