Guest Post By: Yocheved Golani
Nurses are the eyes and ears for physicians. Without nurses the doctors likely see only what they would observe during their “60 second rounds.” Nursing personnel, however, are exhausted.
They contend with physical labor, mental/emotional demands, legal concerns, limited career options and Puzzled Patients who are/feel needy but fail to realize the Bigger Picture and how to best work with it. Wondering what you just read? Let’s take this paragraph apart thought by thought.
Consider the average hospital, nursing home or other in-patient medical care facility. Nurses are busy moving patients ranging in weight from newborn to several hundred pounds. Americans are becoming fatter, especially in the south, and that’s not limited to derrieres.
Nurses are lifting patients into and out of tubs, showers, gurneys, wheelchairs, beds, examining tables, and outdoors for fresh air and sunshine. Whoops, meal time: Let’s get those food carts delivered while the stuff is fresh and hot. Stairs? Ramps? Crowded elevators? They hardly relieve the strain. Now, let’s roll this bed-bound patient over to avoid Decubitus ulcers once again, shall we? All together now: Ooomph!
Oh, dear. The roommates in 212B still don’t get along. We need to find some available beds to separate them. Got any open rooms? Did you hear about that dementia patient in 501? Tossed his food tray, claw cane and few curses at the staff trying to visit him. One of the doctors needed stitches in his hand. Darn! There’s not enough time in a day, or a month, to finish all this documentation.
Those Medical Records harpies are making me crazy. Lawyers, too. How can I write about everybody who received all their shots, creams, powders, wound care dressings, visitors, pills and pokes when I have to care for 60 people on the unit – give or take a few – in an eight-hour shift? I only have two hands and one tired brain! Nuts. Hey – do your hear that psych patient getting agitated again? I’m gonna go in the room to check on … I’m back. Gotta use the PA a minute: Doctor Allcome to room 204 STAT!
On another unit, different but equally compelling scenarios might be going on. Once in a while you can hear a murmur, “Administrator posted something on the bulletin board. Let’s see… JCAHO wants this, WHO demands that, the Peer Review Committee warns that… Watch the desk for me, OK? I’m heading to the break room. I need some air and quiet time before I have a breakdown.”
That’s pretty much the picture for a very overworked population receiving dismal pay for keeping somebody’s loved ones alive and as healthy as possible. The Allied Physicians salary survey, among other information sources, indicates poor prospects for improvement on that score. See the average pay, by location and occupation here.
When I trained for certification in Medical Record Science, the holy grail of a nursing career was the BSRN. Well, holy of hollies perhaps. Those initials paid the highest wages a nurse could command decades ago. Things haven’t changed much over time. Nurses get to think about that everyday, and more so when severe weather locks them into the facility. Why? Because new personnel can’t arrive for subsequent shifts.
Add up the factors listed above and we get one Interesting Equation: Physically Drained nursing personnel + low pay + the ever-present fear and threat of lawsuits (felicitous and otherwise) = Difficult Working Conditions. Introduce disruptive visitors, pressured doctors, harried schedules, power outages endangering medical efficacy plus everyone’s immediate welfare, and the math goes haywire along with some brain cells.
Patients are a huge part of the picture. They don’t necessarily appreciate the background to their medical setting and care. They’re in pain, frightened, possibly embarrassed by their situation. They need help with their ADLs let alone a reassuring back rub, smile or conversation.
How can we improve on all that? Sensibly. One step at a time.
You’re wiping bottoms, changing sheets, serving – maybe even preparing – meals or snacks, pushing gurneys and wheelchairs, and lending a hand with recreation therapy. I fully appreciate the role nurses play.
I worked alongside several and, as an HIM professional working in various facilities; I handled paperwork so that careers need not be threatened by poor documentation and opportunistic lawyers or relatives. I prepared scripts for doctors and nurses to follow when dictating their notes for transcription (e.g., “Patient X presented with xandsuch problem, these specific complications and whatever else is relevant. I administered Y and Z, conducted somesuch test, and in response to lab results ABC I…).
I prepared a 12-Step Plan for Medical Documentation Efficiency at a medical institution burdened by time crunches but eager to comply with relevant laws. I introduced color-coded tags that alerted specific personnel about where their signatures on phone orders or other documentation compliance was urgently needed. These and similar initiatives resulted in faster, easier documentation, increased compliance with state and Federal laws, and lower blood pressure for all concerned.
The Other Side
Solutions to your career complications can be created with deliberate, goal-oriented thinking. Now, let’s look at the other side of the bed rail, shall we?
Your patient is already upset with an illness or trauma. Drugs are not improving matters if they cause confusion, slurred speech, visual problems etc. Their visitors are worried relatives and friends (look out for estranged spouses. They’re a health threat all their own!). Calm perspective is not on anybody’s mind unless they’re seeking sainthood.
I address the mess with specific instructions in my book. They can be printed out and posted above beds and on medical charts. They alert staff of the need to 1) Treat Patients with Respect at all times, to 2) Be Alert to Allergies, to 3) Stay Aware and Monitor Underlying Conditions and more. The messages soothe and speak for a patient who can’t or is afraid to. Your Patient Bill of Rights might or might not reassure them. But it’s a step in the right direction: it opens the communication channels.
Today’s digitally enhanced world is all about sound bytes and eye candy. Web 2.0, the Social Media phenomenon, demands that we immediately show credibility a.k.a. Transparency, Insight and Raw Guts, even in real life. I suggest that nursing staff capitalize on that to ease the load on you. Have fun creating informative brochures, posters and in-services for staff and patients to share good-sense procedures that can improve everybody’s health.
Hold a “Giggle on Purpose” day by sharing jokes you prepared in advance, or something similar, for Humor is Healthful Day. Select times and days when nursing supervisors and anyone who chooses to assist them can go from patient to patient, introducing themselves as people and professionals, not pain pushers. Ask your patients to tell you what concerns them and address those concerns in practical terms.
Let your patients know what you’ve understood all along: that health care need not be a guessing game. The man who can safely confide that his fears are being realized can explore solutions with you. Let him and that nervous woman down the hall know that compassionate you is on call to the best of your limited human ability. It’s the honesty that reduces pressure, making life more bearable in many ways.
How can you be paid more for the superb, critically important work you’re doing? Chart the course you’re about to take to make that happen Figure out what you need to do each step of the way with a reputable business adviser. Create circumstances you want. Clarify the conditions and pay scale you deserve while emphasizing the value you bring to patients and the medical facility employing you. Focus on what’s stopping you from achieving your goals and take action to overcome it. You summoned necessary help to room 204 that way, didn’t you?
By all means, set up ways for satisfied patients to recommend pay raises for you and your colleagues. Comment boxes, fill-in-the-blank recommendation slips and other solutions await your use. Write Op-Eds, and alert the editors of professional nursing publications to know that they can share this essay with readers by buying it from me.
Yocheved Golani is the author of highly acclaimed E-book “It’s MY Crisis! And I’ll Cry If I Need To: EMPOWER Yourself to Cope with a Medical Challenge”