The Ubiquitous Call Light

Now the purpose of the call light is right there in the name--to call!  However, the delicate balance of call light use seems to be lost on most folks.  Lets review how to get the most out of every use of the call light.

The call light is the patients (and families!) link with nursing staff.  It is the communication tool provided to each patient to get what they need when they need it.  I don't think we, as hospital staff, do a good enough job explaining how and when to use the call light, so here's my best shot so you as the consumer can get the best service possible.

Disservice #1: Under use
I always feel terrible when I walk into a patients room and they have either been in pain, hungry, thirsty or in need of the bathroom but didn't call for what they needed because they didn't want to bother anyone.  We are here to take care of you, so let us know what you need!  As a nurse, these types of patients make me nervous because they are the same ones that won't call when they are having chest pain, shortness of breath or other changes in their condition that it is better to intervene on sooner rather than later.  Asking for what you need is not bothering anyone, and we rely on you, as the patient, to let us know.

Disservice #2: Overusage
Now after reading #1, we have established what appropriate usage is, now lets talk about what it is not.  It is not calling every five minutes for differing requests (i.e. I want ice ***5 minutes later*** I want water***5 minutes later***I want a warm blanket***5 minutes later***I want coffee****five minutes later... you get the idea) It is also not calling for nursing staff to provide services to visitors.  Now when I say "services" I don't mean like how to get out of the building or what visiting hours are, although most hospitals are providing a pamphlet to patients on admission to answer questions such as these, as well as the channels on the TV and where to get food, I am talking about requests such as "Please make a dinner reservation at restaurant 'x' for a party of 6 for 7:00" (no joke, this actually happened).  It is also not to get your visitors food, drinks, pillows, blankets, movies, etc.  I assume that since they brought themselves in they are also capable of caring for these basic needs on their own.  The last and biggest one, at least for most of the nurses and CNA's I know, is not calling for something you can do yourself.  Examples of this are "Please move my foot", "please pull my table closer", "please move my pillow up/down/etc", "hand me my glasses", "Move my tissue box closer".  These types of requests are really frustrating because just because you are in the hospital, does not mean (at least in most cases) that you are a complete invalid and unable to care for yourself.  We are here to take care of what you can't do for yourself, surgery, IV medications, cardiac monitoring, not to flip your pillow to the cool side--again.

Disservice #3--Not using it at all!
This disservice involves family members repeatedly leaving the room to go find someone to assist you the patient, or them as family members.  I completely understand why this one happens: family members don't want to use the patients call light because it is for the patient, or they don't feel it is urgent so they think that going and finding someone to help them will be less disruptive. The problem with this is the way hospitals work: nurses are assigned a group of patients, usually between 4 and 6, and they have no idea about all the other patients on the floor.  Finding a nurse or CNA is not necessarily finding your nurse or CNA, so in the time it took you to wander around the floor, find the wrong person, have the wrong person go find the right person, then the right person come attend to you takes about five times as long as if you or your family member had used the call light in the first place.  The other problem with this method of getting help is that in a hospital, a lot of staff wears the same set of uniforms: the lab, the housekeepers, the nurses, the CNA's.   So when you ask for your loved ones incontinent wear to be changed, I guarantee you the housekeeper can not help you. 

I labeled the above issues "disservices" because in the end it means that you are not getting the care you need when you need it if you don't know how to properly utilize your call light.  To get the most out of your call light try the following steps:
1) call when you need something!
2.) group your needs!  think of everything you need or think you will need in the foreseeable future, so you can get the most out of every call
3.) be specific about what you need.  When you call say exactly what you need i.e. "can I get another pillow and some water?" not "I need my nurse"  This way your nurse or CNA can come prepared with what you need.  It means faster service for you and fewer trips for your nurse.

Happy Calling!

What Nurses Do

While one would think that the answer to this is simple, I think a lot of common perception and understanding of what a nurse does is mired in poor movie portrayals and a 50 year old sterotype.   There was a time when nurses fluffed pillows and gave foot rubs, but that is no longer the case.  Nurse are now responsible for highly technical tasks that were once only entrusted to physicians.  In the last ten years, the acuity of patients that we care for has increased dramatically.  They are sicker, get more treatments, more medications, and have more co-morbid conditions that make them that much more complex.  It is not that people are just getting sicker, it is that they are living longer and acquiring new illnesses and conditions and requesting or expecting more advanced lifesaving efforts.  Along with the sicker patient comes hospital budgets that are being trimmed on a quarterly basis, which means each nurse takes more patients, even though the patients are more difficult to care for.  Add to this the drive to use electronic medical records, which requires about five times the amount of time that paper charting took, and you have one gnarly recipe for a burned out nurse.

Here is my typical day on a typical medical/surgical floor: I go to work at 6:45am.  I get my patient assignment that has been made by the charge nurse from the previous shift.  I get their demographic data (name, age), hospital data (attending physician, diagnosis) and orders (diet, activity, IV, tubes/drains).  I get report from the off-going nurse at 7:00am.  This is when I find out what brought the patient into the hospital, what has happened while they have been there, and what occurred during the previous shift.  Then I take that information, write down the medications that are due when, then go off to meet my patients.   Now it is 7:30.  I go into each patients room, introduce myself, review the plan of care, assess my patient, evaluate their pain, offer to assist with ADL's (activities of daily living i.e. toileting, teeth brushing, etc), and arrange for breakfast.  I leave the room and log in to a computer where I proceed to chart everything I just did in that patients room.  The time?  Now almost 8:00am.  I do this for all five of my patients, and I am lucky if I am done seeing everyone by 10:00am.  This does not take into account the multiple phone calls put through to my hospital issued cell phone, fielding calls from patients needing things, family members calling to check in and physicians calling with new orders.  10:00 is medication administration time for all routine daily medications.  Patients can have 20 or more medications at this time, and many times the medications need to be crushed or individually fed to the patients.  I am done with medications, hopefully, around 11:30.  Giving medications is not just going to a medicine cabinet and pulling them out.  No, you log into a machine called "Pyxis", move through the screens selecting your patient, then individually select each med, and once you have selected the medications, various drawers pop open and dispense the medications.  I take the medications to patient rooms, log in to the computer in the room, take my scanner and scan the barcode on the patient's wristband, enter the correct screen for medication administration, scan in each individual med, and then and only then can I give the patient the medications.  There is a new rule just being instituted that all meds be administered within 30 minutes of their scheduled administration time.  It is just not possible.  So by now it is after 11:00, I go briefly into interdisciplinary rounds where each specialty in the hospital, including the physicians, give a brief summary of the patients and how they are progressing.  Once I am done in rounds it is 11:30.  We start to rotate out nurses at about this time, hoping everyone can get a 30 minute break in before the cafeteria closes at 2:00pm.  I go around and see my patients again, help them get lunch, and take out their trays.  The afternoon is coming fast, and by now I have probably discharged at least one of my patients, so here come the emergency department admissions.  I put all my other patients on hold to admit a new patient, which takes about 90 minutes.  If I am lucky I get a post operative patient from recovery that is not too painful, too sedated, too unstable or too demanding.  By now it is 5:00.  Time to get everyone their dinners, fill in all the last minute charting (every drop of water or pee, every morsel of food, every time the patient was repositioned in bed, sat on the edge, or took a walk has to be recorded).  Now it is 6:00.  Final medications for the day, go to each patients room and address any final needs, remove all the dinner trays and get ready for report to the next shift.  Darn it!  I forgot to note off all the orders in the charts!  Every order that is written by a physician during the course of the day has to be reviewed, completed and signed off my the nurse.  Now I am done and night shift is on the floor.  I hunt them down, give them the same report they gave me, shred my "brain" sheet for the day and head for the locker room.  It is 7:45 pm.  I am heading home, ready to return the next morning at 6:45am and do it all again. 

This is a day that goes smoothly, where none of the patients get sicker, need any extra help, no families have melt downs or demand your immediate attention, no one dies, or you don't discharge your entire group only to get another one.  Did I forget to write above when I take my breaks?  Nope.  One thirty minute break for lunch, if we're lucky, and that is it. 

You know, there are days when I wish I could fluff that pillow, rub those feet and call it a day.  But I don't think that is going to happen any time soon.

Why I am Burned Out

I am an RN.  I have been one for over 10 years.  I hate my job.  But before you think I am a totally cold and heartless woman, let me clarify--I love taking care of people.  It makes me feel alive and like I am doing something worthwhile.  It is the only part of my job that actually keeps me sane.  But I hate all of the total bull that goes along with it: dealing with physicians who think nurses are idiots and handmaidens, patients that take and take and demand and demand and then have the nerve to complain about the service after discharge, dealing with families and friends who will tell you how to do your job when they have no clue what your job is, being told to work harder, longer and faster by management who have not been in patient care since nurses stopped wearing white dresses, and our national media who tells patients to stand up for their rights, even when they don't know what their "rights" are.  I started this blog for two reasons: 1.) provide myself an anonymous outlet for the day-to-day frustrations I find increasingly annoying in my job and 2.) if anyone ever finds and reads this blog, to hopefully provide them with some information on how to navigate our complex medical system and hospitals and how to get the most out of their stay and give themselves the best chance of having a good outcome.

I feel better already.  Thanks for finding and reading my little blog.