"Nurses’ Prescriptions for Patients and Families" By Allen Weiss, MD, MBA, President and CEO

Nurses’ Prescriptions for Patients and Families

September 1, 2011 - This year, 36,000 patients will be cared for by more than 1,000 dedicated and compassionate nurses in the NCH Healthcare System. Being on the inside of the system, every hour of every day, nurses have a unique view and ability to share what they think is most important to patients and their families.

Nurses address many common anxieties, and have many different channels to communicate with patients. Several months ago, a panel of 33 nurses in the Philadelphia area came up with more than two dozen observations about their work and their patients.

In my opinion, the 18 most meaningful issues to us are as follows:

1. When you are in the hospital, it’s okay to buzz. In fact, nurses and Care Technicians purposely place the call bell within reach before leaving a patient’s bedside. Most times, nurses and care technicians work hard to anticipate your needs so that you are comfortable and content and won’t even need to call. But if you have a problem, we want to know about it sooner rather than later. Typically, floors are busy and there can sometimes be a delay in responding. In this case, ring again and share your concerns.

2. Do your homework and get a second opinion. The more you know about your disease or illness, the better you will do. Be an active participant— your life is your most important possession. Be free to ask, “If this were your child, mother, or father, what would you do?”

3. Get on the internet and do some research. There are many credible sites which can give you background information to make subsequent discussions with your physicians more productive. Be careful about over-relying on the internet because your situation may not be exactly like what you are learning about as you surf the web. The internet is a supplement, not the primary source for diagnosis and treatment.

4. Everyone is afraid at some point, and it is fine to discuss your fears with your nurse. They understand and have been through this before with others. Most likely, this illness or situation is brand new to you.

5. Get to know your nurse. In the hospital there are many different folks coming and going from your room or taking you to other areas of the hospital for care or diagnostic tests. Our nurses have large name badges with “RN” in big block letters. Each patient room has a white board with your nurse’s and care technician’s names prominently displayed. You want to be known by them, so learn some names and something about them that they want to share. They are real people, with real families, and real lives outside their profession.

6. Ask questions, lots of questions. Initially this breaks the ice. Your nurse will understand you better; and you will better understand what is happening. Being in the hospital is not the time for a silent stoic. Asking questions will usually lower your anxiety.

7. Be honest. There’s no point hiding the truth. If you haven’t been taking your medications, fess up. You will just complicate the situation by not being honest. If you drink and/or smoke, let the hospital team know. These are not original sins, but can and do affect other areas. Most everything we do is interconnected.

8. Have reasonable expectations and share them appropriately. What are your goals? How much are you willing to change? Are you more interested in being pain free, being functional, or living as long as possible? All three are reasonable, so let people know so they can help you get to your goal, not their perception of what you might want.

9. Nurses have realistic expectations about their patients. In other words, they understand not everyone will stop smoking, quit drinking, lose weight and exercise. Nurses have compassion, but are also motivators for folks to do the right thing for themselves.

10. Pick an advocate whom you trust and who understands you and your desires should you become incapacitated and unable to direct your care. Discussions about how much care and end of life issues are difficult, take time, and should be done way before the ambulance ride to the hospital. The advocate should have good communication skills and be effective in carrying out your wishes.

11. A bad day for nurses is when they could not do what they wanted to do for a patient. Nurses get blamed for everything since they are present 24/7 and generally can help get problems solved—ranging from clinical (why do I feel so tired?) to environment (it is too cold in here). Nurses are good problem solvers.

12. Nurses have most likely had patients and families with similar problems before. Armed with this prior experience, they can walk you and everyone else through a problem or crisis with less anxiety and fear than trying to go it alone.

13. Quality care doesn’t always equate to faster care. Compassion, listening and empathy all take time. Be patient and understanding, as there are other equally important patients to be cared for by “your” nurse.

14. Privacy is important and we now have the Health Insurance Portability and Accountability Act (HIPAA) which directs who has access to your information. Certainly a well-meaning relative could be calling, but a nosy neighbor could be impersonating a close relative. Let the nurses know who you want to see and keep informed. These designated contacts can spread the word if you like.

15. Understand that all the paperwork and documentation is necessary, time consuming, and does add value—even though it may not always appear so. Our computerized charting is getting more sophisticated and has been redesigned to be easier to use. We need to be able to communicate shift to shift, from person to person, and have a record of what happened in the past for the insurance company and your other care givers.

16. The traditional role and look of a nurse has radically changed. Over 11% of nurses at NCH are now men who add tremendously to the profession. Having a gender bias is just out of date since nursing is such a satisfying profession for all concerned.
17. Most every American avoids sickness and infirmity. But not nurses. Their calling is to be with you when the chips are down. They cannot always cure but they can comfort. This attribute, combined with the technical skills of modern medicine, makes a profound difference.
18. At the very end, most likely a nurse will be with you and your family. Most people rarely experience death. But not nurses, as they are accustomed to helping us through the final moments of life. This transition from life to death is an experience we all will have, even though we spend most of our life in denial. Nurses understand this unavoidable passage. Simply put, they’ve been there before.

So at the beginning and end of life, and more than a few times in between, the profession of nursing touches us with compassion and care.

We should all listen, take advantage of the wisdom that comes with experience, and benefit as much as we can from this most noble profession.

Past Health Advice Articles

Dr. Allen Weiss is CEO & President of the NCH Healthcare System. He is board certified in Internal Medicine, Rheumatology and Geriatrics, and was in private practice in Naples, Florida from 1977 - 2000. Dr. Weiss is active in a variety of professional organizations and boards, and has been published in numerous medical journals, including the American Journal of Medicine and the Journal of Clinical Investigation.