UNDERSTANDING HOW THE SYSTEM WORKS
In nursing, administration gives an RN anywhere from 5 to 8 patients to juggle on an average medical/surgical floor. Typically, the job would go smoothly if you never asked for anything and your "scheduled" needs would likely get handled without exception. However, this is not realistic, therefore the RN is in a position of juggling many balls to try to accommodate and take care of all of his/her patients needs. Your job, as the patient, is to try to get your "unscheduled" needs fulfilled. I am not talking about a food request but an urgent need for pain medication.
KNOWING WHO YOUR RN REALLY IS
It can be difficult, especially if you are ill and not fully aware of your surroundings to read someone's badge and figure out who is who when all these strangers enter your hospital room. Good news - you can ask! Your RN is usually more than happy to let you know what job title they hold. In addition, you can observe the employee in your room and discern your RN from a nurse's aid by the jobs they do. An RN is in charge of your medication, whether it be in pill or IV form. The RN does "invasive" procedures like starting an IV, placing a foley catheter or nastrogastric tube into the body or calling the doctor. The RN rarely has time to dump your urinal, get you up to the bedside commode, deliver your food tray or help you eat your meal (if you are unable to do so). This is just a matter of time management because your RN has too many tasks to attend to, to do the nurse's aids job. To further complicate everything that is going on, your nurse has to create gobs of paperwork to "justify" everything he/she does. In some cases, this is to get the hospital their insurance reimbursement and in other cases, it is to protect the hospital and the RN from lawsuits.
WHAT HAPPENS WHEN I RING THE CALL LIGHT?
Nine times out of ten, a nurse's aide will answer the call light. If the request is something that requires the RN, the RN will be informed of the need.
GETTING SOMETHING FOR PAIN
When you ask for pain medication, the nurse's aid will usually tell the RN. If you have not received something within an hour, you can assume your request has been interrupted along the way. I know an hour seems like a long time to you, the person in pain but with the juggling tasks of the nurse, this span of time can go by in a blink of an eye. If the RN has nothing else to do at that moment (freakishly rare) she may be able to get you the pain medication within 15 minutes. Be sure to speak up after about 45 minutes and let the nurse's aide know you haven't received anything for pain yet. If there is nothing ordered, the RN should take the time to let you know and make you aware that he/she is trying to reach the doctor for an order for pain medication. From there, paperwork has to be sent and the pharmacy has to make the medication available to give - this takes a long time as well. The take-away message here is to ask as soon as you are uncomfortable because typically, pain increases without pain medication.
GETTING MY OTHER NEEDS MET
Aside from pain medication, a sudden medical emergency and your scheduled medications, labs or tests, a nurse does not put the rest of your wants very high on his/her priority list. Being a pleasant human being to your nurse when they enter your room will get you the most attention and the best care possible. This positive attitude goes for your visiting family and relatives as well. Why is it so important? Because it is human nature to avoid "stressful" situations and your nurse and other ancillary staff are only human. If I interact well with the patient and their family, I am far more likely to be in their room and attend to their needs.
CHANGE OF SHIFT
Why can't I get anyone's attention when I ring my call light? Typically, during change of shift, all of the staff is busy trying to hand over a report about you and their other patients to the next oncoming shift. In most hospitals, the shift remains 12.5 hours long. So, if the employees start their jobs at 7am, they do not leave until 7:30pm, giving them a 30 minute break during the day for lunch, if they are lucky enough to find that time. What does this mean to you? You will probably not get great care if you are on your call light from 650am to 730am and from 650pm to 730pm. Keep in mind that other hospitals have different shift change times and some are 8 hours long and others are 10 hours long.
REALISTIC EXPECTATIONS
This is managed care nursing at best. Hospital administration is busy trying to squeeze as many dollars out of each nurse that they can. Although you may hear how the hospital cares about your needs, they also care about their bottom dollar and juggle both by squeezing staff in the middle. This creates nursing burnout very quickly. Therefore, nursing work is very stressful and very high energy all day long. In addition, nursing work pays very poorly for the level of expertise the nurse must command and the output of work he/she must perform. There really is no wonder to many nurses why there is a nursing shortage. The years it takes to become a knowledgeable expert and the liabilities the nurses now shoulder, makes this a field that needs to command more money for the work being done. You as the patient, need to start demanding nursing staff with lower ratios. What does that mean? Your nurse should have 4 or 5 patients on a typical medical/surgical floor and he/she should have a nurse aide that has no more than 8 to 10 patients to care for. Until we, as nurses, make the the public knowledgeable and get you fully behind us we cannot advocate for the patient properly. Organizations like CNA, The California Nurse's Association, have done great things in the state of California for their nurses and we can all hope their efforts will translate into national legislation that protects the patient and decreases the work stress of the nurse.
