Here is another article that helps define staffing levels from a patient’s perspective.
From the nurses’ viewpoint, I especially liked the statement “they are asked to be everything – nurse, house cleaner, secretary”. This is, unfortunately, the trend in nursing. When cutbacks occur in one of the other patient care disciplines, the nurses are expected and told they are “to pick up the slack”.
Nurses today have very little time to spend doing actual nursing. Between all the legalities of charting and being the unit clerk, the housekeeper, the dietary aid, the pharmacy clerk, or the phlebotomist, nurses have little time left over for patients. This article shows that patients are beginning to recognize the problem and are beginning to attribute the problem to the correct source. Yea!!!!
Nurses really want to be nurses. We want to spend time with our patients and talk to them and their families. We want to help make our patients comfortable and improve their health status. We want to advocate for them when they are unable to do so. We just don’t have the time anymore. If we forgo our charting requirements, we may be written up by our supervisors and, worse even, we may find ourselves embroiled in a legal dispute over inadequate care because all nurses know “if it isn’t charted, it wasn’t done”. If we opt to actually take care of patients, the discharged rooms go uncleaned, the diet trays don’t get passed, the medication orders don’t get checked and rechecked, the blood draw goes undone at the correct time. One person is now and always will be just one person, no matter how many hats you place on the head.
By Robert Higgs
January 12, 2009, 6:30PM
Published April 4, 2008
Nurses can make or break a patient’s hospital stay. National studies provide concrete evidence of their importance at the bedside to reduce patient deaths and life-threatening complications.
But patients in Northeast Ohio weren’t overwhelmed with how nurses communicated with them.
And many nurses complain that they are asked to be everything – nurse, house cleaner, secretary. And the strains may be showing.
In a national survey of patient satisfaction, Medicare asked patients how well their nurses communicated. Seventy-three percent of patients nationally said their nurses always communicated well, according to Medicare scores.
Just four local hospitals topped that figure.
Most of the region’s hospitals also fell short of the 79 percent national figure for patients who said their doctors always communicated well.
But nurses make up the largest share of a hospital’s work force, and they’re the ones who are at patients’ bedsides 24/7.
“Absolutely — nurses make the hospital experience,” said Jan Lanier, deputy executive officer of the Ohio Nurses Association. “We have tried to make that point. But I’m not sure everyone is hearing that.”
Experts say the patient survey data, while good, don’t tell the whole story. Patients may be unsatisfied but could still be receiving quality medical care. But these and other indicators give patients a stronger voice in the delivery of their care.
Nearly all hospitals hire companies to survey patients about their experiences. Such patient information prompted a new program at Lake Hospital System about a year and a half ago, said Mary L. Ogrinc, senior vice president of patient care services.
It ensured patients are visited every hour, usually by a nurse, regardless of whether they called for help. Seventy-six percent of Lake Hospitals’ patients in the Medicare survey said their nurses communicated well with them.
“We check in on the patient to find out do they have pain, do they need to go to the bathroom, are they comfortable?” Ogrinc said.
She said they will know soon if these routine rounds are reducing the number of calls patients make for help.
The Cleveland Clinic, nationally recognized as a premier health center, also has done internal reviews of patient satisfaction — a level it knew “wasn’t so good,” said Dr. Bridget Duffy. Known as the “chief experience officer,” Duffy was hired last year to improve Clinic patients’ opinions.
One patient’s spouse was so frustrated that she contacted the hospital ombudsman.
“When I first called [the ombudsman] to complain, there was no answer and someone told me, ‘Oh, yeah, they’re really busy,’ ” said Robin Hryckowian. “What does that tell you?”
Hryckowian said her husband’s calls for help often went unanswered, including calls to bring back his urinal. That happened on several occasions, forcing him to use a cup.
Her 49-year-old husband, who had colon cancer, later died. But the uneven care still upsets Hryckowian.
“I hate to make a general sweeping statement, because some nurses were very good,” she said. But Hryckowian said she felt as if she couldn’t leave her husband’s side, that she had to be there to watch him.
The Clinic’s high volume of extremely sick people — it’s 92 percent full on most days and more so on the weekends — can leave nurses overwhelmed and maxed out, Duffy said.
Nurses could be so concentrated on providing care that the communication could be suffering. And, she said, some doctors may not be doing their part in communicating to the nurses.
About 2,500 U.S. hospitals participated in the Medicare survey. Medicare officials believe that as they begin to update it quarterly, the number of hospitals involved will increase to nearly 4,000. Ultimately, Medicare will dock nonparticipating hospitals $100 for every patient discharged.
Medicare has taken the lead nationally in releasing data to the public to compare hospitals. Besides learning about patient satisfaction, people can check how much Medicare pays hospitals for common procedures as well as how hospitals care for patients with conditions such as heart attack, heart failure and pneumonia.
In the satisfaction survey, patients were asked three nursing questions:
• How often did nurses treat you with courtesy and respect?
• How often did nurses listen carefully to you?
• How often did nurses explain things in a way you could understand?
The new patient satisfaction numbers highlight a struggle that’s happening in Ohio and other states about how to keep nurses at the bedside as patient advocates. The national shortage of nurses, exacerbated by some who have left the field because of burnout, has led initiatives to turn that around.
Ohio, while experiencing a shortage, isn’t in as bad a shape as other places. The state has many nursing programs, and in fact, people are lined up waiting to be trained to be nurses. But there are not enough slots to teach all of them.
A group of vocal Ohio nurses are advocating mandatory nurse-to- patient ratios similar to California’s, where there is supposed to be one nurse for every four patients.
They also want whistleblower protections for nurses who report on unsafe conditions for patients.
On the other side is the Ohio Nurses Association, in conjunction with the Ohio Hospital Association, which supports legislation that would require hospitals to create nursing staffing plans that use the best research available and establish a “nursing-care committee” that would include direct-care nurses. The Ohio House passed the bill.
They believe a mandate could hurt patient care, requiring a certain level of nurses in one area without the ability to move them to another department experiencing a surge of patients.
Critics have labeled it a “faux reform bill” aimed at blocking real patient safety provisions that Ohio needs.
“Right now we have nothing,” Lanier said.
“Our belief is that something is better than nothing.”