When I first read this article, I was amazed by the fact that it is newsworthy to talk about spending time with your patients. That stopped me cold for a few minutes. Then, as I reread this article, I wondered just what the staffing pattern is in this hospital. What is the nurse:patient ratio?
It is apparent that to enable this “relationship-based nursing” the nurse must be able to spend quality time with patients and it seems that a fair quantity of time was needed in this instance. I am all for building trust and establishing continuity in treatment, but I usually am in the minority. When a nurse has 8-12 patients each shift, where does that nurse find all this time? Between charting, transcribing doctors orders (some of which need some form of clarification–needing a call to the physician), administering medications, treatments, IV therapy, and such when do you get to sit and talk with your patients?
I am a psychiatric nurse and I am supposed to spend time talking with my patients, but with increased work load, more paperwork, clarification of ambiguous orders, and dealing with emergent situations, I am lucky to spend a few minutes each shift with each individual patient during which I am doing my assessments. I would love to be able to just sit down and talk with my scared, psychotic patients or my sad, depressed patients but rarely do I get to do so.
Let me know what you think about this and if you have any ideas or solutions, I’d love to hear them.
January 30, 2010, 8:15AM
A Nurse’s Journal Kathleen Koviak University Hospitals
A Nurse’s Journal is a column written by nurses about their working experiences. Today’s author is Kathleen Koviak, a registered nurse at University Hospitals.
At University Hospitals we have something called relationship-based nursing (which is similar to “primary nursing,” a term some of you may have heard). The goal is to consciously build an intimate relationship between the nurse and patient by assigning the same few nurses to a patient during his or her admission to the hospital.
This practice helps the patients and their families feel like someone is personally overseeing their nursing care.
During the summer of 2008, newly licensed and still working alongside my preceptor during orientation, I had my first opportunity to sign up for an “RBN” patient. She was a dignified lady—tall, intelligent, and well-spoken. She was very sick, and required an extended stay.
Every morning half a dozen or so doctors in white coats would come into her room and tower over her, or so it sometimes seemed to her.
One day she asked me to be there with her at her side when they came in, to remind her of the questions that she wanted to ask of them. Everyday I tried to do that for her. She expressed her appreciation, and I could see that my presence comforted her.
It is for instances like these that I decided to become a nurse.
In consistently working with her, I came to know the “little” things that I could do to make her hospitalization as stress-free as possible.
She required more than one blood product transfusion during her stay, and I had the opportunity to sit and converse with her for an extended period of time while periodically monitoring her vital signs.
She told me of her travels, of her family and how proud she was to live in Cleveland and the privilege she had of being able to contribute to the community. By her discharge from the hospital — much improved in health, I’m happy to say — I had gotten to know her pretty well, and she had gotten to know me, too.
I hope that she will never again have to be admitted to any hospital, but I feel that, partly due to the practice of relationship-based nursing, she would feel secure in her nursing care here.
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