Nursing Notes

February 3, 2010

Nurse-patient relationship lends personal touch to hospital stay: A Nurse’s Journal

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 UH-Koviak, Kathleen2.jpgKathleen 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.

  • Previous columns in A Nurse’s Journal
  • 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.

    Please go here for the original article

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    1. “If we only had more staff I could spend more time with my patients”. I’ve heard that cry from the heart from countless nurses and healthcare assistants. And yet, in most healthcare environments there are no more staff to be had. There’s just you and the team around you. And your frightened, distressed and lonely patients, aching for eye contact, human touch and connection.

      What I know of Relationship Based Care is that it was designed to consciously create that connection. Between carer and patient, between nursing staff, between the nursing team and the wider multi-disciplinary team. Because it’s why most of us wanted to work in healthcare in the first place. To help patients. To work in a caring team. To be acknowledged. To be human.

      Shirley, you say you are in a minority in wanting to build trust and establish continuity of treatment. Is suspect that you might be wrong. My guess is that you are surrounded by distressed people, most of whom would love to do exactly that. And yet most of them, most of us, allow ourselves to be run by circumstances. We tell ourselves that if only there were more staff/more time/less chaos/fewer crises we could do the important things.

      RBC sets about changing those circumstances. It STARTS from relationships, from the patient and family. It starts from knowing that the most crucial factor in healthcare is the relationship between patient and nurse. Nothing matters more.

      Get that right and communication all round improves, patients who feel safe interrupt nurses less, better quality decisions are made. Those things that seem to get in the way of spending time with the patient – like administering medications, treatments and IV therapy become times to strengthen the bond.
      RBC needs to be a whole organisation effort. Creating that caring and healing environment on your own is a tough ask. I’m not surprised that you feel it’s an impossible one. And yet there are small things you can do.

      Like making it a priority to spend just 5 minutes sitting with each of your patients every day, having a conversation at eye level.

      Like stopping to take just three deep breaths before you enter the patient’s room, bed space or home.
      Like asking “what’s the one thing that I could do for you today that would help?”.
      Try it. See what happens.

      And before anyone says it for me, I’m not a nurse – so how can I possibly understand. I’m a coach, trainer and facilitator. And I’ve worked for some years in healthcare supporting nurses to find different ways to provide care. I’m passionate about creating ways in which nurses can get back to what they value most – caring for patients.

      Comment by tillabrookcoaching — February 3, 2010 @ 9:57 am | Reply

    2. This article makes me sad. Sad, because this is what I was taught in nursing school over 20 years ago. Sad, because we are talking about relationship-based nursing like it’s a new thing. Sad, because so much of my university nursing program focused on communication skills with patients. (There was even a movement going on while I was in nursing school to call our patients “clients”.) The theory wasn’t new even then. Does anyone remember the nursing school movie that must have been made in the 1960’s called “Mrs. Johnson Needs a Nurse”?

      I was drawn to the study of nursing because it combined the science of medicine with psychology and sociology. Most of us were drawn to nursing because of the “caring” aspect of the caring profession. I could never have imagined how limited my actual “emotional caring” contact with patients would be . . . there is never enough time to take care of the critical fundamentals, much less be there to provide the hope and encouragement that patients need. It’s no wonder that nurses are leaving the profession, and even those staying have a low satisfaction level. Sad indeed.

      Comment by kitchrn — February 5, 2010 @ 3:04 am | Reply

    3. I share the same opinion as the writer. Very interesting and I imagine that a lot of people would agree with myself with regards to the report. Awesome Stuff and many thanks for such an informational read!

      Comment by Earle Zavacky — August 29, 2011 @ 11:37 am | Reply

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