"Effectively" is the key word here.
Communication does not seem to exist in the hospital.
Think of nurses as project managers. They basically coordinate everything for the patient and he/she is the expert resource to everyone in the healthcare team if there is any questions/comments/concerns about the "project" or patient in this case.
Let me just say, I NEVER want to be a project manager. If I were, I am sure I would be a very strict one because I don't enjoy wasting my time chasing after people to do their job. Time is money. I expect them to know their role and have it done when it should be done. No excuses.
Day shift is very busy because the day starts off with the MDs making their rounds. Right after they make their rounds they sit in front of the computer and start to put in new orders depending on what happened over night with their patients. As the nurse, on top of the normal AM routine that needs to be completed you also are starting your day with new orders that need to be done. Examples of new orders that are usually placed in the AM are: take down PCAs, start patients are oral pain meds, draw stat labs if needed, hang electrolyte replacements, assist MDs with dressing changes ect. Specifically, what makes day shift so busy is the tracking down of people to do things that should have already been done. Especially when it comes to discharging patients and patients that are "NPO" or nothing by mouth. Let me explain.
Patients that have been "NPO" since midnight the FIRST question they ask me as the day shift nurse is, "when can I eat?" They have been fasting for 8 hours by the time I see them. Often doctors place patients on NPO status for a POSSIBILITY of a procedure. The doctors will know by 10 am or by noon that the patient WILL NOT be going for the procedure but don't think about the fact that this patient has not had anything to eat or drink in almost 12 hours waiting for this "procedure". That is when I have to take the time to track down the MD and ask why the patient is still NPO. Are they still going to for the procedure or not? More often than not, the reply is: "oh no we decided not to do the procedure. I forgot to change the orders ill do it right now"or "we are waiting on cardiology (or some other team that is consulting on the patient) to get back to us on the procedure". That bothers me. The reasons are 3 fold. First, if you are waiting on another team to decide, pick up the phone and find out right now and call me back with a response so I can inform my patient what is going on with their care. Second, my patient was left starving because of carelessness because you forgot to discontinue the NPO order. Third, I had to waste my time I could have been doing something else because the MD doesn't know how to effectively communicate and do his/her job.
Busy is not an excuse. We are all busy. It's part of the job.
I hate, I mean I absolutely despise having to waste so much of my 12 hour day chasing people down to put in orders or just simply do their job. Calling pharmacy to track down where medications are or why the pyxis has not been restocked. Having to go to the pharmacy myself to pick up medications that should have been delivered. Finding out why I don't have paper work that should have already been completed by the time the patient is discharging. Calling multiple MDs to clarify an order or put an order in. Calling MDs to come up and consent patients for procedures that THEY put orders in to be completed. Releasing orders MDs wrote hours prior to the patient coming to the floor and making sure they apply to the patient's current status just to name a few. It's very frustrating. The reason for it all is COMMUNICATION. No one communicates in the hospital. Everyone works as their own entity. It makes absolutely no sense. All the different aspects of the healthcare team is working for the patient. Everyone SHOULD be communicating. God forbid I am discharging patients...
Patients that are being discharged need a lot of things to be coordinated. Where are they discharging to? Is family picking them up or are they leaving by ambulance to a nursing home? If by ambulance, is all the paper work completed? Who do I need to call to give report to? Are their prescriptions filled? Did the MD even write the scripts? Does their insurance cover their prescriptions? If it doesn't, what is going to be done about it? Do they need assistive equipment such as a wheelchair or walker? Have they received it? If not, I need to find out why and when it will be delivered? Is there discharge orders? If not, I need to contact the MD. You get the picture? Now times that by 2 or 3 patients being discharged. It's absolute chaos.
Four or Five hours easily lost coordinating all of this on top of doing my daily job responsibilities as a nurse. I love being a nurse and caring for patients. I do not like chasing people down to do their job so that I can do mine effectively.
Nurses are what make a hospital function. There are really good nurses and their are bad ones. Not every nurse will be proactive and find out why the patient is still NPO or go pick up medications from the pharmacy to administer it on time. It's not an easy job. Not everyone is cut out for it.
I am so passionate about it because I really care about my patients. It frustrates me when people are careless in their care of patients. When people are hospitalized it is a traumatic experience. They are already stressed about a million different things. They should not have to stress because a doctor forgot to put in an order or is waiting for another team to come up with a decision. Be proactive! Get answers! It's not fair to leave patients waiting.
What happens when we have that one patient that is proactive in his/her care and demands the MDs come in and explain why they want to do a CT scan, why they want to place a foley catheter, or why they want to start the patient on a new medication. That patient is labeled as "difficult". That is sad. Because most of the time in the hospital we OVER utilize resources. Patients just trust the doctors know what they are doing. As the patient, it is YOUR body, YOUR health, YOUR care. Be involved! It is our job as the health care team to communicate and explain. If someone has a problem with that, they need to re evaluate their profession.
Communication is a difficult issue to solve in any setting. Most importantly I start with myself. If I effectively communicate it makes my job that much easier. Then collaborate on committees to try to establish a system that facilitates better communication. Problem solving is key and with change comes resistance.
Be adaptable.
Remember that change starts with you first.
Leaders create more leaders.
Until next time.
-Norah
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