There is room for improvement in the Nurse call system. We all have a big red button on our bedside remote, labeled Nurse. We have many different reasons to press it: need water, pump alarm going off, having trouble breathing, and so on.
Typically, the call is answered by the unit's secretary, who then (in theory) informs the appropriate person to take care of the request. Secretaries have more duties than just answering these calls, so sometimes they are away from the nurse station. In that case, somebody else will respond -- could be a nurse, or an NSA. If you're lucky, it's your nurse, and he or she says, "I'll be right there," and you know it's true. If it's anybody else, you enter a zone of uncertainty.
The initial response to pressing the button is inevitably, "Can I help you?" After you convey your request, you almost always hear, "I'll tell your nurse," and that's the last you hear from the secretary. Typically, the nurse comes by in a few minutes, so all is well.
Typically, the call is answered by the unit's secretary, who then (in theory) informs the appropriate person to take care of the request. Secretaries have more duties than just answering these calls, so sometimes they are away from the nurse station. In that case, somebody else will respond -- could be a nurse, or an NSA. If you're lucky, it's your nurse, and he or she says, "I'll be right there," and you know it's true. If it's anybody else, you enter a zone of uncertainty.
The initial response to pressing the button is inevitably, "Can I help you?" After you convey your request, you almost always hear, "I'll tell your nurse," and that's the last you hear from the secretary. Typically, the nurse comes by in a few minutes, so all is well.
However, there have been more than a handful of times that the nurse does not come in a few minutes. A few days ago, I called the nurse station about a pump alarm. "I'll tell your nurse." Fifteen minutes later, the alarm is still going off, and there's no nurse. I call again. "I'll tell your nurse." Five minutes later, the nurse comes, pleased at having timed her arrival just as the alarm was going off. When she hears that the alarm has been going off for 20 minutes, she is puzzled. She had not received a page after my first call. (She had received the second page, but mistook it for one about a patient she was attending at the time.)
My worst case, when I first started having a significant fever, required about 75 minutes and multiple requests for attention before there was any indication of a response, and that was only because my father went out into the hall to find out what was going on.
There was a small but extreme case of non-communication a few nights ago, where the responder never spoke, just opened the channel, heard the pump alarm, and closed the channel again, causing me to call again. He or she perhaps figured that the treatment I was receiving not only cured leukemia but also gave me mind-reading capabilities.
Earlier today, I called about a pump alarm, and the secretary hung up on me without saying anything (but did tell the nurse, who came shortly).
As I write this, I am 15 minutes past "I'll tell the nurse," with a pump alarm going off. Just called again. "I'll tell your nurse." I've been here long enough (9 weeks, 1 day) to know that all this alarm means is that my magnesium is done, and I don't need to worry, and I barely notice the alarm anymore because I have heard it so often.
The nurse comes in, 20 minutes after my first call. She did not receive a page after my first call. Earlier today, she walked past a patient room, heard the alarm, went in, asked if the patient had called, and learned the patient had called 20 minutes earlier. In that case, again, no page.
So, one problem is the secretary (or whoever receives the request from the patient) not actually following through on the promised response to tell the nurse.
Even if the nurse has been contacted, there is no guarantee that the nurse can respond right away. There are plenty of legitimate reasons that you might not get an immediate visit from your nurse: your alarm is less pressing than the needs of another patient at the moment, your nurse has been called away from the floor, the pagers aren't working...
Whatever the cause for the delay, let the patient know. It's common courtesy, and good customer service. "I'm sorry. Your nurse is with another patient right now and might not be there for 15 minutes." "I'm sorry. I paged your nurse but haven't heard back. I'll try again, and if I don't hear anything, I'll send in another nurse."
There was a small but extreme case of non-communication a few nights ago, where the responder never spoke, just opened the channel, heard the pump alarm, and closed the channel again, causing me to call again. He or she perhaps figured that the treatment I was receiving not only cured leukemia but also gave me mind-reading capabilities.
Earlier today, I called about a pump alarm, and the secretary hung up on me without saying anything (but did tell the nurse, who came shortly).
As I write this, I am 15 minutes past "I'll tell the nurse," with a pump alarm going off. Just called again. "I'll tell your nurse." I've been here long enough (9 weeks, 1 day) to know that all this alarm means is that my magnesium is done, and I don't need to worry, and I barely notice the alarm anymore because I have heard it so often.
The nurse comes in, 20 minutes after my first call. She did not receive a page after my first call. Earlier today, she walked past a patient room, heard the alarm, went in, asked if the patient had called, and learned the patient had called 20 minutes earlier. In that case, again, no page.
So, one problem is the secretary (or whoever receives the request from the patient) not actually following through on the promised response to tell the nurse.
Even if the nurse has been contacted, there is no guarantee that the nurse can respond right away. There are plenty of legitimate reasons that you might not get an immediate visit from your nurse: your alarm is less pressing than the needs of another patient at the moment, your nurse has been called away from the floor, the pagers aren't working...
Whatever the cause for the delay, let the patient know. It's common courtesy, and good customer service. "I'm sorry. Your nurse is with another patient right now and might not be there for 15 minutes." "I'm sorry. I paged your nurse but haven't heard back. I'll try again, and if I don't hear anything, I'll send in another nurse."
Because if we don't see a nurse within 5 minutes, we start wondering if you actually paged the nurse, and with good reason. In many cases, we're going to worry, and with good reason. Worry is bad for our health, so don't undermine the excellent medical care we're getting with your poor communication skills. Keep us informed, unless you know, for sure, that the nurse or whoever is about to walk into our room.
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And another (minor) thing... I don't really understand "Can I help you?" as the standard response to the call button. I pressed a button that effectively means, "I need help." "Can I help you?" is not the right response. I'm constantly tempted to say, "I certainly hope so."
"How can I help you?" makes more sense, but maybe the hospital's supply of that question has been commandeered by Food Service so that they can get their calls off to an inefficient start by asking how they can help me instead asking for my name, which they need before they can actually help me by taking my order.
I associate the phrase, "Can I help you?" with either mixed or negative situations. There are the sales staff who approach you as you browse the offerings at a store, which is sometimes appreciated and sometimes not. I associate it even more with people who are actually saying, in a sarcastic way, "Stop invading my (expansively defined) space/bothering me/existing." Parents of teenagers may know what I'm talking about.
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Of course, tone makes a big difference. And many of the secretaries say, "Can I help you?" with a tone that makes it clear they want to know how they can help you. These are the ones that often fulfill the request themselves, if it's not medical: bring you water, or a copy of your most recent labs, or a juice.
And another (minor) thing... I don't really understand "Can I help you?" as the standard response to the call button. I pressed a button that effectively means, "I need help." "Can I help you?" is not the right response. I'm constantly tempted to say, "I certainly hope so."
"How can I help you?" makes more sense, but maybe the hospital's supply of that question has been commandeered by Food Service so that they can get their calls off to an inefficient start by asking how they can help me instead asking for my name, which they need before they can actually help me by taking my order.
I associate the phrase, "Can I help you?" with either mixed or negative situations. There are the sales staff who approach you as you browse the offerings at a store, which is sometimes appreciated and sometimes not. I associate it even more with people who are actually saying, in a sarcastic way, "Stop invading my (expansively defined) space/bothering me/existing." Parents of teenagers may know what I'm talking about.
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Of course, tone makes a big difference. And many of the secretaries say, "Can I help you?" with a tone that makes it clear they want to know how they can help you. These are the ones that often fulfill the request themselves, if it's not medical: bring you water, or a copy of your most recent labs, or a juice.
On the other hand, others convey annoyance, boredom, fatigue...
There is one secretary here who surpasses them all in her negative tone. Her rendition of "Can I help you?" is set to a melody familiar to parents.
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| I do not have the knowledge to write this score. I could not even have told you how many lines on a staff. Original draft by my father, with help from Wikipedia. Final draft by me. |
It's the melody that usually goes with the lyrics, "Do I have to?" So you feel like that's what she's really saying, despite the words.
This same secretary has a lot of trouble keeping her finger on the Talk button long enough to complete her response. So after you burden her with your unreasonable request for water, or pain relief, or breathing assistance, you might get the response, "OK, I'll (click)." You'll what? Forget to page my nurse? I'm sure you have better things to do than respond to patient requests for help, but once you've stirred yourself to listen to my plea, the least you can do is hold the button down for the whole 10 seconds (or less). If that's too hard, please get another job.
One thing that could possibly help...have the protocol response include the identity of the responder: "This is Bud/Jim/Lorrayne at Nurse's station...".
ReplyDeleteIt would especially help when the responder is not the expected/standard one.
Of course, the idea is to make it a tad more important to every responder that his/her promise to the patient gets carried out.
Since the patient knows he's calling to get help of some sort, the "This is Bud..." protocol might even be sufficient, without any needless query about what help is wanted.
I like that.
ReplyDelete