How many of us, as nurses, have had the experience of speaking to an “enflamed” family member, and practiced all our communication skills to bring calm and rational judgment into play? Recently, in the midst of a friend’s pain crisis and a families’ sense of being overwhelmed and powerless in a hospital’s decision to discharge without effective treatment rendered, I had the opportunity to use some of these skills—with the hospital staff.
I had a “run-in” with a nurse manager at a regional hospital. Though this was only a phone conversation, this person’s irritation, even anger, with me was a palpable sense through the radio waves. She had been given an order. She had already applied her decisive approach to the patient and family and spoke as though there were no options available. She was orchestrating the discharge. She really did not want to talk to me.
It makes me wonder: Are we listening, when family express great concern about symptoms that medical staff seem to downplay? (Remember, who decides what “pain” is…us or the patient?)
Are we listening, when the stoic patient is making statements like “I just want to die” with pain totally out of control, and the treatment furnished is not effective?
Here is the dilemma: It is a weekend, the specialist is not available until the following week, and the hospital has limited beds. Here is the answer: Send him home, and perhaps hurry up the appointment with the specialist? Not acceptable.
One statement is never the right answer: There is nothing more that can be done. There is ALWAYS something that can be done. For one, ADVOCATE. Every nurse needs to have this role. We are the “eyes and ears”, we are the ones the family is depending on, to listen and see what is happening, using our refined clinical expertise and judgement, to defend the patient from a system that does not always see the individual, does not necessarily care if the home situation is adequate, if the symptoms are controlled, or if the cause of symptoms has been deduced. This is not a coding problem, or a patient-bed management solution, or an insurance issue…this is first and foremost, really seeing the patient. I can’t help but wonder, with all our technology and streamlined productivity and effectiveness, are we missing the most important aspect of providing medical care…LISTENING WELL?
In the business of the day, in the overworked staff’s experience, and in the power that rests in the hands of the decision makers, we must first and foremost advocate for the patient and family, and truly demonstrate what most medical establishments’ mission statements claim: The patient/family unit is at the CENTER of all the care received from the entire medical team.
Thanks again for your continued and thoughtful posts. I’ve shared this one with a neighbor friend of Jan’s and mine who is a nurse; her son is also starting out his career in nursing. Shalom. —dave
Amazing and frightening. I have felt for many years that everyone in the hospital needs an Advocate. But now, it seems the Advocate is needed more than ever. Totally agree that we should never say, ” There is nothing more we can do.” There is always more we can do to control symptoms. I’m sure your friends appreciate having you as an Advocate. Thanks for all you do.
just wondering, was there a solution to that sounds like unhealthy early discharge?
Yes, discharge was delayed and in fact he wasn’t sent home until symptoms were much improved.
Agree. As always make great points!