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What Nurses Wish People Knew About Hospitals/Hospitalization [Part 1]
A happy nurse! Clearly staged.
From a nurse with over a decade of experience working in acute care, adult populations on cardiac telemetry and critical care step-down units… here we go.
What Nurses Wish People Knew About Hospitalization
Hospitalization is not fun for anyone. As a nurse, it is what I do: I take care of people who have the great misfortune of meeting me under these circumstances. Given my specialty, it means they broke something or have had a neurovascular event or surgery. It is not a fun experience for people, by any stretch of the imagination. As much as I can, I try to inject humor into things, particularly as the hospital day moves forward. People can be easily frustrated, because almost all autonomy is taken away. Trust me, we do not enjoy torturing you (that’s the physical therapists).
You will have your autonomy taken away. Hospitals, by design, are meant to be a very controlled environment. On my unit, almost all patients are cardiac monitored. While we are lucky to have technology that allows one to be monitored more freely and not attached directly to the bedside monitor, it is still pretty restrictive. There will be wires and tubes everywhere. We will do our best to position them in such a way that you can move around in your bed. Let me, rephrase that. We will do our best to position the tubing and wires in such a way that you can wiggle around in your bed and possibly roll over a few times. Largely, you will not be allowed to freely walk around in your room or outside of it (particularly with COVID). Many times, there will be a bed alarm. More on that later. We will ask you to call us for everything. I’m not joking. Everything. Want to urinate? Great! Call us. Want more water? Call us. Want to sit at the chair instead of the bed? Call us.
This is a “sexy patient” costume. I couldn’t make this up if I tried.
You will not have very much privacy. We do our best to help maintain modesty, but biological functions being what they are and limited mobility being what it is, you may find yourself in need of someone to clean you up. Sometimes it will be more than just one someone. I guarantee you, this is not unusual. While you may feel embarrassed or upset that someone is doing this for you, it is often for the best. If you can help, we would love you to! If you have mobility, it’s best to use it. If you can wipe yourself with bath wipes, great! We are pleased to let you do it. There will be times that we do not let you alone: bathrooms and showers are a good example. It isn’t that we do not trust you. It is that you are in the hospital. Not only are there liability issues, but if anything ever happened to you (and sometimes is does), we need to be within arm’s reach to break your fall, guide you to the ground, and deal with whatever may arise. Really. We get no joy out of sitting with you at the toilet. It’s just necessary.
Please do not try to “be helpful”. If you are in a position to be helpful, you’re probably getting discharged. If you aren’t, ask the nurse if there is any way that you can assist in bathing, toileting, etc. Also, ask the aide. The aide is there for most of your bodily functions and they are an unused resource in the nursing world. Many of our aides have been CNA’s for longer than our nurses. One just celebrated her 20th Anniversary. Oftentimes, when people try to be helpful, there is a fall, or something gets dropped/broken, or people are massively inconvenienced. It often has the exact opposite effect of what you are trying to do. We appreciate the sentiment, really we do, but more than helpful, we want you to be safe and well. If that means that me or my aide are at the bedside grabbing your charger that’s just a teeny bit out of reach, so be it. It’s one stitch you didn’t pull and one doctor I didn’t have to notify.
Please use your call button. Please. PLEASE. I cannot emphasize this enough. Use your call button. Do you have questions for your nurse that need immediate attention? Use your call button. Do you need to go to the bathroom? The second you think you might, use the call button. Do you think you can make it to the bathroom alone and try to be helpful (see above)? NO. Use your call button. Often, people will be tangled up in multiple wires. There are also bed alarms (more on this later). If you do not use your call button and get us on your own, there’s a decent change that those wires will get pulled off and your IV, pulled out. This means that we’ll have to poke you again and more often than not, there’ll be a bloody mess everywhere that will require everything to be changed, floors mopped… just don’t do it. Please call us. We’re really much happier when you do.
Borrowed from RD. Copyright is all theirs.
Please, PLEASE, use your call button. Do not send family to the Nurses’ Station. Again, people think they’re being helpful by coming up to the nurses’ station rather than “bothering” them with a call. More often than not, that’s an excuse and it’s transparent. We know you want your family member to get assistance super quickly and you think that showing your face and asking at the station will get you what you want faster. This is incorrect. At the station, your nurse may not be there. When you say something like, “My mom needs to go to the bathroom” to someone who appears to maybe be a nurse at the station, we’re pretty confused. You see, we don’t know every patient. We certainly do not know every patient’s family members. We don’t know who your mom is and now we’re going to have to ask follow-up questions. “I’m sorry, I don’t know your mom. Who is your mom? What room?” Then we will walk over to the paging system and page. So now, instead of getting a quicker result, you have made things much slower, as well as demonstrated to the entire staff that you are impatient or think that your family member deserves special treatment. That may not be what they’re thinking, sometimes people think it’s nicer not to page. Let me reassure you: pages are where it is at. In my call system as well as many others, if a call is not answered within a few minutes (meaning someone actually goes in the room), it rolls to the next higher person until it hits the charge nurse. If a page isn’t answered, trust me, someone knows.
There will be new and unusual sounds and alarms. On my floor, there are many unusual sounds and alarms. Many of them do not mean anything to the patients. If you hear an alarm in your own room and you just got out of bed, sit back down in bed. That was probably a bed alarm and you probably aren’t supposed to get out of bed without calling someone first. If you are in bed and you hear alarms, feel free to call the nurses’ station and describe it. Mimic it, even. If you know what the sound is, tell us. It’ll get paged out and usually resolved pretty quickly. Other alarms will be softer; these are usually alarms for the nurse to be aware of. If you can tolerate it, great, tell the nurse when she comes in where the sound was coming from. That’s helpful. If you don’t know, describe/mimic it. This is also helpful. Sometimes when something needs to be plugged in, it’ll alarm. As soon as we plug it into the wall, it’ll go away. It’s really an easy fix. Please tell us. We don’t want you suffering through all of the alarms if we can help it. You might also hear hissing sounds. That’s your oxygen. If you hear a high-pitched squeal and you’re on oxygen please immediately tell your nurse. It’s not dangerous. They probably just forgot to vent your oxygen humidifier and it will pop off soon if they don’t. Then there’ll be a puddle on the floor and a pain for the nurse/aide. If you hear bubbling sounds, that’s usually your chest tube. There’s a water seal (often) and it bubbles. This is normal. If you don’t have a chest tube and you hear bubbling, please page your nurse. I have no idea what that is.
Some of the unusual sounds will be other patients. On a neuro floor, some of the usual sounds for us are our patients. It can be really, really distressing for other patients. When you hear someone screaming, literally screaming, “HELP! HELP! AAAAaaaaaaaaaahhhh!” it can be borderline traumatic if you are sick in the bed next door. It can be terrifying. You might call the nurse and ask them for help. They might tell you that the patient is always like that. If you hear things like this, please do ask the staff. We really cannot break HIPAA, but we can reassure you that it is not an acute issue, they’re being helped, etc. If you hear a nurse or staff calling for help, please do not hesitate to also shout for help for the nurse or to use your call button to call for help. If a nurse is shouting for help, it is usually because her hands are full and something is going on (either a patient is trying to fall or there’s an emergency). This time, calling is actually helpful. If another patient’s sounds are really bothering you, please let us know and we’ll try to shut the doors. Sometimes we’re able to move you to another room. Sometimes, we can’t. We can offer earplugs and reassurance. In neuro cases, patients often do not understand what is happening and may scream and we cannot be there the whole time with them and sometimes, even if family can be, it does not stop the shouting. We’re sorry it isn’t very restful, but these patients need care too. Please try to have some compassion and some patience. We are all doing our best.
Thank you to @garymcvey and @sawatdeeka for the suggestion. It started to get exceptionally long, so I am breaking this up into two or three parts. I will also have a sequel: “What You Can Do To Have a Better Hospitalization” with helpful hints for friends and family. It will be some of the ideas here compressed with others to help people have a smoother ride in the hospital.
Published in Healthcare
It didn’t look nearly as good on me.
When I visited a patient in a dementia facility, it was a joy to spend time with her. But every now and then, one other woman would be sitting in the common area and she would start calling, “help”–softly, then louder, then louder until she was shouting. Every one, including staff, ignored her. After I’d been visiting for several months, I couldn’t help myself, and said to her, “Why do you keep shouting help?” I don’t remember her exact words, but it was something like, “It gets me attention.” Odd, since no one paid her any attention. She knew just what she was doing, and that even though she was ignored, she knew people heard her. She was quite bright, actually, but irascible, unfriendly and lonely. Sad.
With dementia, these things are a bit different. And yes, it gets easy to ignore those calls over time. You have to. Often times, dementia patients will make things up to cover for the fact that they don’t remember why they started calling for help to begin with. I’m guessing she said she wanted attention, but she knows it doesn’t get her any…so why would she do it? There has to be some sort of secondary gain. Unless, of course, she doesn’t actually know why she’s doing it.
We have neurologically intact patients who game the system to get attention. One such trick is tapping on their telemetry leads. Tapping it over and over and over looks like a lethal cardiac rhythm and will usually get the monitor to alarm over time, if not someone to tell the nurse to check on the patient. I have had patients do this in the past. When asked, they said they wanted something and knew that they would get attention faster if they faked an emergency. Unprofessional, unhelpful, and rude.
Those things happen, not just in nursing, but everywhere. Someone should write a post about people who “Game the System,” but they’d probably also have to do a series of posts. It’s awful. Especially when someone else has to pay the prices. Too depressing for me to write!
I bet @hankrhody would be game for it. (Or at least gamey.)
My Dad and his Cousin both were getting leukemia chemo treatments at the same time. I occasionally went with my Dad, and would see my Uncle. One of the things I saw him do, that was genius, was he always had a pocketful of gum or chocolates, which he offered to every nurse, aide, and volunteer in sight. They loved my Uncle, and greeted him by name and with a smile. My Dad was more stoic when receiving his treatments. He was treated with respect and consideration, but not with the same joy I saw my Uncle receive. They both received years of treatment, with breaks of course, when they would temporarily slow the progression of the nasty disease, so there was a lot of contact with the crew in the chemo department.
If I am ever in that circumstance, I hope to remember the manner of my Uncle. (I doubt it, because I am always so skeptical of the medical field… it is a practice right?)
Actually, I am very friendly with the nurses, and not only do I kid them, but they kid me back! It lightens the time for all of us, and it feels so good to feel that mutual appreciation. I’ll have to think about the chocolates! Thanks, @nohaaj.
“Hi! I’m just here to make you all fat!”
Being a patient is hard. The best thing is to remember to be kind.
Back in an earlier incarnation of Rico, there was an ongoing series of member posts called “What Your [service provider/job title] Would Like You To Know”. It would be lovely if this helped to resurrect it!
This post is terrific, exactly the kind of information I wanted! Thanks, TRN!
This times 100!
“Please, PLEASE, use your call button. Do not send family to the Nurses’ Station. Again, people think they’re being helpful by coming up to the nurses’ station rather than “bothering” them with a call. More often than not, that’s an excuse and it’s transparent. We know you want your family member to get assistance super quickly and you think that showing your face and asking at the station will get you what you want faster. This is incorrect. At the station, your nurse may not be there. When you say something like, “My mom needs to go to the bathroom” to someone who appears to maybe be a nurse at the station, we’re pretty confused. You see, we don’t know every patient. We certainly do not know every patient’s family members. We don’t know who your mom is and now we’re going to have to ask follow-up questions. “I’m sorry, I don’t know your mom. Who is your mom? What room?” Then we will walk over to the paging system and page. So now, instead of getting a quicker result, you have made things much slower, as well as demonstrated to the entire staff that you are impatient or think that your family member deserves special treatment. That may not be what they’re thinking, sometimes people think it’s nicer not to page. Let me reassure you: pages are where it is at. In my call system as well as many others, if a call is not answered within a few minutes (meaning someone actually goes in the room), it rolls to the next higher person until it hits the charge nurse. If a page isn’t answered, trust me, someone knows.”
If you don’t take anything else away from what TRN said in the OP, pay attention to this.
Almost 75 but never spent a night in a hospital. Wife was in for 2-3 days after knee surgery. Will try to remember these rules if I get sent to one. Would help if I knew you and Dr. B would be there.
Hey, I’ll be there by phone if you need me!
A complaint from a patient’s mother the other day: “You need to do something about all the crying babies. It’s not very restful.”
It’s a children’s ER. We are doing something, that may be the reason they are crying.
That’s when you just have to walk away and roll your eyes. People can be so stupid.
The imagery . . . my eyes hurt . . .
My work here is done.
The thought causes me stress, I need to go self medicate, with luck I will return shortly. Coherence not guaranteed.
Afternoon TheRightNurse,
As a tangential question, how would you improve nursing, or what short comings do you see in current nursing or nurses? For history, my pop was a doc and taught at IU med school for 25 yrs and had a private practice, my bros is a private practice internal med doc, my mom was a head nurse, and my wife was an orthopedic nurse in England, and worked as a clerk in Radiation Onc at the VA for 10 yrs and volunteered for 15.
Hello there, Child of Medicine! You poor thing. Your mom was a head nurse? Or a charge nurse?
England is a whole different wonderful wacky world. The VA is a lawless place; I cannot imagine how totally savage and how much of an absolute nursing God she must be!
Current nursing is too fixated on administration; much the same thing that ruins physicians. However, in order to appease the docs, they usually hire staff or have staff hired to do their audits. Nurses do their own, report on their own, police their own. The tasks are never reduced, only piled upon more.
To improve nursing? I would return nurses to nursing. Right now, nurses have had to specialize just so that regular nurses can do less nursing and more documentation. Indeed, entire positions exist now to prevent litigation, not becausr it is anything too complex for the standard hospital nurse. No, these positions are created primarily to do the work so that it can be *documented* properly.
This is the shortfall of nursing. There is less and less time for care and more time for documentation and litigation prevention. Nurses, thusly, are encouraged to behave as superhumans: eventually becoming disenchanted and leaving or losing touch with a large part of their humanity in order to comply with the necessary audits and “proof of productivity”. Unfortunately, one can not measure compassion: it is certainly not terribly productive. Sitting with a patient might bolster one while denying other their jello retrieval and reducing the HCAHPS scores which dominate all things. “Value Based Purchasing” and productivity determine everything and nurses are largely expected to be used up in a short span of time. Turnover is often high since nurses are more commonly injured or assaulted and are prone to moral injury that repells them from a calling they loved.
Thus the new nurses receive great reviews for their caring and customer service while the old nurse’s patients may be better cared for; the new surpass the old in value and the old leave. Meanwhile the young begin to see the machine for what it is, become disillusioned with continuing the farce and instead focus on clinical excellence…until they eventually educate upward or leave the career.
Humans are not an endless resource and nurses can be broken.
Nurses need better respite care. If we want to keep those we have.
This comment is a fully-formed post right here.
I have a program in mind. I just need to win the lottery. I can prove that better care for nurses results in better care for patients, better hospital scores, and better soecialty programs. It would increase loyalty, reduce turnover, and in time reduce absenteeism. It might even reduce insurance costs for the employers while reducing nosocomial infections in patients. I have a suspicion that there is more absenteeism caused by in-house sickness.
…in any case, I could start small. $200K. $500K. I’d name the grant after someone. Point is, it would change nursing for the better by emphasizing actual continuing education as well as research into self-care and methods specifically devoted to shift work caregivers. The majority of research is done by administrators to increase productivity. What if the goal was overall wellness? What if the goal was to increase longevity, reduce costs, increase loyalty and make more *functional* workers? What if you didn’t have to threaten them into better quality care?
It would be nothing short of revolutionary. It would finally provide the profession the obvious scientific foundation that is regularly overlooked. It would create a self-sustaining model of care, reduction in harm, increase in education….
But no one wants that. They want their name on a building or a laser. Or a vaccine.
Yeah, but who wouldn’t want their name on a laser. Or spelled out with a laser. On the Moon.
Especially not the politicians.
Now, I’m interested.
Morning TheRightNurse,
Wonderfully generous answer. I am sure mom would have totally agreed with your answer. For an little additional information and perhaps a bit of entertainment. When mom was in nursing school as WWII started, and when mom was on the floor, nurses stood up when a doc came on the ward, docs did not seek patient information from nurses other than stats, nurses wore a uniform on the ward and white gloves when they left campus. While mom was a student she got scarlet fever and while she was in bed in the hospital pop visited her (not in physical contact) and sat on the bed, for this she was grounded for the summer, that is couldn’t leave campus. Nothing happened to pop who was a resident at the time. Mom was a head nurse on the OBGYN ward, at the IU med center. At that time folks came from around the state to the med center, on the OBGYN ward there was a lot of cancer. Other than surgery there were fewer treatments.
You highlight that nursing has been buried in paper work and accountability, and that patient care has suffered. At the end of pop’s career he said just as you, that docs no longer practiced medicine.
As a dinosaur, you are often with hospitalized folks, I wish one could have the same nurse for more than a couple of days, modern scheduling seems to break this continuity of care, my mom wished the nurses at least knew her name before they came in and looked on the chart or on the screen and would speak directly to her.
Lastly I am more sympathetic to patients (no self interest here :) ) You come to the hospital, something is wrong, you may sit in the ER for 5 hours to find out what’s wrong, stroke or seizure, and you wait and wait and wait. You’re admitted, you’re hooked up, you’re questioned, and I forgot you are first IDed and quizzed about insurance and if you have had a stroke and forgotten your name well then…, then you are up on the floor and between the noise, seeing the docs at 6 am having you vitals taken often, food selection, and waiting and waiting, The docs have an ocean of info they could tap into, they don’t, they reinvent the diagnostic wheel and the patient is asking, “this is where I came to get better?”
Most, I won’t disagree with (right now). But if you had a stroke or seizure, you would be triaged *immediately*. Particularly stroke. So if you’re waiting 6 hours, something is broken, needs surgery, or can’t be fixed in the hospital anyway.
Evening TheRightNurse,
Thanks again for your response. The patient is complicated (my wife), in ‘84 had radiation for left frontal astrocytoma, her symptoms leading up to her diagnosis were seizures. In ‘95 had surgery when tumor came back and it turned out to be an oligodendroglioma, then in 2018 couldn’t talk for a brief period, Went to hospital and maybe the blood did not show up right away, or the scan slices were too corse but we were told it was not a stroke but a seizure. We had been through many seizures but we had never had one where her gait was thrown off, or she did not have a headache. So 4 days later we go to another hospital as her gait has not improved and her right hand was not right. Second scan for this event shows the stroke at the edge of the cavity of the surgery site. So hospital for a week, then three weeks at rehab hospital. Speech, right hand, right foot still a bit off. However, since her prognosis was 2 to 8 in ‘84, and 3 to 5 in ‘95 we are on extra bonus time. My rather self serving response was to suggest that expecting that patients might act in a more rational or informed way might be ambitious given that patients are discombobulated by having to go the hospital, panicked by fear, and having false expectations about what can be done in the hospital to improve the health of the patient.
You would be surprised how often stroke patients try to 1) drive themselves to the hospital and 2) sleep it off.
I’ve asked them. “You just thought you were tired? Think about your children. Think about childhood. When you were tired, did one side of your body go numb and you developed a facial droop and slurred speech? No? Yeah. Not normal in adults, either.”
And the 90’s still had some pretty crappy stroke care. I don’t even know how useful CTs were at that point for stroke.