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Old 05-02-2011, 09:06 AM
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Default What Nurses Wish You Knew

Forget the doctors. Who knows what really goes on in a hospital? The nurses. We convened dozens of the region's best and asked them everything we've always wondered about: How can I get the most out of the health-care system? How do I choose an end-of-life advocate? What do you think of Google-diagnosing? How about "Nurse Jackie"? And are you going to get mad at me if I buzz you again?

By Jenna Bergen and Sandy Hingston

No matter what health-care reform winds up looking like, one thing’s certain: Nurses will play a bigger role than ever, taking over duties from doctors, moving out of hospitals and into the community, looking after frail aging boomers, leading the push to keep costs down and improve outcomes. So this seemed the perfect time for a consult with the people who really run health care in Philadelphia. As one nurse told us, “Doctors only think they’re the quarterbacks.” Here’s what nurses had to say about their work, their patients, life and death, and those little white caps they used to wear.

It’s okay to buzz: Really. Go ahead. Room too cold? Need a pillow? Got a question about your meds? Use the buzzer; that’s why they put it there. “My 82-year-old mother was just in the hospital for a stroke,” says Presbyterian Hospital’s Michael Becker, “and she said, ‘I can only hit the buzzer two times a day.’ I asked, ‘Why is that?’ and she said, ‘Because they’re going to get tired of seeing me.’ I said, “No, no, Mom, it doesn’t work that way.’” If somebody’s pushing the buzzer all the time, nurses know there’s a deeper issue and work to address it.

You don’t have to be afraid: Nurses understand that patients often don’t speak up because they feel vulnerable. But when we don’t voice our thoughts, they have no way of knowing what needs improvement—until the patient-satisfaction survey arrives after the fact. And they hate finding out there was something they could have fixed if they’d known about it. “It’s natural to be fearful,” says Pennsylvania Hospital’s Mary Del Guidice, “because you’re lying in bed with all these faces looking down at you. But don’t be afraid of us.”

They still save your life if you're an organ donor: “It’s not like we’re looking at you and going, ‘Oh, I bet you’ve got a nice liver,’” says Barbara Riegel, a nursing professor at Penn. Yet they’ve all heard the same fears about pulling the plug on organ donors. In their eyes, we’re looking at the issue backwards: “You’re my patient,” says Marilina Mancini of Mercy Philadelphia. “Organs are donated to someone else’s patient. I’m going to do everything possible to take care of you.”

Get a second opinion: Everybody should get more than one opinion. And do some homework beforehand, so you have questions lined up. The most important question? “Ask what the person would do if this was their child, their husband, themself,” says Penn nursing prof Linda Jacobs. “Make them think about it on a personal level.”

Go ahead and Google: We thought nurses would hate patients who Google to self-diagnose, but they were cool with it. They even do it themselves and say it can help patients feel they have more control over what’s going on. They do caution that when people self-diagnose, they sometimes don’t seek proper care. Your best bet: Use the Web to arm yourself with questions for a living, breathing health-care professional, says Nancy Marie Valentine of Main Line Health: “Even if you’re not using the best resources, it gives you something to ask about.”

Become your RN’s BFF: The number of scrub-bedecked folks scurrying in and out of a hospital room can make anyone’s head spin. Thankfully, there’s only one person you need to get to know during your stay. “It’s the nurse who knows what’s going on,” says Kathleen Gorman, chief nursing officer at CHOP. Rely on your RN to answer your questions, break down “doctor-speak” and address your concerns and fears.

Germaphobes rule: There’s a reason hospitals smell of Lysol: Sick people and germs are tighter than mac and cheese. If medical staffers aren’t washing or disinfecting every time they touch you, warns Victoria L. Rich, chief nursing executive at UPenn’s medical center campus, they’ll pass those germs on to you. Even when health-care professionals say they wash their hands, only half actually do—and that includes doctors. If you don’t see your nurses and doctors wash up, politely ask them to. (Visitors, too!)

You should be asking questions: It’s true: Nurses want you to ask questions. In fact, peppering them with queries is the first step toward better care. Plus, you’ll be less anxious if you understand what’s going on. And being informed prevents mistakes, especially when nurses are busy. Just as you’re taught to be a defensive driver, you have to be a defensive patient, says Nancy Marie Valentine: “You’re in an environment with a lot of moving parts and different people.” Which means, adds Lankenau’s Margaret Iacobacci, “You should feel comfortable asking questions like, ‘Is that the medication I’m supposed to get?’”

They’re gonna figure everything out anyway, so you may as well 'fess up: There’s nothing more human than wanting to hide beneath a hospital bed rather than discuss the intimate workings of your body or admit you haven’t been following the doctor’s orders. But fudging about symptoms and unhealthy behavior won’t keep nurses from finding you out; it will just lead to more tests, a longer stay and a higher bill. “A lot of times, patients say something like, ‘I don’t know why I’m GI bleeding. I don’t drink,’” Michael Becker says. “They mean they only drink a fifth a day. Or they don’t tell you they break their pills in quarters because they can’t afford them.” Nothing you say will shock nurses—and they need to know the truth.

You need to share your expectations: Different people want different things from medical care. Unless you share your expectations with your nurses and doctors, they won’t know how to give you what you want. Doctors, says Fox Chase Cancer Center’s Theresa Pody, tend to be “gung ho: We can give you this, we can do this, we can do that.” But what are your goals? Do you want your life to be prolonged even if you’re in pain? Is it more important to you to stay functional? To be free of symptoms? What they think is your priority may not be what matters to you at all.

Think hard before you designate an advocate: Nurses were very specific about how to choose someone to carry out your wishes when it comes to matters like ending life support. It should be someone you trust and who cares about you, and who is cognitively intact and has good social skills, since he or she will have to lobby for your needs. Family members often won’t carry out a patient’s wishes even when they’ve been clearly stated. “Your advocate has to make that hard decision,” says Doylestown Hospital’s Andrea Marino. “It has to be someone who can take a step back and say, ‘This is what she wanted; I have to do it.’ Everyone can’t do that.” She says most ethics consults requested by nurses at her hospital come when there’s a conflict between what the patient wrote down and what the family wants to do. Adds Presbyterian’s Lorie Fosbenner, “You need somebody to implement the advance directive. It’s not just, ‘Oh, because it says this, this is what we’re going to do.’”

It’s a HIPAA thing: Patients and families don’t always understand the Health Insurance Portability and Accountability Act and the privacy rules it dictates, says Jefferson’s Jaime Stazi: “Everyone who calls the nurses’ desk says they’re a cousin, and it might just be a nosy neighbor.” Nurses wish you and your family would choose a spokesperson they can tell everything to, who’ll then tell the rest of you. Sometimes family members get offended if nurses won’t tell them what’s going on, Stazi says, but the nurses aren’t being rude. They’re only trying to protect your privacy.

A bad day for a nurse isn’t what you think: It’s got nothing to do with bedpans, or vomit, or being too busy to eat lunch. When nurses say they had a horrible day, what they mean is they couldn’t do what they wanted to do for a patient. “It’s because of the stuff,” says Lorie Fosbenner. “I couldn’t get a suction canister, or I couldn’t find a pillow, and I had to make a pillow.” Marilina Mancini says nurses on her floor have a running joke: No matter what goes wrong—cold food, bad food, a mean doctor—it’s the nurse’s fault. But there’s a truth at the heart of the joke: No one else is with the patient 24/7.

There are 3 more pages if you care to check it out:http://www.phillymag.com/health/arti...wish_you_knew/
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Old 05-02-2011, 12:09 PM
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Did anyone go to the article and read the list of "contributors"??? I'd bet my bottom dollar that 85% of them are "clipboard and heels" nurses,
not the ones actually answering the call bells!


And all I have ever seen in a Magnet hospital is a lot more committees and self-congratulations, not happier nurses or HIGHER STAFFING!!!!
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Old 05-11-2011, 01:46 PM
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enjoyed the post!
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Old 05-21-2011, 10:30 AM
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I liked this article. It's interesting to see all of the different attitudes in the article and in the comments. Such a wide variety of personalities in both.
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