How Hospitals and Long-term Health Care Facilities Work
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Story 1: Care During Hospital Shift Changes
When my brother was in the hospital he needed a lot of attention in the early morning, but he discovered that this was when he got the least attention. He observed that attendants visited his room less frequently between the hours of 6:00 A.M. and 8:00 A.M., and he also learned that this was the shift change time, that the hour before the shift change the attendants were doing end-of-shift paper work, and that the first hour after shift change the just-arrived attendants were learning -- from the paperwork and the head floor nurse -- how the patients on their floor were doing. At least, that was my brother's perception. We weren't sure if the perception was accurate or if it was influenced by the morphine he was taking to reduce his pain. It sounded plausible, however, so we asked the head nurse (charge nurse) if it would be okay if we hired someone from 6:00 A.M. to 10:00 A.M. to give him the care he needed. We explained that we understood that this would cover the shift change time when the hospital personnel could not give him this attention. She said that would be fine. We asked if she had any recommendations of people we could hire and she suggested that we talk with the Hospital's Director of Nursing.
The Director of Nursing said she would be happy to provide us with a list of care assistants that we could hire, but that it was unlikely we could get them for a half shift, that we would have to hire them for a full eight hours. She also added, however, that it was the hospital's responsibility to provide the services my brother needed, and asked that we delay hiring someone for a day to give her time to correct the problem. We agreed to wait.
During the next two days' shift changes my brother said things went much better, so we decided to put off hiring someone. In fact, the hospital solved this problem once we had reached the right person, the Director of Nursing. I wondered if this is the way most hospitals work.
Did we just stumble on the most effective way to resolve this kind of problem -- talk with the Director of Nursing -- or does how to solve this kind of problem vary a lot from hospital to hospital? What are other possible solutions
David J. Rosen
djrosen@theworld.com
Story 2: The Fruit Basket
My friend's son was in a small hospital recovering from a nasty bike accident. A group of us sent a big basket of dried fruit and candy. The son's thank you note let us know he and his family AND the nurses all enjoyed eating the goodies. In fact, he reported, that after the basket showed up, the nurses came by more frequently. I thought that was great. Now I don't worry whether to bring food or not, if the patient is eating or not, to me the whole point is to do a little something to make nurses' want to be in the same room as my loved one.
Martha Merson
martha_merson@terc.edu
Story 3: Timing is Tricky
Twice in my experience I've found that the tyranny of hospital shifts and staffing schedules compromises patient care and contributes to patients' discomfort. One time my mom began her hospital visit in the ER. Although it was certain they would admit her at 7 p.m., she had to wait until after 11 for a room. She missed the 4:00 cycle because she was still getting tests and then I think the nurses at the end of a shift don't want to do the paperwork, so they leave people hanging. It wasn't the end of the world to miss food and TV. The ER bed was really uncomfortable, but at least she was eventually in a more comfortable setting. I made a mental note to keep track of the time in the hospital.
A year ago (October 2006), my mom was again in the hospital. This time I was with her on the day the staff were ready to move her from the regular hospital to hospice. They wanted to move my mother around 1, so the hospice doctor could evaluate her before he left for the day. My mother did NOT want to move. She liked her room and she didn't want to leave in a hurry--she had been in the room for a week or so and she wanted to take her time to gather her belongings. But I didn't want to miss the window and assisted with the move, accommodating the hospital staff's wishes. I think in retrospect that was a mistake. Why couldn't the doctor have assessed my mother in her original room? The "hospice" was one wing of the hospital, on the very same floor. He would have needed to walk perhaps 100 steps out of his way. But I get the feeling that the territory in a hospital is strictly defined. I had the sense that there was a glass wall for him between the units that he wouldn't penetrate, that he wouldn't, couldn't think of penetrating.
Have others encountered this type of problem? How have you handled these conflicts?
