Sunday, May 22, 2011

Home at Last

by Leann

My husband had major surgery a little over a week ago, and I have to say his hospital experience was far better than mine in 2008. That doesn't mean it was GOOD. Just better than horrendous.

I am a nurse who was trained in a hospital, so I guess I bring plenty of ideas about the right way to do things. You don't let IVs run completely out, for one thing. (Yup, that happened.) You make sure the epidural pain medicine is QUICKLY available. (They ran out and how hard would it have been to go down to the pharmacy and get the med rather than wait for a delivery? Had to get the nurse manager involved in that one.) And to allow tubing of any kind to lie on the floor is unacceptable. I don't care if it's catheter tubing or IV tubing, floors are dirty and those tubes connect to the body. No wonder there is such a rise in hospital infection rates. No one seems to pay attention to ALL the details of good nursing care.

Who knew that dressing changes for an incision are no longer sterile procedures--using sterile gloves and gauze, where gloves are changed after a dirty dressing is removed so germs are not transferred to the new dressing. That and catheter care are treated as "clean" procedures--no glove changes--but I'm not so sure that's a change I like or that it's being done correctly even being done as "clean" procedures. Again, look at infection rates and tell me that nurses are being trained in good, common sense techniques. I think not. I have never been more certain that if a loved one goes into a hospital these days, make sure someone is there who is unafraid to speak up to the staff AND to the (haughty) doctor. Just sayin'. Dealt with my share of doctors and I am not intimidated. I saved their butts on dumb or illegible orders more than once in my time on the hospital floor.

None of this is to say that I do not appreciate the kindnesses offered. Kind is good. The nurses my husband had were skilled to a point. And there were always people available to bug--which I did. They didn't mind. Drinks and snacks were in abundance, but of course not even part of the nurse's aide job to go and get. My patients always had fresh water on their stand. My husband wouldn't have had fresh water t if I wasn't there.

Instead, the staff spent 2-3 hours every shift writing notes on the computer. Back in the day, the entire shift was spent giving nursing care and notes were only done at the end. If I had to stay to finish my notes, I stayed. But interacting with my patients was more important than sitting at a desk typing. This is not to blame the nurses. I saw this coming a few years before I retired. Nurses want to give care first, not make sure the hospital doesn't get sued.

Now he is home. The surgery went well and his incision looks great, but then, he has his own nurse. Now ... if I could just get him to cough and deep breathe more ... yes, I am a pest! What about you? Have you seen the change in health care? And I mean the folks who actually should be spending an entire shift providing that care.

25 comments:

Anonymous said...

Oh yes ! Just got back from being in hospital for major surgery. Had to ask for water & ice. Mystery person ordered my liquid diet without consult. Nurse never came, unless I buzzed, then answered over intercom. After they took my catheter out, they got me up for the first time to pee. Aide said to pull cord for assistance when done - so I wouldn't fall. Took a while, Aide had to go, I pulled cord, got pissed off nurse - wanted to know what I wanted.

When I was walking in hall saw her on computer in control room - think that was the type of nursing she wanted to do, not deal with patients.

Sara said...

Amen, Leann! My dad had several hospitalizations during the last year of his life and I saw excellent nurses and some who paid little attention. I know how difficult the job is, especially with new regulations not to mention dealing with sometimes demanding physicians. That said, I was too often "brushed off" when on the phone (I was 1 1/2 hrs away) but I learned from my own medical care that you have to be a "belligerent patient" (or family member)! Some nurses, and sadly I can count them on one hand, were wonderful and caring. There were some that I saw at the beginning of their shift and never saw them again until they were ready to leave.

But I do need to say this...my dad was sent a wonderful guardian angel in the ICU. She cared for him during what turned out to be his last two days on earth. She took the time to talk to me about him and she would joke with him and brush off his sometimes testy comments with a laugh, then he'd laugh. Dad improved to the point he was being moved back to the floor, and when Nicole learned there was just one orderly to move him, she insisted on going. They stopped in radiology to change his dialysis port while I went on to his room & they came to tell me I was needed in radiology. Nicole met me at the door and said the dr. would be out. I'm sure I looked puzzled and she seemed torn, then took my hand and said "It was quick...he didn't have any pain." Then it hit me what she was saying...she told me he was talking and joking when suddenly he couldn't breathe. We had a DNR in place so she stopped them from ventilating him...he hated the breathing tubes. She then told me they'd take him back up to ICU, clean him up, and then I could have all the time I needed. I called my aunt and she came; we went in together. Even then, Nicole came in to give her sympathy and made a point of saying how much she came to care for him in just two days.

I'm so glad that was the memory I was able to leave with after all the different nursing experiences while visiting him.

Fiona said...

We belong to an HMO for our health care. That means we don't see our doctor until SHE says SHE wants to see us. First, we have to send her an email and tell her our symptoms. Then she send us an email with suggestions for home treatment. If the home treatment doesn't work, then we send another email and say it didn't work. Then, she emails and says to call the office and schedule an appointment. So far, neither my husband or I have had any major problems since getting this insurance. Fingers are crossed!

Aurian said...

I am lucky not to have been hospitalized ever. Only once overnight when they had my tonsils removed (I was 34 at the time). But it sounds like if you don't speak up, you don't get the care you need.
But Leann, you husband is lucky to have his own private nurse the help him get better fastest.

Raquel said...

I work in a hospital as a medical transcriptionist. I do not do direct patient care, so don't see a lot of what you are talking about, but I do know that the amount of documentation required has at least tripled in the past years. Some of our documents have gotten a lot longer, which increases our workload. So I am thinking this is not on the nurses, or even the doctors so much as the governmental regulations.

Beth Groundwater said...

I'm glad you and your husband are home, Leann, and that he's recovering well. I, too, think it's VERY important to have a family member or other care advocate in someone's room most of the time at the hospital. The nurses actually thanked me for my help when I left with my husband after his surgery. They are soooo understaffed that being there is the only way to assure your loved one is cared for properly.

Sue said...

I'll be at a hospital on THursday with my sweetie. He's having back surgery so you can bet that I'll be watching very closely everything they do. Last time he was there I had to have them put a note on his door not to bother him with things like magazines and kept on them about his IV bag getting low. I hope things have changed since then. That was in 2006

Leann Sweeney said...

None of these stories surprise me and Sara, your comment made me cry. Someone has to change how much time a nurse spends on a computer. I understand the documentation is tremendously time consuming, but you know what? In my time, when I was writing notes by hand, it was also time consuming. Documentation should not be the largest consumer of a nurse's time. That makes no sense. Insurance companies are also part of the problem. They want to make sure the care is "justified" before they dole out the money. We pay a good sized premium so it's not like they're giving away money. Of course they probably would think differently. Sigh. I am most troubled by the amount of time my husband spent without seeing a health care professional in an 8 hour span. Scary. But then, when I was in a different hospital in 2008, with a woman screaming all night long in the room next to mine, I knew their lack of care might kill me. (I got very sick after a surgery and was dehydrated). I still have flashbacks about those long hours spent alone and fearing I might die. Good thing I'm a fighter!

Barbara said...

My husband and I have been very fortunate in the hospitals we have had procedures in. I'm a retired medical transcriptionist so I've heard enough horror stories to keep my eyes open. My only real complaint was when my husband was supposed to be discharged one morning after being held overnight as a precaution, but we didn't actually leave until after 5 pm. One shift left paperwork for next shift and they were angry so put it off. His roommate and wife were in same position and all four of us were stalking the nurses. The paperwork is horrendous and no one wants to do it.

Min said...

I worked in a hospital in a dept of infection prevention and control, and some of what you said horrified me! If I had seen some of that, I would have been writing people up and having meetings with nurse managers, patient safety, and the CMO! Eesh!

As a public health practitioner, working in the medical health field was difficult for me. The focus is VERY different, and now that I've been laid-off, I'm very happy to reshift my focus and look at public health jobs again, which focus more on patient advocacy, patient-centred issues, etc, rather than the bottom line.

For instance, when my mom was recently in hospital (earlier this month), admitted after a two-day monstrous headache, they suspected temporal arteritis. The gold standard test for this is a biopsy of the ophthalmic nerve. But the doctor in hospital wanted to do an MRI instead. So he did that although the MRI has a higher rate of false negatives. I pushed Mom to push him for answers about why he would do a test with higher specificity over a test with higher sensitivity (epidemiology and biostatistic terms), but she was of the mindset "he's the doctor and he knows what he's doing."

Now that she's home and back in the care of her rheumatologist, she (of course) has to get the biopsy. So all of that for nothing.

Very frustrating. But at least she's being treated. And I'm very happy for you that your husband is back home, as well, and is doing fine with his nurse! :)

South Jersey Quilter said...

I was in the hospital last spring after a hyster. My daughter, also a nurse, came up from NC. The first thing she saw when she walked in the door was used sharps on the bedside table. She complained all the way up to nurse mgr! And I went 3 shifts without seeing a nurse! We asked the nurse mgr how they were doing their documentation! She said she was going to discuss this with her staff.
Holly

CindyD said...

The last time my husband was in the hospital he had a shivering fit. The person who responded (RN?LPN?aide?) questioned HIM about why he was shivering before giving him a blanket. The gastroenterologist's PA contradicted what the gastro told him. There were several other minor mess-ups. I thought it was that hospital but I guess not.

Debra said...

I had my knee replaced a few years ago. Overall the health care was excellent except on the morning after the op. They refused to give me my prescribed meds (unrelated to surgery). I have been taking prednisone for many years and as I felt myself going into steroid withdrawal the nurses kept giving me reasons why I had to wait. If I ever go back into the hospital I'm bringing my own meds.

signlady217 said...

I know enough about medical things to be absolutely, incredibly (and probably) "annoying" in asking about the whats, whys, and why nots of everything being done with my family members and friends when they are in the hospital. I want to make sure things are done right!

Unfortunately, in hospitals, as in schools and other places, they've increased the paperwork and decreased the personnel to such an extent that it's making everybody crazy!

Mary Jane Maffini said...

I am so glad he's home, Leann. Good thing you were there to make sure he got the care he needed!

Wendy Lyn Watson said...

I hear so many horror stories, even witness them with my friends. But I have been so very lucky. Both of my foot surgeries were great, with awesome, helpful nursing staff and efficient procedures that got me home ASAP. And Mr. Wendy's horrible crisis 18 months ago was, well, awful ... but all of the personnel involved were incredible.

We've been blessed. And I'm glad Mr. Leann is home and in your competent hands now.

Anonymous said...

Me, too. I'm glad Mr. Leann is home and in good hands.

My mother was in the hospital for a couple of weeks, and it was okay. The nursing home afterwards--horrible! I've brought her home and am caring for her. Not easy, but at least I know she's safe and not left sitting on the toilet for half an hour!

Lyn

Peewee54 said...

OMG, those stories are horrible-we should all be treated like we are at a 4 star hotel with a butler/maid!! We pay enuf and they make a heck of a lot more than butlers.. scary

Aurian said...

Hi Leann, what does this mean:
well, slap me naked and sell my clothes!

Leann Sweeney said...

That is just an old southern expression of astonishment or surprise. I have been "collecting" things I hear people say in Texas since I moved here 36 years ago and someone said that at the school where I worked. Cracked me up. :-)

Len said...

As a nurse, I am not ashamed to say that getting a patient water and ice is not very high on my priority list. I work in a hospital with very sick patients, and it is much more important for me to administer my medicines with safety than to fill someone's water pitcher.

You are absolutely correct; dressing changes are not sterile. I have no idea the reason behind this, but I was taught in school how to perform a sterile dressing change. No doctor has ever ordered a sterile dressing change for me to do personally, but, at my hospital, we do have specialized wound care nurses who perform sterile dressing changes.

A urinary catheter should be a sterile procedure, but complete sterility is very hard to manage when inserting a catheter. I do not know when you retired from nursing, but the paperwork is tremendous. Myself and my collegues constantly complain that we really don't ge to do much nursing b/c we are so bombarded by paperwork in order to get insurance reimbursements/not get sued, ect. If I waited until the end of my shift to do the paperwork, I would be at work all night. Then, I would be told I was not using my time effectively.

My mom has been a nurse for 30 years, and she has seen the changes. Patients that should be in ICU are sent to the floor, and the paperwork at admission and discharge is just incredible. It takes me an hour alone to type up a discharge; it takes the doctor at least an hour to finish his/her discharge paperwork. I would love to simply nurse, but that is no a reality in today's healthcare setting. I am not saying that you don't have a right to be upset with your husband's care, but there is more to the picture than meets the eye. Yes, some nurses and aids are lazy, but the majority of us are simply tryig to do the best we can, usually working ourselves to death and glad if we can somehow get a lunch break in there.

Len said...

On another note, my husband is a doctor, and he barely has time to spend with his patients b/c there are so many. He can barely get home by 10 at night, and he is being told that his group is over staffed. It's incredible.

Who knew the stimulus package made it harder for hospitals to get reimbursed? I just found that out today. So much documentation and more changes to come. I love taking care of my patients and have never had a problem there, but this endless stream of paperwork has got to stop. Half of my time is spent on paperwork, and that is the truth.

Leann Sweeney said...

I understand your frustration, Len. Unfortunately, paperwork has been there for a long time. I did plenty in a thirty-five career in all kinds of different settings, though I am certain not as much as you are required to do. The focus, no matter what the obstacles, must remain on the patient--and I'm sure that's where your heart is. I have no problem with the kindness and concern of the nurses where we were. Each received a signed book from me as thanks. But I hope that you can see from the comments on this blog that I am not the only one who has experienced the problems of being on the patient end of the hospital experience. I totally agree nurses should be allowed to give the majority of their shift time to direct patient care. I do not know the solution, but unless complaints like mine are heard and understood, nothing will change. You are not able to make those changes. I understand that. One thing I do disagree with--making sure that a patient who is not NPO has plenty of water should never be a low priority. It may not be a nurse's direct responsibility, but it needs to be someone's responsibility. Yes, I worked myself to death, too, and rarely ate a meal while on shift. That, unfortunately, will probably never change. Thanks for your comments. They are much appreciated.

Katie said...

as one going into the nursing field and working currently at a hospital as a nurse's aid/unit secretary, I pray that I am never the kind of nurse who will ignore patients. I watch the nurses and observe how they go about things. I think how I'd do things differently or how I want to be like a specific nurse.

I was working in our ER today. we had a patient waiting for a room in ICU, we weren't busy. this patient's nurse is brand new, just graduated in December. she was getting frustrated with the room situation, I was looking at something and noticed it was 1230 and she hadn't charted on the patient in 2 hours. for an ICU status patient, it was unacceptable especially since she had no other patients.

I know there is a lot of charting, I try to do mine only when I have time to do it. patient care comes first. if I can finish something up quickly that I'm charting I will, but in the end, the paperwork doesn't matter as much.

Leann Sweeney said...

Sounds like you are going about this the right way. You are observant and that is one skill that will prove invaluable in your career. Follow your instincts, too. I remember that when I was working on a post-op floor early in my own career, I knew my patients well--made sure I did. One man, couldn't have been more than 40, just didn't look right to me. Skin color, mood, energy level. I couldn't put my finger on it but I called the doc on call to check him out. The patient had vague complaints, just "didn't feel well." The doc listened to his chest, tested reflexes, took his pulse and that was about it. Didn't write any orders. Two hours later that man was dead from a pulmonary embolism. That evening shift has always haunted me. He died not long after I went off duty. I learned to trust my instincts after that night. I should have pressed harder for tests but I was too timid, the doctor was rushed and I didn't want to get chewed out. It wasn't my job to diagnose or write orders, but I learned after that to find a way to press doctors if I got "that feeling" in my gut--and I never worried again about getting yelled at (and that sure DID happen quite a bit). Patients don't die because their nurse got yelled at--and I didn't die from that either. But I will never forgive myself for not being more of an advocate for that man. Nurses work for the patients not the doctors. Sometimes we forget. Best of luck on your journey!