I visited a friend in the hospital last week. I expected us to have a little chat and after 45 minutes or an hour, we would run out of things to say or he would tire so I’d go. Over two hours later, I was still there. During my visit I observed three problems that reminded me again how much nurses’ expertise is underutilized. See what you think:
My friend, in his 80’s, has multiple chronic diagnoses that are difficult to manage. He had been in and out of the hospital three times in the last six months. While I was there his doctor visited. She did a good job of talking with my friend about what the next step was and why he had to wait another day or two to be discharged. She included my friend’s children in the discussion and willingly answered their questions. I helped interpret some of the doctor’s answers so his family would understand. The first problem came when one of the children asked the doctor how they could keep their father from being readmitted. The doctor listed some of the signs and symptoms they could watch for. I could tell that my friend and his family heard very little of this and understood even less. I wasn’t sure I should give any advice, but I found it impossible not to make one suggestion.
“What about a public health nurse visiting at least for the first few weeks?” I asked the doctor.
“Medicare may not pay for it.” She answered.
“Dad has good insurance.” One of my friend’s children replied, “Can’t we at least ask?”
The doctor agreed to a public health nursing referral.
I didn’t understand. Why wouldn’t the doctor think of involving public health nurses, especially when my friend lives in the country with the nearest access to health care at least 20 miles away? I’ve been a public health nurse. I know what they do. Their presence in the home can make the difference between recovering from an illness and or being re-hospitalized. Then when my friend’s children suggested the referral, why would the doctor be so reluctant? I thought hospitals were trying to prevent re-hospitalizations because of the money they lose if patients with certain diagnoses return within a month.
Why wasn’t there a nurse rounding with the physician? If I had not been there who would have advocated for the patient or family? Who would have known what questions to ask or what referrals needed to be made? Where was the team approach? The doctors may make my uncle better, but without the nurses, he may not stay better or recover completely.
After the doctor visited, my friend asked me to look at a ‘rash” on his chest. This was no rash. It was a sore that had not healed. The center was filled with eschar. I’m no wound care expert but I knew from experience that area of dead tissue needed to be debrided before the area would heal. My friend had asked for a visit from the dermatologist. However, the dermatologists were too busy to see him during this hospitalization. He would have to return for an appointment in a few weeks. I suggested to my friend that he request the wound care nurse see his sore to suggest treatment.
I didn’t understand. Why would a doctor look at this nasty sore and think it could wait weeks for anything to be done? Was she focused only on the diseases my friend was hospitalized with? Why would she wait for my friend to see a dermatologist when he could see the wound care nurse specialist in the hospital in a day or two?
I recently watched a play called, “Bedside Manners” that demonstrates poor communication between doctors and nurses and how it can negatively impact patients. What about no communication? If doctors are not willing to work with nurses in teams or refer patients to nurses, we registered nurses have a lot of work left to do. It is going to be up to us to educate the public and other health care professionals what expertise nurses possess.