… seen you before and knows nothing about you, and he or she has dozens of other patients for whom he or she is responsible. Although they are busy people, you have a right to demand their attention and ascertain that they are treating you as an individual, not simply as just another body with a problem.
If you are a patient in what is known as a “teaching hospital”, medical students, interns and “residents” (senior medical students almost complete with their studies) may also be part of the team, and it can be confusing trying to sort out just who’s who.
Remember, if you don’t know who someone is or what they’re doing in regards to your care, ask to see their identification and have them explain their role to you clearly. If you are uncomfortable being examined or treated by a medical intern or student, you also have a right to refuse their care, although this is truly how they learn.
Ask your nurses (and your family) to help you keep notes and understand who is doing what and who is taking responsibility for each aspect of your care. With this information, your knowledge then becomes a tool for asking the right people the right questions at the right time.
You Have the Right to Refuse
At any time during your hospital stay, you have a right to question, refuse or accept any suggested test or procedure. Your body is still your temple even when you’re in the hospital, and you have a right to know what’s being done to you, why it’s important (or not), and what the consequences might be if you refuse. As I mentioned earlier, uninsured patients must be vigilant in making sure only necessary tests and procedures are ordered, but even fully insured patients don’t want tests that seem to be ordered as an afterthought. Understand the care that you’re receiving, and feel empowered to say no (it if feels safe and prudent to do so).
Navigating the Nurses
While doctors may be important to your hospital stay, nurses are crucial, and they will deliver the lion’s share of your care throughout your hospitalization. Nurses are the largest portion of the health care workforce and are one of the most trusted professions in the country in poll after poll. That said, a good nurse can make your day and a bad nurse can make it hell. Therefore, it’s a good idea to establish a good rapport with your nurses and understand their role.
Nurses do indeed carry out orders given by physicians or nurse practitioners (advanced practice nurses), but nurses also have their own science that they bring to the table. On many hospital units, nurses have dozens of “standing orders” which allow them to make independent decisions regarding your care, and they also report their findings to the attending physician or specialist. Nursing science has its own set of non-medical diagnoses and research-based protocols that impact how your care is delivered, and nurses use critical thinking to assess, plan, implement and evaluate patient care. If you’re confused about anything, a nurse is often a good person to turn to for clear information and advocacy on your behalf.
With nurses delivering care around the clock, remember that three shifts generally make up most hospital floor schedules, those shifts being 7am-3pm, 3pm-11pm, and 11pm-7am (except for units that use 12-hour shifts from 7am-7pm and 7pm-7am). This means that in the course of 24 hours, you may have up to three different nurses responsible for you along with their shift colleagues, so you will have to negotiate relationships with three sets of caregivers during the course of each day. “Change of shift” involves the incoming nurses receiving “report” from the outgoing nurses, and these periods of the day are times when nurses will generally be less available to you, so plan accordingly.
The “Charge Nurse” is the nurse “in charge” of the particular floor or unit where you are staying. If you have an issue with a particular nurse, have a question or concern, or want to speak with a nurse with the most authority, ask for the “charge nurse” during any given shift and communicate your concerns to him or her.
Nurses are people too, and they understand—or should understand—that you are an individual with individual needs and desires. For instance, my wife found that being woken up every three hours for vital signs and assessments was exhausting, so she negotiated with the nighttime charge nurse to only be awoken once during the entire night. She also negotiated for the door to her room to be kept closed, and she asked for earplugs and a sleeping pill to assist her in getting needed rest. Since my wife has chemical sensitivity, she requested that the floors not be waxed during her stay, and she requested that housekeeping clean the room only with water mixed with vinegar in order to minimize the effects of chemical cleaners on her respiratory status and health. She also refused care from any nurses or personnel wearing perfume or cologne. These requests were honored by the nursing staff, thus my wife’s stay was more restful than it may have been otherwise.
Being hospitalized is no fun, and when we are in the hospital, we are in a vulnerable state, and are often frightened, anxious and not at out best. Use common sense, the assistance of friends and family, and the development of positive relationships with your health care team in order to get the most out of your hospitalization while remaining an empowered and informed patient.
Also remember that the only dumb questions are the ones that are not asked, so be inquisitive, curious, and unafraid to question anything that you don’t understand. You’ll be healthier and more informed in the process.