I have been challenged to develop a top 10 list of appropriate responses to a patient’s request that a nurse can use when she is too busy or working with a more critical patient. We have heard many examples of what not to say, and have offended patients when the nurses are trying to prioritize the patients’ needs and requests. Your thoughts?
You probably have some nurse leaders who already do a good job with this. Pull your best nurse leaders and nurses together and ask them how they handle this issue. My feeling is they will give you what you are looking for and will feel good about coming up with the answer.
I also feel that nurses can work as a team, so that if one nurse is tied up with a critical patient and cannot meet routine requests from his other patients, another member of the team that day (charge nurse, staff nurse, or even the house supervisor) should step in to help. It’s important that a critical patient be invisible to the rest of the patients so their care does not suffer as a result of that situation. Patients don’t want their needs to be prioritized by someone else. They know only what is important to them.
The new nurse could say, “Your nurse is delayed with another patient, but is thinking of you and asked me to give you your pain medication (or whatever the request is). Your nurse, Jane, is committed to providing you with very good care and wants to make sure we are managing your pain even though she is tied up at the moment. Please let me know if there is anything else I can do for you until she’s available. I have the time.” This way, seamless care is provided regardless of short-term events. That defines quality.
I would also use a dual approach in that, during rounding, nurse leaders look for issues that are taking up too much nursing time and should be corrected.
These issues usually come under the area of tools and equipment, sub-par coworkers, systems that don’t work well, and support department issues. Ask nursing staff how much time they would gain if the identified areas were fixed.
Finally, take a hard look at call lights and pain management. If these two areas are addressed, staff will have more time.