Working with nurses in the hospital as a hospitalist is one of the most memorable experiences. As an experienced hospitalist, I understand the magnitude of the task performed by nurses.
I feel that hospitalists and nurses should have a strong working relationship which will help in taking care of the patient better and make our work life easier.
Hospitalists and nurses can form an excellent team when we understand each other better. We have to understand how busy each of us are. A hospitalist with more than 14 patients is busy. Hospitalists spend a few minutes with patient but have to do a lot of behind the scene work for each patient including talking to specialists, social worker, case manager, calling families, doing a comprehensive documentation of patient care, answering multiple texts/pages from the nurses etc. It gets more complicated when this has to be done for 15 patients through out the day.
A nurse with more than 4 patients is busy. Sometimes it can be easy and sometimes one single patient if very sick or difficult can make us even more busy. We all know that. Only a collaborative work between nurses and hospitalists will make it easy and effective for both. Respecting each other will go a long way to make this easier.
Sacrifices and challenges the nurses go through while working in the hospital floors:
1. Working long hours with very little break. Not eating on time. Not using restroom on time.
2. Stressful situations with patients, families, other staff and physicians. Imagine being with patients and consoling them during their worst times of their life either it is being in pain or being anxious about a terminal diagnosis or dying from disease. Imagine the stress of dealing with an upset patient or family member. Some patients punch them, some spit on them and some shout at them. Patients and families could be under a lot of stress due to illness.
3. Putting themselves in danger with highly communicable diseases like COVID19.
4. Working in short staffing conditions. The patient load is very variable in the hospitals. Sometimes it is very busy and sometimes not so much. Due to this there are always a staffing mismatch issues in hospitals. Having more patients than normal load of patients could get very difficult for the caring nurse.
5. Coordinating with multiple members for each patient care. Each nurse has to coordinate with other nurses or staff from a different location with in the hospital like ER, OR, cath lab, imaging, and has to work with CNAs, PT, OT, RT, social worker, case manager, unit secretary, telemetry monitor tech, transport personal, families, multiple consultants, environmental service personal etc. Just imagine how stressful it is to work with so many people for almost every patient.
What can nurses do to work well with hospitalists:
1. Assess the patient’s overall situation and if there are signs of deterioration, call hospitalists immediately.
2. If there is a patient waiting for discharge and anxious about it, please inform the hospitalists about it. Do not wait for hospitalists to round as it can delay the discharge and cause patient dissatisfaction.
3. Look if important home medications were restarted or not. Medications for conditions like seizures, diabetes on long acting insulin, conditions requiring chronic steroids, psych meds, pain meds, eye drops, etc.
4. If the nurses can spare couple of minutes for each of the patients they took care of during a shift, please write a short summary of the events for each patient in their chart. This will really help the hospitalists get a good idea of what happened so far and take it from there. e.g. “Patient had abdominal pain, 8/10 in intensity, improved with pain medication, had 2 bowel movements, watery, had fever with Tmax of 101 F, family visited and had concerns about his mental status…”. This kind of summary is really helpful.
What can hospitalists do to work well with nurses:
1. Answer pages or texts as soon as possible when a nurse texts the hospitalist. If the nurse is concerned about a patient and wants you to examine the patient, go and see the patient immediately.
2. Do not put the nurses in between two doctors when there is a disagreement.
3. Call the families and give an update earlier in the day especially when the patient is sick or difficult.
4. Round with nurses to see patients so that they know exactly what the plan is and can take better care of the patient and answer the family’s questions better.
5. When they text you about simple things like Potassium is 3.4 or HCO3 is 43 in patients on Diuretics or HR is 54 and they are holding beta blocker or holding insulin as blood sugar is lower normal or urine output is 160ml in 8hrs or patient fell but no injuries etc, just say “OK” if you don’t need to act on it so they can document “doctor aware” or if you act on it, it means that their text was useful.
6. Take time to educate the new nurses when they are struggling regarding a particular patient. No one knows everything. It is good to help each other fill in those knowledge gaps whenever there is an opportunity.
7. Be kind to the nurses. Talk politely. Be supportive while they take care of the sick and difficult patients.
I have been working for 10 years in hospital as an attending and all I can say to the nurses is “I appreciate and respect for all that you do. I just can’t thank you enough from the bottom of my heart. As a hospitalist, I can’t take care of patients without your help. Continue to do what you do because it is saving lives.”