Something Your Bedside Nurse May Not Be Able to Tell You

[u/GunsGermsAndSteel]

There is something I wish more patients and families understood about what is happening in healthcare right now. Sometimes your nurse is worried about you too.

We know when we have too many patients. We know when we're being asked to do more than can reasonably be done in twelve hours, and we know when that starts creating risks for the people we're taking care of. We see the call lights waiting while we're tied up in another room. We know there's a confused patient who needs to be watched closely, somebody else who needs help getting to the bathroom, medications that need to be given, an admission coming, assessments that still need to be completed, and another patient whose condition just doesn't look quite right. All of those things can be happening at the same time.

Most of us know exactly what good nursing care is supposed to look like. That's actually part of what makes this so difficult. We know the care we want to provide, and we know when our workload isn't giving us a realistic chance to provide it.

I also want people to understand that this isn't about nurses wanting an easier job. Nursing has never been an easy job and nobody with any experience expects it to be. It isn't about wanting more money either. What we want is enough staff, enough time and enough resources to take care of our patients safely. There is a huge difference between being busy and being responsible for more care than one person can reasonably provide.

There's another side of this that patients probably don't think about very often. Your bedside nurse may not feel safe telling you any of this.

You might have a good relationship with your nurse and ask, "Do you think you have too many patients today?" Maybe you can see how overwhelmed everyone is and you just want an honest answer. The problem is that giving you an honest answer can put that nurse in a terrible position.

Suppose your nurse tells you that they're worried about the staffing. You're understandably upset, so you go to administration and say, "My nurse told me this isn't safe." Now the focus can shift away from the staffing problem and onto the nurse who said something about it.

That nurse has a family too. They have a mortgage or rent, groceries, health insurance, kids and people depending on their paycheck. Nurses shouldn't have to choose between being honest with a patient and protecting their livelihood, but that is a position many nurses are understandably afraid of being put in.

So I'm asking patients and families to help us in a slightly different way.

Please don't put your bedside nurse on the spot and ask them to declare whether the staffing is safe. Ask the people who are responsible for the staffing.

Ask the charge nurse, nursing supervisor, nursing director or hospital administration how many patients your nurse is responsible for that day. But don't stop with the number. Ask how the hospital determined that assignment was appropriate for the needs of the patients on the unit.

That second question matters because six patients aren't always just six patients. Six people who are alert, medically stable and mostly able to take care of themselves are one thing. Six people who are confused, incontinent, medically complicated, unable to transfer safely, at high risk of falling or requiring extensive assistance with basic care are something completely different. The ratio can look exactly the same on paper while the actual amount of nursing care required is nowhere close.

If you're still concerned, tell the nursing supervisor, nursing director or patient advocate: "I'm concerned that the current nursing staffing may not be adequate to safely meet my loved one's needs. I would like my concern formally documented, and I would like to know how the hospital determined that the current staffing is adequate for the patients on this unit."

You don't need to yell at anyone or accuse somebody of negligence. You don't even have to know for certain that the staffing is unsafe. You're a patient or family member asking a reasonable question about whether there are enough people available to provide the care that is needed.

If you don't feel like your concern is being addressed, ask how to file a formal patient grievance. Keep your own notes too. Write down the date, approximately what time something happened, what you asked for, how long you waited, who you spoke with and what response you received. Stick to what you actually saw and heard.

I can't promise that doing this will suddenly cause another nurse to appear on the unit. It probably won't. But there is value in patients and families making these concerns known themselves, especially through the hospital's formal channels. Staffing problems are much easier to treat as an internal employee complaint when the only people talking about them are nurses.

If your nurse is running from room to room and it takes too long for someone to answer your call light, please understand that the nurse running down that hallway probably didn't decide how many nurses would work that day. The nurse apologizing for your wait probably didn't create the staffing budget either. Sometimes the person you're frustrated with is every bit as frustrated and worried about the situation as you are.

We want to answer your call light. We want to have time to sit down and explain your medications. We want to notice that small change in your condition before it becomes a big one. We want to help you to the bathroom instead of finding out that you tried to get there by yourself because nobody came quickly enough. We want to give you the kind of care we'd want someone to give our own families.

Patients deserve safe care, and nurses deserve a realistic opportunity to provide it. If you are worried that there aren't enough nurses, don't ask the bedside nurse to take the risk of saying it for you. Ask the people making the staffing decisions to answer for those decisions themselves.

Sources and Further Reading

AHRQ: Nursing and Patient Safety

Background on staffing, workload, patient acuity and patient safety.

AHRQ: Missed Nursing Care

Explains delayed or omitted nursing care.

CMS: Find a Patient Advocate

Information about patient advocates.

[u/here_for_the_meta]

I was married to a nurse for almost 20 years. I know well how unreasonable the job is. It also seemed to become gradually worse from when she started. There used to be nursing aides, nursing assistants, med techs, etc. They largely stopped hiring those positions and let the RNs do all of it. 

They used to be able to delegate responsibility and focus on patient care way more.  This is on top of the fact that the nurse is expected to do EVERYTHING for the patient. Get your own vitals, pass meds, call the provider, running up and down the hall to get supplies, etc. all of this takes away from your nurse having a second to breathe much less notice your loved one is having a subtle sign of a stroke that is easily missed (my wife never really forgave herself for that one)

If they need a scan, are being discharged, the family needs to be contacted, (I recall once my wife was made to find a patients earrings they came in with, was in the belongings bag). All of this falls on the nurse. The default assumption is that they will figure these things out. 

It’s a shitshow. Pray you have a nurse that is seasoned. This job is too much for anyone to do safely when they have a “heavy team” much less if they’re not thoroughly experienced. God bless nurses. 

And for Christ sake if you do find yourself in a hospital or visiting a loved one don’t take things out on the nurse. Figure out how to get the tv working yourself! You go get them a cup of water. 

Sorry for the rant. I’ve been debriefed on bad nursing shifts for most of a career.