Nurse, will you hear me?
Jacqueline Vance, RN
There was a recent New York Times op-ed piece titled “Doctor, Shut Up and Listen.” Basically, it took you through a case about a woman who was having symptoms of a rapid heartbeat and feeling “stressed.” However, every doctor she saw wrongly referred her for psychological counseling for an anxiety disorder.
Turns out she was on an over-the-counter weight loss product containing ephedrine that was causing her symptoms, but she never had a chance to tell a doctor that. Eventually, she stopped taking the product and her symptoms discontinued. That is after thousands of dollars and multiple healthcare visits to primary care physicians and specialists.
Not one, she declared, ever took the time to ask her about any diet aides or supplements, etc., she may be taking. And the thing is, if she had, would any one of them had listened? Because one recent study found that on average, physicians wait just 18 seconds before interrupting patients' accounts of their symptoms.
A report by the Joint Commission found that communication failure (rather than a provider's lack of technical skill) was the root cause of over 70% of serious adverse health outcomes in hospitals.
Now, I am not trying to finger point here. With cuts in reimbursement to physicians, they have a limited time per patient to keep the lights on. But sadly, America is No. 1 in healthcare costs, and No. 10 in delivery of healthcare. So would taking just a few tiny minutes to listen and dig down improve both costs and health outcomes? I'm inclined to think so.
Now, I can't fix how much time a physician will spend with a patient or how well they will listen to them, but what I can speak to is the role of the nurse. The fact is, we do listen. We may have to learn to ask better or more targeted questions, but we have always been the ones to listen (look at the yearly Gallup poll). I cannot count how many times, when I worked in the hospital system, a doctor quickly rattled off complex details to a patient, left the room, and left the patient with that “deer in the headlights look.”
I know each one of you reading this know what I am talking about (though a shout-out to many long-term care doctors who, at least in my experience, take extra time to communicate with their patients, compared to office physicians). So, as a nurse, we play interpreter and intercessor. Asking the resident what they understood, take the time to fill in the gaps and list what they want to communicate back to the physician.
Oh, a true story: At a teaching hospital I had worked in I went into a room where a patient's family was anxiously awaiting the results of husband's/dad's surgery. He unfortunately coded on the OR table and did not recover. The new young surgical resident with a heavy accent walked into the room, stated that husband/dad died of a massive myocardial infarction and woodenly left the room. (Yeah, he could work on that bedside manner as well).
So fast-forward to lots of crying and “Mom” making a call to an adult child who wasn't there and saying, “I'm sorry, Honey, Dad didn't make it. He died of a massive internal fart!” Now, if the doctor had just waited a few seconds and asked the family if the understood and had any questions...
Let's just make sure that we, as nurses, don't get too busy to be that needed communicator as we continue to admit residents who are more acutely ill. Otherwise, we will lose our way from “Florence Nightingale” to becoming “robots on steroids” just to keep all those balls in the air.
It's hard feeling you can't be heard at any time, and it has to be worse when you are ill and/or frail. Let's make sure we “hear” and “speak” for our residents. Otherwise, we may lose our most trusted profession identity. You hear me?
Just keeping it real,
The Real Nurse Jackie is written by Jacqueline Vance, RNC, CDONA/LTC, a 2012 APEX Award of Excellence winner for Blog Writing. Vance is a real life long-term care nurse. A nationally respected nurse educator and past national LTC Nurse Administrator of the Year, she also is an accomplished stand-up comedienne. She has not starred in her own national television series — yet. The opinions supplied here are her own and do not necessarily reflect those of her employer or her professional affiliates.