Good communication is essential to successful therapeutic relationships. This is all the more evident when talking about the interaction between patients and nurses. The exchange of information not only can lead to better compassionate care and outcomes, but it also puts patients at the center of the clinical decision making process.
It’s a two-way street: nurses need to know about their patients and patients need to know information from their nurses. For example, if patients understand whether their nurse can prescribe medications or offer advice on how to take a drug, they may be in a better position to access important medication and take it as directed.
Deborah Ray, RN, a clinical nurse on a surgical floor at Pennsylvania Hospital (PAH), said doctors may prescribe a pain medicine with a standard dose, but nurses can help patients understand when and if the drug can be taken more often.
“Patients and nurses must work together with pharmacists and other members of care teams to ensure patients know explicitly when they can take medications and how to do so safely,” Ray said. “It’s important for patients to ask their nurses about a PRN, meaning ‘as needed,’ if they are not sure.”
Her colleague Carlene Black-Young, RN, also a clinical nurse on the same floor at PAH, echoes this sentiment and adds that the direction of treatment and medication prescribed may be influenced by information often overlooked when patients and nurses discuss aspects of a patient’s life that may be relevant to their physical health.
“Some patients are afraid of disclosing certain health information for whatever reason, perhaps out of fear of being stigmatized or being treated poorly, but if they do not share this information, they could miss out on vital resources available to them,” Black-Young said. “If nurses are aware, they can talk to social workers if applicable and can advocate for patients more effectively if we get a comprehensive background.”
As patient advocates, nurses make patient safety paramount to care administered.
“Patient safety is our utmost concern and is often the driver of what we do and say,” said Jennifer Perno, BSN, RN, CMSRN, a clinical nurse at the Hospital of the University of Pennsylvania. “From preventing falls to ensuring medication safety, we spend a lot of time communicating with other professionals, such as pharmacists and physicians, to make sure what is being ordered won’t cause any harm.”
Perno notes that she and nurse colleagues are often the last safety check before patients receive medications or go for a procedure. Weighing possible side effects, ensuring proper doses, given at the appropriate times, and not interacting with other medications the patient may be taking, can sometimes take longer than patients would like.
“While feeling terrible, patients do not see all of the steps that are involved in the process,” Perno adds. “We want our patients to be made comfortable as quickly as possible, but we also strive to provide safe and quality care.”
James Kurtz, RN, a clinical nurse on a cardiology floor at Penn Presbyterian Medical Center (PPMC), adds that this open and honest communication with nurses is critical to both care for patients and prevent ways of them landing back in the hospital.
“I wish at the time of admission, all patients would feel comfortable being open and honest about their support systems – family, community,” Kurtz said. “This can help us identify important discharge needs ahead of time and identify potential gaps in care. We want to discharge our patients home as safe and as healthy as possible.”
Nurses care for many patients at once during a shift and do not have nearly as much down time as it sometimes appears.
Both Kurtz and Jessica Rothman BSN, RN, a clinical nurse at PPMC who cares for trauma patients, mentioned that a greater effort is needed to educate the general public about how technology shapes their on-the-job role.
Occasionally patients and families comment that nurses waste time at a computer instead of working, but this stems from a limited understanding of their roles.
“Really we are documenting our nursing assessment, looking up lab values, and making sure we are up to date on our orders so that we are providing the best possible care to our patients,” Kurtz said.
In addition to other aspects of clinical care, sometimes the tried-and-true efforts to manage patient comfort still helps. On her trauma and orthopaedics/trauma unit, many of Rothman’s patients turn to her to heal, not only physically, but also for help in mentally processing the traumatic event they just experienced. For these patients, a bit of extra effort goes a long way.
“If patients share their preferences regarding how they care for themselves at home, we can do little things, like coordinate what time they eat their meals, which could make the world of difference in making them feel more at home and help improve their satisfaction,” Rothman said.
While miscommunication happens at times in all medical settings, and the unique roles of nurses are not always well-understood, the nurses at Penn are honored to serve their patients.
“People say thank you to nurses all the time for taking care of them, but I'd like to say thank you to the patients for not only choosing us to help you heal, but trusting and opening up to us about your fears and concerns,” Rothman said. “Thank you letting us be a small part of your family while you are on your road to recovery.”