Meeting with the PTU Staff
I was taken by how young the staff members was. Typically there is a wide age range among the staff members on units. “Tell me how long you all have been nurses,” I asked. The answers from the 20 or so people ranged from 6 months to 3 years, except for one RN who’d been on the unit for more than 10 years.
Next I wanted to know, “What would I see happening if I were observing you during a good shift.” Several people responded simultaneously: “We’d be helping a nurse who was overloaded.”
“The physicians would be communicating what was happening with their patients,” chimed another group.
“We’d have more staff members, but everybody knows that’s not going to happen,” said one of the 3-year veterans. “For that matter,” she continued in a derisive tone, “the docs ‘won’t’ start communicating and the nurses aren’t able to help out more than they already do.”
I didn’t have to ask what a bad shift would look like; the floodgates had been opened.
“And when a doctor does talk to you, it is one-way communication,” added one of the nurses indignantly. “Even when the patient’s having problems, like incontinence, it’s impossible to ask their physician about a plan for dealing with the issue.”
“Another problem we have with patients is our high fall rate,” one of the millennial pointed out. “We need more training to deal with uncooperative or confused patients. And we need the physicians to stop writing so many prescriptions for pain meds. Some patients have so many painkillers in them they can’t even stand up. Others become nasty when we try to deal with them.”
“These transplant patients are manipulative when it comes to getting pain medications. To make matters worse,” one of the fresh faces offered, “they’re young and they don’t believe they need nurses helping them get to and from the bathroom. That’s why the PTU always has the highest patient fall rate in the hospital.”
“It’s not just difficult asking the physicians for help with patient problems,” suggested one of the newer nurses. “I feel bad asking another nurse for help—even when I’ve got two or three problems happening with patients at the same time.”
“We have a number of nurses with bad attitudes,” stated one of the young charge nurses. “They have a negative effect on your whole shift. I try to avoid them, but they have a way of getting to you.”
“What would I see if I were observing someone with a ‘bad attitude’?” I inquired.
“They roll their eyes if you ask for help with something” was the response. “Or, they flat out say, ‘I’m too busy’.”
I asked the group what they believed would improve the situation.
“Getting a lunch break would help,” one of the nurses said sarcastically.
“We’ve talked about starting to round with physicians. But we need the docs to see the benefits of two-way communication,” suggested one of the nurses who had been quiet until then.
“Maybe it would help if we could tie improved communication to increased patient safety,” offered the newest nurse on the staff members.
My final question: “Who do you think would be good at building on these ideas and would be willing to work hard to figure out how to implement them? Feel free to nominate yourself.” In about a minute 14 names had been offered as potential PROPEL team members.