Hospital nurses, please help me out!

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My 81 year old mom has been hospitalized a couple of times this fall. Once for a large and very painful hematoma in her thigh and most recently for complications from a routine kidney stone procedure.

I went in this morning and was told the doc had not been in. My brother went in this afternoon and was told the nurse was not aware that the doc HAD been in this morning and did not have concerns. Shouldn’t it be written down somewhere? Should the nurse know?

Other things happened the last time mom was hospitalized, but is this typical? How do we get straight answers from people? My mom’s hearing is not good and neither is her memory. How do I get someone to tell ME everything they’re telling her?

The nurses are all very nice, so I am in NO WAY ragging on nurses. I’m just trying to figure out how to get the info I need. (my mom lives with us, so I need to know what’s happening)
 
I’m not a nurse, but my parents have spent time in the hospital. The hospital may have computerized notes, the doctor may have an irregular schedule of making his rounds (or may have rounded at an odd time) and the nurse may not have had a chance to see his notes in the system by the time she was asked. (The doctors do not necessarily notify the nursing staff directly, “Hey, I’m here to see so-and-so”, but just cruise in and out to check on their own patients.)

Ask your mom’s doctors directly about their visits. Generally speaking, if you want to know when the doctors will be by and what they said when they did, the person(s) given the privelege to know by your mother ought to be in direct contact with her doctor’s office. Get directions from the doctor, from the hospital, and from the staff on the floor about how you can keep tabs on this directly. It is not uncommon for the right hand to occasionally be ignorant of what the left hand is doing. Sometimes, it can get so nuts that the right thumb and forefinger are barely aware of each other…there is just so much information and so many patients. It has even happened that a patient can have several doctors who are not communicating with each other very well or who miss important points in the nurses’ notes. Most of the time, the nurses are very glad if a member of the family is around to keep tabs on each individual patient and all the goings on with their care, especially if the family takes the trouble to keep tabs on what the doctors are doing and whether it has been communicated correctly to all of the rest of the staff. This goes ten times over if the patient can’t understand or remember who was there when or did what or why over the course of their own treatment.

If you are thorough, you will take care to see that the doctor’s orders got to the rest of the staff and are being followed as specified, and that they don’t lack the official notifications needed to carry out his decisions. These things very easily get through the cracks. Many families find this hard, because of course they have jobs and other family members to care for. too. Sometimes the hospitals have ways for family members to keep tabs on things online, though. This is something to talk to the doctor about.

If you can be there when the doctor comes through on his or her rounds, so much the better, but that can be a chancy thing, because it can come last after all the clinic appointments and urgent things that drop into their laps. You can ask for an expected time, but expect that it can be a) very early in the morning or b) not at all close to the time the doctor had hoped to be there.
 
EasterJoy said:
Generally speaking, if you want to know when the doctors will be by and what they said when they did, the person(s) given the privelege to know by your mother ought to be in direct contact with her doctor’s office.
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Thanks. I did last time and the doc didn’t call me back.

This is all so new to us. I wish there was a handbook about caring for an aging parent-- how to do things and what to look for. Plus I’m at the point where I’m not sure mom should be going to any Dr appointments alone, because I’m not convinced she hears and remembers everything.:o
 
Is it possible that the doctor was in to see your mother between the time you were there and when your brother came in?

In my experience (I am not currently a nurse but spent some time in nursing school), nurses try to be around when the doctors come by, especially if there are any complications or if they have questions for the doctor about their patient’s care. Sometimes though, they are busy with another patient, updating records, passing meds, or any number of other things and they miss the doctor. In that case they’ll check every so often (look in the records, or just ask another nurse or staff member “hey have you seen doctor so-and-so yet this morning?”) and keep themselves updated regarding any new orders.

As for how to get straight answers, you can always call the nurses’ station when you are not able to be there and ask for an update. If your mother’s nurse is unavailable, they can either have her nurse call you back or have another nurse check your mother’s record. Oftentimes hospitals will ask that you appoint one person as the contact, and ask that only that person call, so you might want to talk to your brother and anyone else to decide who that would be and then arrange it.
 
I’m a hospital nurse and generally what I see is that there really isn’t a way to give family members a definite time for when a doctor will round on their patients. The doctor’s have patients all throughout the hospital, and if they are also spending time in clinic, or handling an emergency somewhere else, Then it does become difficult to tell family members what time the doctor will be rounding on a specific patient. Usually what I say to family members is “I’m sorry, I can’t tell you when the doctor will be in. But, if you are not here when he visits, I can provide him with your number to discuss what is happening and questions that you may have.”

I’m an ICU nurse and generally speaking we have two patients/nurse. However if your mother is staying on a medical ward be aware that that one nurse may be taking care of anywhere from 5-8 patients/nurse. Which is a lot, so yes that nurse may have missed the time that the doctor visited your mother because she may have been occupied with another patient. However, what I would do is have the nurse leave a note on your mother’s chart to have the physician call you with an update. From what I’ve seen in my unit, our doctors are good about this.
 
Go to the department of Nursing Administration and tell them of your concerns and tell them you wish a full report on your mothers from her nurses when you ask. If you want to know if she was seen by the Dr. call his office and tell him none of the nurses were aware of his visit.
You can also ask the nurse to please go to the chart and check it to see if notations were made today. She may not tell you what he said but if he made notations you can call him and remind him that you depend on his information and would appreciate a call from him if any changes to her condition occurs. This is your mother and the more assertive you are the more likely you are to be notified. As a retired nurse I understand your concern. Pt’s families are the best advocates for their loved ones. If the answers are not forthcoming you can always tell them that your lawyer will be consulting with them if this communication gap cannot be remedied.
 
taliesin319 said:
Pt’s families are the best advocates for their loved ones. If the answers are not forthcoming you can always tell them that your lawyer will be consulting with them if this communication gap cannot be remedied.
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What is she going to sue about? That she’s frustrated, her feeling are hurt? I’m not underscoring the seriousness of her mother’s situation. Or the fear and concern that she is experiencing right now. Believe me I’ve had family members in the hospital. My father was recently in the hospital with a heart attack. But, I don’t understand the need to throw around the lawyer card, and I don’t see a valid reason here for a lawsuit. When people threaten to sue like that, in my humble opinion it doesn’t make you any more of an advocate for your loved one. It just makes you an adversary for the nurses. For the few times that family members have threatened to sue me…My response has always been “Fine…sue…and you will see that I have provided excellent care for your mother, and will continue to do so in spite of your threat.”
 
You need to talk to a Social Worker. The hospital should have one on staff.
If they don’t, laws vary from state to state so the best place to start with with your state’s office of aging or an attorney that specializes in Elder Law

Again, things vary from state to state. Here In NY we use what is call a MOLST form for the elderly patients in my skilled nursing facility. Every patient, along with their family/responsible party has to fill one out.

Here are a some links, the first 2 are about MOLST, the 3rd is to the USCCB.

health.ny.gov/professionals/patients/patient_rights/molst/

en.wikipedia.org/wiki/Medical_Orders_for_Life-Sustaining_Treatment

usccb.org/issues-and-action/human-life-and-dignity/end-of-life/

There are also things that can be put into place for elderly people who still live in their own homes. Again laws vary from state to state, so it is best to check with your state or county to see if they have an “office of the aging” and go from there.

It is also a very good idea for adult children to talk to their parents about these things. It is often a very difficult discussion to start, and you will be glad that you did in the run! 😉

It is so much easier when everyone is “one the same page” before something happens and the only way that can happen is through thoughtful communication.

OK, I’ll get off my saopbox now! 😛
Anyway, there is help out there, I am very familar with the laws in NYS, so if anyone wants/needs any info feel free to PM me.

I will keep you & your family in prayer KCT. :gopray2:
 
nurse here…generally,docs round at any time of the day or night. if they stop in, it’s not necessarily documented. sometimes they can round several times before they write any notes. pretty typical…

i guess i would simply talk to whoever is your mom’s nurse. let her/him know what questions you specifically have for the docs. a good nurse will find the doc when he’s there, even if YOU are not, get your answers and sit with you later to fill you in.

i don’t think there’s any need at this point to get super excited. this sounds normal to me. honestly. you can always ask for the unit manager to talk to also, if you feel like the nursing staff isn’t helping. they might be as much in the dark about her as you are. sometimes docs will round and never communicate with the nurses.

if, after your mom is dicharged, and you are still not happy or have questions, you can always call the person called the Patient Advocate. they are the person assigned to take calls with questions, complaints, etc and get answers for you. but i think you’re a ways off from that.
 
Not nurse, but do clinical work in healthcare with many nurses in & out of hospital. As has been mentioned, if a floor nurse was on (5-8 patients) they may not have seen the Dr. If a shift change took place between you and your brother it might not have been passed along during report.

If you are otherwise satisfied with the nursing staff just ask them kindly to implement the suggestions listed above re: note asking Dr specifics etc. Squeaky wheels get oiled but very squeaky or annoying wheels in my experience get the letter of what needs to be done but nothing extra.

When a family continually goes to administration the nursing staff tend to become very hesitant/guarded with any interaction with the family due to concerns of what they say may be passed along without proper context. Just a thought…

Good luck with your mother.
 
KCT said:
My 81 year old mom has been hospitalized a couple of times this fall. Once for a large and very painful hematoma in her thigh and most recently for complications from a routine kidney stone procedure.

I went in this morning and was told the doc had not been in. My brother went in this afternoon and was told the nurse was not aware that the doc HAD been in this morning and did not have concerns. Shouldn’t it be written down somewhere? Should the nurse know?

Other things happened the last time mom was hospitalized, but is this typical? How do we get straight answers from people? My mom’s hearing is not good and neither is her memory. How do I get someone to tell ME everything they’re telling her?

The nurses are all very nice, so I am in NO WAY ragging on nurses. I’m just trying to figure out how to get the info I need. (my mom lives with us, so I need to know what’s happening)
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Have you asked the nurses for the best way to keep you informed? Is there a protocol that can be implimented or already exists that you can be part of? Do they have your contact information? Do they know you are the primary contact person (if you are)? Many hospitals err on the side of caution when it comes to patient privacy.

These may sound like basics and obvious, but don’t assume anything. You are not the first family member in this situation, so I am confident there is a system that is in place… but often you have to ask about it.

As others have said you need to be assertive and clear in your requests, but you will not get anything thing resolved by waving the “lawyer card” as some have suggested; especially if there is no obvious or glaring attempt or evidence of malptractice or abuse.
 
One question I would have – and I apologize if I missed this information – is do you have legal authority to get information about your mother? Have you been designated as a person the medical staff can speak with about your mother’s care or do you have power of attorney. With the threat of lawsuits constantly being thrown around, medical staff is extremely cautious about what information they will or can give out. I would just make sure that the paperwork is in place so you can receive the information you need.

As has been mentioned, I would be cognizant of the nurses’/doctors’ schedules before asserting that you get no return call – I’m not saying you aren’t. Just be aware. I am NOT in the medical profession – I work in a courtroom – and people will leave a message for me and get irritated that the call is not returned within the hour. Ummm, I’m in the courtroom. Sometimes it’s a week before I can even listen to my messages. I do realize that medical staff is different and need to timely respond, but sometimes that needs to be realistic timelines.
 
Nurse here…

Yes, we have anywhere between 5-8 patients, all with varying degrees of how serious their illnesses are. Physicians breeze in and out all day, and don’t always let us know. We know right away when we get orders or stat orders, but if there are no orders, we may not know for a while. They don’t always chart that they’ve been in the room because they will dictate their notes and it will show up on the computer later in the day. My current facility loves their paper charts, but many other facilities are ‘paperless’ and many components of their chart are in the computer.

If a patient’s family member came to me just as you have, with the same information in your post, this is how I would have responded.
  1. do you have a passcode/password? If not, let me get permission from the patient to give it to you. If you have it, then:
  2. I would go through the chart to see if the physician left any orders (he may have just left them while I was in another room)
  3. Give me your contact information and I will call the physician and let him know you wish to speak with him/her. I would tape that to the outside of the chart.
  4. I would call the physician as follows…different hospitals are different in their policies and often doctors have 'preferred contact methods". IF they are open to getting phonecalls on their cellphone, I would call and tell the doctor. IF you have to to through their office or answering service, I would call and leave that message with their nurse/answering service.
  5. If you have done this and you feel your nurse hasn’t helped you, go to the charge nurse. And if that doesn’t help, the department manager. You can call the doctor’s office yourself too.
Keep in mind, your nurse may not be able to call the doctor/office right away. Patient care comes first. Keep in mind, the unit secretary can also put a note on the chart.
 
I hope things got straightened out. When I had surgery my doctor stopped by just after 6 am before he went to his office in the adjacent clinic and just before 6 pm as he was heading home each day. But then again I was peds and he was a very excellent surgeon.

It also depends on if it’s during the weekend, which is usually not optimal as the on-call doctor does not know the patient and is covering more units than during the week. My poor nurse had to get approval to go back to my original pain management protocol when my pain got out of control and it took him over an hour to get doctor approval on a Sunday morning while he had a screaming patient on his hands (yes, it was that bad!).
 
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