You Can’t Say That

Last week I was speaking with a physician about one of my patients whose family members had (in my opinion) unrealistic expectations for nursing staff. When bringing this difficult situation to thier attention, the MD’s argument was that “it is just a concerned mother advocating for her son.” Having a chronic condition since childhood, the patient’s parent had always worn multiple hats: mother, caregiver, advocate, nurse. Because of that, when in a hospital setting it was hard for her to not wear every hat. I expressed that I was unable to meet her requests becuase I have 2 other patients to care for. The MD quickly said “You can’t say that” and continued to explain that by saying that I was implying that the patient was not important and that they were not my priority.

I struggled with this. What do you mean I can’t say that?

I understood the MD was trying to see things from the mother’s perspective. However I needed them to see things from my perspective, the nursing perspective. I saw her son as one of my 3 patients, and a relatively stable one at that. I saw him having routine cares that I was capable of completing per hospital policy. I saw his medication passes and repositioning needs along with dozens of others throughout my 12 hour shift. And unfortunately, this was not enough. Unfortunately, we were not on the same page when it came to nursing expectations.

I could not deliver one-on-one care.

I could not perform interventions using home supplies or methods.

I could not spend my whole shift coordinating discharge care with their home health agency.

I could not page every doctor, intern, or fellow on the renal, pulmonary, or hospitalist team to come bedside.

What I could do is provide appropriate, quality care within my scope of practice to the best of my ability. I could round on him, with the help of my nursing assistant, as frequently as my time allowed. I try not to let the fact that I have 2-5 patients (depending on location of my assignment) affect the care I give each individual. However it does not change the fact that I do have other patients.

I try to have a positive reflection I can take away from each shifts, regardless of the events of the day. But this one was just plain tough.