Issue Date: August 31, 2003

In this article:
10 tips when you have a loved one in the hospital

The nursing shortage & you

What all patients -- and their loved ones -- need to know.

You've pressed the call button, but a nurse hasn't arrived. You have a question about a particular medication or procedure, but whom should you ask?

Such situations are "what hospital patients and their families fear the most," says Linda Aiken, RN, a professor of nursing at the University of Pennsylvania. With healthcare/medical staffs stretched to the breaking point nationwide, such patient anxiety has become commonplace at hospitals and long-term-care centers. According to the Center for Health Workforce Studies, 45 states have shortages of quality nurses. And the shortage extends to operating rooms and intensive-care units.

"The nurses do everything they can. They are fantastic, and they helped save my son's life," says Esther Huffman of Alexandria, Va., whose infant son, Thomas, spent eight weeks in the hospital with colitis and a viral infection. "But you need to be able to be there for your [loved one]. Just look at the shift chart and you realize how overloaded the nurses really are."

More than 126,000 nursing positions in hospitals around the country are unfilled, according to the Joint Commission on Accreditation of Healthcare Organizations. In addition, the workforce is shrinking, because it's aging (and retiring) at twice the rate of other occupations.

"We're in a fix," says Peter Buerhaus, RN, senior associate dean for research at Vanderbilt University School of Nursing and an expert on the nursing shortage. "We need to rebuild the nursing workforce, and the sooner the better."

Short-term options include giving more responsibility to nurses' aides or allowing more immigration of nurses from other countries. But for now, experts say, families need to be better advocates for their loved ones while they're in the hospital or an extended-care facility.

"A hospital can be like a foreign land," says Patti Rager, RN, president and publisher of the Nursing Spectrum family of publications for nursing professionals. "Families can really help things by becoming key parts of the team to get their loved ones well."

USA WEEKEND Magazine, in partnership with the experts at "Nursing Spectrum", has compiled a list of tips that can help families learn what to expect and how to prepare for a patient's stay in the hospital. This advice is relevant for every kind of healthcare setting, from acute care to pediatric hospitals to nursing homes. Here are our 10 ways to help you cope with the current nursing shortage:

Go to top

Know the players: A registered nurse, or RN, should be in charge of day-to-day patient care in hospitals. In a long-term facility, a licensed practical or vocational nurse (LPN or LVN) may be your point of contact (these nurses also work closely with RNs in the hospital). A certified nursing assistant may check a patient's temperature, or a laboratory technician may draw blood, but neither is able to answer questions about your loved one. For such issues, talk with the assigned RN or the LPN/LVN. Before scheduling surgery at a particular hospital, ask what the nurse-to-patient ratio is on the unit where your loved one will receive care. The state of California recently instituted mandatory staffing levels -- a minimum of one RN for every six medical/surgical patients. For intensive-care, emergency, labor-and-delivery and other patients with special needs, the nurse-to-patient ratio usually will be lower, perhaps 1-to-2. The ratios take effect in January.

Be aware of shift changes: Nurses rotate between days and evenings. Some may work only three 12-hour shifts in a week, so your family member is likely to have several RNs during a given week. Rest assured that a nurse is assigned to every patient, but it probably will not be the same person more than a few days in a row. So get to know all the nurses. Also, keep in mind that shift changes often are the busiest parts of the day and thus are not a good time to ask a lot of questions.

Partner with staff: Ask what you can do to help. Brushing a patient's hair, helping with makeup or shaving, and knowing where to find an extra blanket are just a few of the things visitors are capable of doing. Meal times can be hectic, so be there to help feed the patient, open a carton of milk or take away the tray. Meals are a great time to talk, and in many hospitals they are also a good time to pitch in. Don't be a nuisance, though; your loved one may be on a restricted diet, so don't bring fast food.

Know warning signs: Remember that you know your loved one better than anyone in the hospital. If things aren't going well, family members can be the first ones to sense it. Ask the nurse whether there's any particular complication you can help watch for, especially after surgery. If the patient has had surgery on his leg, for example, and a lot of blood is coming through the bandage, let your RN know. It's OK to ask, "What's normal?"

Know the medication: The nurse needs to know about any medication the patient is taking, so make a list before going to the hospital. This rundown can range from antidepressants and other prescription drugs to herbal remedies and vitamins, and it should include dosage amounts. In the hospital or long-term-care facility, family members should be aware of any new medications the patient is taking. If you have questions, you can ask the RN or the physician.

Keep a notebook: Buy an inexpensive spiral-bound one, and carry it with you. Many questions come up away from the hospital, so jot them down and ask the nurse the next time you're there. If you're not getting the answers you need from the RN, find the unit manager or head nurse (who is responsible for the overall functioning of a wing or floor). Also, start a working glossary in the back of your notebook. Many healthcare professionals use abbreviations (industry lingo). Ask what a strange word means and write down the definition. Designate a family member to communicate with the nurses on the major issues and have him or her share the information with the rest of the family.

Fight clutter: Not every square foot needs to be taken up with cards or flowers. Use the bulletin board for cards and photos. Storage is at a premium, so take jewelry and keepsakes home. They'll be safer there, where they won't get mixed up with the linens or the trash. Many hospitals prohibit latex balloons, because other patients may be allergic to them. Make sure nurses have easy access to the patient, and don't mess with the medical equipment. Help fight infection by washing your hands, keeping your feet off the bed and not sneezing on the patient. Sounds sensible, but nurses are amazed at how few visitors actually do those things.

Ask for pain medication as needed: Nurses say too many patients try to tough it out. They may be in pain because they don't want to become "addicted" to painkillers. As it is, healthcare providers tend to under-medicate people. If the patient begins to feel discomfort, urge him to ask for help, because the medication needs time to act. If your loved one won't ask, ask for him.

Ask about visiting hours: Find out from the RN or nurse's assistant how flexible visiting hours are. You may be able to go in for a quick visit before work or stay past the posted visiting time to help your loved one make the transition to sleeping in a hospital. But patients are supposed to rest, so don't turn visiting hours into a party. Too many visitors in a room can become a noise problem for other patients, especially if it's a shared room. And the numbers also can overwhelm the patient. Two or three visitors at a time is plenty for someone recovering from surgery.

Take care of yourself: Stress levels run high when a loved one is in the hospital or after a health emergency. Make sure you and other family members are getting enough rest and eating well. Because of patient anxiety, even misplaced guilt, some family members may believe they need to be at the hospital eight hours a day. That does little good for you or your loved one. Rotate visitors, stay fresh, partner with the nurses and work together toward the goal everyone has: taking your loved one home.

Cover photograph by Herb Watson, Corbis