“Yes, I Hear it is Change of Shift, AND My Friend is Suffering.”

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Please note this is based on a true story w/ names and details changed to protect privacy.empty hospital hall

Alice shared her recent experience of visiting her friend, Mary following a major surgery to treat a life-threatening cancer.  When alice arrived, Mary had the call light on because she was extremely nauseous.  Alice sat with her and tried to comfort her.

Ten minutes went by.  Ten minutes can seem like a lifetime when you are nauseous, in pain or having trouble breathing.

Fifteen minutes later there was still no sign of help.  Alice went out to find a nurse.  The halls were empty, but eventually Alice ran into someone in scrubs.

Alice: (Worriedly)  “My friend has been ringing for a nurse.  She is suffering and no one is coming”.

Staff:  (After looking at her watch) “Ah it’s change of shift.  Someone should be there soon”

Alice went back to be with Mary.  She told Mary that ‘someone would be there soon’.  She didn’t the mention the shift change part.  Her friend looked and sounded so sick, the supposed justification didn’t feel right.  Five more minutes went by.  A grueling five minutes for Mary and on top of circumstances that are already so troubling.  Again, Alice went out into an empty hall.  Walking around a corner she found a group of nurses at the nurses’ station talking.  She interrupted them.

Alice: (More worriedly)  “My friend has been ringing for a nurse.  She is suffering and no one is coming”.

Nurse: (After looking at her watch) “Ah it’s change of shift”.

Alice:  (Worried and angry)  “I hear it is change of shift, AND my friend is suffering!  Please make sure someone sees her right away”

This event took place in metropolitan hospital.  As my friend, Alice was telling me this story, she wondered how this could happen.  Frankly, I can envision it happening in any facility that is chronically understaffed. Nurses and other staff may be fighting to ensure time is available for change of shift dialogues and no doubt this is very expensive time for an organization.  But we shouldn’t shut down the business of healthcare in the process, right?  And understanding how this could happen does not justify it.

Ten minutes can seem like a lifetime when you are nauseous, in pain or having trouble breathing. Click To Tweet

Change of shift was tragically in the news earlier this month when a NYC Emergency Response System failed to notice an emergency call for four minutes.  In this case, 4-year-old Ann Russo, a victim of a hit and run in the Upper West Side of Manhatten died and we know, don’t we, that the first few minutes of emergency care are crucial to survival?

How would you answer Alice’s question?

It is hard to defend, yet with enough staff, cohesive teamwork, and progressive leadership  this type of situation can be avoided altogether or readily addressed in the moment.  Adequate staffing (at least most of the time) would help prevent this problem because ensuring patient’s needs were met before shift change would have been more likely.  In addition, adequate staffing would  have fostered teamwork and co-creative problem-solving to ensure that someone was available during shift change to triage calls and either solve the problem or get someone who can.  Progressive leadership in this situation includes advocating for staff, role-modeling healthy limit-setting, creating an environment for collaborative problem-solving, and discipline for instances or patterns of neglect.

The top three root causes of sentinel events are; Leadership, Human Factors, and Communication! 

(All of which can be improved with Medical Improv!)

 

 

 

 

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5 Responses to “Yes, I Hear it is Change of Shift, AND My Friend is Suffering.”

  1. allewellyn says:

    very sad. Many of today’s nurses are in a routine that they think ‘allows’ them to take care of patients on a schedule. This story shows how untrue this is. When a patient has nausea, (especially post-op) someone should see her right away and take the measures available, medication, fluids or just comfort. The friend tried to get someone but got the answer, the nurses were on shift change…this is wrone and it an ongoing problem that needs to be corrected.

    • Beth_Boynton_RN_MS says:

      I agree, Anne. A c/o of nausea should be assessed and treated or addressed right away. We’re supposed to help decrease suffering not postpone it according to our schedules. I tend to think it is a staffing issue.

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  3. Hi Martine,
    Thanks for your comment. Your interview results strike me as a great example of nurses/organizations trying to solve a problem via limit-setting, but loose sight of the bigger picture. I doubt very much that any hospital leaders would tell patients to use the call bell before or after change of shift. And they would probably find fault with nurses who tell patients that if they got wind of it. Yet, because it is a reality of understaffed facilities, an underground culture emerges where this is an unspoken or covertly spoken suggestion. Working in chronic understaffed situations, we develop a guardedness about our time and our lens for limit setting is narrow. It is a survival mode. In a fully staffed unit, we would have a plan. A designated nurse or nurse assistant with back up from a unit manager could easily help sort what patient needs could wait and what should not. Patient needs would be more likely met before change of shift and nurses and other staff would not be working at a rushed pace all the time, so that when we need to shift into high gear we can. Versus burning out, shutting down, giving up. You are so right in your conclusion that understaffing is a big problem and translates to the patient. Healthy teamwork, delegation skills, Nurse-patient rations, and supportive leadership can all help to create systems where there is a better balance between budgets and staffing.

  4. Sadly, this is all too common. I’m not a nurse but have been a caregiver/advocate for hospitalized loved ones and experienced the same situation on a number of occasions. When I interviewed over 175 nurses, doctors, hospital staff for my last book, Critical Conditions, I asked the nurses what to do about this problem. Several suggested finding the patient’s RN as many family members find any nurse or staff member and the request for pain medication doesn’t make it to the appropriate person.
    I also asked about shift change. Each said that during that time try not to bother the nurses. So, that leaves us to make requests either before or after the shift change.
    Nurse understaffing is a big problem and that translates to the patient.

What are your thoughts?