Thursday, March 20, 2014

If Patients Had To Sign an Expectations Contract Before Entering the Hospital...

I love being a nurse. I think it is the most rewarding job in the world. I’m so grateful that I have the opportunity to help people every day AND get paid for it. But nursing definitely comes with frustrations. It’s not just the best job in the world, but it can also be the hardest.  Some of those frustrations come from the expectations of patients. 

Empty playground at a hospital in Ecuador, 2012
Patients are the reason that nursing is a great profession, but sometimes the expectations of what nurses, and the medical community can do, is misunderstood by patients. And this causes stress for everyone. I joke all the time that everyone would be so much happier if patients had to read and sign a contract before they were admitted to the hospital so they had a better idea of what to expect.

After a particularly hard week at the hospital, I wrote a “joke contract” as a form of pseudo-therapy for myself. But all joking aside, apparently some doctors are already instituting patient expectations contracts. I find this really interesting, as both patients and the medical community need to take responsibility for patient expectations and outcomes.

I think it would be so great if patients were given a clear, honest picture of what to expect as a patient from the medical staff. I think this could only improve patient care and satisfaction, and open up more of a dialogue between the staff and patients on what they are hoping to accomplish by the hospital stay. Here is a start to what I would have patients read and sign before admission. 

The Patient Expectations Contract

1. I understand that I am in a hospital and will likely experience pain, nausea, discomfort, anxiety, sleeplessness, frustration, more pain, and boredom. I understand that, although medicine is wonderful and advancing every day, there may not be a medication or miracle to solve all of these problems, including the problem I was admitted with. The staff is doing their best to make me happy but sometimes I will just have to grin and bear it.

2. I am my best advocate. When I need something, I will ask for it before the need becomes extreme. I will speak up when I am scared, hurt, hungry, etc., before I take my frustrations out on the staff. I will ask questions while my doctors are in the room, especially when it is a question only a doctor will answer. I will write down my questions and thoughts so I can share them with the appropriate staff and not forget them. I will say no when I want to, because it is my body.

3. I realize that my nurse is not my waitress, maid, punching bag, or personal slave. My nurse is my nurse. My nurse’s job is to keep me alive, and as comfortable as possible. It may not be possible to keep me comfortable. My nurse is my advocate, but can only advocate as much as I let them. For example, if I tell my nurse I’m in excruciating pain, and that nurse summons the doctor, yet I put on a brave face for the doctor, I realize my nurse will not get an order of pain meds from the doctor, and cannot help me. I realize for my nurse to help me I must be honest, clear about what I need, and straightforward with all members of the medical team. 

4. I acknowledge that I am not the only patient. I will have to wait, sometimes a long time, for things that I need. My doctors and nurses will not be able to spend as much time with me as they want to. I will rarely get things the moment I ask for them. My doctors and nurses will do the best they can to accommodate when I want to walk, eat, sleep, have tests, and talk to them, but I will also have to be very flexible and patient because things rarely go exactly as planned in the hospital.

5. I know that my doctors and nurses are only human. They are not gods, miracle workers, or invincible. Although my doctors and nurses care about me (yes, we really, really do) and will use all their skills and compassion to do everything they can for me, I know that not all medical issues are fixable, and most medical courses run into complications. My doctors and nurses have feelings. They get frustrated, sad, and hurt, just like me. They also celebrate with me, and are genuinely happy when I get better. They will do everything they can for me, but I will be kind to them, too.

*Alright, so this isn’t exactly a “gluten-free” post. But I wanted to share it, so hopefully you’ll give me some slack ;)

Wearing my grandmother's medal for "most compassionate nurse"

Disclaimer: Having been both a nurse and a patient, these opinions are entirely my own and not necessarily the opinions of my employers or fellow nurses, past or present.