10 INSIDER TIPS ONLY NURSES WILL TELL YOU

During the four years I spent reporting my book The Nurses: A Year of Secrets, Drama, and Miracles With the Heroes of the Hospital, I learned that nurses are not just the unsung heroes of healthcare; they’re also its secret keepers. If you want to know the truth about your doctor or healthcare institution, ask nurses. Meanwhile, here are 10 of the insider tips they shared with me to help patients get better care.

1. Get a Second Opinion on the Surgery Your Doctor Recommends You might not actually need the surgery your physician says you need. Nurses told me that the healthcare system incentivizes some doctors to advise high-cost procedures, which can lead them to bully patients into undergoing treatments that won’t necessarily help them. “If I could talk to my open-heart surgery patients before the surgery, I would probably advise 30 percent of them not to have surgery,” said one New York nurse. “Doctors undersell how much rehabilitation the successful recovery from heart surgery requires. Every time I see patients over 85 opt for an aortic valve surgery because they were becoming short of breath on exertion, I scratch my head a little bit because I know that many of these high-risk patients will not get back all the faculties they had before the surgery, and some won’t even make it out of the hospital.” Getting a second opinion (and a third) may give you a more accurate picture.

2. Appoint One Family Spokesman Your hospital nurse will have more time for you if she doesn’t have to answer repetitive questions from each of your visitors. Designate one family member to be the completely informed individual — in addition to you — who communicates with nurses. Visitors with questions can relay them to the spokesman or in some cases they can write their questions directly on the whiteboard in the room.

3. Avoid Teaching Hospitals in July Every July in teaching hospitals, medical students become interns or first-year residents, first-years become second-years, and so forth. These new doctors are immediately thrust into direct patient care. New doctors can make mistakes: In July, U.S. death rates in these hospitals surge between 8 percent to 34 percent, or between 1,500 and 2,750 deaths. University of California at San Diego researchers found that fatal medication errors “spike by 10 percent in July and in no other month.” The healthcare industry calls this upheaval “The July Effect” in the United States and “August Killing Season” in the United Kingdom (where the shift happens in August). If you must be hospitalized in July for a particularly complex procedure, you might consider avoiding teaching hospitals. Approximately 25 percent of U.S. hospitals are teaching hospitals, which you can identify by checking the “About Us” page on a hospital’s website.

4. Watch Carefully When Hospital Staff Enter Your (or Your Loved One’s) Room Not all doctors and nurses remember to wash their hands when entering a patient room. Nurses encourage patients and visitors to keep a close eye on every staff member who walks in the door and to speak up if someone forgets. A simple “Could you please wash your hands?” should do the trick. This is an easy way to reduce a patient’s chance of infection. Along the same lines, it doesn’t hurt to bring your own sanitizing wipes and wipe down surfaces in your hospital room.

5. Do as Much As You Can for Yourself and for the Patient You can help maximize your or your loved one’s time with the nurse by doing as much as you can on your own. Bring or find your own food and beverages, and ask the nurse if there’s anything you can do to help the patient. You might be able to assist by recording fluid intake and output, brushing the patient’s teeth, handling feeding, or participating in therapies. “I’ve given a bath to a child while the parents sat there and watched,” an Arizona pediatric nurse told me. “Nurses do not give magical baths. We give fast ones when we are busy. Any type of care that can be done by the family is not just a help to nurses; it aids in the healing process. Who better to care for someone than the people who love them most?”

6. Have Honest End-of-Life Discussions Before They Are Necessary Nurses see it more often than you’d think: A patient with a Do Not Resuscitate order is unresponsive, a family member insists the medical team “do everything you can” to save the patient anyway, the hospital complies, and the patient’s end-of-life wishes are ignored. “I think if people better understood exactly what ‘do everything’ entails, they would be less likely to demand it,” said a Texas travel nurse. “Performing CPR is probably going to break multiple ribs, [some patients] will almost certainly die in the ICU after a prolonged barrage of horribly toxic medicines, and we can put someone on a ventilator but their anoxic brain injury means they’re never waking up again. If we could show families how much more horrible it is to prolong treatment of a dying person, perhaps they would choose differently.” Nurses suggest that families make sure they are on the same page about end-of-life wishes long before they are placed in urgent situations.

7. Have Someone Stay With the Patient 16 Hours a Day A second set of eyes and ears is always helpful to a hospital patient. Loved ones should try to have visitors take turns so that someone is in the room with the patient 16 hours a day. “It is really important to have someone stay in the hospital with you. Nurses may not always be able to keep a close eye on each of their patients,” said a Pacific Northwest PACU nurse. “Sometimes, the aggressive patients needing more nursing care take time from the quieter patients. It’s like the squeaky wheel gets the grease.” Ask the staff what time the physician conducts his/her daily rounds and let them know that a visitor will be present for them. “Patients get better care when their family is involved, actively,” said a Virginia nurse practitioner.

8. Don’t Be Afraid to Ask Questions Patients and family spokesmen shouldn’t hesitate to ask doctors and nurses questions about their care and reasons for procedures. “Even if you’re worried about annoying a doctor or nurse, if you have questions, you should ask them,” said a psychiatric nurse in Hawaii. “The patient and patient’s family need to know enough about what’s going on to advocate for the patient’s well-being. It could save your or your family member’s life.” When asking questions, avoid using “Why,” which can put healthcare providers on the defensive. Instead of inquiring, “Why did you give him that medication?” try “Help us to understand why he’s getting this medication,” a Texas family nurse practitioner suggested. Additionally, double-check the identification information on your armband or make sure your family/visitors know to check it for you. If questions aren’t urgent, don’t ask them on a nurse’s first visit of her shift, when she might be particularly busy visiting each patient. By the second pass-through, she should have more time to focus on your concerns.

9. Being Kind to Your Nurse Matters While nurses try to give every patient the best healthcare possible, they don’t necessarily treat every patient equally. You’d be surprised how many people are rude to nurses, many even to the point of physical or verbal abuse. Patients and visitors who are unkind can delay processes like repeat pain medication, a Washington, DC nurse said, “because the nurses don’t want to deal with them.” Respectful patients, on the other hand, might get faster service than the pain-in-the-ass down the hall – and, sometimes, some extra perks, too.

10. Understand Why Your Medications Might Not Arrive Promptly Even if your hospital medications are due at 9 o’clock, you might not receive them at exactly that time because your nurse could have several other patients with medications due simultaneously. Many nurses are overloaded with patients, and might have to give them one pill at a time or crush pills into applesauce and feed them carefully to a patient. Also, “Your nurse may be late answering your call light because she was just holding the hand of a patient breathing his last breath; someone who just lost their mother, father, or spouse was crying on her shoulder; or she was being verbally and physically abused by a drunk,” said an Illinois ICU nurse. So cut your nurses some slack. They are doing the best they can.

Alexandra Robbins is an investigative reporter and author of five New York Times bestselling books, and a contributing editor at both Marie Claire and Washingtonian. In 2014, Robbins received the John Bartlow Martin Award for Public Interest Magazine Journalism. The author’s best sellers include, The Overachievers, Pledged, and The Geeks Shall Inherit The Earth. Her latest, The Nurses, chronicles her year spent reporting on the daily lives of the “secret-keepers of healthcare.”