Patient Advocacy During a Hospital Stay
When patients learn that they or their loved one needs to be admitted to a hospital, it can seem frightening and overwhelming to enter such unfamiliar territory, especially with a layman’s limited knowledge of a hospital’s practices, personnel, and terminology. During their stay, they may feel ignored, marginalized, or patronized, because they’ve had little preparation for what they might encounter. Most patients don’t know how to be their own Patient Advocates in a hospital setting.
Nurses can be a vital resource for teaching Patient Advocacy techniques to their hospitalized patients. Here are some of the issues that can make a hospital stay feel uncomfortable:
- Staffing shortages: not enough registered nurses (RNs), certified nursing assistants (CNAs), pharmacists, other healthcare providers and administrative staff
- High nurse/patient ratios
- When for-profit hospital systems buy not-for-profit, safety-net hospitals. Different hospitals having different cultures
- Medical errors—one of the leading causes of death in the U.S., with 80% of those errors occurring during handoffs
Let’s take a closer look at some of these issues and then we’ll consider 12 strategies patients or their loved ones can use to make their hospital stay less intimidating.
Factor 1: Nursing Shortages in 2022
Over the past decade, the average age of employed RNs has increased by nearly two years, from 42.7 years in 2000 to 44.6 in 2010. This year, the U.S. Bureau of Labor Statistics anticipates more than a half a million seasoned Registered Nurses will retire, prompting the need for 1.1 million new RNs to accommodate expansion and replacement of those retirees. Already there are far more registered nurse jobs available than in any other profession: more than 100,000 a year. “The magnitude of the current nursing shortage, is greater than ever before in this country. It is projected that 1.2 million new registered nurses (RNs) will be needed by 2030 to address the current shortage” (Greenwood, 2021).
Due to extremely low wages ($10-15/hr.), high turnover, and excruciatingly difficult working conditions, there’s also a critical shortage of Certified Nursing Assistants (Ohmart, 2022)
Short staffing is every nurse’s worst nightmare…and every patient’s fear.
Factor 2: Medical Errors
J.T. James outlined five types of errors found in hospitals in a 2013 article (James, J. T., 2013)
1. Errors of commission: a patient can be harmed when a mistaken action occurs, either because it was the wrong action or the right action performed improperly.
2. Errors of omission: a patient can be harmed when the medical records indicate that an obvious action necessary to heal the patient was not performed.
3. Errors of communication: a patient can be harmed by insufficient communication between two or more providers or between providers and patients.
4. Errors of context: a patient can be harmed when a physician fails to take into account the unique constraints in a patient’s life that have a bearing on successful post-discharge treatment. These can be things like a patient lacking sufficient cognitive ability or enough money to comply with a medical treatment plan.
5. Diagnostic errors: a patient can be harmed when treatment is delayed or ineffective, or when the wrong treatment is given.
Handoffs are the leading cause of all five types of medical errors in hospitals, including change-of-shift reports and other communications between roles such as:
- Certified Nursing Assistants
- Physician Assistants
- Case Managers
- Physical Therapists
- Respiratory Therapists
- Transfers from Hospitals to Home, Home Health, Independent Living, Assisted Living, Skilled Nursing Facilities, Palliative Care, and Hospice
- Pharmacy Orders
- Durable Medical Equipment Order
Handoffs also include Transitions of Care, such as when a patient is going home or is being transferred to another healthcare facility, home health care, rehab centers, assisted living, palliative care, or hospice care.
Better handoff communication is essential to reducing medical errors (MacDonald, 2013) (Mary Ann Friesen et al., 2008)
Traveling Nurses are often Used in Hospitals to Help with Short Staffing (Covid-19’s Impact on Nursing Shortages, The Rise of Travel Nurses, and Price Gouging/Health Affairs Forefront, 2022)
Solving staffing shortages with RN Travelers can relieve short term staffing needs but can also cause budgetary and morale problems. Traveling nurses earn upwards of $100/hr., $950-1,000/day, and $2,100-4,200/week. Typically, they are hired for 4-week or 13-week short-term contracts, and are utilized heavily by hospitals with high RN turnover rates. They are the most expensive way to staff for RN vacancies. Sometimes they are not fully vested into the hospital culture or community and because of short-termer’s attitudes and, at the same time, build up resentment in the hospital staff that their employer is willing to pay such exorbitant salaries.
12 Patient Advocacy Strategies for a more comfortable hospital stay
BEFORE YOU’RE ADMITTED
#1: Become an expert on yourself or your loved one before going into the hospital.
- Learn about all your diseases or chronic conditions. A free and comprehensive source of online medical information can be found at mayoclinic.org.
- Know your medications, including dosage, frequency, side effects, and route (such as pill, liquid, or inhaler).
- Know your lab work details and vital signs.
- Obtain recent copies of your medical records, either on paper or via a patient portal. This should include any prior hospitalizations within the last year (physician progress notes and the discharge summary), primary care physician records, and specialist visit notes and recommendations.
#2: Plan to bring the following with you to the hospital:
- Communication Tools: pen, paper, diary or journal, dry-erase markers for whiteboards, laptops/tablets, and smart phones (including power cables and chargers)
- Personal Health and Hygiene items: Bleach wipes, hand sanitizer, soap/washcloths/towels, paper towels, lip balm, toothpaste and toothbrush.
- Food and Drink Items: snacks, eating utensils, preferred sweetener, creamer, salt/pepper
- Important Medical Documents: List of current medications, original copy of a DNR (Do Not Resuscitate) form (if applicable), your Medical Orders for Scope of Treatment (MOST) form
- Contact Lists: emergency contacts, key hospital department phone numbers
#3: Plan to leave these things home (do not store in the hospital room’s bedside drawer):
#4: If you’re overwhelmed, consider designating a patient advocate with healthcare experience. This could be a spouse, a family member, or a friend. Preferably, they should have:
- Adequate healthcare literacy and familiarity with medical language
- More than ten years of healthcare experience, ideally in your region
- Healthcare education and/or employment: associate degree, BS degree in nursing, pharmacy, dietician, physical therapy, occupational therapy, or other health-related disciplines
WHEN YOU’RE ADMITTED
#5: Things to include during your Admission Day registration process:
- Provide the Admission staff with the names and mobile numbers for key family members and/or friends, which will allow them to speak with your nurse directly when they call during your hospitalization.
- Identify your designated Patient Advocate and provide Admissions with name, mobile number, and a completed Hospital Authorization for Release of Health Care Information
- Insurance Information, Medicare Part A and B cards.
#6: Always ask any questions, both during Admission and throughout your stay, but don’t be rude or unreasonably demanding. Keep these points in mind:
- You have a right to be informed, even if the hospital staff becomes annoyed with your questions.
- Take notes and use a journal or whiteboard to jot down your questions and concerns, as they occur to you.
- Prepare daily agendas to discuss with your healthcare team: nursing staff, physicians, case managers, and others.
- Don’t be afraid to ask questions during Rounds.
- Always be patient and kind to nurses, physicians, and hospital staff, all of whom are under tremendous pressure to provide quality patient care under difficult circumstances, including insufficient resources and staffing.
- Remember that you can have your issue addressed if you’re persistent and tenacious. Never give up: never, never, never!
DURING YOUR STAY
#7: Use your smartphone or computer to obtain additional healthcare information, and keep a daily diary of your care in the hospital, including pictures.
- Use the WiFi available in the patient’s room.
- Research your disease, your medications, and any new findings encountered during your stay.
- Use MayoClinic.org for free and comprehensive online medical information.
- Call the hospital operator if you have specific concerns you can’t resolve.
- The daily diary you keep can be handwritten or electronic, whichever is easiest for you.
#8: Learn the right person to call when you need help by asking questions. These are some of the people you may need to contact in order to get the help you need:
Your primary nurse
Unit Charge Nurse
Unit Nursing Manager (someone is on-call 24 hours/day)
The Rapid Response Team (available 24/7 for any emergencies)
#9: Learn about patient-care alarms, which include:
- Infusion devices:
- Heart rate, Blood Pressure, and Oxygen Saturation monitors
- Out-of-bed alarms
#10: Learn how to use the Hospital Bed Call Button or Pillow Speaker.
- Don’t be afraid to press the call button for any questions or patient care issues that include pain, nausea/vomiting, position change, toileting issues, nutrition and fluids, infusion device alarms, or other medical care needs.
- If there is an emergency, call the Hospital Operator by pressing “0” or call the Rapid Response team (available 24/7). If you don’t know how to call the Rapid Response team, ask someone to show you…before you have an emergency.
#11: Request a Patient Care Conference via phone or in-person at the hospital:
- PATIENT CARE CONFERENCE: Ask to speak with your primary RN or assigned Case Manager to set up a conference with your primary hospital physician, case manager, primary nurse, and RN Patient Advocate within 24 hours or sooner. Topics that can be discussed include your vital signs, plans for discharge after hospitalization, plans for transfer after discharge to skilled or rehab facility and what is their star rating, or any patient care issues (including medical staff unresponsiveness or if you’re unsure about any medical diagnoses or treatment plans).
- DAILY PHYSICIAN PROGRESS NOTES: Your primary RN can read you the daily physician progress notes for your case. You can also ask the primary RN to explain any daily lab work that is abnormal, the current list of medications and why they were ordered, and any high-risk diagnoses that have been made. You have the right to request a paper copy of all this information.
- You can use the whiteboard in your room to document questions you have.
#12: If you were dissatisfied with the care you or your loved one received in the hospital, you can make a patient care complaint to Hospital Risk Management or your state Department of Health and Human Services, or contact an RN Patient Advocate or Healthcare Advocate.
To learn more about how to be an effective Patient Advocate for yourself or your loved one, contact Karen Sanders, firstname.lastname@example.org, 828-295-1140
COVID-19’s Impact On Nursing Shortages, The Rise Of Travel Nurses, And Price Gouging | Health Affairs Forefront. (2022). Healthaffairs.org. https://www.healthaffairs.org/do/10.1377/forefront.20220125.695159/
Greenwood, H. (2021, May 25). The 2021 American Nursing Shortage: A Data Study. University of St. Augustine for Health Sciences. https://www.usa.edu/blog/nursing-shortage/
James, J.T. (2013) A New Evidence-based Estimate of Patient Harms Associated with Hospital Care. Journal of Patient Safety. September, Volume 9, Issue 3, p. 122-128.
MacDonald, I. (2013, December 4). Better handoff communication reduces medical errors. Fierce Healthcare. https://www.fiercehealthcare.com/healthcare/better-handoff-communication-reduces-medical-errors
Mary Ann Friesen, White, S. V., & Byers, J. F. (2008, April). Handoffs: Implications for Nurses. Nih.gov; Agency for Healthcare Research and Quality (US). https://www.ncbi.nlm.nih.gov/books/NBK2649/
Ohmart, G. (2022, March 11). CNAs Cite Low Wages, Burnout, Lack of Respect as Key Contributors to Staffing Crisis. NAHCA | the CNA Association. https://www.nahcacna.org/cnas-cite-low-wages-burnout-lack-of-respect-as-key-contributors-to-staffing-crisis/