As promisedin this thread, I’ve made a list of people a patient may run into in the hospital. Edits/changes/additions welcome. This is very first-drafty.
Nurses:
Triage Nurse: The triage nurse is trained to quickly assess you and figure out how quickly you need medical attention. She decides what order patients are seen when they don’t have appointments, based on the severity or instability of their condition.
Floor Nurse: A nurse who works primarily in one area of the hospital, such as the Surgical Floor, Pediatrics or Oncology. This is “Your Nurse”. They may be referred to by their specialty, as in, “Pediatric Nurse”, or they may not have a specialty. They provide direct ongoing patient care over many hours. Most have 5-6 patients at a time, some as many as a dozen in very busy hospitals. This is the person to ask for your medications. If you are placed on Fall Restrictions, your nurse will need to be present whenever you get out of bed, or he needs to delegate that responsibility to an appropriate person.
ER Nurses, ICU Nurses and Critical Care Nurses: These nurses specialize in the most unstable patients with a wide variety of severe medical issues.
Charge Nurse: The charge nurse is in charge of the unit for the shift. She is responsible for assigning patients to each nurse based on their training, their experience and the condition and needs of each patient. Her job is to make sure that staffing levels are safe and appropriate, and to assist with patient care as needed when her floor nurses need help. She very often has patients of her own to take care of as well. Think of her as the manager on duty.
Do NOT complain to your doctor about your nurse (in a hospital setting). The doctor is not the boss of the nurse. The chain of command doesn’t go that way. If you have a complaint about a nurse, take it to the Charge Nurse.
Nurse Supervisor/Director of Nursing: This may be one position or two. These are administrators of the nursing staff. If your charge nurse doesn’t satisfy you, ask for the Nurse Supervisor or Director of Nursing.
Advanced Practice Nurse: An Advance Practice Nurse has completed at least a minimum of a Master’s Degree after receiving their Registered Nurse license. They serve internships after their graduate courses much like doctors do, and in many states may work as medical care providers in many of the roles formerly reserved for Medical Doctors.
Doctors:
Students: Medical students are people who are still in medical school. If you’re at a teaching hospital, they may follow doctors around like ducklings and huddle in a circle to talk, but they’re probably not going to have much interaction with the patients.
Interns: Interns have completed Medical School and have their medical degree and their license, but they may not practice medicine independently yet. Internship is usually the first year after graduating medical school. They may ask you a lot of questions, and may tell you their plan for treatment, but they’re just practicing. *Everything *they do must be discussed with and approved by a Resident or Attending Physician first. This is why you hear a lot of “we’re going to have them do an x-ray…” and then the x-ray never happens. The Intern thought an x-ray would be a good idea and told you that, but his Attending said no, it wasn’t necessary. (Then no one remembered to tell you that the plan - which was never really a plan, only an idea - was changed.)
Residents: Residents are recent graduates up to 7 years out of medical school, depending on the specialty. Sometimes they call them Residents in their first year, instead of Interns. They are a little more independent, but they still need the approval of the Attending. They can usually order the x-ray without asking, but they’d better actually need it and be prepared to defend why they need it, or the Attending will be upset.
Attendings: Attending are full fledged independently practicing doctors. In teaching hospitals, they are also teachers. These are the “doctors in charge” and if you have a problem with an Intern or Resident, the proper person to speak to about it is the Attending. (Not the nurse. Just like doctors aren’t the boss of nurses, nurses aren’t the boss of doctors. We have our own separate chains-of-command.)
Therapists:
Respiratory: Respiratory therapists will administer inhaled medications, like nebulizers. They will set up, monitor and change the settings on ventilators, CPAPS, BIPAPS and other machines that help people breathe. They analyze complicated information about a person’s breathing that helps them decide when and how to make changes to the breathing assistance a person is receiving. (In other words, don’t try to convince your nurse to turn off the ventilator because you feel like you can breathe on your own – convince the Respiratory Therapist.)
Physical: Physical Therapists perform and teach exercises to stregthen, improve balance and flexibility and prevent worsening of conditions which affect the large parts of your body - backs, arms, legs, shoulders, knees. They can figure out which assistive devices (canes, walkers, scooters, etc.) would be best for a person and teach them how to safely use them.
Occupational: Occupational Therapists perform and teach exercises to strengthen, improve flexibility and dexterity mostly of small muscle groups, especially hands. They also have adaptive devices to make the Activities of Daily Living (eating, bathing, toileting, dressing) easier and safer. They can show you a new way to tie your tie that won’t give your arthritis fits, or give you a sock puller upper. They have weighted spoons for people with grasping difficulties and reacher bars for those in wheelchairs. They have all the cool toys.
Speech: Speech Therapists work with speech and with swallowing. After a stroke or accident, the speech therapist may give you a “swallow test” before your doctor will let you eat or take pills. They also work with people who have lost their speech or who have trouble with speaking.
Technicians:
Radiology: Radiology technicians take x-rays, CT scans, ultrasounds and other imaging tests. Sometimes they come to your room, sometimes you go to them. The person doing the test is usually not “The Doctor” who interprets it. If you ask them how it looks, they probably won’t tell you. You have to wait for the doctor’s report.
Pharmacy/Surgical/GI Lab: Many departments have Technicians who help the Licensed professionals in their area. These are not nurses or doctors, but people who have experience in assisting doctors and nurses.
Phlebotomist: A person who draws blood for lab tests. Some hospitals have a dedicated phlebotomy team to draw blood for everyone. Others have the nurses draw blood for most patients, and only call Phlebotomy if they can’t get enough blood for the tests they need.
Other Providers and Support Staff:
Certified Nursing Assistant/
Patient Care Technician: These people go by a variety of titles and have a variety of educational backgrounds. The hospital and the Floor Nurse will determine exactly what they are allowed to do. They do things like give bed baths, help you get dressed, take vital signs and blood sugars, and help you eat. Some of them can temporarily stop your IV and let you go to the bathroom without the pole (but they can’t always do that). They can usually get you extra pillows and blankets and ice or water if you’re allowed those things.
Pharmacist: Pharmacists help the physicians and nurses choose safe and appropriate medications and the way in which they’re administered. They often make medications in the hospital, especially in Pediatrics and NICU, where the medications available from the manufacturer are often too strong or in the wrong kind of dose (like big pills) for little kiddos. Some hospitals are having pharmacists visit patients and answer questions and teach patients about their high-risk medications.
Clergy/Chaplain: The Chaplain is available for spiritual counseling and will pray with you and your family if you like, or make reasonable and safe accommodations with the nursing staff to allow you and your family to pray as you need – bringing in prayer rugs and closing the door, for instance. Chaplains come from many religions - Christians, Jews, Muslims, Pagans. There are even some Atheist Chaplains. Their religion is not of interest, and it’s not good manners to ask them “what they are”. They should have interdenominational, interfaith training and be willing to work with you no matter what religion you are. If you are of a specific religion or spiritual path and would like to talk to someone of your faith, ask the Chaplain if they have a list of volunteers that can be checked to see if there’s one who meets your needs. Sometimes they can call someone in.
Social Worker: Medical social workers know about community resources for things like money assistance, living arrangements, discount bus and train fares, shelters, food pantries and day cares (adult or child). They will often come visit you near the end of your stay to discuss what can be done to help you out when you leave. If you think you might need the help of a nurse or therapist at home, please tell your Social Worker! The order for home nursing has to come from the doctor, but social workers are often the only ones in the hospital that know much about home health care, and they can help to arrange it.
Case Manager: The case manager may be a Medical Social Worker or a Registered Nurse. He is responsible for coordinating all of the services. He’s responsible for making sure that at least one person knows what your nurses and therapists and doctors are all doing, and ensuring that it all agrees with your Plan of Care. You will probably never meet this person.
**Discharge Planner: **The discharge planner may be a Medical Social Worker or a Registered Nurse. It may be the same person as your Case Manager. Your discharge planner’s job is to make sure that before you leave, you know what medications to take when you get home, that you’ve gotten education on important things like when to call or see your doctor, you’ve been told of any diet or activity restrictions and anything else you should know. If you need rehab, the Discharge Planner will find a rehab facility for you. If you need home health care, they will send a referral to a home health care agency for you. If you want a specific home health care, or if you already have home health care, make sure someone tells your Discharge Planner, so they can call your own home health company to tell them you’re going home and send them a report.
Dietician: The Dietician is responsible for your meals meeting the requirements your doctor has ordered.
Food Service Staff: These are the people who bring you your meals and take away your used meal trays. They do not usually have the power to change the prepared meal that the Dietician authorized and the Doctor ordered.
Porters/Transport: These are people who help those in wheelchairs and confined to beds get from one part of the hospital to another. They are responsible for handing you over to a nurse or technician at the other end of your trip.
Housekeeping: These are the people responsible for cleaning patient rooms daily and then for sanitizing them thoroughly between patients.
Security: Responsible for keeping the hospital safe by diffusing tense situations and removing aggressive people.
Ethicist: The hospital Ethicist is called in to consult on cases where ethics may come into play. End of life decisions, risky or experimental surgeries and cases where doctors or patients may disagree about the correct course of action might call for a consultation with the Ethicist. Usually this is a medical doctor, but not always.
Patient Advocate: The Patient Advocate is who you talk to when you’re seriously concerned about your treatment at the hospital, and your attempts to work things out with the nurses and doctors have failed. They are trained to diffuse tensions and reopen lines of communication and to remind everyone what the law says about things like patient rights.
