How about “Physician’s Assistant”? Is that the same as “Advanced Practice Nurse”?
This is a great “cheat sheet” for patients and their families/advocates. I certainly would have appreciated having something like this when things went sideways with my husband’s care after his wreck, and I plan to keep this bookmarked in case I ever need to refer to it!
A question of mine that you might or might not be able to answer: When Tony was in the hospital - surgical floor of Level I trauma center/teaching hospital, if that matters - on day 7 of his stay, two doctors whom I’d never met came into his room to give orders to release him that day, directly home. The situation, as I posted it at the time (okay, a day or two later, because I was truly, truly too angry to type anything coherent.)
I was under the impression at that time, based on the apparent youth of the two doctors, that they were likely to be residents, as described in your cheat sheet. I finally got help from an advanced practice nurse/trauma nurse, but I’ve wondered since then whether there was a different chain of command that I should have sought*?
If I might hijack just a little bit: Hirka T’Bawa, during your work with the ombudsman’s office, were there any safeguards in place to protect patients after a complaint was made? My grandmother is in nursing care in Georgia, and there have been a few times when I recommended to my mother and aunt that they contact the ombudsman’s office. (Mainly because the nursing home isn’t feeding their patients properly - very, very limited menu, with too much starch and not enough protein, especially considering the high proportion of diabetic patients within the home’s care.) My mom and aunt are afraid that, if they contact the ombudsman, Grandmother will be targeted for revenge. I understand their concerns, but the situation is ongoing and can’t be good for the majority of the patients. Is their concern valid, in your opinion? (This is a case where Ma and Aunt Barbara see Grandmother daily - because they bring her meals to her. I live a distance away, so I can only offer second-hand information, or else I’d be the one making the call.)
*As it turned out, the pain and weakness Tony was experiencing then was due to an as-yet-undiagnosed kidney bleed that required two blood transfusions. He spent another week in the hospital, plus another week in medical rehab, after those doctors tried to discharge him. The list of injuries that were diagnosed after that attempt and before his final discharge were: kidney bleed, broken pelvis, broken elbow, and labral tears in hip and shoulder.
I disagree with this. The misconception that the doctors are the nurses’ boss is very widespread and very ingrained. To overcome this, you need to not just provide an alternative but explain why talking to the doctor won’t work (different chains of command). This misconception frequently results in patients and family wasting time complaining to a doctor about nurses that they have no control over. Then, the family is upset when nothing changes.
WhyNot, you may want to make a basic list with the general hospital staff and duties, then an appendix or second list of “specialists you might see”. If the list is too long, no one will read it, let alone remember anything. The short list could be used as a general “what to expect in the hospital/how to navigate hospital staff” sheet and the appendix for reference only if the patient comes across a specialist they don’t understand. This is a great idea and I’m sure your patients will appreciate it.
I was thinking this, especially anesthesia.
Thanks!
very helpful
I agree with this idea. My understanding is that “Nurse-Midwife” and “Nurse Practitioner” are species of what you call “Advanced Practice Nurse” - is that right? You might want to include the other names as well.
No. PAs go to a 3 or 4 year school and come out PAs. Advanced Practice Nurses went to school for 2, 3, or 4 years to get an RN, then went back to school to receive a master’s or even a PhD.
The main things that were stressed to me as an ombudsman volunteer was that we were the patient representative. The only one we cared about was the resident, not the family, or anyone else. If you make a complaint while not the resident they can’t do anything directly… However, like all budget minded non-profits, how often they get inspected and who inspects (volunteers like me, or a high level paid inspector), depended on the quality of the facility and complaints. While they might only take direct action based on the resident’s complaint, by making a complaint as a family member, they will increase the frequency of inspections, and they’ll know what to look for in particular.
All complaints are confidential, as an anonymous family member nothing you say will get back to the patient… If you can get the resident to make the complaint that would be ideal (remember, it is confidential), otherwise, make the complaint yourself. Even if it is second hand, they’ll increase inspections and know what to look for.
Even if the ombudsman don’t find anything themselves, the knowledge that the facility is being inspected more often will make the facility clean up their act and fix the problems. The companies that run these private nursing homes want to cut costs, but most of all, are afraid of being shut down.
In the two years I was a volunteer, I actually only went to one high risk facility, and in that case I went with the paid ombudsman. Most of the time when we went alone, we were given a check list, and went to the facilities that weren’t at risk.
So, report your issues… No matter how minor. If they don’t know, they won’t know to look for it. Even if you have no standing, call, make a report, they’ll put it on the list to look at, and will schedule more often visits.
Well, one form of APRN (Advanced Practice Registered Nurse) is a CRNA (Certified Registered Nurse Anesthetist), who practices anesthesia, sometimes under the supervision of an MD anesthesiologist but very often the CRNAs are practicing anesthesia alone.
That is, it’s often the case that the CRNA currently on call is the only one in the hospital who knows how to practice anesthesia, and is therefore legally empowered to prescribe drugs because anesthesia inherently requires the use of controlled substances. That’s called “prescriptive authority” and nurses usually don’t have it.
Also, even though (in that scenario) the surgeon would be an MD and the CRNA’s obviously a nurse, nobody’s responsible for the actions of anyone else: Their practices overlap, but the surgeon isn’t qualified to do anesthesia and the CRNA isn’t qualified to do surgery.
From a patient’s perspective, you’ll probably see the CRNA briefly before surgery, and have a nice little chit-chat where they’ll be happy to talk about what they’ll do to you and how you’ll probably feel afterwords. And, of course, if you’re knocked out (that is, if you’re put under a general), theirs will likely be the last voice you hear before you pass out. The interaction might be more elaborate if they just numb a part of you (that is, if they put in a local); I’ve never had that kind of surgery, myself.
Oh, and a final note: In my (limited) experience, CRNAs are men. I’ve never seen a CRNA who isn’t male.
Me three. Many patients have no idea that a radiologist must read an imaging study, or that a pathologist must examine whatever was removed during the surgery, or interpret a blood test, or whatever. Then they think they’re being ripped off when they get a bill from a doctor they didn’t even know existed and the radiologist’s billing staff gets to hear all about it. :rolleyes:
And while I’m on the subject, it may be helpful to include a short section on the administrative staff, from the unit clerk (or coordinator or whatever job title the facility uses) who makes sure that orders get to where they need to go, to the billing staff who can help you understand the bill and light a fire under the insurance company’s ass when necessary. Some of these are people the patient will meet, others aren’t. But it’s still good to know who they are and what they do.
One to add: Medical Librarians/Consumer Health Librarians
They do research and provide support to all of the above professionals. They may also provide information resources directly to patients or their families (the consumer part.) They can help provide the information (in many formats) that you need to understand a health condition. Some round with the docs and/or nurses as they learn and help them make evidence-based decisions. We may round to your room to offer health books and handouts (and/or fun books and magazines.) If you are lucky, your hospital has a consumer library that you can visit.
As someone who was a medical student until fairly recently, I have to say this is an inaccurate description of the role of a med student in a hospital setting.
Generally medical students work with one or more interns, residents, and a supervising physician. The attending is ultimately responsible for all the patients on the service.
A typical academic medicine attending will have 10 - 20 patients on their service. Each medical student is assigned about 2 - 5 patients, based on their level of experience. For these patients, the student will see them initially when they are admitted, do a history and physical exam relevant to their presenting symptoms, and present that to the intern/resident/attending along with an assessment of the patient’s condition and a plan for their care.
After that, they are usually expected to see the patient every morning before the team does, see how their condition is changing, follow-up labs and imaging reports, and write daily progress notes. Before the team has come into your room in that little huddle, the student probably presented the patient to the team outside the room, discussing what was new that day and what has changed in the assessment and plan. Of course, students can’t enter orders or actually do anything other than relatively minor procedures.
Because medical students have far fewer patients than anyone else on the team, and because they are inexperienced at efficiently doing a history and physical exam, they actually may spend considerably more time with their patients than interns and residents do.
TL;DR: Medical students interact a great deal with their patients, although many patients, even in a teaching hospital, may not be assigned a medical student and so may have little interaction with them.
I have definitely never heard of this role. It sounds awesome. Is this standard in your typical large metro hospital?
Whynot: Why were you concerned about getting this nurse in trouble? She messed up! From what you describe, it was something pretty damn basic. If she’s messing that stuff up, someone needs to know, so she’s held accountable.
Thank you, Hirka T’Bawa. In the case of my Grandmother, she’s unable to make the complaint directly, due to dementia, so it will fall on one of us to make the call. It’s good to know, though, that there are protections in place for the patients.
CRNA’s are most decidedly not only, or even mostly, men. In my quite broad experience, CRNA’s are at least 50%, if not more, female.
We can only hope! It is common but by no means standard. Hospitals have squeezed their library budgets down to nothing and in some cases eliminated them. Check out the website of your hospital and see what they offer.
We had to take our infant daughter to the ER about a month ago, in the middle of the night, and we had someone from “Child Life Services” come by when she was getting poked and prodded. Her job in that particular moment was the sooth the baby (and I suspect Mom and Dad as well) she came with a collections of rattles and pacifiers and a sound machine. And a very calm voice. She was wonderful, at one point I asked if I could bring her home with me, and I was only half-joking.
This was at a children’s hospital, I’m new to the whole world of pediatrics so I don’t know how common this is. But hey, so long as we’re naming “People you should look out for at the hospital” then I’ll mention my friend 
May I suggest an appendix or other separation of “People You May See” and “People You Probably Won’t See”? Most of us never see the pathologist. When I had my gallbladder out, I’m told I did talk to the anesthesiologist, but I have no memory of it. So I don’t know which list that should fall in.
Also, depending on how you present this information, you might consider organizing it by type (nurses, doctors, technician), location (ER, ICU, Med/Surg), or order (triage, doctor, specialist).
Child Life Therapists are what used to be known, in my health service at least, as play therapists. They do more than provide craft activities and other distractions for bored hospitalised kids. They also accompany them to MRI scanning, PET scanning, radiotherapy planning etc and help to make the whole process as unscary as possible.
One of my patients had haemorrhagic cystitis and we had to do bladder irrigations which were incredibly painful for her. The Child Life Therapist would sit in and read to her and play if she was up to it. These people are awesome and, because of the nature of their job, are always the most popular people in the hospital.