Much has been written about high patient-nurse ratios. Most articles correlate staffing ratios with nursing morale, staff turnover and patient mortality. But, there is another potential problem with inadequate staffing. Poor staffing can take an emotional toll on patients and their families.
If you work on a med-surg floor, it may seem that newly transferred patients are more demanding than newly admitted clients. This discontent may be partly due to the severity of their conditions. But, it may have also related to the change in their physical health care environment and staffing ratios. If they came from an intensive care or step-down unit, they may not be used to sharing a nurse with more than one or two other patients.
Sometimes newly transferred patients complain that, compared to the ICU, floor nurses are “always too busy” or “never around.”
Unless a patient comes to the floor for palliative care, most transfers from the ICU have been newly upgraded from the serious condition that landed them in intensive care in the first place. Although many of these patients remain ill enough to stay in the hospital, they are in the process of adjusting to their “newly improved” status.
Intensive care units can be scary places, filled with intimidating equipment and the constant buzz of mechanical alarms. Yet, these units may also be comforting to some patients. In a typical ICU, each patient room opens the nursing station, where doctors and nurses can easily view their clients through glass doors and large windows. Continuous monitoring devices instantly alert professionals to potential problems.
When a patient transfers from the ICU to the floor, he will likely find himself in a more private setting. Glass entranceways may be replaced with solid doors. Some of the patient's monitoring devices will be replaced with nursing assistants who monitor vital signs on scheduled rounds. While patients may appreciate the increased privacy and relative tranquility of the floor, this change can be distressing to others.
As a new ICU nurse, I am keenly aware of certain differences between med-surg floors and intensive care units. Like floor nurses, critical nurses work very hard. They must maintain focus and remain proactive in an incredibly complex setting. They adeptly operate a huge array of complicated equipment. The intensity of an ICU setting, along with complex medical concerns of ICU patients, make low patient-staff ratios imperative in this environment.
Ironically, critical care patients sometimes complain about getting too much attention. In the critical care setting, the patient may have visits from multiple health care professionals: surgeons, residents, nurses, respiratory therapists, X-ray technicians, chaplains and dieticians. No doubt, each of these visits plays a vital in a patient’s recovery. But all that attention can leave some patients feeling tired or overwhelmed.
As nurses, we should recognize the psychological burden that patients face as they transition to any new inpatient setting. Whether the patient transfers to or from the ICU, we should expect an emotional response. And, what about patients who leave the hospital to go to rehab or skilled nursing facilities? Probably more traumatizing is when a patient leaves the hospital for palliative or hospice care. Although it may, at times, be difficult to muster time and empathy, it is important for us to anticipate emotional reactions to such shifts in a patient’s environment. In this way, we can better address our patients’ underlying emotional concerns, even (and especially) when a patient seems unusually demanding or overwhelmed.
Have you noticed an emotional response in your newly transferred patients? Please share your experiences and ideas. We look forward to hearing your comments.