COMMENTARY

Nurses' Questions Answered: When a Nurse Becomes a Patient

Diane M. Goodman, BSN, MSN-C, APRN

Disclosures

July 15, 2022

Divulging Professional Status

Readers may know that I have been diagnosed with an autoimmune disorder for many years, although I am not the only individual among my nursing associates. Nurses frequently discuss symptoms and hospital stays.

Nurse: Although we may be inpatients, we do not always divulge to the team providing care that we are nurses. Is this wrong?

Goodman: Each situation feels unique and therefore requires a careful response. For example, if the nurse checking us in for a short outpatient procedure is young and inexperienced, we may refrain from telling her we have over four decades of nursing experience, especially if she appears nervous about missing the intravenous start after two attempts.

If a clinician asks if we mind having students observe a bedside procedure, we may answer "of course not," while explaining that we have also spent years teaching new nurses how to perfect their skills.

Tell us your thoughts in the comments. Let us know how you would react under similar circumstances.

Nurse as Patient Educator

As any medical/surgical RN can attest, diabetes is a leading cause of hospital readmissions in the United States. A patient with diabetes is typically complex. Yet only about 24% of hospitals and large hospital systems are lucky enough to have specialty diabetes educators for inpatients/outpatients, despite multiple studies demonstrating reduced length of stay for patients with these specialists on staff.

However, floor nurses wonder about their responsibility in teaching diabetes management if a specialist is unavailable.

Nurse: What is the floor nurse's liability for teaching diabetes care when the certified diabetes educator is unavailable?

Goodman: Each facility that cares for patients with diabetes has a team available for managing patients: pharmacists, dietitians, nurse educators, nurse practitioners, and in some cases, certified diabetes educators.

The team would be responsible for determining what the minimum education needs would be for patients with newly diagnosed diabetes and for patients with diabetes who require reassessment of their needs. The team may also include lists of equipment providers for continuous glucose monitors and insulin pumps and meters for teaching.

Floor nurses may be required to attend a basic class for bedside diabetes teaching to discharge patients appropriately; for example, teach sick day management, meal planning, carbohydrate counting, and avoidance of hypoglycemic episodes. The diabetes team may provide folders, videos, or checklists for the staff RN to use on holidays and/or weekends.

Floor nurses are also responsible to assure that patients with diabetes being discharged to the home have been assessed for understanding of medications prescribed to manage their disease, whether that includes oral medications, pre-meal bolus injections, daily insulin, or other instructions. Additional instruction may be necessary for patients to demonstrate capabilities related to insulin injection, particularly if visual or psychomotor skills are impaired.

It is the floor RN's responsibility to know what resources are available and how and when to use them. It is also the nurse's responsibility to discuss the patient's phase of readiness with the physician and discharge planning. Patients who live alone and are unable to perform glucose checks would not be ready for discharge. It would be particularly important for patients to recognize and intervene during potential hypoglycemic events, so they could treat their own low blood sugars.

With elderly patients (or those with limited monetary resources), it is imperative to determine whether the patient has adequate funds and resources for nutritious meal planning post-discharge. Seniors on fixed incomes may have difficulty with meal planning, particularly with the escalating cost of food.

At unit meetings, the nurse should discuss potential liability for all nurses who are asked to discharge a patient with diabetes on busy days (weekends), holidays, and times of high census when the nurse believes the patient lacks sufficient resources to be alone.

Modern Work Settings

Nurse: A nurse has been working from home on data entry, assisting her unit with quality assurance for stroke data. While her work-from-home situation has been meeting her needs for the previous year, especially throughout the pandemic, her unit manager has requested she change her employment to a hybrid situation, because hospital educators have become scarce and nurses are far less experienced than pre-pandemic.

Nancy (name changed to protect privacy) is worried about changing her work status, particularly with the skyrocketing price of fuel. Adding 2 days of driving and traffic onto her workweek doesn't fit into her home situation. Her husband has heart disease and requires special dietary/exercise management. Nancy believes he will be less attentive to his diet and exercise should she be away from the home.

She wants to refuse the manager. How should she proceed?

Goodman: Nancy should proceed carefully with her response, because states with "at will employment" may replace employees who fail to meet the changing needs of the work environment. However, with the shortage of experienced nurses, Nancy may be in an excellent position to negotiate her needs.

She may prefer to negotiate, particularly if she did not have a work-from-home deal in writing from human resources. Would her manager be willing to start with a trial of 1 day a week, or meet Nancy halfway? Nancy should contact her human resources (HR) department prior to asking for a meeting with her manager. Being proactive about her home situation is the best option in this case.

Could Nancy write a counterproposal of "x" number of classes she might be willing to teach on site in exchange for another 6 months of working from home? It is worth a try.

Experienced employees are scant these days, and offering what you are willing to give might be preferable to a manager who fears yet another open position. HR could help Nancy to make this a win-win for both her manager and herself.

Nancy may even be able to offer solutions for pressing needs on the unit with novice nurses, creating a solution the manager did not know she needed.

Comments

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