May 11, 2022
Odd Things We Expect From Nurses, But Shouldn't
As a non-medical person, I’m in awe of nurses - the procedures they do with ease while holding a conversation, their intimate knowledge of hundreds of medications, and the nuanced details of each patient. I’m also in shock at conditions they treat- bowel disimpactions, purulent drainage, and the like. And I find myself in dismay, beyond all the care and specialized knowledge, at the expectations put on nurses that are below their license or a drain on time.
In the inpatient unit of a top 10 health system, during the time of COVID, I asked nurses what problems they thought software could solve. I was working on our inpatient concept. In the emergency department, we had “service request” buttons in the app for patients in the waiting room - “I’m in pain”, “I’m nauseous” and “I’m cold” being the most popular.
“We have call buttons for pain” a nurse replied. “But I spend 15-20 minutes on hold with Food & Nutrition every time the patient wants to eat something different, or the doctor places a ‘heart healthy’ order”. This nurse was being asked to be a waiter: judiciously taking orders, placing them in the “kitchen” and sorting out why the main course arrived before the appetizer. This was not the best use of time during a national nursing shortage.
Another nurse expressed dismay at trying to reach environmental services saying, “they’re always on the move and not in their office”. A wired phone number was all she had when the toilet paper was out, or a room cleanup was needed. More hold time. More searching. The nurse was being asked to be a housekeeper, or at least call housekeeping.
“Some patients just...talk more than others,” a nurse said. It’s not that nurses would avoid certain chatty patients - often patients were feeling isolated because of strict no-visitor policies during the pandemic - it’s more that time was being “budgeted”. “I know if I talk to Mrs. X, it’s going to be 20 minutes”, another nurse said. Nurses are often asked to be empathetic friends and understanding therapists in the middle of their shift.
For the most part, with more understanding and care than stoicism, these nurses were happy to do all of these tasks. But in reality, they shouldn’t (always) have to. Taking all the nursing feedback into account, we built an inpatient tool where patients can place food orders using a no-download-required mobile web-app. Food and Nutrition love it. They don’t have to transcribe voicemails, and instead get a dashboard of requests. Nurses love it, there’s no more time on hold on the phone. Patients love it, they get exactly the meal they want.
Beyond food, we’ve added push-button requests for patient experience (staff praise, staff complaint), environmental services (room cleaning needed), and lower-priority nursing requests. These messages get routed to the right team at the right time. In the middle of the night, buttons accessible to the patient automatically disappear if the service requested is unavailable. Based on the initial success, more teams signed up for “electronic requests” directly from patients and we built in additional features like requests for chaplain, legal services/wills, and pet services (ordering a friendly dog to your room).
All of this is a big boost to patient experience, patient satisfaction, and HCAHPS scores. But what I’m most pleased about? The fact that this service is freeing up heaps of nursing time.