Nurses Tell All
How do you get the best care possible for you and your loved ones? We gathered a group of nurses to tell us—and discuss a few other things. And boy, did what they say surprise us.
|Kim Goldfine, RN, BSN; Oncology Nurse at Memorial Sloan-Kettering Cancer Center, Sleepy Hollow|
Donna Pascarelli-DellaMedaglia, RN; Clinical Nurse Manager at St. John’s Riverside Hospital, Yonkers
|Caryn LaMattina, RN; Formerly Neonatal ICU Nurse at Westchester Medical Center, Valhalla; Now a Private Nurse|
Janet Rella, RN; MSN Chief Nursing Officer, Westmed Practice Partners, Purchase
|Kevin Mena, RN; Trauma Nurse, Emergency Department at Sound Shore Medical Center of Westchester, New Rochelle|
Nancy Turrone, RN, BSN; Post-Anesthesia-Care Unit Coordinator, Phelps Memorial Hospital Center,
We asked six nurses in different medical specialties—oncology, trauma, neonatology, surgery, and management—to come in to our offices to discuss the challenges and rewards of their profession, what they wish people knew about nursing care, and what patients can do to ensure the best outcome from a hospital stay. After all, your nurse is your first line of defense.
Westchester Magazine: We brought you here to help us help our readers know how to get the best possible care for themselves and their loved ones. What would you tell our readers to do first when they first get to a hospital?
Nancy Turrone: What families don’t realize is that, before we medicate for pain, before we allow families in, before anything else happens, we try to assess the patient to ensure the safest care possible. I need to focus in on the patient and not the family.
WM: Isn’t the doctor doing that?
Turrone: No. Sometimes the nurse is the first person, especially in the emergency room.
WM: And what is the first thing you do?
Kevin Mena: I assess the patient to see what kind of an emergency he or she has. Is it something a doctor has to see right away? Is it something that can wait? In that ER, there is probably one doctor, or two if you’re lucky. People come in and focus on their emergency without realizing everything that is going on around them. I try to give patients a timeline of how long they are going to have to wait, try to keep them informed on what is going to happen. I find that, if you communicate with a patient, it is usually easier. Communication is key.
Caryn LaMattina: Having come from a newborn intensive care unit, while you obviously can’t hold a conversation with the patients themselves—well sometimes you do, depending on what hour of the night it is—a lot of it is trying to keep the family calm. The vast majority of the time, they come in on the ceiling.
WM: What do families do that make your job more difficult?
Mena: Sometimes the patient and I are fine, but the family is frazzled. And, often, families don’t communicate with each other.
Donna Pascarelli-DellaMedaglia: People involve nurses in their family disputes. Like, ‘I don’t speak to my sister,’ so you have to spend another half-hour explaining the situation to her. And you really can’t spend a half-hour with each family member, going over their one mom, when we have about twenty patients on the floor.
WM: So you are saying, ‘Have a family spokesperson.’
Pascarelli-DellaMedaglia: Yes. Families are not thinking clearly at that time. They are thinking, ‘I want to know what is going on with my mom right now.’
Kim Goldfine: And ‘I hate my sister, so could you please tell her?’
WM: What would you do that the rest of us don’t know to do at the hospital?
Goldfine: Spend the night. Especially with the shift in the economy and the shift in healthcare, family members should be more involved in the care.
Goldfine: Because nurses are really pressed for time. There is always a shortage, especially on certain shifts.
WM: Spend how many nights?
Goldfine: Rotate it with other family members, if you can.
WM: How irritated do you get when the patients ‘buzz’ for you?
Pascarelli-DellaMedaglia: It depends. We have patients who just like to buzz. That bell is like their security blanket. Sometimes they just want somebody there because they are scared.
WM: And you don’t get irritated?
Pascarelli-DellaMedaglia: No. If someone is ringing the bell constantly, there is a problem and we try to figure out what is going on.
Janet Rella: And you always need to speak up. My father was in the hospital three times between September and January. It was a horrific time. At one point, I watched the nurse come in to take his vital signs. She brought in three pieces of equipment separately instead of all at once. It was disruptive and unnecessary.
Pascarelli-DellaMedaglia: I have patients who want to talk to me about a specific nurse. I will talk to that nurse and try and figure out what the problem is.
Turrone: Hospitals are reimbursed now on patient-satisfaction scores. So we do want to know if the nurse at the bedside is not delivering the type of care that is satisfying you, because that impacts the hospital.
Pascarelli-DellaMedaglia: We have a speak-up program: ‘See something, say something.’ There is a number you can contact. I am the manager. I call it ‘damage control.’
WM: What do families complain about?
Pascarelli-DellaMedaglia: Usually they will say something like, ‘The nurse was rude to my mother. She wasn’t very nice. She seemed irritated.’ And a nurse acting that irritated is not appropriate, because it is not about the nurse; it’s about the patient. So a nurse may have a million things going on, but it’s not the patient’s problem. A nurse can’t go in annoyed.
Goldfine: You always have to put yourself in the place of the patient. How would you feel in this bed or chair or whatever?
WM: But the fear is that, if you complain, your loved one is going to be treated even worse.
Pascarelli-DellaMedaglia: Actually, nurses do respond to complaints and maybe learn from it. They won’t retaliate. I have no problem with family members asking me a litany of questions; that is their right.
WM: We’ve been talking about how family members deal with nurses. What if I am going into the hospital and having surgery. What do I do?
Turrone: When you go to the hospital, the first person you meet is the pre-surgical assessment person. And you need to ask that person all of your questions. She should tell you everything. She should tell you about pain management. And vice versa—you need to tell her if you have sleep apnea, what types of medicines you are taking, if you were taking a lot of narcotics before you came to the hospital, if you are on
Pascarelli-DellaMedaglia: Tell them everything, even if it is the smallest detail.
WM: Like what?
Turrone: Like if you smoke marijuana. It is very hard to treat acute pain in people who routinely smoke marijuana.
Pascarelli-DellaMedaglia: A lot of times, patients will just leave out things that happened years ago, like their appendix was removed or their tonsils are out.
Goldfine: Or they have allergies.
Turrone: Motion sickness is also important to note because then you are more likely to have post-op nausea and vomiting.
WM: What else do people keep from you?
Turrone: The amount of pain medicine they’re taking.
Pascarelli-DellaMedaglia: Also if they drink or do drugs. They are ashamed to tell us the truth. But we need to know.
WM: Okay. Do you recommend second opinions?
Pascarelli-DellaMedaglia: Always get a second opinion. How many opinions do you get when someone is going to re-do your bathroom floor?
WM: Good point. On another matter altogether: The Affordable Care Act—how do you feel about that ruling?
Turrone: Scared. To me, it is very much like another HMO being thrown into the mix of things. I am not sure how much doctors are really going to participate. From what I see, doctors are very selective about what insurances they do take and they really prefer to have patients with a PPO [Preferred Provider Organization] rather than with an EPO [Exclusive Provider Organization] so that they can go out of the network. They don’t like to stay in the network because they get reimbursed very little. And under The Affordable Care Act, the reimbursements will be much less.
And doctors don’t necessarily have to participate in this. I’ve seen a big decline in elective surgery over the past two years at the hospital. Doctors are not getting the referrals, and they’re not taking a lot of the referrals. They will wait to get a referral from somebody with a PPO because it is not worth it to them to pay all of that malpractice and get paid so little for a surgery. It will cause a big decline in our census in the operating room. The census is down tremendously.
WM: You mean the number of surgeries you do is down?
Turrone: You depend on your elective surgeries to keep you going.
Rella: Don’t you think some of the decline is due to the fact that, with the economy, a lot of people are uninsured? If you were working within the outpatient environment in 2008, when the economy nearly tanked, you’d see well-dressed people scurrying into preventative care because they wanted to get whatever they could before they lost their insurance. Our rate of colonoscopies went sky high. People were coming in to be vaccinated. I mean, routine physicals were out of control!
Turrone: When you go to your doctor for your physical, are you going to get an EKG every year? You’re not going to get this kind of service.
Goldfine: I was at my GYN yesterday, and he said the GYN Society just decided that pap smears would be every three years now.
Turrone: And it makes sense, too! Unless you are a promiscuous person, do you really need to have it every year?
Rella: The Affordable Care Act is encouraging physicians to become Accountable Care Organizations.
Mena: In the ER, I am forced to see anyone who comes in, so we get a lot of uninsured people, and most don’t pay. We don’t get reimbursed. So, for us, it’s actually a plus because now everyone, unless they are undocumented, is forced to have some insurance. Now, the question a lot of doctors, like plastic surgeons who do elective surgery, ask me is, ‘Does the patient have insurance?’ And if they don’t, it is either the ER doctor or a resident who has to perform the surgery.
WM: Let’s change the subject once again. Is there a good time to go to the hospital?
Turrone: When you need to be there. There is no good time.
WM: Everyone says, ‘You’ve got to get out of the hospital as quickly as possible!’ Is that correct?
Pascarelli-DellaMedaglia: A lot of patients want to stay because they are comfortable or scared to go home alone. I try to explain to them that everybody here is sick. You may catch something from another patient.
WM: When the doctor says, ‘You are good to leave,’ should you just leave? Even if you don’t feel that you are good to leave?
Pascarelli-DellaMedaglia: You do have the right to refuse your discharge.
WM: Have you seen that?
Pascarelli-DellaMedaglia: Many times.
Turrone: Well, a member of my family had surgery on a Friday at three pm, and the hospital discharged her Saturday morning at seven. I said, ‘Come on!’
WM: So what happened?
Turrone: She went home, and she was back in the hospital two days later.
WM: When you go home, are there things you should demand from the hospital?
Turrone: A written discharge plan and a hard copy describing each medication that you are discharged on.
Goldfine: Yes, and what they are for.
WM: What is your best health advice?
Pascarelli-DellaMedaglia: Do not smoke.
Turrone: Smoking affects every organ of your body. Believe me, it will get you.
Pascarelli-DellaMedaglia: People say, ‘Oh, but I have to die of something.’ It won’t work that way. You won’t just go to bed and die one night. You will suffer for years and years. It is a horrible death.
WM: Please tell us your most heart-
LaMattina: There was a baby boy born at twenty four weeks. The night he was admitted to our unit, he full blue coded six times, which required chest compressions, mechanical ventilation, medications. His heart stopped six times in a matter of about eight hours. The baby was with us for four months, and he went home around his fifth-month birthday, or what would have been his second-month birthday if he’d been born full-term. I ran into them about two weeks ago, and I nearly fell over. I could not believe it. The baby left us needing a lot of physical therapy and occupational therapy. If you go back to how many times we sat with that mother and father and said, ‘This might be the last time we will have this discussion because we’re not sure what is coming.’ Now, he’s trying to walk.
WM: Oh, that’s lovely. How often do you guys cry?
Goldfine: Like right now, after hearing that story!
Pascarelli-DellaMedaglia: You get really emotional. You get attached to your patients and their family members.
WM: So you cry because something bad happens?
Pascarelli-DellaMedaglia: It isn’t always considered bad. Like, if someone dies, it isn’t necessarily a negative. You can make that death a comfortable, peaceful process. It is inevitable that we are all going to die and you can help a patient die in peace and help the family come to terms with it. I know it sounds weird, but it can be a really beautiful process.
Rella: It’s personal satisfaction in knowing that you made a difference. It’s not easy. I resent when people say, ‘Oh I couldn’t do that; I’m too soft-hearted.’ Well, I cry at Hallmark commercials!
Goldfine: Road-kill is a big one for me! I just cry easily. So many people say to me, ‘Oh your job must be so depressing because you deal with oncology.’ And I say, ‘I laugh more at this job than when I sold women’s shoes years ago.’ Patients have a profound sense of what life is when they are sick. It’s like, ‘Life is short; I am here today, and I am thankful.’
Turrone: It puts life into perspective for you. I went to the beach Tuesday, and, when I looked up, I said, ‘Thank you God for another year.’
Turrone: Yes. You have nothing if you don’t have your health. You could have a big house, nice car, be Donald Trump. It doesn’t matter. If he gets cancer tomorrow, he’s got nothing.
WM: So you don’t get upset about little things?
Turrone: We don’t sweat the small stuff.
WM: We should have your job.