None of us ever plan to be a patient in the hospital. When we are made aware of a necessary hospital stay, we often attempt to schedule it into our lives, if we are fortunate enough to do so. Still others of us have no idea that by the day’s end, we will find ourselves as hospital patients who have had little warning of being displaced from our homes with health concerns. Fortunately, having information regarding hospital staff, schedules, policies, and regulations will help you to understand your care and to be able to navigate yourself around the hospital while you are a patient.
While you may be expecting to see a physician initially, often times the first person you may receive care from is a nurse. The nurse may direct you to your hospital room if you have a planned admission or may take your vital signs if you enter the hospital through the emergency room. The nurse provides day-to-day care as ordered by your physician. Nurses have a wide variety of responsibilities and work under rather unique conditions. Nursing involves both physical and mental tasks, and isng is a demanding and challenging field. Presently, there is a shortage of nurses in this country, causing nurses to be concerned about burnout, working conditions, and compensation.
There are four levels of nursing staff you will usually encounter in the hospital: CNAs (Certified nursing assistants, sometimes referred to as PCAs, personal care assistants), LPN (licensed practical nurses), RNs (registered nurses), and CRNP (certified registered nurse practitioners.) The CNA will assist with activities of daily living such as bathing, walking, dressing, eating as well as escorting to procedures if necessary. The LPN will assist with further nursing needs, monitoring treatment or wound care, for example. The RN will dispense medication and administer treatments, and may also be responsible to supervise other nurses. The RN is better able to address questions regarding medical treatment, but will likely refer you to your physician if you have specific medical questions. The CRNP is likely to have a leadership role in the hospital or work directly in a specific practice with a physician. In many states, the CRNP can write prescriptions. For return outpatient appointments (following discharge from the hospital), the CRNP may meet with you initially and then consult with the specializing physician.
Being a patient, it is easy to assume that all nurses can answer your questions and can provide medication as needed. It is difficult to distinguish between the various levels of nurses, especially if they are dressed similarly. You may ask for pain mediation when a nurse enters your room and be told that another nurse will be providing that for you. How do you know how to tell the nursing staff apart from one another? The best avenue is to first check the ID badge to see the level of certification. (As a side note, if any staff enters your hospital room and does not have an ID, ask to see it before receiving any type of care.)
Ask questions when you do not understand something. If the nurse cannot answer your question, he/she will find someone who can. Nurses have unique responsibilities, often filling the gaps when a patient doesn’t understand the peculiarities of the hospital setting. Get to know your nurses. Of all the hospital staff you will meet, you will spend more time with the nursing staff assigned to you than any other hospital staff.
The next person you will encounter in the hospital setting will be a physician. Physicians carry a great deal of responsibility. Physicians specialize in different areas, and are quite aware of the litigious concerns in our society. They carry great amounts of responsibility, not just in the hospital setting. In addition to seeing hospital patients (called “rounding”), physicians see patients in an outpatient setting which may or may not be located on the hospital premises. Additionally, if you are at a teaching/university hospital, your physician may have hours reserved for instructing courses as well.
Because of other responsibilities, many physicians will see patients at set times during the day. It is not unusual for a physician to complete rounds early in the morning or late in the afternoon to avoid a time conflict with clinic appointments or teaching responsibilities. Ask the nursing staff when your physician generally rounds, or call your physician’s office. Be assured the hospital staff can page your physician in the event of an emergency or if additional assistance is needed for your care.
Your physician may be referred to as the “attending physician,” meaning that he/she is the main physician responsible for your care while you are in the hospital. This physician writes daily orders, determines treatment, prescribes medication, and discharges you from the hospital. Most times the attending physician remains the same throughout your hospital admission. However, if you are admitted for one type of diagnosis and after further review you are given a different diagnosis or a second diagnosis, you will be assigned a physician who specializes in that area. The first physician would be referred to as the “admitting physician” and the second physician would then be referred to as the attending physician. Your attending physician may periodically consult with other physicians if needed to provide you with the most thorough care. Usually, a consultation is ordered when the medical issue warrants a particular specialty in which your attending physician is not certified, however, will be continuing to monitor and provide care.
In addition to your physician, there may be residents who are involved in you care, especially if you are admitted to a teaching/university hospital. Usually, there is team lead by either the chief resident to the attending physician. Your attending physician is responsible for this team and may introduce you to the entire team during your stay. Don’t be alarmed if an entire team enters your room to discuss your care.
Social Workers/Discharge Planners
Hospitals vary on the level of social work or discharge planning presence. Some hospitals, especially children’s hospitals, have a very strong presence while other hospitals engage social workers or discharge planners only when this will facilitate a quicker discharge from the hospital. The responsibility of this staff is primarily to create your discharge plan to include any services or equipment you may need to leave the hospital. (Some hospitals require this staff member to monitor your needs the moment you are admitted while others are consulted once a discharge date is determined.) The social workers/discharge planner will conduct an assessment including input from you, your physicians, and your nurses. Additionally, the social worker/discharge planner will consult with your insurance company to determine eligibility for discharge services. Services will vary according to your health needs, but areas social workers/discharge planners are involved with include home health services (nursing, physical therapy), infusion services (usually continuing infusion services started at the hospital), medical equipment, referrals to state services, nursing homes, or local agencies.
In addition to knowing the various staff who will be providing care, the hospital setting and hospital policies are helpful to know in navigating your way around. After being admitted, you will be directed to your room, which may be a single or double room. This is determined by many factors, including availability, your condition, and the level of medical care needed. Sadly, having a loud roommate is not reason to request a single room. The room assignments are handle solely by the hospital staff.
Many hospital rooms have a television and a telephone. It is likely you would need to place a deposit to use either service. Many hospitals are also including a directory in the room, which is similar to a hotel directory, so that you and your family are aware of the services available as well as the layout of the hospital campus. Services many hospitals provide include: gift shop, ATM, public telephone, cafeteria, snack shop, vending, visiting area, waiting area, library, internet services, lounge/TV area, play area for children, walking area, and a list of local attractions.
To help you feel more at ease with multiple people entering the hospital room, many hospitals area placing a bulletin board that lists who the health care professionals are for that shift. A board may read something like this: “Today’s is October 7. Your physician is Dr. Jones. Your nurse is Sally, RN. Your PCA is Cindy, CNA.”
You may also need to know about laws that may pertain to your stay. Hospitals carry a heavy responsibility to protect your privacy under a law called the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Each hospital is responsible to develop policies consistent with HIPAA in order to protect your privacy. You may authorize family members to be involved in your care if desired, however, the hospital’s main contact to discuss medical information will be you. For more information on HIPAA, go to The Department of Health and Human Services web page at http://www.hhs.gov/ocr/hipaa/
What happens if you are unable to discuss your health condition? Hospital will then discuss care with the next of kin. If you have a preference as to how this is handled, you may want to designate someone to be Durable Power of Attorney (DPA.) You likely have heard others talk about this common type of arrangement. Having a DPA will authorize a representative of your choosing to act on your behalf when you are unable to do so. This should be someone who understands your wishes for care and will respect that, even if his/her opinion differs. Be aware that there are two types of DPA, medical and financial. You can designate one person to oversee both types or select two different people to do so. In order for the hospital to acknowledge this, a copy of the medical DPA documentation would need to be presented to the hospital staff upon your admission.
(There are other options as well, including advance directives, living wills, and do not resuscitate orders (DNR). For a quick summary of these types of arrangements, please visit familydoctor.org at http://familydoctor.org/003.xml Before making any type of designation; it is advised that you discuss this with your attorney to get a fuller definition of each option as it pertains to your specific situation. It is wise to investigate this regardless of whether you plan on being in the hospital in order to prevent future confusion and to protect your wishes.)
While you are in the hospital, you will often be presented with several documents to sign regarding your privacy, your care, your preferences, your insurance, and information regarding the hospital policies. If you have a question regarding anything you are signing, ask questions for clarity before signing. When in doubt, ask. Keep these papers in a central location should you need to reference them. Depending on the length of your hospital stay or how much information you want to share with your family, it may be helpful to you later if you can readily find such information. In addition to any hospital forms, you may want to keep any educational brochures you receive from the medical staff. Another rather simple but often overlooked form is the menu request. Whether you feel like eating or not, take a moment to just fill it out. You may feel better tomorrow and may want something to your liking. If only takes a minute to complete.
While you are recovering, you may go through a host of emotions, especially if your admission was not planned. Hospital staff is aware of this and yet will continue to challenge you to participate in your recovery as much as possible. For example, if you are having a difficult time and do not want to get out of bed, your nurses will acknowledge this, but will continue to try to get you to walk before the day is through. This is being done for your own recovery. A good nurse will explain how this will benefit you (i.e. strengthen muscles, reduce risk of blood clots, etc.) and continue to challenge you to see what you are able to do. If you are having problems, the nurse will relay this to the physician who will then discuss this with you to determine if there are additional supports or services you may need.
As you are being treated, ask questions about your treatment. If something does not make sense to you, ask for clarification. Physicians and nurses are prepared for questions. It actually helps them to know if you understand the implications of your care.
As you are recovering, there will be discussion of a discharge plan. Often times the plan to discharge you to your home. Sometimes the plan may include discharge to rehabilitation or to a nursing home. If you have preferences or do not understand the plan, ask for details and then state your preferences. The hospital staff can tell you how long it will be anticipated that you may need services and why you may need them. They will also explain what type of help you may need at home, whether it is family or professional medical staff. Some discharge plans may include services to your home or for equipment to be ordered. If you prefer a certain company provided theses services, state so. A social worker or discharge planner will investigate your insurance eligibility to see if the coverage is consistent with your request.
When you are being discharged from the hospital, your physician or nurse may meet with you to discuss any new information regarding follow up care, physician’s orders, basic instructions, medications, or lifestyle changes. Once again, this is an opportunity to ask if anything is not clear. Find out if you will need to make any dietary or lifestyle changes. Ask if there are any side effects of the medication you will be taking. What kind of help will you need once home? Are there any physical limitations placed on you? What constitutes an emergency and a return to the hospital? When do you return to the physician’s office? Will you need home health services? Ask for phone numbers of any providers, physicians, or specific pharmacies before you leave the hospital if you are receiving a new service or seeing a new doctor. Also verify dates of any set appointments.
It sounds rather simple, but yet it can be very overwhelming: when you leave the hospital, you will want to follow the orders given to you. Yes, you may have been hospitalized for several days and may want to get out and about, but if there have been driving restrictions placed on you, this may land you back in the hospital if you decide to not follow orders. Take an active role in your care and recovery. Use the above information so that you are overseeing your own care, knowing fully what to expect should you receive care in a hospital or are in the process of returning home following a hospital stay. Navigating the hospital setting need not be difficult or frustrating once you understand the setting and general practices that make this setting so unique.