Logan Reid
Nurses are essential to the healthcare system, providing care and enhancing healthcare equity. They work in hospitals, physicians' offices, schools, and community health centers, often in shifts to provide round-the-clock coverage. The nursing profession has been facing a shortage since the 1930s, and the COVID-19 pandemic has exacerbated this issue. Nurses have been overworked and overwhelmed, leading to stress, fatigue, and burnout. As a result, hospitals are now focusing on improving nurse retention by addressing heavy workloads and implementing policies that consider the needs and concerns of their staff. This involves setting clear expectations for nurses and providing the necessary support to ensure a harmonious healthcare ecosystem. Effective communication, continuous learning, and understanding patient needs are key to helping nurses thrive and deliver exceptional patient-centered care.
| Characteristics | Values |
|---|---|
| Patient satisfaction | Directly linked to patient expectations |
| Setting realistic expectations | Consider patient's background, baseline health, communication style, education level, culture, and personality |
| Understanding patient expectations | Ask patients about their needs, concerns, and reasons for seeking care |
| Communication | Clear, open, and honest communication with patients and their families |
| Patient safety | Explain safety measures and check in with the patient's understanding during discharge |
| Patient involvement | Empower patients to make decisions about their health and set realistic goals |
| Patient education | Educate patients about the healthcare process, treatment options, potential risks, and limitations |
| Emotional support | Empathize with patients, acknowledge their emotions, and provide reassurance and guidance |
| Workload | Address heavy workload and staff shortages to improve nurse retention |
| Working hours | Nurses may work nights, weekends, holidays, and be on call |
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What You'll Learn
Understanding patient expectations
Patients and their families often enter a hospital with preconceived notions about the patient's abilities and recovery timeline. As a result, many fail to understand that a patient's treatment and recovery often extend beyond their hospital stay. They may overestimate how well the patient will respond to treatment and assume that they will "bounce back" more quickly than they actually will. This creates an expectation gap, which is the difference between what a patient expects to happen and what the care team anticipates.
To prevent this gap, nurses must have open and honest communication with the patient and their family early in the patient's stay. This involves asking the patient about their needs, concerns, and preferences from the start, which will set the stage for a positive experience for everyone. Nurses should also involve the patient and their family in developing care plans that address the patient's needs, empowering patients to make decisions about their health and helping them set realistic goals. This gives the patient a greater sense of ownership of their treatment, which can lead to increased compliance and better outcomes.
Additionally, nurses should communicate openly about treatment options, potential risks, and limitations in care delivery. They should also provide emotional support, acknowledge patients' emotions, and create a safe and comforting environment. Nurses must be sensitive to patients' expectations for compassionate and empathetic care, timely and accurate information, effective communication, involvement in decision-making, and respect for their cultural and personal values.
By understanding and addressing patient needs, providing effective communication, emotional support, and culturally sensitive care, nurses can ensure that patients receive high-quality, patient-centred care.
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Setting realistic goals
To set realistic goals, nurses must have open and honest communication with the patient and their family. They should ask the patient about their needs, concerns, and preferences, and what outcome they hope to achieve from their care. This can be done during an admission interview. Nurses should also communicate treatment options, potential risks, and limitations, as well as educate patients about the healthcare process and outline the steps involved.
Nurses should also be aware of the patient's living situation after leaving the hospital, who will be involved in their post-discharge recovery and treatment plans, and which activities of daily living (ADLs) the patient will need to accomplish and how. Comparing patient expectations to the care team's assessment of the patient's condition and abilities is crucial to identifying and addressing any discrepancies.
Nurses play a vital role in managing patient expectations, especially in the context of the push for instant gratification and consumer-centricity in healthcare. By setting realistic goals and providing emotional support, nurses can enhance patient satisfaction and create a positive care experience.
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Managing workload
Nurses play a critical role in ensuring patient safety and providing direct care. They are responsible for monitoring patients, detecting errors, coordinating with other healthcare professionals, and performing various tasks to ensure high-quality care. However, nursing workload has been a significant concern, impacting the quality of care and patient outcomes.
Nurses today often care for sicker patients, resulting in more intensive work. Factors such as an aging population, inadequate nurse supply, reduced staffing, increased overtime, and shorter patient stays contribute to higher workloads. This can lead to adverse effects on patient safety, nurse job satisfaction, and increased turnover.
Managing nurse workload effectively is crucial. Hospitals aim for excellent patient service, good care quality, operational excellence, and employee retention. Achieving this balance requires a proper fit between patient needs and nursing staff capabilities. While there is no one-size-fits-all solution, some methods and studies offer insights into managing nurse workload:
- Workload Management Methods: Hospitals can develop workload management methods in collaboration with staff nurses and ward management. This ensures the method's usefulness and broad support. It should be easy to interpret, applicable to different wards, cover all nurse activities, and enable prospective planning.
- Patient Characteristics and Nurse-Patient Ratios: Determining adequate staffing is complex and varies by shift and unit. Patient characteristics, such as acuity, turnover, and care intensity, influence required nursing time. Nurse-patient ratios impact patient outcomes and nurse stress levels. A ratio of less than 1:2 during evening shifts for post-abdominal aortic surgery patients was linked to a 20% increase in length of stay.
- Nursing Proficiency and Experience: Current methods often lack differentiation for nursing experience levels. Student nurses are less efficient than experienced nurses. Proficiency and experience should be considered when assigning workloads.
- Work Interruptions and Environment: Interruptions are common in nursing and can increase the risk of errors, especially in medication administration. Creating a conducive work environment and minimizing interruptions are essential to help nurses manage complex tasks safely.
- Nurse Involvement and Influence: Nurses should have a say in hospital staffing, policies, and patient care. Their input can promote high reliability and reinforce nursing practices.
- Planning and Staff Allocation: Flex staffing can help accommodate fluctuations in patient census and status. Proper planning ensures adequate staffing levels, considering variations in patient complexities and medication requirements.
While there is no single solution, hospitals can use these insights to develop effective workload management strategies, ensuring nurses can provide safe, timely, and high-quality care without compromising their well-being.
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Open communication
To prevent expectation gaps, nurses should foster open and honest communication with patients and their families early in their stay. This includes asking about post-discharge plans, such as where the patient will stay, who will be involved in their recovery, and what activities of daily living they will need to accomplish. Nurses should then compare these expectations to the care team's assessment and address any discrepancies immediately. For example, if a patient expects to be able to walk unaided within a week of surgery, but the care team anticipates a longer recovery, this must be communicated clearly to the patient and their family.
Nurses should also work collaboratively with patients and their families to develop care plans that address the patient's needs and ensure everyone is in agreement. This empowers patients to make decisions about their health, giving them a sense of ownership over their treatment and improving compliance and outcomes. Nurses can also offer emotional support by empathizing with patients, acknowledging their emotions, and providing a safe and comforting environment.
Furthermore, nurses should actively seek patient feedback through surveys, focus groups, or one-on-one conversations. This feedback provides valuable insights into patient expectations and helps identify areas for improvement. By understanding patient needs and providing effective, culturally sensitive communication, nurses can deliver high-quality, patient-centred care.
However, it is important to acknowledge that nurses often face a heavy workload and high expectations, which can lead to stress, fatigue, and burnout. To improve nurse retention, healthcare facilities should address this issue by ensuring adequate staffing levels and implementing policies and incentives that consider the needs and concerns of nursing staff.
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Patient education
When providing patient education, nurses must consider the individual's needs, background, baseline health, communication style, education level, culture, and personality. It is important to use clear and easily understandable language and visual aids, correct misinformation, and involve family members in the teaching process to improve the chances of adherence to medical advice. Nurses should also be mindful of the patient's emotional state, such as the shock of receiving a critical diagnosis, and manage their expectations to ensure a positive experience.
Technology has enhanced patient education by making educational resources more accessible and customizable. Telehealth nursing, in particular, has increased access to care and patient education, especially in rural or geographically distant areas. However, nurses providing telehealth services must become comfortable with the technology and develop effective communication skills for this medium.
Overall, patient education is a critical component of nursing care. By providing comprehensive and individualized education, nurses can improve patient outcomes, enhance patient satisfaction, and empower individuals to make informed decisions about their health.
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Frequently asked questions
Nurses must have open and honest communication with patients and their families. They should ask patients about their needs, concerns, and preferences and involve them in decision-making to set realistic expectations and shape perceptions. Nurses should also educate patients about the healthcare process, setting realistic goals, and outlining the steps involved.
Managing patient expectations can be difficult for nurses due to the high workload and pressure in healthcare settings, especially during the pandemic. Patients and their families may have unrealistic expectations influenced by the push for instant gratification in today's society. Nurses must address these discrepancies between patient expectations and the realistic treatment plans and recovery timelines.
Hospitals aim to improve nurse retention by addressing the heavy workload and staff shortages. They may use PRN nurses to reduce the burden on full-time staff and implement policies and incentives that consider the needs and concerns of nurses to retain experienced staff.
