Va. Patietns see benefit in bringing own nurses

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Pilot reporters News / Health

Patients see benefit in bringing own nurses

By LIZ SZABO, The Virginian-Pilot

© April 30, 2001

At age 78, Murrell Werth has had seven operations and has been

hospitalized many times over the years. Lately she's noticed a disturbing trend.

Nurses seem so busy and overworked that they don't have time to help her with

basic needs like making up the bed or getting a glass of water.

One time, she rang her call button for 2 1/2 hours to no avail.

So now, when Werth needs to stay overnight at the hospital, she tries

something different:

She brings her own nurse.

Werth is one of a small but growing number of patients in Hampton Roads

helping to fuel a resurgence in the use of private-duty nurses. These

professionals were popular with wealthy clients in the 1950s and 1960s, but all

but disappeared from hospitals by the early 1980s, when medicine became more

sophisticated and high-tech.

Today, with hospitals across the country facing a critical shortage of

nurses, patients such as Werth say they're willing to pay out-of-pocket for

extra care.

``I tell all my friends, `If you are going to the hospital for more than

one night, get a private nurse,' '' said Werth, a Norfolk native who recently

returned to Hampton Roads after living in New York. ``I would not go to the

hospital again without a private nurse.''

Hospitals generally prohibit private-duty nurses from performing invasive

procedures such as giving intravenous fluids, said Pat Schulte, chief nurse

executive for Bon Secours De Medical Center. But many do allow them to

monitor vital signs such as pulse, blood pressure and breathing. They also can

provide ``comfort measures'' like bathing and feeding patients or helping them

get to the restroom.

While a patient's loved ones can sometimes provide these services, nurses

are trained to notice things that even dedicated family members might miss, said

Ann Letson, client services manager for Interim Healthcare, which provides

nurses to hospitals and to individuals. Private-duty nurses sometimes can spot

medical warning signs and seek help before problems become more serious.

``They can't give medication, but they can be proactive to make sure that

patients get their medication on time,'' Letson said. ``Their observational

skills are much better. . . . You might have a very stoic patient, for example,

who won't tell you he's in pain. If you notice he's moving his right arm but he

won't lift his left, that's a very small, very minute thing that gives you

insight into his condition. You're not going to notice unless you're with a

patient for half an hour or so.''

This level of awareness means a lot to Werth.

During a recent hospital stay, she said, the staff wrapped her legs in

tight nylon stockings -- a common procedure intended to help prevent blood clots

after surgery. The nurses apparently forgot she had told them she's highly

allergic to nylon.

Werth's legs swelled and her skin peeled. She endured pain for several

days before realizing that the stockings were the cause. Her private-duty nurse

helped her remove them.

``The hospital nurses are overworked,'' Werth said. ``They are too busy

with too many patients. . . .

``When I was in the hospital in New York and had a private-duty nurse, she

felt so sorry for the other nurses that -- if I didn't need her -- she'd run and

help the other nurses on the floor for a few minutes. The nurses were so scarce.

It was just an impossible workload.''

Indeed, many nurses today complain that hospitals ask them to cover more

patients than ever. Nurses who once had to care for five patients now sometimes

struggle with seven.

But nurses can only work so much overtime. Hospitals that can't find

enough of their own nurses turn to temporary employment agencies that specialize

in medical professionals.

Local hospitals sometimes close off beds when they lack the nurses to

cover them. Doctors delay surgeries. Patients sometimes spend the night in the

emergency room because beds aren't available on regular floors upstairs.

Most nurses say they willingly stay late to handle emergencies. These

days, however, they find little time to tend to less urgent needs, said

Nichols, chair of the School of Nursing at Old Dominion University in Norfolk.

Nichols, a registered nurse, got a glimpse of what it's like to be a patient

recently when she was hospitalized for reconstructive surgery relating to a

mastectomy performed several years ago.

``It's not a good time to be a patient,'' said Nichols, who was in

intensive care after her operation. ``The problem is that the nurses were doing

the bare minimum, but they don't have time to think about what else needs to be

done. What I got was really good care. But I didn't get a lot of stuff I should

have.''

Nichols said she had to ask nurses three times to add moisture to her

oxygen supply, which left her lips dried and cracked. Her request was finally

met, almost 15 hours later.

``It's not that nurses don't want to do this stuff,'' she said. ``But so

often they don't have the right help and assistance.''

Like Werth, Nichols recommends that patients hire their own nurses -- if

they can afford it.

Agencies charge anywhere from $12 an hour for a certified nurse aide to

$25 an hour for a licensed practical nurse with more advanced training, Letson

said. Some patients even request registered nurses, who have more education and

command higher salaries. For a 24-hour hospital stay, that can add $300 to $600

to a patient's bill.

And health insurance plans typically don't cover the cost of private

nurses.

In spite of the high cost, demand for private nurses is growing, said

JoAnn Eure, a registered nurse and the administrator of Eure Professional

Staffing and Medical Services. Many of her clients are the adult children of

elderly parents.

These customers often are exhausted from staying with their parents

round-the-clock while trying to care for their own families. Sometimes they're

looking for a ``sitter'' so that their mother or father won't be alone, said

Harper, assistant agency manager at Americare Plus, an employment

service.

Hospitals that might usually require restraints for patients with dementia

-- to prevent them from wandering or harming themselves or others -- will often

waive this rule if a patient is under close supervision, Harper said. Sometimes,

hospitals will even pay for sitters to stay with patients who are in danger of

falling out of bed.

, a nurse who worked in the emergency room at Sentara Virginia

Beach General Hospital before moving to Texas recently, advises patients to

bring a nurse or relative with them to the hospital.

But others doubt the benefit.

Dr. , a gastroenterologist, sees private nurses as

``probably just a waste of money,'' since they are not permitted to perform much

real medical care.

Instead of suggesting a private nurse, some doctors, such as urologist Dr.

Steve Schlossberg, said they ask hospitals to assign patients with extra needs

to a ``step-down unit,'' which provides more monitoring than a regular floor but

less than intensive care.

Some medical professionals worry about promoting a two-tiered health care

system -- one for most patients and another for those affluent enough to hire

private nurses.

``That will lead to quality care only for those who can afford it,'' said

Marci head, a nurse who owns her own medical/legal consulting business and

specializes in issues such as worker's compensation and medical malpractice.

She also fears the hospitals might come to rely on private nurses, instead

of raising salaries and stepping up efforts to hire more staff.

``The fact that people hire their own nurses shows that staffing trends

are getting worse, not better,'' head said. ``The more people start to hire

their own nurses, the less importance the hospitals will place on staffing. . .

.. Nurse-patient ratio should be a No.

1 priority for a hospital.''

New research shows that patients fare better when there are more nurses

around.

A study released last week by the federal government found that the

patients of nurses assigned to care for a small number of people leave the

hospital sooner and suffer fewer medical problems. The study, conducted by the

Department of Health and Human Services, examined 5

million patient discharges in 1997. Patients in units with more nurses

were up to 25

percent less likely to suffer complications such as urinary tract

infections, pneumonia, shock and upper gastrointestinal bleeding.

Reach Liz Szabo at 446-2286 or lszabo@...

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