I have been a critical care nurse since 2008. In our unit, patients have call lights, and of course, patients and families want them answered immediately. My practice is partly guided by two bad experiences I had as a patient, before I ever started nursing school.
A long wait…
By the time I was 20 years old, I had already undergone multiple procedures, treatments, surgeries, and medication regimens for complex regional pain syndrome (CRPS). On this day, I had been admitted for the surgical placement of a peripheral nerve stimulator in my left leg. The surgeons made two incisions: One was several inches long on my left buttock while the other incision stretched 4 to 5 inches down the outside of my left thigh.
Later that evening when I had fully awoken from the anesthesia, I needed to use the bathroom. Because I was alone, I pressed the call light and patiently waited for the nursing staff to help me to the bathroom in my room, which was the farthest point away from my bed.
Five minutes…seven minutes….10 minutes….still no one came. My parents arrived, and I begged them to help me to the bathroom because I had no crutches, couldn’t bear any weight on my left leg, and was in excruciating pain. They helped me, and then, 20 minutes after I had turned on the call light, my nurse walked in and asked, “Did you need something?”
The next day, I again had to use the bathroom. I looked at the clock as I was talking on the phone with my Dad, who was driving to the hospital to keep me company. As I hung up, I pressed the call light the first time: 10:00 am. I told the voice that answered that I needed to go to the bathroom quickly and was told someone would be right there. 10:15…still no one, call light pressed again…10: 30 am…call light pressed the third time, this time nobody even answered me.
One hour and fifteen minutes later, my Dad had arrived to find me in tears, sitting in my own urine. It was now almost 11:30 am and no one had come to help me to the bathroom. When my father realized what had happened, he went to the nurses’ station and brought back the charge nurse and my nurse to my room. He angrily questioned them both as to why it took them so long to help his daughter. They apologized and said they would help now, but I informed them that it was too late; I already went—in my bed.
As my Dad slipped out of the room so the nurses could clean me up and change my bed, the nurse taking care of me began grumbling and complaining to her colleague about how busy she was, how she had eight other patients to take care of, and how there were other priorities she needed to attend to before taking someone to the bathroom. I was fully conscious and heard everything the two nurses said. By the time my bed was cleaned and remade, I had had enough! I looked them both in the eyes and said, “Maybe next time you’ll take heed of the call light when it rings and answer it promptly so that you don’t have a mess like this to clean up again. How would you like it if you couldn’t move your leg from the hip down, had no way of getting to the bathroom on your own and then had to lay in your own urine for over an hour?” The nurses stopped dead in their tracks overwhelmed with disbelief and embarrassment. Their thoughts were written all over their faces: I cannot believe that she just said that to us. Neither nurse bothered to apologize or even try to smooth over the situation.
Many hospitals and units have policies regarding the expectation of answering the patients call light promptly. Of course, there are going to be emergency situations where the time it takes to answer a patient’s call is going to be longer than the nurse or patient would like. However, on average, the patient should not have to wait longer than three to four minutes at the most to get their call light answered.
Tzeng researched how long it took for a call light to be answered when the main reason for the call was for help in using the bathroom. Surprisingly, the research didn’t show much difference in answer time among day, evening, and night shifts. On average, it took nurses 3.42 to 3.57 minutes to answer a call light. Patients expect a call light to be answered between 3 and 4 minutes…not 75 minutes.
One way to proactively reduce the number of call lights is to make hourly rounds on patients. Making regular rounds also prevents the need to go to the bathroom becoming an emergency.
A promise kept
I have used my experiences to make me a better nurse. I try to not forget what it was like to be a patient. I remember how demoralizing, embarrassing, and humiliating it was to lie in my own urine. I made a promise that I have been able to keep. None of my patients have had to lay in their urine or feces because I did not answer the call light promptly.
Christina Montana, SRNA, RN, BSN, is a student at Midwestern University, Glendale, Arizona.
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Tzeng HM. Perspectives of staff nurses of the reasons for and the nature of patient-initiated call lights: an exploratory survey study in four USA hospitals. BMC Health Serv Res. 2010;10:52.