TMI? How Transparent Should Nurses Be With Patients?

While on vacation, my husband and I waited patiently in a restaurant for our food.  In contrast with our leisurely pace, the wait staff swarmed almost cartoony in the effort to serve the endless crowd of customers. Clearly, they were short staffed, but not a single server complained.

Since we work in healthcare, my husband and I were sympathetic. Our server earned every bit of his tip.

Likewise, most nurses feel badly when patients wait too long for their care. Delays occur for many reasons: orders that haven’t arrived, lab results that aren’t back, unexpected admissions, critical changes in a patient, short staffing, unavailability of a medication, clerical errors, the list goes on. Because nurses are at the bedside we take on the brunt of the problem, whether or not the patient complains.

Hospitals competing for healthcare dollars compound a nurse’s frustration by intertwining messages of customer service with expectations for patient safety. In the worst cases, under duress, nurses and patients also confuse the two.

Most patients admitted for treatments are already aware of the potential risks: medication errors, hospital-acquired infections, or enduring the wrong procedure.They come to us for treatment because their options are otherwise limited. So, where is the line between giving patients honest answers about their treatment delays, and disclosing that you are short-staffed on the day of this patient’s very first chemotherapy infusion? Do you tell a patient that their treatment is delayed because there’s a mistake on the orders? If so, how do you do so without intensifying their anxiety?

Putting this conundrum into another context, I’m imagining how I’d feel if a flight attendant announced that our flight is delayed because “The captain heard a funny noise during the landing gear check,” instead of simply saying, “Please remain patient. We’ll take off shortly.” Would you want to know, and perhaps exit the plane? Or would you rather not know, trusting the plane wouldn’t take-off if there is an unresolved problem? How much transparency is too much?

Do you feel patients need to know everything happening behind the scenes about their care? If so, how do you engage in this disclosure? Does consideration for colleagues come into play? For example, has a colleague ever blamed you for a delay or mistake in front of a patient?