The Intensive Care Unit: An Information Guide

Communicating With Staff

Doctors:
Why So Many And Who Is In Charge?

It's quite common for an ICU patient to have more than one physician. With those who are very sick or have multiple or complex problems, a number of physicians may be called in to consult on their specialty area. Generally, the doctor who sent the patient to the ICU is the "admitting" physician and the "attending or primary physician" is the one who is treating, the main reason for the patient being in the ICU. The primary or attending physician is tasked with being in charge and overseeing the care given to the patient.

Tip: Ask the nursing staff to give you the name, specialty and office phone number of the primary physician in charge of your loved one.

How Can I Talk To The One I Want?

Doctors primarily spend their day split between two major tasks; seeing and attending to their patients at their office practice and seeing and attending to their patients at the hospital ("making rounds"), as well as other tasks and obligations such as surgery, consults, meetings, etc. Some make their hospital visits first thing in the morning, others in late afternoon or early evening. In addition, they have private lives outside of their medical practice, with spouses, children, hobbies and interests and personal commitments, just like the rest of us. To speak to the physician caring for your loved one, call his/her office and identify yourself as a family member of his patient and request a conference. Provide a phone number or an effective way in which you can be contacted and come prepared with your questions and concerns.

Why Don't All My Questions Get Answered?

Unanswered questions are one of the most common problems faced by families early on after the admission of a loved one to the ICU. There are two frequent causes with relatively simple solutions: First, is the lack of someone to give you information. Initially, all staff may be busy giving care to stabilize your loved one and make them safe. However, immediately following that period, you can expect to have the doctor or nurse bring you an update. Remember, your loved one's nurse is the most accessible and comprehensive, ongoing source of information regarding their status and treatment. Second, most family members try to store all their questions and concerns in their head, relying on memory at a time when they are most stressed. Consequently, when they get a chance to speak with the doctor or nurse, important questions and concerns are often forgotten. This leads to more frustration and anxiety.

Tip: Get a small notebook that is easily carried and write down all your questions and concerns as they occur. Carry it with you and when the opportunity presents itself to speak with a doctor or nurse, you will be prepared. Cross them off as your questions are answered. As an added benefit, by identifying and addressing your questions, concerns and fears you will lessen your stress and anxiety.

Nurses:
Why So Many And Who's In Charge?

You will find the greatest concentration of nurses (per patient) in the ICU. Only the emergency department and surgery/recovery share this trait. In the ICU, accepted practice is to have no more than two patients per nurse. As required, very sick patients will have one or rarely, two nurses just for that single patient (referred to as a one-to-one or two-to-one patient). In addition, the ICU will have a "charge" nurse whose role is equivalent to a job foreman. Lastly, there is a "house nursing" supervisor, who is the head nurse for the entire hospital.

Who Is Really Taking Care Of My Loved One?

Responsibility, accountability and the role as a patient/family advocate, are the most important aspects of critical care nursing and is thus taken very seriously by ICU nurses. The nurse assigned to your loved one for each shift is his/her primary nurse and is totally responsible for his/her care and all that takes place to them during that shift. Usually every effort is made to assign the same patient to the same nurse(s) on a daily basis. If you have a question or concern regarding the care of your loved one, the primary nurse should be your first stop. She/he can communicate with all other staff, seek and direct changes in patient care and act on the family's behalf as well as that of the patient.

Other Staff:
Who Are Those Other People And What Do They Do?

As previously mentioned, other staff on the ICU consists of lab, X-ray, physical therapy, dietary, medical social work and so on. All staff is required to wear easily visible name badges, usually with a picture. They are just as committed to their work and patient care as the nurses and doctors. So, if you have questions or concerns about their role or interventions with your loved one, you can simply ask them. If you're still concerned, speak to the primary nurse.

Family Spokesperson:
Who Is A Family Spokesperson?

A family spokesperson is an immediate or close family member who is elected by the family to represent the family.

What Does A Family Spokesperson Do?

They act as the conduit or voice for the entire family to the staff and the relay information from the staff to the entire family. This person should be someone who listens well, speaks well, tends to remain calm in a crisis and is respected by all (family). This person is seldom the most immediate relation to the patient, such as the spouse. It's vitally important that whole family knows that they are to seek and relay information through the family spokesperson.

Why Do We Need A Family Spokesperson?

Small families often don't choose one, but a family spokesperson is a blessing and a necessity for medium to large families, both to the family and hospital staff. A common situation without one has each family member calling at different times with essentially the same request for information and updates. This draws the primary nurse away repeatedly from the bedside (and from providing care for your loved one), to answer the same question. It also places a burden on staff to determine over the phone whether that family is entitled to information. Lastly, a family spokesperson benefits the family by relaying updates and status reports on the patient's condition to family and friends.

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