Going to the Hospital? Don’t Forget to Pack a Nurse

Published: September 17, 2005

A FEW years ago, a friend having major surgery was advised to hire a private nurse to be at her bedside in the hospital.

When I heard this, I mentally rolled my eyes. Was this one more example of baby boomer excess – the regular nurses aren’t good enough that we need someone at our beck and call 24 hours a day?

But then, a few weeks ago, my sister-in-law in California was hospitalized with double pneumonia. For a few days, her condition worsened. She was not attached to monitors, and at one point, she seemed to go into respiratory failure. Had her sister not been by her side to alert the nurses, she might have died.

When I began checking around, I heard similar tales. Suddenly round-the-clock attendance by a relative, hired nurse or companion seemed not so outrageous.

“When my sister-in-law went in the hospital for an operation a few years ago, I hired a private-duty nurse,” said Diana Mason, editor in chief of The American Journal of Nursing. The hospital was “one of St. Louis’s finest, but I knew there were some staffing stresses, and I wanted someone to tend to her in the first 24 hours.”

Ms. Mason is not alone. Interestingly enough, almost every medical authority I spoke to noted that when a relative was hospitalized, they made sure someone – either a paid professional or a friend with nursing experience – was at the bedside.

But that doesn’t mean hiring a nurse is a must. The professionals also say it depends on the nature of the illness, the hospital and its nurse-to-patient ratio.

Although it is hard to find statistics on trends, there is no doubt that people’s concerns about nursing shortages over the last decade have prompted more affluent patients to think about hiring their own.

The situation seems to be in flux. The shortage of nurses has deepened every year since 2000, according to the American Nurses Association. But at the same time, over the last few years, studies have demonstrated how dangerous it is to load too many patients onto one nurse.

In 1999, California became the first state to pass a law requiring minimum staffing ratios for hospital nurses. The ratio now is five patients for each nurse, except in critical care units. Eighteen states are considering similar legislation.

“There’s a lot of pressure to improve staffing,” Ms. Mason said. “Nonetheless, private-duty nursing is alive and well.”

When Paula Zingarelli of Boston went into Massachusetts General Hospital three years ago for a gastric bypass operation, she said, “I knew nursing ratios were really bad.”

Ms. Zingarelli, 50, had some medical background, having worked as a surgical assistant for a plastic surgeon for many years. She hired a private-duty nurse, which ended up costing her $3,000, to help out and to make sure she got her pain medication on time.

She returned to Mass General for surgery this year to repair complications from the previous operation. This time she decided to wait before hiring a nurse because her sister could help.

“The nurses were extremely attentive,” Ms. Zingarelli said. “My meds were given on time. In fact, I wrote a letter commending them.”

How can those of us who are not familiar with the medical world know if we need to bring our own? After all, it’s not a cheap option, and it’s not covered by insurance. A companion who is not medically trained costs about $15 to $22 an hour; a private-duty nurse $35 to $75 an hour.

If you’re going in for a planned procedure, rather than an emergency, it’s a good idea to ask your doctor’s opinion of the hospital’s staffing and whether you should consider hiring someone privately. Since most physicians have privileges at more than one hospital, you may have a choice.

All the medical authorities suggested checking whether a hospital is a magnet facility. Magnet status is like a seal of approval, developed by the American Nurses Association to encourage hospitals to develop and maintain good practices, both in patient care and in collecting, maintaining and evaluating data.

To find a magnet hospital in your area, go to ana.org/ancc. Most hospitals have Web sites; sometimes they list nurse-to-patient ratios and other information.

“If not, call a hospital and ask,” said Barbara Blakeney, president of the American Nurses Association. “If they are unwilling to divulge that information, then find another hospital.”

It’s hard to pin down a “good ratio,” as it depends on how ill the various patients are on a given floor, as well as how experienced the nurses are. But there should not be more than six or seven patients to one nurse on a floor for those recovering from surgery, Ms. Mason says, and no more than two patients per nurse in an intensive care unit.

It seemed a bit unlikely to me that I would get any satisfactory answers by just calling a hospital out of the blue. So I decided to try it at the hospital where my sister-in-law was treated.

Not identifying myself as a reporter, I simply said I wanted to know about nurse-to-patient ratios on a floor for those recovering from major surgery, and whether they could help me find a private-duty nurse if I decided I needed one.

First the operator transferred me to a voice-mail box. I left a message, but didn’t receive a call back.

I tried again later in the day. I was transferred to someone who was very nice, but put me on hold for about 10 minutes; I was then disconnected.

I called back. This time I was transferred to a floor nurse who told me they’d be glad to supply a list of agencies who offered private nurses or companions once I checked in. She also told me that the nurse-to-patient ratio on her floor was one nurse to about every five patients.

A recommendation directly from the hospital is useful, not only because it gives you some idea of where to go, but because it also means the agency will provide nurses who are familiar with the hospital.

And if you’re going into a specialty unit, like oncology or cardiology, “make sure they are certified,” Ms. Blakeney warned. “Find out what the training and education is in those areas, and whether they have recent experience.”

Not everyone wants or requires a highly trained person at their bedside; often the need, especially at night, is simply for what is called a sitter or companion. That person can offer water, help to the bathroom or simple reassurance.

“Let’s say, God forbid, Mom slips and cracks her hip,” says Louise Weadock, a registered nurse and owner of Access Nursing Services, which provides private-duty nurses and companions to many New York hospitals. “You don’t want her to be alone all night long, yet you have kids or a career. For your own peace of mind, you might hire someone.”

Not all hospitals welcome outsiders coming onto their floors; it depends on the culture.

“When I did nursing, there was certain resentment,” said Jean Whelan, an adjunct professor of nursing at the University of Pennsylvania, who was a practicing nurse for 35 years. “But I loved it at night – it was one less patient to worry about.”

Note from my last column on cleaning up your PC: Thanks to the loyal Mac users who wrote to tell me that I wouldn’t have had a problem if I had bought a Mac. Your (many) messages are noted.