Vol. 3 Issue 17
Liaison to the Rescue
PACU nurse liaison keeps surgical patients' family members informed
For family members of patients undergoing surgical procedures, the hours spent in hospital waiting rooms can seem like an eternity. Perched uneasily on the edge of their seats, family and friends recall horror stories about operative mishaps and anxiously jump to their feet whenever a staff member in surgical scrubs enters the room.
But, the addition of a nurse liaison in the day surgery center, postanesthesia care unit (PACU) and surgical observation unit at St. Luke's Episcopal Hospital, Houston, has done much to reduce family members' anxieties at that facility.
Pam Windle, MS, RN, CNA, CPAN, CAPA, nurse manager of the three units, recently explained how the additional position came about. She first noticed some trends when reviewing data her staff members gathered when speaking with families of postoperative patients on the day after surgery.
"When a patient is in PACU and the family is sitting in the waiting room, everyone's anxious," Windle noted. "In the past, we had situations where the family left the waiting room to eat and the patient was transferred to an inpatient unit without them knowing it. When we talked to family members, they had three basic concerns: anxiety, miscommunication and lack of attention from the perioperative staff."
Carving Out a New Role
Herminia Robles, BSN, RN, CPAN, PACU charge nurse, described the problem-solving approach used to address family members' concerns.
"We are active in shared governance here at St. Luke's and guest relations are important to us in PACU. To resolve the lack of communication, we established a nurse liaison role," Robles stated. "At first, we assigned one PACU nurse every shift to act as a liaison. But, we ran into problems because that nurse would get pulled into patient care or transporting when the unit was busy, and communication wasn't as good as we wanted it. We also wanted to incorporate a preoperative component, allowing the nurse to meet the family before the procedure."
To justify the nurse liaison position, the staff developed a list of issues, outlined changes needed for improvement and presented reasons for the position. After meeting with nursing administrators, the PACU staff was given one full-time equivalent for a PACU nurse liaison.
"Now, families get regular updates before surgery, during the procedure and while the patient is in PACU. The nurse liaison can call the OR, talk with the circulating nurse and tell the families what's going on," Robles said.
Pioneering the New Role
Ray Rivera, BSN, RN, CPAN, was the first nurse assigned to the role and continues in that capacity today.
"At first, I didn't know what was expected of me and how the PACU nurse liaison role would work out, so I was scared but excited," Rivera said. "Immediately, though, I could see the families felt so much better, especially the families of patients who are here from out of town. They respond so positively when I introduce myself as a patient advocate and tell them what I can do for them."
Families and patients particularly appreciate the chance to meet the nurse liaison in the preoperative area, Rivera said. "Their anxiety decreases as they meet me and know I'll be carrying through with them during surgery and into the PACU. We establish rapport early on, so it's easier to interact with them at any point in the perioperative period."
Rivera has attended a number of conferences and seminars on customer service and appreciates the opportunity to help patients and families through a difficult time.
"I've been told my voice is soothing to them, and I try to anticipate their needs," he explained. "For example, an international patient may want to be transferred to a suite room after recovery, so I'll start working on that as early as possible."
While most families respond positively to Rivera's approach, there inevitably are some who are more difficult to deal with.
"I just count from one to 10, take a deep breath and try to accommodate their requests whenever I can," Rivera said. "If I can't resolve the situation to their satisfaction, I'll go to my nurse manager or involve myself with other departments in the hospital to help resolve the conflict. For example, I might consult with the nursing supervisor about the bed situation, discuss interpersonal concerns with a chaplain, notify patient services the family is unhappy or request assistance from environmental services."
Accolades From Patients & Families
Today, four nurses rotate through the PACU nurse liaison role, and Windle has a better sense of what to look for when assigning staff to that role.
"The characteristics I look for are good communication skills, patience, flexibility to move around the perioperative units and a willingness to stay busy," she said.
Patients and family members shared their enthusiastic response to the nurse liaison role in the latest Press Ganey patient satisfaction questionnaire.
"We see notations such as, 'The person who came and gave us the update after surgery was wonderful.' Surgeons don't always have the time to talk with families between cases, so the nurse liaison provides that consistency. We're no longer just the patient advocate, we're the family advocate as well," Windle noted.
Rivera, the first PACU nurse liaison, has received presidential awards from hospital administration after being nominated by family members.
"He relieves the family's anxiety and the outcome is so much better for those families. Plus, the patients are much more relaxed because their families are informed and can visit them in the PACU," Robles said.
Always Raising the Bar
Never content with the status quo, Windle and Robles are reviewing options for family visitations in PACU as a logical outcome of the nurse liaison experience.
"We can't remain constant – we need to look for ways to excel in our nursing care, and I'm always raising the bar," Windle said. "We've just finished a study where we had the nurse liaison bring in one family member for each patient for a 15-minute visit. The qualitative interviews conducted during the study showed both staff and family members are very supportive of the concept."
The next step is to formulate guidelines for family visits that mesh with current nursing care practices in the PACU.
"We need to look at the patient care requirements and the work flow in this very busy unit and carefully think through things," Robles said. "When we have something in mind, we'll sit down with the entire nursing staff and discuss what will happen next."
Windle and her staff are heavily involved in their professional organization, the American Society of PeriAnesthesia Nurses (ASPAN). Windle currently is vice president/president-elect and brought staff members along to deliver poster presentations at the national meeting in Chicago in April. One of their presentations described the PACU nurse liaison role and outlined the positive effect it has had on patient care.
"A lot of nurses from major hospitals came up to us and said they needed to take this idea back to their facilities, which was very nice to hear," Windle said.
At the meeting, Robles received the Outstanding Clinician Award after competing with perianesthesia nurses from around the country. She serves as the regional president for ASPAN in the Houston area and is involved in a number of ongoing research projects at the hospital.
"What makes my staff so excellent?" Windle asked rhetorically. "You hire the right people and you work with them. It has to be teamwork, from the top on down. The nurse behind you is the one that makes it work."
Sandy Keefe is a regular contributor to ADVANCE.