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?”
Too late
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.
Expectations
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.
From our readers gives nurses the opportunity to share experiences that would be helpful to their nurse colleagues. Because of this format, the stories have been minimally edited. If you would like to submit an article for From our readers, click here.
Selected references
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.
9 Comments.
I an in a SNF, and have been for two years. I have a bedside commode I can transfer to, but I don’t always make it there in time. When I put on my call light to get cleaned up and my bed changed, most of the CNA’s will come in, say they will be right back, turn off the light, and then forget about me. So I turn my light back on. Most times, they will come in again, say ‘I just have to help one more person, and then I’ll be right back’, turn off the light AGAIN, and leqve without helping me; even though sometimes, I just need a quick wipe and can go straight back to bed. I have waited as long as SIX HOURS on the commode and spanning two shifts, where my previous aide simply went home, leaving me stranded on the commode. I have complained enough to the director thst he told me himself to turn the light back on immediately, if an aide turns it off, and thst is policy to leave the light on untul the aide is actually ready to help us. I even made a sign of the policies regarding the call lights, English only by staff (unless the resident speaks the same language as the CNA), personal cell phone use by staff, and wearing name badges. Not a single CNA here follows all 4 policies at a single time, and usualy only one or two. How would any of you CNA’s feel if you were in our poaition, or your beloved family member was in this position? How would you want them to be treated? And do you have rhe same policies in your facility?
After reading some of your experiences as a patient the only thing I could is cry. I am on the other hand a cna for the last 35 years with taking a 2 year change of occupation due to the fact (my colleagues, nurses, would rather not cause waves while I am fighting to get my confused, doesnt remember that he is restless and just had surgery for a broken hip a pain pill (prn). Did he ask for it is the nurses reply. You know he can’t remember that he even had any type of surgery. I have always put my 100% to my residents. Now to why I am writing this. About 8 months ago I decided I wanted to go back to long term care part time. I really MISSED the residents. Last night I went to work like a normal 6pm to 10pm. I had about 8 or 9 residents that actually needed full assistance and my partner had 5 residents that actually needed her help with one not till 9 PM. She would not answer her call lights. I left my hallway numerous times to get her call lights to find her coming the hallway not even near her hall. I guess I went off on her and she said she thought the garbage needed more attention than her call lights. I cannot begin to understand why you would think garbage was more important than someone’s well being. One of her call lights was clocked in at 39 min. I know what one might think I should of answered it. I answered a lot if them. I have 2 alarms down my hallway so there comes a time where my residents safety (alarms) needs my attention. I delegated it to the nurses. I left work crying
I am sitting here, in a Skilled Nursing facility,
Just having waited for a CNA to come and change my “pad” (diaper) for an hour and fifteen minutes. I’m a patient with many diagnosis including Multiple Sclerosis and heart disease. To have to use a diaper is humiliating enough but to have to sit in urine and feces for what seemed to be an eternity. I experienced the same demeanor from the CNA as in the above article. And then the same demeanor from the LVN. And then the same demeanor from the RN Supervisor. The only recourse ~~ CRY. Please let me know what other recourse you would have taken.
I am so sorry this happened to you. I am a retired nurse with 46 years practice. The nursing assistants I have worked with were more responsive than most of what we have in the work force now. I think the I do not care attitude prevails. A lot of workers are only there for the check not to do any work to earn it. I have gotten to the point that I will take my own nurse with me when I go to the hospital for a procedure. I know this is not an option for many. I am sorry but I do not have any solutions to you problem. I will be praying for you.
I worked in a nursing home as a non-medical worker. I used to see people sobbing in despair after waiting over an hour for someone to answer their call bell/lights. I would always pop in and see what the person needed. If it was something simple like wanting a sweater, or the TV remote, or water I would always get it for them. It’s so infuriating though when it’s something I couldn’t do like take them to the bathroom or help them after soiling themselves knowing they had to sit there in misery waiting way too long. Then when you go get a nurse or CNA and tell them, “hey so-and-so has been waiting a really long time for the bathroom” they get angry at you and tell you to worry about your own job. Sorry, my job IS making sure the residents are the #1 priority, even if I’m just cleaning their rooms – I’m still not going to let someone sit there in despair for an hour because you don’t want to do YOUR job. The absolute worst is when there are 3-4 call lights on and people yelling “Hello!?” from their rooms and the nurses/CNA’s are standing around at the nurse station or dining room chatting it up like they don’t have people depending on them.
Let’s change the nurse to patient ratio then so we can care for our patients the way we want to!!!!
My heart-felt appologies to any of my patients who have waited too long for me to answer a call light. I did not plan it that way; some procedures can last an hour or more. Sometimes all the available staff are with others. I know that htere is no acceptable explanation or rationalization for a call light not answered in 30 minutes. Let’s get staff on to answer lights or free up the manager to answer lights. I bet few of us are neglecting call lights by choice.
Thanks Christina! A similar experience occured when my elderly mother was hospitalized with chronic N/V & diarrhea. An episode of diarrhea was fairly imminent and she needed assistance to the bathroom. Activating the call light & waiting 20 minutes she got out of bed unassisted and had a diarrhea stool on the floor. A CNA entered the room, chastising her for not calling soon enough. My sister, an RN, confronted the CNA & reported her behavior.I believe a “reality check” is needed for all of us
Thanks Christina, for this first person reminder. As an ARNP consultant in nursing homes I see to many occurences of excessive call light waits. I sometimes wish all RNs, LPNs and CNAs could experience things from their patient’s perspective.