Getting the best care from your ART nurse

July 28, 2010Carole 2 Comments »

I had a patient ask me, “Do RE staff think we are all crazy?” Of course not!- was my quick answer but then I got to thinking about an extension of that question. How can you get the best care from your nursing staff?  Having sat at the lunch table with  ART nurses for many years, I heard a lot of venting about patients that were difficult to take care of – the “ARTzillas” of IVF. Sometimes the relationship soured so much that patients asked for their records and they were outta there! If you don’t feel you are getting good care or you don’t like how that care is delivered, and don’t see any way to improve things, by all means, find a better match. It serves your needs better and everyone is happier. But sometimes the relationship can be salvaged-assuming of course that you’ve done your homework and your clinic has the best CDC reported pregnancy rates.  After all- why put up with crap at an inferior clinic?

It might help to understand how your RE office runs so that you can get the most out of your medical care. My disclaimer here is that I have worked with small and medium sized programs in two states with several different practices and each practice did things somewhat differently so my suggestions are based on my own limited experiences. But I will try to stick with things that are likely to be common across the board.

Come prepared to every appointment. If the nurses gave you some materials to read or a video to look at before your next appointment, please do your homework. Studies have shown that most people need to see the same material several times before they fully understand it. Your nurse may go over the same information with you in person, but if this is your second time with the material, you’ll remember more. Also, the first read may raise some questions in your mind which you can get answered at your appointment.

Write down your questions and use the consult time for long Q&A. If you have your questions ready, you can get the most out of your doctor or nurses’ consulting time. If you have a pad and pen, you can take some notes too. You have every right to have every question answered fully. If you don’t understand something, say so. A good nurse (or doctor) can explain things in more than one way. And with something as important to your cycle as med teaching, you need to get it right. Using short appointments like blood draws or follicle scans to answer a few quick questions is perfectly fine but these appointments usually aren’t long enough to repeat your med teaching. Schedule a longer appointment for those.

Leave a phone message once. It might feel like you are alone in suffering from infertility, but the fact is, your nurses might be making twenty to fifty (or more) call backs a day to other patients. Some patients would leave a message, wait 30 minutes and call back to leave the same message again. Chances are pretty good that your nurse has a stack of charts one to three feet high to review with your doctor  so it may take some time but you are on the list to get a call back. If that nurse pulls off ten voicemail messages from the same patient, it’s delaying her call back to that patient and everyone else too. Most programs set aside call back times in the afternoon after the blood results have come in, after the doctor has reviewed the results and after the doctor has given the nurses their patient orders for call-backs.

Ask the nurses to define an emergency and how their on-call system works. Who will be calling you back- the nurse or the doctor? What is the expected response time when you call the answering system? What type of problems/questions will they respond to after hours? What constitutes an emergency? When should the patient head to the emergency room instead of calling the on-call nurse? For instance, our nurses would get very irritated with the patients who called them at 3AM to let them know that their period started because there was no medical action to be taken until the next day when they could schedule an appointment and receive further instructions. Of course, the nurses were equally upset with the patient who suffered all night with abdominal pain instead of calling or heading directly to the ER with a suspected ectopic pregnancy. That’s clearly an on-call emergency. As a patient, it is hard to know what is an emergency and when to use the on-call system- so please ask.

Expect your nursing staff to be professional but realize that they are human too. Some days just seem to be filled with disasters, pregnancy losses detected on ultrasound, yet another negative beta, a failed fertilization report, poor embryo development and maybe a twenty-week loss or still birth. Unexpected cancer diagnoses have derailed treatments and even terminated pregnancies for our patients. IVF nurses are expected to deal with a lot of the patient’s emotional pain which is the hardest thing for a good empathetic nurse to do. Unless she’s filling up her emotional reserves at home, and nurses have personal problems like everyone else!- she could be running near empty and still have twenty call backs to do. We had a critical care nurse who transferred to IVF because she thought IVF would be so much fun and so life affirming. She was a good nurse but she quit after six months and went back to taking care of comatose patients because the emotional pain was too much to bear.

What you need to speak up about.

Your nurses and your doctor should always speak to you in a professional and respectful manner. If your feelings are hurt or you are made uncomfortable by something they said or did, speak up. If they are just having a bad day, they will feel remorse and make things better. If they don’t improve, well, there are other providers out there.

You need to make sure you understand your treatment plan. How does this treatment work and why do you think it will work for me? How likely is it to succeed for patients like me? Why are lab tests being run? What do my lab results mean? How will the results be used to decide on next treatments? What are the alternatives? What will this treatment plan cost me? If they won’t explain this or can’t explain things so that you feel comfortable and confident about your plan, maybe it’s time to look around for another provider.

Sometimes you need to change your providers but other times, you can get better healthcare by getting more involved with your care and understanding how your RE’s office runs.

© 2010 – 2015, Carole. All rights reserved.

2 Responses to this entry

  • sulfababy Says:

    Great entry and great blog! Thank you for being so encouraging of patients to ask questions and speak up. We have to be our own advocates but we also can’t get upset with our health providers for not being psychic! It took me a long time to really get that.

  • heartincharge Says:

    Thank you!!! I have an appointment on Thursday and I will revisit this post before I go.

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