Discharge Planning Advisor

ED patient advocate draws on nursing skills

'It's nice to get involved, address the issues'

Working for 10 years as emergency department nursing manager at St. Mary's Hospital in Tucson, AZ, Cassandra Pundt, RN, CEN, recalls she was constantly struck by the "tremendous need" for a patient advocate specifically dedicated to the ED.

"Because of the hotbed [of ED activity] that we are, there are real bottlenecks," she says. "There is so much anger and distress when patients have to wait. Sometimes when the admit beds are full, there can be up to a two-day wait for a bed. There can be ICU patients in the ED [waiting for admission]."

The demand for ED services is worse in different parts of the country, she notes, "and in Arizona, in particular, there is a pretty big problem."

As ED nursing manager, she received referrals from the hospital's patient advocate, Pundt says, "but sometimes other things get a higher priority than patient complaints," and she and the two assistant managers were unable to follow up as thoroughly as they would have liked.

Concerned about the need for patient advocacy in the ED and ready to "let go of the manager hat," she adds, Pundt wrote a job description and talked to her superiors at the hospital, who accepted her proposal. She began her job as emergency services patient representative in August 2006.

"I wanted to ratchet down from management because I was planning to retire in a couple of years," Pundt notes. Additionally, she says, "as much as I hate to hear complaints, it's nice to get involved indirectly and address the issues."

As part of her job, Pundt teaches customer service classes to staff, focusing on "how to deal with difficult patients, difficult situations — all the things you want people to demonstrate as professionals."

"We also created a bereavement support group, and follow up with patients who have lost a loved one," Pundt says. "We deal with them at the time, offering support and giving them a nice packet of information about the grieving process, and then send a sympathy card from the department."

A few weeks later, she notes, Pundt makes a phone call to the family members who have experienced a loss.

"We've had a very positive reaction," she adds. "People are very appreciative. I got a thank-you card from a family thanking me for sending them a card."

Pundt, who also has worked as a cardiac nurse, believes her nursing background adds an important dimension to the advocacy role.

"Many places have advocates, but they're not nurses," she says. "That's fine; but with the critical thinking skills of a nurse, you can work through a lot more troubleshooting — especially if there is a quality-of-care issue. I do chart reviews and pick up on things I might refer to other departments, such as risk management."