'Tremendous need' filled by ED advocate position

Nursing skills add important dimension

When Cassandra Pundt, RN, CEN, decided to "ratchet down" from her demanding job as emergency department nursing manager at St. Mary's Hospital in Tucson, AZ, she created a position for herself that made use of her nursing skills and filled a void in the ED operation.

During her 10 years as ED nursing manager, Pundt adds, she was constantly struck by the "tremendous need" for a patient advocate specifically dedicated to the ED.

"Because of the hotbed [of 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, Pundt 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, she 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.

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 trouble-shooting — 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."

Concerned about the need for patient advocacy in the ED, 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.

In addition to her desire to leave management because she was planning to retire in a couple of years, Pundt says, she was attracted to the idea of having more time to spend on patient concerns. "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, she says, 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."

[Editor's note: Cassandra Pundt can be reached at cpundt@carondelet.org. Look for an article on a new customer service recovery program at St. Mary's Hospital in the next issue of Hospital Access Management.]