Families usually find sitters through the nursing office. At Northwestern Memorial Hospital in Chicago, for example, general instructions posted on the Internet tell consumers: "If you would like a private-duty nurse, please talk with your nurse, who can make arrangements for you. It is your responsibility to pay the private-duty nurse or agency directly." This is generally the case unless a hospital deems the extra nursing help a medical necessity.
Nurses have traditionally been hospitals' "safety sentinels," notes Mary Foley, director of the American Nurses Assn. But she advises hospitalized patients, "Don't assume that everything is going to be taken care of."
According to an Institute of Medicine analysis, as many as 98,000 Americans may die each year of medical errors that occur in the hospital. Many are medication mistakes--the wrong drug, the wrong dosage.
"How do you not make errors?" asked Oregon's Talerico. "What's most important is the assessment--to look, touch, feel and see how the person is doing. If you don't have the time to do that, then everything that happens isn't going to be of high quality, particularly for the elderly."
To some leaders in the nursing field, the bring-your-own-nurse trend is a flashing yellow light that signals basic problems in the way hospitals operate. There is general consensus among medical leaders that when you go to the hospital, you need an advocate--a relative or friend who can follow your care and watch out for errors. The private nurse or nurse's aide can serve as a stand-in.
"You want your own advocate there all the time," said David Lawrence, head of Kaiser Permanente health plans and member of the IOM committee on medical quality. "If there is no family member, you can hire a care management nurse to be there with you. Or a minister. You need an adult who is not going to be intimidated by the place.
"That will be necessary until we put in more systematic approaches that build in safety."
One afternoon at Sibley Memorial, Ledecky--father of Jonathan Ledecky, co-owner of the Washington Capitals hockey team--felt dizzy and faint. Alexia James went immediately to the nurse, who called the doctor. Ledecky's blood pressure had plummeted. He was put to bed with a drip in his arm. In a few hours, his blood pressure had recovered.
"That's the advantage when you have somebody," Ledecky said. "You don't have to worry. Alexia is my voice out there in the nursing station.
"I don't know what I would do if I couldn't afford it--if my children couldn't afford it," Ledecky said.
"What do people do who don't have resources?" asked his wife, Berta Ledecky. "Where are we going with health care [if] you can't go into the hospital and count on the care?"
