SILVER SPRING – A mother sits with a crying child waiting to see a doctor. A young man going through alcohol withdrawal jumps off his stretcher, shaking, as nurses try to calm him. Nearby, a wide-eyed elderly woman who speaks no English lays alone, tugging at her bed sheets.
And this, by all accounts, is a quiet morning in the emergency room at Holy Cross Hospital.
That’s why Doris Goff does not mind “doing whatever she can” to let the nurses focus on those patients who need it most.
On the “days when four or five ambulances arrive at once,” the 76-year-old volunteer has fetched bedpans and helped patients use them. She’s fed patients, even when it meant finding their missing false teeth and putting them in first.
As they grapple with a shortage in skilled-care nurses, more and more Maryland hospitals are turning to people like Goff. Sometimes volunteers and sometimes paid customer-service staffers, they are increasingly being called on to provide the one-on-one patient and family support — the emotional nursing — traditionally associated with the profession.
“The days of volunteers stuffing envelopes and pouring water have gone by,” said Sandy Wolk, director of volunteer services at Holy Cross. “The hand- holding and comforting falls to volunteers increasingly to fill in as much as possible.
“Nurses have welcomed the volunteers because they know patients and families are getting the extra TLC they may not have the time to give,” Wolk said. “The old days of just a few patients on nurses’ caseloads are no longer the case. Nurses have to do the skilled work they’re trained for first and foremost.”
But the executive director of the Maryland Nurses Association said that while nurses appreciate the work of the volunteers, they are not happy about having to hand over an integral part of the nurse’s job.
“Volunteers are a mixed blessing for patients, who are getting more psycho-social care from them but not necessarily the kind that nurses are trained to provide,” said Kathryn Hall, the association’s executive director.
“Nurses are upset about not being able to take the time to talk to patients about their fear of going home before they’re ready, of an upcoming surgery or a chemotherapy treatment,” Hall said.
She said that the gap in psycho-social care cannot be closed by volunteers and customer service initiatives. “That’s something consumers are going to have to demand,” said Hall.
Health care workers are also quick to point out that volunteers are not allowed to relay and translate medical information for patients and families. But hospitals across Maryland have still found roles for people like Goff.
Franklin Square Hospital in Baltimore has “emergency liaison volunteers” who are “able to support family members in crisis mode, make connections, find who’s in need of information and what they need to know,” said spokeswoman Dawn Lyons. She said that, “staff, patients and families are all looking to volunteers to interject the human element.”
Washington County Hospital has paid a nurse assistant to serve as its emergency room receptionist for the past three years, said Diana Donegan, director of patient relations there.
Sinai Hospital in Baltimore also relies on paid “patient advocates” who have backgrounds in social work and customer service to “really take care of all the non-medical needs of patients and families,” spokeswoman Jill Bloom said.
“Volunteers don’t get to serve as liaisons between families and medical staff,” she said.
Bloom believes the demand for patient advocates at Sinai is great, but because they are paid positions and “not something someone’s insurance will cover,” they are “considered a bit of a luxury.”
Unlike Sinai’s advocates, Goff is not paid for her work at Holy Cross. But that does not make her any less valuable to the hospital.
Goff, an emergency room “runner” for 11 years, stocks medical carts, runs tests to the labs and stops by patients’ beds to answer “the pity calls for ‘nurse, nurse,” she said.
Emergency room “greeters” — Goff’s volunteer counterparts in the waiting room — field patient and family concerns, work with the triage nurse who decides which patients need to be seen right away, and escort family members back to visit patients or explain why they might have to wait.
Kyle Jossi, a charge nurse in the Holy Cross emergency room, said: “Sometimes patients and families will say something to a volunteer they wouldn’t say to us. They’ll ask them, ‘Will you call my family?’ They feel like maybe volunteers have more time for them.”
Maria Jurlano, a Holy Cross triage nurse, said that demands on nurses have escalated to the point where they do not have time to go back and forth, find family members and update them.
“Patients and families could care less who comes and talks to them, so long as someone tells them what’s going on,” said Jurlano.
But Donegan disagreed.
“Families still look to the actual caregivers for that. That’s their role — to care for the whole person,” she said.