Okay, let’s all have our hot cups of tea around the newborns!
Hmmm….look at the ages of the nurses. I’m not sure how old this ad is, but there are two things that catch my eye.
One, there isn’t a single nurse in this photo who looks under the age of thirty.
I guess we’ve been an aging workforce for awhile now.
And, out of seven nurses, there isn’t a single guy.
Unless the baby is a boy…..
Once upon a time there was a nurse. An emergency room nurse.
Let’s say they are a “friend” of mine.
They pride themselves on their nursing care and their ability to document that care.
A few years ago, this nurse found xanadu in the form of a particular emergency department.
And it was good.
The waiting times were short.
Their nursing colleagues were experienced.
The doctors were top-notch.
This nurse was able to give excellent care to their patients.
And it was really good.
One day the hospital administration decided to have their nursing professionals punch a time clock.
Such a sight to see a bunch of professionals crowded around a digital read-out waiting for the precise moment to swipe their badge.
You see, if they punch out one minute too soon, they will lose 15 minutes of pay.
It would be funny if it weren’t so insulting.
The nurses protested having to punch a timeclock.
Were they not professionals?
One day hospital administration decided that a written report would be faxed to the receiving unit on all admissions.
My “friend” thought this was a great idea! They loved to chart, you see. They were wierd that way.
Besides, the report was not part of the record but it gave plenty of room to give a narrative of the patients ER stay. Yes, it was a bit of additional work but the reports were thorough and my “friend” could clearly see the benefit.
But then the hospital administration decided that the same report had to be used for all admissions and transfers in house. A committee was formed. Much feedback was given and the emergency department representatives did their best.
The resulting form had virtually nothing to do with the emergency nursing. It did not fit the needs of my “friend” and their colleagues.
Now it was hard to give a thorough written report. This truncated, sketchy report form became part of the permanent record.
There was much protesting by the nurses.
No one cared.
JCAHO recommended that hospitals implement a medication reconcilliation form.
Hospital Xanadu was one of the first to try it.
They made their emergency department nurses responsible for starting it.
First it was just a list.
Then my “friend” had to add dosages.
Then they wanted the dosage regimen.
Finally they wanted the date and time of the last dose.
It put a severe strain on Hospital Xanadu’s emergency department.
My “friend” once had to do three pages. Twenty five minutes of just writing down medications and dosages and times and dates on a patient who had twisted their knee.
The nurses verbalized strongly that medication reconcilliation was the responsibility of the admitting physician.
No one cared.
Ah, but wait!
Hospital Xanadu’s emergency physicians were told they would have to reconcile every single medication on every single patient before they left the emergency department.
They did not protest, for they had the power to just say:
And that was that.
My “friend” no longer feels they can give the nursing care and document that care to the standards now set for the emergency department. The one that once felt like Xanadu. The one that now makes nurses feel they are operating in a vacuum.
My friend feels, even at their best, they are operating at 75% efficiency, maximum.
Their morale is quickly depleting, even as they take their own advice to minimize burn out.
A group of nurses can protest loudly. A group of doctors can just say “no”.
Who has the power here?
It sure as hell isn’t my “friend” or any of their nursing colleagues.
I’m afraid my “friend” is becoming militant and is of the age where they are not shy about letting the world know it.
Of course, my “friend” could find another job, one with computerized charting or one that lays the medication reconciliation at the feet of the primary/admitting physician, where it belongs.
Meaning my “friend” could leave Hospital Xanadu.
They could even tell the hospital administration why they were leaving.
And no one would care.