Thursday, July 19, 2007

wrong time

Apparently I was born in the wrong era of nursing. Don't get me wrong, I love the great strides we have made as a profession and how doctors respect us more now than before (still have some ways to go there though) or how we now make a little more than minimum wage. I also don't think I could have survived in the little white uniforms (wearing essentially pjs to work every day pretty much sealed the deal on the decicion to become a nurse) seeing that 1. I hate dresses 2. I hate white 3. I am the world's messiest person, hands down. However, for all of the forward strides we have made, we now have two huge brass balls (and not the good kind like nurse k's), one chained to each leg that are slowing our strides and pulling us back, named HIPAA and one named JCAHO.

I understand that they are supposed to make things safer and more private for my patient, but, like all things beaurocratic, they have made what should be simple and easy, common sense if you will, into red tape and hoops. Let's look at what JCAHO has done to me at my job first:

1. I am no longer allowed to carry any supplies or drugs in my pocket. Nor in my ER are we allowed to keep supplies in our rooms. So let's say you are having abdominal pain, and you need pain medicine, but first an IV. I have to gather all of my equipment in the supply room (and pray to God I don't forget anything), start your IV, and flush it (if I remembered to grab one, since I used to be able to have that on my body and I am not used to having to grab one). I must then go all the way to the med room and get your meds, draw it up and label it. Then head back to your room, verify your name by your armband, you saying it, have you state your allergies, verify my med, dose and order and then give it to you. (Now I am all for the double and triple checking identity, I do believe in that part of JCAHO's fiendish plot). Let's hope you are not having a real emergency when I get in there and we need an IV started immediately, cause I have none in my pocket and there are none at the bedside.

2. If your IV pump starts beeping, I can no longer just go in the room and stop it and flush your IV. Nope, I have to stop the pump, go to the med room, get a flush and then go back and flush your IV.

3. This is the one I really do not comprehend. In our ER we have 4 sections. We have a trauma end where the really sick patients go, a middle area that stays open all night for less acute patients, and end that stops accepting patients at 2300 that is also less acute, but somtimes stays open "boarding" patients, and a fast track "urgent care" which closes at midnight. In the two less acute areas, if you happen to get a patient that needs to be intubated (which happens more often than you would believe) I have to pray I key in the right code to get into the medicine room, remember my code to get in the medicine pyxis machine, to get a key and run about 100 feet to another coded locked door, go in and unlock 2 old narc cabinets to get a locked tackle box which contains the "rsi" drugs. Then go to the patient's room. Now keep in mind that this patient is in ACUTE DISTRESS needing to be RAPIDLY intubated. Also remember that our doors keep you locked out after 3 missed tries on the coded lock, have you ever tried to type in 4 numbers on an itty bitty pad while your adrenaline is pumping through you? It can be hard. How is this making patient care better?

4. I used to be able to make it through the shift ok just kinda "grazing" at the nurses desk. Have acoupla of light weight snacks sitting below the counter and you really don't realize you haven't had a chance to eat, because you are grabbing handfuls as you chart or call docs or gather equipment and your stomach is not completely empty. In steps JCAHO, I am no longer allowed to have anything but a drink with a top on it. Now my tummy is constantly reminding me it has been 23 hours since anything has been put in it. Now I dont know about other er's but there are nights that I cant make it to the bathroom down the hall, much less to the breakroom to eat, so having a snack at the nurses desk at least kept my stomach growlings to a low roar. Now even that is gone. And I spend all night grouchy.

5. Apparently you cannot have mesh shoes or shoes with holes in them for fear of being exposed to body fluids. Now inal traumas we wear gowns and shoe covers that protect us, but in other areas, we don't. So just how is the mesh on my shoes any worse than the clothing I am wearing. If I have a spurter, and it hits my clothes, it will seep through just like if it drips on my shoes, I am exposed! So unless you are going to make me wear leather or polyesther scrubs,your reasoning makes no sense. (I have probably opened a can of worms and now they will require us to wear leather scrubs, I apologize to nurses everywhere).

6. We now have to write up "discharge" meds for our patients on their home meds sheet and fax them to thier primary doctor so their is a "continuance of care". #1. Probably 90% of our patients consider our ER docs their primary care doctors and we have their records already, why do we need to write it again? 2. The ones who have primary docs, I work nights, not just nights, weekend nights, what if I fax it to the wrong number? I have no way of knowing and we are talking MAJOR hipaa violations. 3. We don't require their primary care docs to fax us their meds prior to coming, what about our continuity of care? 4. We have ALOT with their primary docs OOT (out of town), how do we get their fax numbers (some of these docs I would really like to get a hold of, to become my primary, putting someone on 12 mg dilaudid every 2 hours, that's my kinda doc). ISSUES.

I don't have as much problem with HIPAA, just the fact that it can put you in awkward positions and it can come back and bite you when you least expect it.


ERnursey said...

#5, while annoying, did not come from JCAHO, some clipboard nurse at your facility no doubt.

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