Monday, September 17, 2007

Newer does not equal better

We have remodeled and built a new ER. Apparently this has been in the works for years and "a lot of thought, planning, nurses, doctors, techs, RT's and patients advise went into planning this ER." Well, we have now learned that apparently not enough of these things went into it. Some issues:

1. If you build it, they will come. Especially if as part of your PR campaign you get on all the local news stations bragging about how much more efficient and how much shorter the wait times will be. We saw double the patients last month than we did the month before and since this is still a work in progress, it also doubled the wait time.

2. Less beds equal longer wait. Even if it is only 2 less beds. Especially when your fast track area,which used to have 10 beds now only has 2. and especially when you used to have 6 less beds that are open all night long than previously.

3. Heavier work loads equal less efficiency. In our old set up, we tried to put our more critical patients on the end with 6 nurses all with a 1:2 ratio and maybe a hall patient (or 6). In the new place, there are only 2 nurses period that have a 1:2 ratio, and critical patients everywhere. This leaves all nurses busy and unable to help out each other because we are all drowning, especially since we really don't have the staff to have the built in extras, i.e 3 float nurses to help out, and God forbid we close beds.

4. Location, location, location. We are further away form the OR, radiology and 85% of the rest of the hospital, making transport suck. Also much further away form the important tings like the cafeteria, corner store, parking deck, and smoke deck(for those who utilize this).

5. Call lights on the remote control. I do not know what idiot thought this up, but there are 2 buttons on our remotes. One is for the TV (it turns it on and changes the channel) and one if the nurses call light. Inevitably 22 calls an hour are because a patient thought that the button with the little picture of the nurse was the down channel button.

6. Floor plan. While in theory it is super nice to have a huge amount of vastly open space and not be crowded over one another, it sucks to have to walk all over creation to get what you need or go where you need to go. On top of this, only a hand full of rooms are visible from the nurses desk, so you can not keep an eye on all of your patients while charting or talking to the doctor. also, the doctor's rooms are as far away from the nurses desk as imaginable, which irked the doctors and nurses both, we have to travel to ask them questions and they have to travel to have orders put in and so forth, so usually, the doc ends up staying at the nurses desk, which is too small to begin with and traveling to their office to look at xrays and stuff, cause apparently, nurses are not allowed in the docs office, although no one, doc or nurse,is really sure who came up with that rule and why. The blanket warmers are located just about as far from the trauma areas as possible. And most of the supplies are as far from all the rooms as possible and we still are not quite sure between the three supply rooms what is stored where.

7. No break rooms. Except for the doctors and it is outside of the actual er, and I don't know any of them who utilize it except for a coat closet, contrast it with the nurses "break room" which i swear my walk in closet is bigger than, that has one chair, a mini fridge and a microwave. and since these"break rooms" are attached to the nurses desks, we are no longer allowed to have drinks at the desk, yet we can not do any of our actual work in the break room, so we just stay less hydrated, which I guess works out since we do not have time to pee.

8. No reports from ambulances. This is not exactly true, but the nurse who used to get the patient would take the ambulance report. Now one nurse is assigned to take all the reports and make the bed assignments. Since we can not see all the rooms, there is no definite way of knowing when an ambulance or patient is coming, especially if an enterprising doctor goes to see the patient before you do and the chart gets placed in the orders rack, which you are not looking in because you have no reason to have orders because you thought you had no patients.

9. Nursing staff leaving in droves. For various reasons. When we had a section that was strictly designated for non emergency Dr office type stuff, everyone was more or less happy. Those nurses who loved that kinda thing signed up to work there and whose of us who would rather hammer nails under our toenail beds and run a mile than to take care of those type patients, were mostly spared of the majority of these patients. Now, you have people complaining because they have not done real emergency medicine in years and having to take critical patients and people complaining because they do not like to take care of people who need to go to a walk in clinic. We are understaffed and overworked, which means more people leave which makes us even more understaffed and overworked. Patients are unhappy because of the wait, nurses are unhappy because they are exhausted and the docs are unhappy because they are overworked.

10. No support. There have been numerous meetings and committees and all other kinds of bureaucracies, but nothing appears to be changing. if it is it is at too slow a speed to even notice and by the time they fix it, they will not have any employees left.

I feel a little better at venting. Some things just makes me wonder if the higher you climb up a corporate ladder in the healthcare industry if you don't have to sacrifice half of your common sense for each rung climbed. What exactly do they not understand about unhappy nurses=no nurses=no hospital?

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