Saturday, January 30, 2016

Why Doesn't This Happen As A Policy? Everywhere?

(I mean, besides the fact that none of the suit-and-tie wearers or lab-coated clipboard commandos of "higher" practice thought of it.)

The sitch is that E.D. is frequently slammed. (I know, who knew, right?) Like, multiple ambulance gurneys in a conga line out the door and down the ramp to the street. No, for real, not just in blog-perbole. We literally have fire engines blocking the street because they can't get in to park when I get to work.

So one night I'm coming in to sign in, knowing it's going to be a special slice of heaven already, and Staffing is telling a perfectly good ICU nurse "Hey sorry, we tried to call you off before you came, we don't need you." So I jumped over the counter and started pummeling him with a fire extinguisher because we were already four nurses short on a ten-nurse shift suggested to him that they send the "extra" ICU nurse to the critically overloaded and understaffed E.D. for the night, instead of telling him to go home, make no money, and leaving us (and 100 patients) hanging. Because mothereffing DUH. We don't expect him to chart, or fully take over care, with zero departmental indoc, but for cripesakes he gets the same patients we send upstairs all friggin' night, so it's not like working the E.D. would kick his ass. (And I'm the outsider here, not a staffer. I just work there more days and hours than the full-time staff do.) And lo and behold, Staffing does it! So we made him the extra float nurse for the whole department.

And this dude kicked ASS! He was a friggin' rockstar for twelve solid hours!

The nurse I was paired with, who was also a float from our step-down Tele floor, who we'd love to steal permanently from them if he wasn't too smart to do it, takes Awesome ICU nurse under his wing, gives him the ten-cent tour, and then we turn him loose for the entire shift.
He passes meds when any given nurse is busy with other patients, and he starts, by actual count, 23 IVs that night. He transports 75% of the tele-monitored patients upstairs, which leaves the regular E.D. nurses free to stay and get sh*t done in the E.D., and we can drag in an empty gurney and turn over a room in 60 seconds instead of 15 minutes, and the nurse doesn't walk into a crapstorm with an unstable patient who's been sitting there untouched while he/she was gone. Which cleans out triage and ambulance overflow in a few hours, instead of the hospital lingering on ambulance diversion all night long.

So now Rockstar has a blast, only charts the care he renders (starting IVs, giving meds, etc.), and if he gets a chance, he wants to come back. And he has a whole new perspective on what E.D. is like, and why, when someone says "I need to give you report on this patient now" they really mean "I'm up to my ass in alligators here and someone tied pork chops around my neck! Hook a brother up and take this patient NOW!" without him being beaten over the head about it.

And he'll pass that perspective on to his co-workers who've never set foot down here.

If you're keeping score at home, I think that's win-win-win-win-win-win-win-win.

So all I want to know is why, in the name of heaven, they can't make a policy for full-time staff that EVERY RN in the hospital will pull a blazing one whole shift in a department that they either get patients from, or send them to, each calendar year. And every year has to be someplace they haven't been before, until they've been everywhere. Where they'll then gain a little 'walk a mile in my shoes" appreciation, insight, and empathy for the people they barely interact with from other floors and departments. Maybe even get to know a few of them a little.

It wouldn't break the bank, it wouldn't cause mass chaos, no patients would be harmed, and people from the back door to the top floor would probably start to feel like they were kind of all on the same team. (What a concept, right?)

We'll forget about the fact that people who move up to management would have multi-department skillz and contacts built in, and everybody would get a free taste of other departments and practice areas, and thus maybe transfer within the hospital, rather than just bail, and leave the clueless monkeys in HR wondering where to find another round peg for the newly empty hole, at a per-hire search cost of $50K, on average. (It's scary, almost like I've thought about this or something, as if it made sense on multiple levels.)

And when I note the specific experience on one shift, the management I tell about it are all smiles. When I suggest they do it as an annual experiment staff-wide, apparently it's like my Invisibility Cloak has descended, and they suddenly have an urge to go to the bathroom, do a bedpan inventory, or something equally urgent.

So now, as I drag myself off to more education, remind me why management with BSNs and advanced degrees means a better-run hospital. Because I need some ibuprofen, or a softer wall to bang my head against.


  1. Amen! I've been saying this for years, and management won't do it. I can't figure out if it's some sort of divide and conquer strategy or what.

  2. I am personally responsible for 4 nurses jumping ship from their units and working in my ER, including one from OB that I cultivated from orientation about 2 years ago. The others were floats. Like your float, they had a blast, volunteered to come back and were eventually poached. Hell of an idea for a hospital wide float day, I vote yes. and if you've never done an EMS ride-along, I highly recommend it. What a perspective.

  3. To be clear, I wouldn't do it as a hospital wide float day as such. But somewhere during each year, everyone in every department would have to do one clinical day in a unit they weren't normally assigned to. It would get to be routine, and get rid of a lot of turf wars based on ignorance of what life is like on another unit. And give people eye-openers and ideas for other practice areas to move to. Everyone wins.

  4. Holy shit yes. If I ever have a stroke and decide to go admin, I'm just going to poach this idea and be the most bamf admin ever. (spoiler alert, that'll never happen.)