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SERVICE EXCELLENCE in a bottle! August 3, 2006

Posted by 5 Wester in General Announcements, Observation Station, On Service Excellence, Query Yoki!.


As I settled in for the night, I decided to have me a peanut butter and jelly sandwich. YUM!

What you are looking at is a picture of America’s favorite bread spread, that creamy goodness that sticks to the roof of your mouth that tastes uncunningly like peanuts. Unfortunately, my jar of peanut butter isn’t as full as the one you’re looking at right now, so naturally, I had to use my 2 cents.

Judging from the volume of peanut butter I had left (about 0.5 oz, not enough to fill my tablespoon), I did some scientific calculations that would allow me to cover a 5-square-inch area of toast (about 0.02 oz of peanut butter per square inch). When I was done, I successfully covered that piece of bread with such a thin layer it looked so anemic I wanted to give it a blood transfusion.

While I enjoyed this piece of bread with a hint of peanut butter, it got me thinking. This is kinda like working a 12-hour shift with 4 RNs, 2 CNAs, a census of 28 patients, and 4 ER admissions all waiting for a bed at 5 West. Of course these 4 pending ER admissions aren’t waiting for a bed, what they’re really waiting for is an RN to take them in. At 7 patient’s a piece, we’d like to think we’re capped. But sometimes, we are called for to do the heroic thing… bite off more than we can chew and swallow. Sure, no problem, I can take all 3 admissions… what do we need to prove anyway?

There is a fine line between RN supply and demand that we are dealing with every single day and this balancing act can cost us (really the hospital for that matter) thousands of dollars if not done right. On one side, we want to take in as many patients as we can, after all, this is our bread and butter. More patients mean increased census, which translates to more money (hopefully they have insurance) and more money means profit. The bottom line…how to get more for less. On the other hand, more patients mean more RNs/CNAs needed, which, by the way things are going, seem to be in short supply. Such a short supply prompted the administration to come up with that new and confusing RN incentive program. If we can’t keep or RN/CNA census up, we can’t keep our patient census up.

What does this have to do with peanut butter?

Imagine you going in a gourmet sandwich shop and ordering your favorite “Peanut Butter and Jelly Sandwich Delight“…$9.99 + tax. The waiter hands you your order and you take a bite, anticipating that rich creamy nutty flavor to hit your tastebuds.

As you sink your teeth in, you discovered that the sandwich chef had allocated 0.02 oz of peanut butter per square inch of bread. What would you do?

I’d imagine you’d call your waiter and ask him… “Is this a joke? You call this a peanut butter jelly delight? What kind of quality is this?”. Then he answers you with, “Oh, we’re trying to save money. We figured that if we can spread the peanut butter really thin, we can actually increase our profit margins by 20% since we don’t have to use more peanut butter than is actually needed and the customer still tastes the peanuts anyway!”. How would you react to that? “Brovo! Good job, this is brilliant! Why did I not think of this?” Of course not! You’d say something like, “This is cheating! I want my money back! You’re making a profit on my expense!”

Of course this kinda thing does not happen on the floor. It’s not like we’re spread thin everyday. But I’m sure you’ve experience this more than once before. You know what I mean… those days you have only 1 CNA scheduled when the census calls for 2 or 3. Those days when you have 3 RNs scheduled when the census calls for 4 or 5. And those days when you have 4 RNs, 2 CNAs, 28 patient census, and 4 pending ER admissions, and they want to cap you at 8 patient’s a piece. Of course in extreme times of crisis spreading ourselves thin is a matter of sacrifice than choice. But what is really at steak when we do this, especially when asked to 3 admissions when the resources are not available?

Just like peanut butter on that piece of toast, the quality of care and attention you can give dramatically diminishes when you have to spread 0.02 oz per square inch. Of course they would argue that the patient care risk may be minimal, but then who knows this for sure? Do we have a patient acuity calculator to ensure that our patients are getting enough of that SERVICE EXCELLENCE good stuff? How much time can we and are we spending at the bedside with our patients, such as introducing ourselves, talking to them, making them feel comfortable, and putting them at ease? Are we keeping enough staff on hand so we can be prepared for that 4 pending ER admissions regardless if there are patients in the ER or not? Are we blaming the “competition” more than finding ways to retain and train our valued RNs and CNAs?

What sayest thou oh peanut butter connoisseur?



1. Watchdog - September 1, 2006

Everyone seems to be spread thin these days. Even the maintenance staff is cut to thin.

Hospital Plant Operations Dept. Associate

2. Melanie Cooksey - August 14, 2008

It is true I was a cna in a nursing hom. It was a 60 bed facility, and a lot of times we would just have 2 cna’s, or just 2 aides. to take care of 60 people. Its not right to the residents.

They don’t get the care that they need. We don’t spend enough time with the residents, not like they need. That is there home, and they don’t have any where else to go. Some times they don’t even have family to come and see them. Some times it is just once in a while. It is sade to see.

It is not right to the cna’s either when there is not enough help. You just got to do what you can, and it ain’t enough. I totally agree with you. There is just not enough help. It is sad to say. Its a problem, and it will not go away.

3. Sherry - June 1, 2011

Hospital staff if spread too thin. I was just reading another blog about errors and this was a huge cause of it. We are not super humans! People’s lives are in our hands and being under staffed and “spread too thin” makes me angry and nervous. There is always the question of “what if?” Things change so quickly. One minute all of your patients are stable, they give you more patients, and then a patient’s status changes for the worse. Nurses are forced to take on too much. I would hate to be a patient that gets neglected because the nurse has too many people to care for and simply can’t be in two places at one time.

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