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The Vicious Cycle March 22, 2008

Posted by 5 Wester in General Announcements.
1 comment so far


Incremental overtime! This is the new buzz word at the ICU. Department heads hate it, nurses love it, but nobody knows how to stop it or come up with a solution to solve it. Funny how this works out (just like most problems that baffle managment). If managers can’t solve problems, why do we have them in the first place? (Just kidding! ūüôā )

I don’t know about you, but whenever I’m faced with a problem (nursing or not), I use the nursing process to¬†solve it. You know, data gathering, analysis, nursing diagnosis, interventions and evaluation. I wonder if our managers know about the nursing process or they just get their heads in a meeting, talk about how we rack up incremental overtime, then pass the buck on us with these encouraging words… “What? You’re still here?”… or “Can you please come in earlier so the previous shift can leave early?”… or “Hurry with your report, it’s already 0730!”, or (I like this one), “Did you clock out yet? Just clock out and finish your charts afterwards.” Isn’t that cheating yourself? Yup… really encouraging. This is just the tip of the iceberg. What most¬†managers don’t see¬†is the fact that there are many more factors involved in causing “incremental overtime”. Let’s explore a few of them shall we?

First of all this is nursing, not some factory job. You don’t come to work, assemble things from 9 to 5, and end up with a finished product. You’re dealing with people and their¬†conditions, which as we know, takes TIME to fix. Secondly, the “healing arts” is very unpredictable, just like the weather. Patient’s conditions change you’ll have to adapt to those changes. Sometimes the change is good, which lessens your nursing time, sometimes the change is not so good, which increases your nursing time. It’s simple economics, i.e., the law of supply and demand. Knowing this, let’s list some common factors that influence “incremental overtime”.

Increased patient matrix. A 3:1 patient ratio in the ICU is just not acceptable, especially if these patients are for “stepdown”. It takes more nursing time to care for the alerts than those who are sedated and intubated.¬†Not only does it take much time to actually are for three patients, it also increase the wait time to get help. For example, if you have a 250 lb individual who keeps having a BM every hour, (unless you’re Superman) you need lifting help. If everyone is tripled, the lifting help wait time increases, not everyone is able to jump in right away because, you guessed it, everyone is tripled! CNA? What CNA? With the kind of CNAs we have, you’re better off not having one. In addition to this, if one of your patients start to get unstable on you, you put the other two at risk because all your time and attention goes to this one patient. Increasing the nurse patient ratio increases the risk that mistakes can happen because now the nurse is in rush hour mode all the time. I guess hospital administration sees this as increase “productivity”. I see it as diminishing returns. Can you say ventilator acquire pneumonia, nosocomial infections, and decubitus ulcers? And yes, it’s the nurses’ fault whenever those develop.

Decrease and Unorganized Supplies. The first thing they teach you in nursing school prior to doing any procedure is, “gather your equipment”. This not only applies to nursing but other fields as well… it’s just common sense. However, its hard to do this if you don’t have supplies to gather in the first place, not to mention supplies that are disorganized. It’s a pet peeve of mine whenever I go to the supply room expecting to find stuff and not finding anything at all. Even worse, stuff that’s there but rearranged. At home I have a place for everything. My wife and kids know not to mess with my stuff because, like I always say, “If it’s not here, or it’s not there, it’s lost!”. I know where everything is to the very last staple. I guess MMC should hire stockers from Walmart. They have a place for everything, fully stocked, all the time. Hospitals should be the same. Want to decrease incremental overtime? Supply us with enough stuff to help us do our work FAST. Spending half your time looking for things is not very PRODUCTIVE. If management haven’t figured this out yet, they’re hopeless!

Decreased supplies cause¬†increased hoarding which cause decreased supplies. I’m sure you know what I’m talking about. You open the patient’s bedside table and you discover the previous shift’s supply stash. No wonder I can’t find the washclothes… its all in here! Now, you can’t use these washclothes on other patients because, you guessed it, infection control will be violated. Can’t we all just get along?

Redundant redundancy doubles the workload unnecessarily. I’ve touched on this one recently. You can read the whole article here. If you do things twice, common sense dictates that it will take twice as much time to get it done. Duh! So, why do we have to enter our patient’s vitals in the computer and still use paper flowsheets? Or why do we need to enter I&Os when the paper form already has it? Besides, doctors refer to paper flowsheets so there’s no point entering them on the computer UNLESS, you use the data from the computer for statistical purposes (which I doubt), otherwise, what’s the point? Both paper and electronic records are legal documents. Why open yourself up for errors? Can you say Two-Two!

Last minute admissions, transfers, and procedures. In the ICU we have an admission cut off time which is 0600 or 1800. Patients coming from the ER or the floor after the cut off time will have to be admitted by the next shift. Problem is, sometimes patients come in at 0550 or 1755. Other times its not an admission or transfer but a procedure. Radiology calls you at 0615 to get the patient down for CT scan NOW! Unfortunately you can’t say, “I’m sorry, I’m wrapping up. I don’t want to get reprimanded for INCREMENTAL OVERTIME… you’ll just have to wait.” Can you say “Arrrggghhhh!?” You’re damned if you do, you’re damned if yoiu don’t. That’s a nurses’ life for you… isn’t nursing fabulous?

And the list goes on and on…. I’m sure there are ways to minimize if not totally eliminate some of these. Until management figures out a way to do this, there will always be incremental overtime. Why? That’s just how the way things are… it’s a vicious cycle of cause and effect.¬†Asking nurses to bite off more than they can chew and punishing them for that is ludicrous! I guess its about time perceptions and systems¬†change. If no one takes care of nurses, there will be no nurses to take care of patients, which leads to poor nursing care, poor patient outcomes, increase health care cost, decrease hospital revenue, etc… etc. And yet who is to be blamed? We the nurses!


Another one bites the dust March 7, 2008

Posted by 5 Wester in General Announcements.


Life is hard for your loved ones especially when you play Chemical Russian Roulette. No, I’m not talking about a revolver loaded¬†with a single round. I’m talking about that white stuff commonly administered through insufflation which causes a sense of euphoria and appetite suppression… you know, that alkaloid substance¬†found in coca leaves commonly known as cocaine.

This was the case of a 24-y/o gentleman who, unfortunately finds himself in the ICU, a victim of a ruptured brain aneurysm 2nd to hypertension due to cocaine abuse. He apparently passed out and was rushed to the ER. By the time they got there it was too late. He was practically brain dead. Today they just took him out of life support amid family and friends.¬†Sadly you hear his mother wailing over him, pleading for him to get up… he’s gone. How many more senseless deaths do we need to see until people get it. Don’t do drugs… nothing good ever comes out from it! When you’re gone, you only¬†hurt those who you leave behind.

It would be sad if the white stuff came from one of the family members. Perhaps a cousin or a brother, or maybe one of his homies. I’ve heard rumors that even grandmas do it. After all we live in South Texas just 10 minutes from the Mexican border, a major drug trafficking area. Oftentimes you see someone drive down the streets with their fixed-up Escalades and those 20 inch rims. My friends tell me “there goes another pharmacist” (if you get the drift). Ironically despite the poverty level down here people still have access to that stuff. Sometimes I wish I could get a video camera and shoot video clips of the tragedy that most people don’t get to see everyday. Maybe it will shock others into steering clear of that potentially lethal habit. But then again, will it change anything?

“There is a way that seems right to a man,¬† but in the end it leads to death.” Proverbs 16:25¬†This proverb written over 2000 years ago still apply today. Oftentimes we may do things that seem right to us. We disregard the laws of health. We abuse our bodies in the pursuit of happiness. But like the proverb goes, it leads to distruction. “Only one more hit”, he must have thought… Unfortunately for him, the chamber was loaded this time.