The Flexible Hours of Nursing

Street Car Cable. photo: jparadisi

One of the many odd things about nursing is its flexible hours. Flexible for the hospital, that is. For nurses, flexible hours means your phone rings every day for weeks. It’s Staffing, begging you to work extra shifts because your unit is under staffed.

Or, it’s Staffing, calling to say there are not enough patients in your unit, stay home.

Today, both circumstances occurred. Since our first patient appointment at the infusion clinic was at 1000 hours, I was told to report at 9:30 am instead of 0800.The loss of pay doesn’t affect me as much as the disruption to my internal clock. I have no idea how long it takes me to get ready and arrive at work at 9:30 am instead of 0800.

Here’s an example: if I have not finished doing my hair and make up by the time I hear Matt Lauer’s voice on TV, I am going to be late for work at 0800. Without Matt’s voice, I have no idea when to eat breakfast. Instead, I start daydreaming, suddenly realizing I only have 15 minutes to get to work!

At 9:15 am there are more people and traffic than at 0740.  It takes longer to get to work. This throws me for a loop, but somehow I arrive right about the time I would normally have a small, mid morning snack.

Lunchtime comes along suddenly. It seems I just got here.

Getting off early is just as bad, especially if it’s around 2 pm (1400). If I go for a walk, I end up shopping, and I can’t spend extra money when my paycheck is short some hours because of my flexible nursing schedule.

I go home, but I don’t feel like napping, because I slept in this morning since I didn’t have to go to work until 9:30 am.

Writing this blog post, I lose the battle to keep from snacking, because now I have more time than usual between getting home from work and making dinner. I feel like Snoopy, lying on top of his doghouse with his dinner bowl balanced on his head. Like Snoopy, my stomach clock is out of sync. It doesn’t understand the flexible hours of nursing.

Cheap, Fast, Or Good

Last week I was on vacation, the centerpiece being a small family reunion of sorts at the

The View is Clear From Here.

home of my mother and stepfather. My sister and her husband flew in for the weekend from out of state. They booked a flight on one of those new airlines offering cheap tickets with a la carte prices, charging you for every little thing beyond a seat on the plane. My sister joked that even the seats were cheap: they did not recline. Passengers sat in full upright position the entire flight.

On Sunday afternoon, we dropped them off at the airport.

An hour later, my sister calls saying their flight is delayed two hours. Soon it was delayed two more. This went on for six hours. Finally they were told their plane was delayed due to mechanical problems in Las Vegas. The passengers asked for the flight to be cancelled, and their money refunded so they could make other arrangements. They were told the flight would never be cancelled. Flights were only cancelled due to weather conditions, not for the lack of a jet. They were not allowed to leave the security area. They were not provided with dinner vouchers. Glasses of wine cost $15.

Sky Law had been declared.

What, you ask, is Sky Law? It’s a reference from the TV show 30 Rock, spoken by Matt Damon playing Airline Pilot Carol:

“Sky law, it’s when I turn on the fasten seat belt light and nobody’s allowed to talk until I get ten minutes of silence. I made it up, but people are stupid.”

Eventually my sister and her husband made it home, but not until 2 am the next day. Between the food tab, and missed time at work, any savings from the inexpensive airline tickets was forfeit.

You can get it cheap, or you can get it good.

After vacation, I returned to work to find my coworkers complaining about how another department’s lagging is causing treatment delays, appointments to overlap, and general dissatisfaction among the nurses, and patients. These complaints from nurses and patients seem sucked up into the Bermuda Triangle of hospital administration.

You can get it fast, or you can get it good.

The airline industry has been cutting back services and raising their prices for a while now. Pop up airlines offer lower prices at the expense of customer service: fewer flights, possibly less crew. Perhaps it takes longer to access a new plane and flight crew when the unexpected occurs, creating long flight delays.

I suspect the delay in service to our patients may be connected to recent layoffs. Although I’m not aware they directly affected this department, layoffs mean that those of us remaining with jobs that impact patient care are doing more work with fewer resources. It takes longer to provide services when a department is unexpectedly short staffed, or hospital census rises unexpectedly.

Once again health care imitates the airline industry. You can get it cheap, or you can get it fast. It’s still possible to get it good, but you can’t have all three.

Who’s a Jethro? Thoughts on an Aging Nurse Population

Study Detail/artist: JParadisi (2009)

     My patient was watching The Beverly Hillbillies on TV while I set up the supplies needed to start her IV. I stopped what I was doing when she said, “What is this show? Is it a movie? What’s the name of this show?”  

     “How young are you?”, I asked, gesturing towards the TV.  “That’s The Beverly Hillbillies. You know how people say, What a Jethro? Well, that’s Jethro. He’s always coming up with good ideas that don’t actually work.”  

     I’m not all that old myself. The Beverly Hillbillies was already in syndicated reruns when I was in elementary school. However, I meet the over 40 criteria which the Age Discrimination and Employment Act uses to identify “older” employees.  

      I read an article on Medscape,  Retaining an Aging Nurse Workforce: Perception of Human Resources Practices, written by Mary Val Palumbo, Barbara McIntosh, Betty Rambur, and Shelly Naud. The paper explains that a majority of employed nurses are over 45, and Human Resources departments worldwide are looking for ways to increase retention of nurses into their 60’s.  

     According to studies, nurses want three things from the organizations they work for:  

  • Recognition and Respect
  • Having a Voice
  • Receiving Feedback

     Really? That’s what nurses in studies say they want? Really?  

      Listening to my colleagues discuss what they want, increased healthcare benefits, increased reimbursement for educational conferences, pay increases for career related achievements such as advanced degrees and certifications, are examples of what nurses want. I think this falls under Recognition.   

     Nurses universally complain about missing scheduled breaks because of too heavy patient assignments, and uninterrupted lunch breaks are considered a luxury by most of us.  Some department managers even post important notices such as changes in policy on the staff bathroom walls, to read during our “bathroom breaks”. Fortunately, the walls of the staff bathroom where I work are free of required reading. This probably falls under the Respect category.  

     Coincidentally, I attended a Human Resources customer service presentation. A Power Point slide projected a scripted phrase to ask the patient (customer): Is there is anything else I can do for you? I have the time.”  The HR representative emphasized that studies show the phrase “I have the time” is a crucial part of the customer service interaction, and we were urged to say it.  I raised my hand: “I’m playing devil’s advocate here: if the phrase is of such importance, then shouldn’t staff be provided with the necessary resources ( i.e. time = staffing)  to say it truthfully?”  

  • Recognition and Respect
  • Having a Voice
  • Receiving Feedback

will never be achieved unless nurses of all ages find the voice to clearly define what these terms mean to us.

Not a Wonderful Life: No George Bailey for Pharmacist Eric Cropp or His Patient

     The Institute for Safe Medication Practices (http://www.ismp.org/) published an article in their August 27, 2009 newsletter, describing a horrific medication error that ended in the death of a child in an Ohio hospital. Just typing that sentence brings tears to my eyes.

     On August 14, 2009, Ohio pharmacist Eric Cropp was sentenced to 6 months in prison, 6 months of home confinement, 3 years of probation, 400 hours of community service, $5,000 fine, and payment of court costs. The Ohio board of pharmacy has permanently revoked his license. He did not mix the chemotherapy.  It was mixed by a pharmacy tech, who inadvertently used 23% saline as the base solution for the infusion that killed the child.

     Documentation from the case further shows that on the day the medication error occurred:

  • The pharmacy computer system was down in the morning, leading to a backlog of physician orders.
  • The pharmacy was short-staffed on the day of the event.
  • Pharmacy workload did not allow for normal work or meal breaks.
  • The pharmacy technician assigned to the IV area was planning her wedding on the day of the event and, thus, highly distracted.
  • A nurse called the pharmacy to request the chemotherapy early, so Eric felt rushed to check the solution so it could be dispensed (although in reality, the chemotherapy was not needed for several hours)

     The article Ohio Government Plays Whack-a-Mole with Pharmacist defends the right of health care professionals and patients to expect safe and consistent systems and policies  from hospitals to prevent the conditions and circumstances creating unsafe work environments, such as the one that has destroyed the life of a child, her family, and pharmacist Eric Cropp. Please read this article.

When Healthcare Providers Make Mistakes

Don't be a Nurse Puppet. photo: J.Paradisi

Don't be a Nurse Puppet. photo: J.Paradisi

   Pauline Chen writes about doctors who make mistakes in the health section of the New York Times (When Doctors Make Mistakes )http://www.nytimes.com/2009/07/09/health/09chen.html?_r=1&partner=rss&emc=rss

On the same page of today’s on-line section, is a story about an ex-surgery technician who infected at least ten people with hepatitis C, by stealing drugs from patients, injecting them into herself, then reusing the needles and syringes on patients.  http://www.nytimes.com/2009/07/10/us/10denver.html?ref=health

   There is a huge difference between making a mistake and committing a crime.  I think that point gets confused sometimes in the discussion of errors made in health care.

   When I was going through chemotherapy for cancer treatment, I couldn’t work with patients in the PICU. Instead, I was assigned to Quality Insurance for the unit. The job involved reviewing error reports, identifying events leading  to errors, and creating systems to prevent recurrence. I loved that job.  A consistent thread running through virtually every report was rarely do single events lead to mistakes. Usually a series of events occur, like a stack of dominoes falling upon each other in a line, leading to Destination Error.  Long hours, too heavy patient loads, extra shifts to cover short staffing, lack of appropriate mentoring for new nurses and doctors, and more, contribute to mistakes. There was always a surge in reports when census was high and staffing was low.

   During the first six months of my nursing career, I thought I  made a disastrous error: becoming a nurse.  Fresh out of school, I worked on a high-acuity unit  utilizing the team-leader model of care. I was a team leader for one LPN (if one was available) and one or two CNAs. If someone called in sick, I was also charge nurse, with a full patient assignment. I worked twelve hour nights and went home most mornings in tears, dreading the little notes I’d find in my staff box, notifying me of things I’d forgotten or mistakes I’d made the previous shift. It never occurred to me the assignments were unreasonable. Instead, I doubted myself, a competent young woman, managing a household and raising a family, feeling unable to do a job I worked so hard to excel at.

   I was rescued by an expert nurse who befriended me and taught me what nursing is really about. If I could wish anything for new nurses, it would be for each to have that kind of mentoring, which for some reason came my way.  I hope I gave some of that back when it was my turn to precept and mentor.

   Be careful out there.

Sometimes Staffing Issues are Beneficial

   How sweet it is!

   You know how it goes, when you’re a nurse. You work your assigned holiday weekends. It’s fair.

   Sometimes, the department you work for has a low census, and your shift gets cancelled, because they don’t need you.

   I got cancelled for the entire holiday weekend, due to low census.  This feels like a gift from the universe (but it actually was Friday’s charge nurse who made it happen), after working my tush off all week installing The Acorn Contains the Tree and “One more than four” at Anka Gallery.

   David and I threw a couple of overnight

Yaquina Bay from Newport's Historic Bayfront July 4th photo: J.Paradisi

Yaquina Bay from Newport's Historic Bayfront July 4th photo: J.Paradisi

 bags in the back of the mighty Subaru yesterday afternoon and took off for Newport, Oregon, to watch  the fireworks display tonight. Some well earned R&R.

Have a happy holiday!