I have a dilemma...quality of care vs. $$$

[nosonew, BSN, RN]

Well, its not really a dilemma, I just want your input. Here is the situation:

We have ALOT of older, some very sick patients right now. We have 10 catheters out of 26 patients....so obviously our labs all the way around stink right now., URR's are lower, KT/V's, phosphorus levels (mainly due to the long-term patients who just really don't care anymore and are non-compliant or due to new patients who haven't been able to get theirs under control yet). SOOOOO..

our director is in a bit of trouble due to our labs and I think she is more focused on how this will affect her BONUS rather than the patients well-being. So, she is starting a "Contest", each staff member will get a certain number of patients to "work on" for 2-3 months to improve their labs. I don't really have a problem with the concept, HOWEVER, the staff member will get monetarily compensated if they "win" the contest.

We have at least 4 patients that are so ill, and have lost so much weight, the doc/myself have takent he patient off of their dietary restrictions (Except for K+ restrictions).

Most of these patient are not likely to live through the summer, and I will adamantly refuse to FORCE them to change how they eat during their final months so my boss can get a BONUS. If that is one SMALL area in which they can find some joy, they should have it. Period.

I told the boss I didn't see the purpose to making these people eat the low phosphorus diet, (their labs aren't that bad, most 4-7 without restriction) when they will die before negative effects can be felt by them.

Am I off base here? Sometimes I think I get tooo emotionally involved with the patient and perhaps I am not seeing the entire picture.

Questions, comments, suggestions?

[jnette, ASN, EMT-I]

Interesting... I don't like this one bit.

We, too, have had occasional "contests", but it was the PATIENTS who got the "prize" for best labs, best compliance, etc.. not the staff.

It has to be the patient who wants this.. we can only educate and encourage.

Your dietician could perhaps spend more time giving them the rationale behind why dietary complaince is SO in THEIR best interest.

I would agree with you in not pressuring a dying patient into strict compliance.

I don't believe in monetary rewards for ANYTHING we do for our patients, period.

That could lead to some crazy consequences all the way around.. NOT a good idea at all. Don't even like the smell of it, and I think your director is way off base with this.. just MHO.

[nosonew, BSN, RN]

Apparently the patient also gets some "cheezy" prize... but I just hate this monetary crap! We teach our patients what is best for THEIR particular situation... not as a whole. Each patient has different situations and needs, as well as other chronic illnesses. I don't understand why the can't look at each persons labs INDIVIDUALLY...I know that takes extra time, but you can't group these people together... you just can't.

I have several that I think will just QUIT if they are bombarded with their lab values stuck in their face every time they walk in the door. No one wants to be bombarded with negativity in a place they wish they didn't go to anyway, much less have to dread their visit even more...

It just makes me sick...