Got Ethics?

  1. So I'm standing at my desk in the ED, stirring in a pile of paperwork trying to figure out where I went wrong, when the charge nurse comes up and hands me a $50 gas/gift card from Exxon.
    I say thanks, and pop it in my pocket, then I begin to wonder what I've really done wrong, so I ask what it's for....

    She tells me I had a patient the other day that came in as a "Cardiac Alert" and that I managed to get the patient from door to cath lab in under 90 minutes.

    Now I'm thinking... ok... so...? Then it's explained that anyone involved in a Cardiac Alert from the nurse, the Assts, LPN's, externs and everyone that lent a hand also got a card as a "Thanks" for a job well done, and it's been going on for a week now with excellent results. And in the words of my kids; OH... EMM... GEE!

    So now... I'm realizing that I made a special trip through the ER on said day to specifically thank certain people for helping, or in other words; thank those lazy sloths that never move; for finally moving. Now today it's Smackdown: Reality Series.

    [So THAT explains the bum-rushing of the last few cardiac patients..... Figures.]

    And now the obvious question.... is the well-intended "Thanks" possibly an unethical "motivation" for these dibwads that are never up and moving??? I mean, PAID EXTRA just for doing what you should have been doing in the first place???
    They're darn near fighing for a spot at the bedside now, in order to sign the assist roster.

    Is there an ethical dilema here??
    Me thinks there is....
    rb
    •  
  2. 8 Comments

  3. by   UM Review RN
    I wouldn't call it so much an ethical dilemma as behavior modification. As these nimrods do teach themselves to get up and moving during a Cardiac Alert, they'll be more inclined to associate the reward with the activity and continue to move their butts when a patient with that designation comes in.

    Hopefully the teaching will stick.
  4. by   elkpark
    I'm foggy on the details (as usual at this point in my life! ), but I recall reading something about how JCAHO, CMS, or somebody is pushing some big, new "quality initiative" thing about hospitals getting people from the ED door to the cath lab within 90 minutes (because it's been demonstrated that that significantly improves outcomes). So the new program in your ED may well be the facility's attempt to implement that new standard and provide (temporarily, one hopes! ) incentives for the staff to meet it -- another "motivational"-type program like the ones that give staff some kind of tangible reward when they get a letter of thanks from a patient, give all the staff "thank you" gifts for doing really well on a JCAHO inspection, that sort of thing ...

    You'd think they would have made staff aware, though -- usually, there's some sort of big administration "roll out" when they start up a program related to a new quality standard.
  5. by   UM Review RN
    Quote from elkpark
    I'm foggy on the details (as usual at this point in my life! ), but I recall reading something about how JCAHO, CMS, or somebody is pushing some big, new "quality initiative" thing about hospitals getting people from the ED door to the cath lab within 90 minutes (because it's been demonstrated that that significantly improves outcomes). So the new program in your ED may well be the facility's attempt to implement that new standard and provide (temporarily, one hopes! ) incentives for the staff to meet it -- another "motivational"-type program like the ones that give staff some kind of tangible reward when they get a letter of thanks from a patient, give all the staff "thank you" gifts for doing really well on a JCAHO inspection, that sort of thing ...

    You'd think they would have made staff aware, though -- usually, there's some sort of big administration "roll out" when they start up a program related to a new quality standard.
    I think you're referring to the American Heart Association's "Get With the Guidelines" program.

    Here's a link. http://www.americanheart.org/downloa...DFactSheet.pdf
  6. by   UM Review RN
    Accidentally double-posted, so I'll use this space to explain that when the GWTG program is initiated, they've identified resistance to change as one of the barriers to providing better patient care in this area, and there are recommendations for overcoming these barriers.

    Rewarding appropriate care is one of them. Here's that link:

    http://www.americanheart.org/downloa..._Solutions.doc



    For those of you who have already been adhering to these guidelines, wonderful! But unless everyone on the team is on board with this, patients will die.

    IMO, if passing out a candy bar or two increase compliance to clinical methods that have proven to save lives, it's well worth the effort.
    Last edit by UM Review RN on Sep 23, '07
  7. by   RN Randy
    Quote from Angie O'Plasty, RN

    IMO, if passing out a candy bar or two increase compliance to clinical methods that have proven to save lives, it's well worth the effort.
    Hey Ang,

    Well.. if we were passing out candy bars, I wouldn't have a problem at all. No one will fight for a bedside spot for the "show" for such a treat. However fifty bucks seems to be worth backstabbing, lying and manipulation of the truth when it comes to 'who did what' on paper...
    Give out the thanks, but be corporate about it... mugs, backpacks, totes, or heck, a free meal. People who care will appreciate the thanks and gold-diggers won't see the worth.

    I don't know about you, but I'll take a single concerned nurse as my assistance, over 6 goofballs under foot; jockeying for a spot on the gimme list.

    I prefer calm orderly time-sensitive task completion... bum-rushing-gimme-it-I-can-do-it-all-super-nursing drives me nuts.

    Help isn't helpful when I've got 2 docs, 3 residents and 4 people competing for an IV stick and I'm not even able to get in close enough to attach a cuff and electrodes.... as the 2 docs keep asking for a strip and a pressure....
    It's unreal sometimes.


    btw, Scrat RULZ!
    rb
  8. by   UM Review RN
    Wow, sounds like some folks have gone a little overboard.

    At my hospital we had an inservice on GWTG and got a mini-Hershey bar for listening and a little reminder card that had all the specs printed on it. We do it, we're golden. We don't do it, we're in the doghouse.


    Maybe they shoulda stuck to candy bars.

    P.S. I'm having a very Scrat life this year. Every time I finally get there....something happens.
  9. by   RN Randy
    Yep, it's got outta hand I'd say. I asked about it yesterday and someone said something about it having become too expensive or something and they haven't heard anything about it lately.
    We'll see...

    and yeah, it's been a Scrat-year indeed.....LOL

    To give you an idea of the seriousness of the issues... we have a pair of campers in the ED, they are consultants and will be camping out for SIX MONTHS in order to find/fix the malfunctions....
    maybe that's what happened to the cards... heh..
    rb
  10. by   elkpark
    Quote from Angie O'Plasty, RN
    I think you're referring to the American Heart Association's "Get With the Guidelines" program.

    Here's a link. http://www.americanheart.org/downloa...DFactSheet.pdf

    (Oh, goody!!! I'm not crazy (or senile)!!)

close