Like I really need feed-back on this. . . .

  1. I get to work and here is the following memo. Like it is so shocking to me. What's more shocking is the complacency that fellow nurses accept this as normal behavior. Are we a sick profession or what???? It is like we have become abused partners in a co-dependent sick relationship. Check this out! Did you have the same reaction that I had? Or is it that I have been in nursing too long and I am just Soooo over crap like this? I high-lighted in bold what really blew me away. This is from a big major cardiovascular hospital in Atlanta; so it isn't like it happened in the boon-docks.
    _____________________________________________

    Memorandum

    To: XXX SSSS Nursing Staff

    From: XX CCCC

    Date: June 5, 2001

    Subject: Time analysis

    Quadramed (previously known as Medicus) has been commissioned to help us define/examine how we spend our time during our shifts. . . what activities are we engaged in, what are our barriers to giving care, what do we do that perhaps could be done in a different way? This is a wonderful opportunity for us to assist in better defining how we function and to help determine what we can potentially change about our practice, affording us greater satisfaction while delivery high quality patient care. This is the first time ICU East will be monitored. In the past they looked at CCU and ICU West, but not us.


    Some key notes about the study:

    • Every nursing unit will be surveyed at least 9 times. . .a representative sampling will occur on all shifts and on the weekends.
    • Each staff member will be assigned a number for that worked shift and that number will be worn on her/his back during the shift. This number is NOT for tracking of individuals, but by skill level only.

    • All activities will be recorded anonymously. . no way to track back to individual staff.

    • Activity of each staff member will be assessed every 15 minutes.

    • All activities will be recorded, even idle time when you might be waiting for a return phone call from an MD or medication to be tubed from the pharmacy.

    • A log will be kept at the nurses' station so that all staff can record every trip off the Unit for any reason.


    If you have any questions, please see me. Thanks for your continued support.
    _____________________________________________

    Ok, so what do you think? I think this means increasing our workload while decreasing our job security and real earnings after inflation. When you point something like this out as SICK, Administration says it involves two problems: our lack of flexibility and bad morale.

    [ June 07, 2001: Message edited by: RunningSoLate ]
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  2. 30 Comments

  3. by   Zee_RN
    Actually, I think it means they are about to implement a Patient Acuity System. They look for things that may need to be added to the scoring system. I attended meetings for Quadramed's PFS patient acuity system and kinda liked it. Not that it generates more nurses which is what we all need, but it is a means of data gathering which actually SUPPORTS our cry for better staffing. Again though...it can't produce nurses for us.

    Just my $0.02
  4. by   CaronRN58
    Sounds like a time study(like they do in manufacturing) to me. If it's going to be done any way, why not suggest that each caregiver wear a pedometer. A large amount of a nurses time is spent walking. Javier Thome RN has written a nursing time study paper(Nancy Nurse Speed Demon) that can be found on the MNM march site (www.millionnursemarch.org). It could be an eyeopening experience for everyone.
    CaronRN58
  5. by   Stargazer
    I agree with Zee. My ICU did this when they wanted to implement a pt acuity system. One thing we learned fairly quickly is that some activities are weighted more heavily than others and got more 'points." As I recall, anything that didn't involve direct pt care was considered, as your memo implied,
    "nonproductive" or "idle" time. However, we learned that handwashing was considered
    "active" care. The amount of handwashing that went on that week..... Infection Control
    would've been proud.
  6. by   natalie
    I would love to have this at my hospital. None of us would have any qualms about idle time clocked since there is a scant amount. I'd also like clocked my lunch break, taken on my unit, (5-10 minutes) as well as break times. (usually none taken in a 12 hour shift.)

    I'd like them to clock the amount of time we spend looking for wheelchairs,equipment, replacing faulty equipment, running to pharmacy, transporting patients, paperwork...

    A few months ago, I had my co-worker clock the amount of time it took me to transfer a s/p bariatric bypass patient out of ICU. Of course this is done routinely by nursing without ANY ancillary assistance in my hospital. Done at 6 pm. I hustled, as usual, and it took ONE HOUR, 15 MINUTES!!

    It included getting the patient OOB (finding the wheelchair again), moving the bariatric bed to the surgical floor, all the patient's belongings as well as medical equipment, completing computer/paperwork transfer.
  7. by   el
    I remember when we used to fill out daily acuity sheets on each patient. You know I swear they threw them right in the garbage! They never ever made a difference in staffing back then, then as our hospital started "down sizing" and "displacing" nurses they stopped having us do them. I often wonder if they realized they were helping create a paper trail of just how dangerously low staffing levels are. That was way back when, no shortage existed, we were short staffed by administrative choice. Anyway, I am very cynical about acuity levels and the true underlying reason for the collection of this "data". Also, how much do you think your hospital is paying to have this Company collect the data, enough to send alot of people to nursing school I bet. Anyway, the article on another bb about 13 things... you should read it. If you don't want to take part, don't, and let administration know that it is ridiculous to treat you or any nurse like a mouse in some science test. I would definately not walk around work with a number on my back, I would tell them exactly where to stick that number!
  8. by   kewlnurse
    Just another way for "The MAN" to keep you down. I'd tell them where they can shove their time study. Actually having worked in placs that tried to do sh*t like this, the best way to combat is to pretend your all into it and find a way to f**k it up. I can be devious at times. Let me know if you want some ideas.
  9. by   Charles S. Smith, RN, MS
    Originally posted by RunningSoLate:
    <STRONG>I get to work and here is the following memo. Like it is so shocking to me. What's more shocking is the complacency that fellow nurses accept this as normal behavior. Are we a sick profession or what???? It is like we have become abused partners in a co-dependent sick relationship. Check this out! Did you have the same reaction that I had? Or is it that I have been in nursing too long and I am just Soooo over crap like this? I high-lighted in bold what really blew me away. This is from a big major cardiovascular hospital in Atlanta; so it isn't like it happened in the boon-docks.
    _____________________________________________

    Memorandum

    To: XXX SSSS Nursing Staff

    From: XX CCCC

    Date: June 5, 2001

    Subject: Time analysis

    Quadramed (previously known as Medicus) has been commissioned to help us define/examine how we spend our time during our shifts. . . what activities are we engaged in, what are our barriers to giving care, what do we do that perhaps could be done in a different way? This is a wonderful opportunity for us to assist in better defining how we function and to help determine what we can potentially change about our practice, affording us greater satisfaction while delivery high quality patient care. This is the first time ICU East will be monitored. In the past they looked at CCU and ICU West, but not us.


    Some key notes about the study:

    • Every nursing unit will be surveyed at least 9 times. . .a representative sampling will occur on all shifts and on the weekends.
    • Each staff member will be assigned a number for that worked shift and that number will be worn on her/his back during the shift. This number is NOT for tracking of individuals, but by skill level only.
    • All activities will be recorded anonymously. . no way to track back to individual staff.

    • Activity of each staff member will be assessed every 15 minutes.

    • All activities will be recorded, even idle time when you might be waiting for a return phone call from an MD or medication to be tubed from the pharmacy.

    • A log will be kept at the nurses' station so that all staff can record every trip off the Unit for any reason.


    If you have any questions, please see me. Thanks for your continued support.
    _____________________________________________

    Ok, so what do you think? I think this means increasing our workload while decreasing our job security and real earnings after inflation. When you point something like this out as SICK, Administration says it involves two problems: our lack of flexibility and bad morale.

    [ June 07, 2001: Message edited by: RunningSoLate ]</STRONG>
    The quadrmed study is a way of determining the average nurse hours per patient day. The ANHPPD translates into a number to use for staffing. It also translates into numbers for patient acuity. It is a manufacturing model approriated for professional work and has its strengths and limitations. There is a bunch of research related to use of acuity systems for staffing. Some of it is flattering, some is not.

    chas
  10. by   RunningSoLate
    I guess I would not be so upset or suspicious of this study, but our hospital is undergoing ways to "get their bottom-line finances under control", or so they were mandated to do it by higher ups. We were told in a recent meeting that "no nurse was worth $50.00 an hour" which translates to incentive,etc being cut out. Instead of 3 critical care patients to take care of, you will have 4. So what do you think? Do you think they are doing this study to benefit the overworked, underpaid nurse? NOT!!!!!

    WELL......my short answer is I think it's :

    money wasted......FORWARD & BACK !!!!!!

    My long answer is some smart bunny went to a conference somewhere and
    got wind of how big businesses use "time management guru's" to milk
    every LAST BREATH out of any employee that still has a PULSE !!!!!!!!

    Number ONE ~ Unbelieveable !!!!

    Number TWO ~ Makes ALL your managers and administration look like FOOLS
    that they have to pay somebody to find out what their employees are actually doing???? I mean we never have to see hospitals waste money on studies until managers get into a wad over cost-cutting measures. I mean it is like having a world-class restaraunt with excellent 5-star service. Then one-day, you decide to increase the bottom-line profit and fire all the waiters except for 3. Pretty soon, customers stop coming because service has gone down the tubes. Then you go out and hire a consulting firm at x amount of dollars to find out what the problem is.

    I mean seriously, if you don't have housekeeping and you get rid of all your nursing assistants, or have one for a unit of 29 critical care patients, what is this study going to show a hospital that is hell-bent to cut costs? What is the point? Next we will have to grease a broom handle and stick it up our butts and sweep the floors as we do nursing care.

    Number THREE ~ Do they REALLY think that any one believes they will not
    be able to single out individuals ????

    GIVE ME A FREAKIN BREAK !!!!!!!
  11. by   mustangsheba
    As RunningSoLate pointed out, do they really have to pay someone to find out what their nurses are doing? As Stephen Covey says "If you want to find out what needs to be done to improve production, ask the people who are doing the work." (Or words to that effect.) If I ever wear a back number it will be because I joined the postal workers underground.
  12. by   Tiara
    RunningSoLate, I totally understand what you're saying and I agree. It's another control issue. This study is being done to the nurses not with the nurses input. Nurses have been complaining and suggesting for years and it has fallen on deaf ears. Now something must be done and the nurses are passive players with numbers on their backs. Frankly, I couldn't take it!
  13. by   nurs4kids
    We still use the patient acuity ratings for staffing and the patient is billed by acuity rating. We also have done the time studies. BUT to wear a number on your back???!!! I'd tell them what to do with their #'s!!!

    btw..runningsolate..i love Mentone..honeymooned there!
  14. by   Zee_RN
    I completely understand being suspicious of ANYTHING coming from hospital management. Especially in light of the "no nurse is worth..." comment.

    As a business-manager-turned-nurse, however, I am a believer in "You cannot manage what you cannot measure." Quadramed provides a means of measuring; what your facility does or doesn't do with the information is where the issue will lay. With the POSSIBLE exception of the rare nurse in management--NO, management does not have a clue what their staff is doing. Who, but a nurse, knows what a nurse does?

    And yeah, I hate wearing number on my back-- take a few minutes to get to know my name and you'll save a lot of hard feeling.

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