What is administration thinking?

  1. 2
    GRRRR. Sometimes administration makes some really dumb decisions that are a train wreck waiting to happen. Here is a prime example.

    Past practice has been when patient census drops nurses are cancelled by sign up on a voluntary list first and then it goes mandatory with low senior first. This same scenario below is supposed to occur on the med-surg floors.

    So, we have 4 ICUs in our hospital: MICU, NICU, SICU, CICU. Rarely, the unit census will drop down and nurses are cancelled. Recently management decided when the numbers drop that certain units will close and their patient census will be moved to another ICU, however, the nurses will go with their patients. (So, if NICU patients are moved to SICU, then the NICU nurse go to SICU and take care of the NICU patients.)

    Here is the plan:
    Bring in extra nurses so there are nurses on both ends to take care of the patients and nurses to move the patients too. Of course, pt's on vents will need respiratory therapists too, so bring in extra RTs. After the move, the nurses will stay with "their" patients in the new unit. Additional nurses are needed on the closed unit to purge rooms for cleaning and then an inventory must be done of all the equipment. A security guard will be posted on the unit to protect it from theft or "borrowing". There are 5 points of entry to the unit and none can be locked.

    As soon as the numbers go back up then the process will be reversed: bring in extra nurses to open the rooms and ensure supplies are present (and haven't been stolen when the security guard took his break). The extra nurses will ensure that there are nurses to take care of the patients on both ends, and transport. Extra RTs to move vent patients. And extra staff will be available for admissions.

    BTW, CICU nurses are the code nurses. If they have no patients they will be assigned to the other ICUs but not take a patient load so they are available to go to codes. So, two nurses paid to not have patients.

    Can anyone tell me how this would be cost effective???!!! They will be paying for extra nurses all over the place and could be playing musical beds on a daily basis. One day the census might be 3 patients, but then the unit fills up within 8 hours. And H1N1 is just starting to hit this area and this is their plan??? Really??? Is it just me or did someone have a bowl of stupid for breakfast? Has this ridiculous plan been tried where you work? If so, what were the results? It just does not make sense.

    Thanks for letting me vent.
    lindarn and mamamerlee like this.

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  2. 10 Comments...

  3. 2
    Stupidity runs deep there, apparently. It all depends on the cost centers and comp time.

    I'd suggest going to 100% self scheduling including comp time. Census is low, use your comp time!

    I worked for a stupid system that sent me home so much because I was new that I actually came in the hole for vacation time and like IDIOTS they charged me triple health insurance because "I was under 32 hours". Well I was working their Fri Sat Sun 12h weekend alternative but being sent home so much wasn't my fault!

    I lasted a whole year there and hate that health care system to this day. Only to find the CEO got a cool million and a half for a bonus (condyloma)!
    VICEDRN and lindarn like this.
  4. 1
    No, I don't understand their thought process at all... like you, I'm seeing just a lot of extra costs for a lot of extra personnel; and I doubt that the units will stay closed for long enough of a time for the saved cost of supplies/electricity/etc. to add up to enough savings to justify those costs. (Wow, hope you understood my run-on sentence there.) Good luck dealing with the situation...
    lindarn likes this.
  5. 1
    I didn't get very far reading your post to be able to determine that there is no cost effectiveness there. Well, stupid is stupid, and your administration has come up with an amazingly stupid plan. They are fulfilling their expectations as administrators.
    lindarn likes this.
  6. 1
    Go figure! The administrators have obviously not ever participated in moving intensive care patients or "closing" units...and yet the group have determined that this is a clever and effective idea. My hope is that your first line managers are going to provide some real leadership and let the administrators know exactly why this is not a viable or cost effective idea.
    Would I be silly to presume that the *ICU nurses are cross trained in the different areas? The ability of nurses to staff between these units when the census gets squirrely can make a huge difference and can nearly eliminate low census days for nurses.
    It sounds like your management has that same terminal disease that so many other companies have today....the WEKNOWBEST disease, it is a huge killer of morale.
    lindarn likes this.
  7. 1
    This the most ridiculous thing I've heard of. This easily takes the cake! That'd be enough to have me walking down the street to a new hospital.
    lindarn likes this.
  8. 5
    O.M.G.

    This is so Monty Python- the machine that goes Beep! I had a mini-movie playing in my head while reading your post.

    Preview- Concerned Management pulling all-nighters to solve the staffing, pt flow, and money crisis. Music somber. They are Concerned. They are Working Hard. Darnit, they're running out of starbucks!! Then- the genius! Uplifting music- we have a plan!!!

    Next scene- Charley Chaplin comedy style music playing- scene played in fast motion with an areial view of everyone scurry-ing around with funny jerky movements- showing the staff pushing ICU beds, vents, IVs, and other assorted interesting things- running back and forth between units. Slows down, management is standing off to the side, smiling as they survey their wonderful creation- full of a sense of accomplishment. As scene ends, we get a shot of all the staff propped against a wall, bent over slightly, and puffing for breath. Didn't they just work so hard being busy little bees. Then a quick shot of near comatose pts drooling and little old ladies looking befuddled, but so sweet the little old ladies are, and goodness! how they appreciate all this hard work to give them the best care!

    Final scene- soft music. First shot, an empty (but how clean it is!) ward with a sterotypical cop, sitting with his chair propped back on two legs drinking black coffee and eating a Dunkin Donut. Out side the closed main doors to the ward.... maybe even the very door said cop is relaxing against- a shot of an empty (but clean!!) hall, light reflecting on the buffed floors......... and families and doctors wandering around aimlessly wondering just where in the hell their loved ones/patients are. Scene fades, with a shot of everyone's favorite older-then-dirt-will-retire-upon-death-buried-with-the-beeper-isn't-he-just-sweet-bless-his-heart-he-first-started-making-house-calls-in-a-cart-and-buggy-with-a-black-MD-bag-aren't-his-specticals-cute-look-at-his-quaint-old-timey-professors-suit-with-the-suede-elbow-patches-wearing-navy-shoes-with-brown-suit standing still in the middle of the wandering and wondering confused, scratching his almost bald wispy haired head with a concerned-but-kind-and-knowledgable-you-can-trust-me-I-inspire-trust look on his face - bless his heart. This final shot, of course, slowly washes out so that the last moments are shown in old-fashioned sepia black and white. It just makes it feel like the good old days!
    *************

    I do feel your pain though, amusement aside. Management either thinks way too much- or not at all.
    The only thing that will save you is the sweet old doctor meeting with the concerned management, taking off his glasses, and with a stern look, sitting them all down to explain to them the error of their ways and lead them to a better, gentler path..... uplifting music......

    Opps, sorry.

    As I was saying, the only thing that will save you is when grumpy old doc with tons of connections and more influence then GOD (and surgeons) loses it and goes postal.

    How do I know? Because something similiar happened at a hospital I worked at while in and then out of nsg school. Dr. Sir-yes-sir, surgeon extraordinaire, liked the floor I worked on. A lot. He wanted all of his pts there but especially the complicated ones. He is a brillant surgeon, a bit crusty and grumpy... but Man- he can all but lay hands on someone, know what's wrong, and fix it. If you were a nurse who worked hard, knew how to do a proper dressing change, knew that not farting was to be reported at any hour, but stupid stuff wasn't- he had your back all the way. If you sucked, or would get flustered to the point of not being able to function- he simply ignored you. He knew I was a CNA but in school, and if I wasn't busy he'd kidnap me to make rounds with him, giving me little lessons on each pt. He barked, and even the cockiest CEO learned quickly to jump and jump high. It frustrated him to no end when we stared moving pts from his favorite floor to the med floor- a stinky, smelly, and germ infested place in his opinion, to 'improve staffing and control costs for low census'. As he said.... often.... there's nothing wrong with a medical floor- it has great nurses- but every pt on it is a walking bag of infection that will kill my surgical patients!
    The pt musical chairs went on for a while despite his protests. After one very bad weekend- I swear, on Sat alone we must have opened, closed, and reopend the floor four times- he came in on Monday morning to find his sickest, most immune-compromised pts on the med floor- and 'walking bags of infection' on HIS floor- a result of filling up the med floor and then having to open our floor to all further admits. He walked in to chaos. We were obviously exhausted, and when he walked to the nurses station and started streaming commands and queries- he suddenly stopped and just looked at us. We were so tried, frustrated, and numb we just looked back. He asked- very quietly- where is pt so-and-so. Downstairs, we replied. With the bags of infection- added an older nurse whom he had worked with for years and was friends with his wife. It was genius, she used such a perky helpful tone of voice. I see- he said looking at her, and started flipping through charts. After a bit, he asked-- if so-and-so is downstairs, I assume because of low census, why are THESE ...um...bags of infection on this floor? So she proceeded to explain step by step and in great detail how the weekend played out and just how many times the floor opened and closed. 'By the way', she added, 'I'm afraid some dressing changes were missed or late because of all the commotion. I believe the nsg supervisor did write it up, though.' I swear, you could hear a pin drop. Not even a call bell dared break the silence. He started to flush at the neckline and we watched amazed as it creeped upwards until his face was on fire. Scared me to death. He looked at each of us, and then said "Is everyone breathing?" Yes sir. And then.... "I'm sorry you had to go through this. I can promise you, I am going to take care of this right now." I missed the rest- we gave report and promptly evacuated the impending war scene with all possible haste and few words. The rest is now legend, and I don't believe our floor ever closed for low census again while I worked there, even on Christmas when we had two patients.
    cloister, VICEDRN, lindarn, and 2 others like this.
  9. 1
    Most occupiers of admin positions eat a whole box o' stupid daily, they don't just have a bowl
    lindarn likes this.
  10. 0
    "What was administration thinking?"

    --- That's the problem... they DON'T think.
  11. 0
    sounds so familiar, i could've wrote the story! the peds unit i work on is equipped with "kid" rooms and "adult"rooms-5 of each. i have said so many times that the 2 nurses that are staffed daily could take adult overflow just to keep our unit open, so that when we do finally admit a ped, we're there, we're ready, and as said before, all of our equipment has not been "borrowed". they tell me that is absolutely not cost effective, but that admitting our peds pts to other floors is...of course this means the kids being taken care of nurses not trained in peds, or being shipped to a hospital about 70 miles away for problems that we could easily solve had we been allowed to spend the money to be in our own department. of course, i am reminded that peds=float pool in my facility, so to open the department means the other departments are supposed to staff themselves-or take away from their low census days (often, they send the other dept staff home and float us all over filling up holes, then if we do randomly open back up, all hell breaks loose b/c now we're short staffed in 2 deptartments, not just 1). the charlie chaplin film narrative was like reading a day in my regular life!!!


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