In my opinion many of the requirements set up by organizations such as the Joint Commission are written by out of touch people who spend years acquiring advanced degrees, yet lack the down to earth experience of working in the trenches of healthcare. Much of what they require seems to be based on nursing theory, and strikes me as being straight out of academia.
They create a workplace that seems more like an obstacle course. There are codes required to get into supply rooms, fall precaution sheets to fill out by the end of the shift, pain assessments to be done with mandatory numbers to plug in based on a pain scale that is not universally applicable to all situations.
Regulating bodies are staffed by people who often don't understand the day to day reality and flow of work that healthcare providers face. They create systems that totally frustrate doctors, nurses, and other providers.
I hear a lot of complaining from doctors as well. They are on our side. They share our pain. Their stress levels are up because of the increased demands on their time be systems put into place that are highly inconvenient to those of us providing direct care to patients.
What I see in my interactions with physicians is a similar mindset that I hear from nurses. They are sick of people in offices making their professional lives more difficult with inconvenient regulatory overkill that tries to solve problems by creating more documentation.
Doctors and Nurses need to unite with other healthcare disciplines to bring common sense back into healthcare! We are on the same team!
For those questioning the drinks at the station - that is an OSHA requirement.
Amen to everybody else!
It's a requirement that we are able to have them at the station or requirement that we NOT have them at the station? Sorry I am dense...I will have to look it up, unless you have a site handy, thanks!
Specializes in FNP, Peds, Epilepsy, Mgt., Occ. Ed.
Back in the day, as an LPN, I did hemoccult cards at the bedside all the time. Those things aren't rocket science, and haven't changed one little bit in 25 years.
Now, as an NP, I can't do a hemoccult card in the exam room. I have to send the card down to the lab. I can do the rectal exam and put the stool on the card; it's the really tricky part, dropping the fluid out of the little bottle, that I'm not allowed to do. Not only does all my nursing education not qualify me to do this; the MD's medical education isn't qualification enough, either.
Now, the person down in the lab who does do the little drops and looks to see if the color shows up? Hired off the street, high school grad with OJT.
I don't know if this is a Joint Commission thing (this particular clinic is very proud of being Joint Commission accredited, which I think is insane) or a CLIA thing, but it's a fine example of regulation gone wild.
santhoney, at the hospital where I've been working as an agency nurse they have the same cockamamie, inconvenient rule: no bedside hemocults. And, it's a PITA there to transport samples down to the lab.
Someone told me it was for billing purposes, I'm not sure if that's the case, but it's utterly ridiculous. At my previous place of employment we still had the 'luxury' of performing this test at the bedside.
I'm not sure if it has been said, but all these regulations seem to be in place to prevent a lawsuit. I'm not a nurse (yet), but I do work in a lawyer's office. The biggest rule here is document EVERYTHING. It looks like that is what the bigwigs at the hospitals are trying to do.
I take calls all the time from people who want to sue because "the radiation that cured my cancer caused a burn on my skin" or " my doctor told me my knee problems are due to my obesity. That hurts my feelings."
When there are so many money-hungry, ill-educated people out there who try (and sometimes win) these frivelous lawsuits, it is no wonder the hospital management wants to keep everything doucmented.
If people would stop suing for this useless crap then maybe doctors and nurses would have more time to spend making people comfortable/happy rather than having to fill out paperwork to cover their behinds!
By the way, the lawyer I work for does NOT help people with these types of lawsuits, but there are some fresh out of law school lawyers that do!
I am going to assume that the person who started this thread is younger than I and does not remember "before" regulations. Regulations are a two-way street. If you know the standards and abide by them and DOCUMENT accordingly, then you are protecting yourself as well as the patient. On the other hand, a few bad apples can make all healthcare providers look lazy and selfish and even harmful. It is a shame we have to practice defensively.
JLSRN: Hemoccults are no longer done at the bedside for two reasons. 1) insurance will not pay for it unless it is done in the lab 2) it is too hard to have quality control in a dozen different places. We found staff who were not discarding old control solutions which meant the test results were not reliable.
Specializes in Level II & III NICU, Mother-Baby Unit.
Concerning drinking at the nurses stations... I remember about 15 years ago when our hospital was charged $3000 per coffee cup found at the nurses stations (3 were found in a 240 bed hospital; I see the fee has gone up to $10,000 now...Wow!). Yes, it was an OSHA violation. As I remember the explanation was that we are not allowed to eat or drink in the same area where body fluid specimens could be also. (Like a nurse bringing lab tubes full of blood she drew in a plastic bag to the nurses station for the secretary to take to the lab, as well as any other body fluid specimen you want to fill in the blank with.) That is why we have breakrooms (as inconvenient as they often are). I think the rule is supposed to protect us workers from diseases. Alas, more regulations aimed saving us from ourselves....
By the way, I also am beginning to believe that our country is mostly run by lawyers. It's the results of their cases that cause laws to be made (as well as the lawsuits of course) and we end up with regulatory bodies to make us all comply with the laws. It appears to be a vicious cycle that never ends.
Specializes in ER, ICU, Infusion, peds, informatics.
santhoney, at the hospital where i've been working as an agency nurse they have the same cockamamie, inconvenient rule: no bedside hemocults. and, it's a pita there to transport samples down to the lab.
someone told me it was for billing purposes, i'm not sure if that's the case, but it's utterly ridiculous. at my previous place of employment we still had the 'luxury' of performing this test at the bedside.
it is a lab regulation thing, though billing may have something to do with it.
one issue is that lab personnel are tested for color-blindness; bedside personnel are not.
a second issue is keeping a log. the er i used to work in got around the second reg by starting a log at the desk for when the docs do bedside hemocults.
it isn't that bedside personnel can't do the testing; it's that sometimes it is easier to send the thing to the lab than it is to jump through all of the regulatory hoops.
I am not a teacher. I was a full-time school nurse for a couple of years, and I can tell you that THAT program is baloney! I know of one woman who would bring her wheelchair-bound, spina bifida-stricken little girl in every day, who could do nothing, not even grunt or track with her eyes, bless her, and leave her. The school had to provide for her, and the mom, as she put it "got a break for 8 hours a day, for free!"
The school put special-needs children in mainstream classrooms, with their own aide, which caused no end of disruptions. An autistic child has no place in a mainstream classroom. It's cruel. They don't process things the same way, and this child would run around the room, trying to get out. The aide would chase him, and it would create havoc all around. But, guess what? The mama insisted he be in there. "There's nothing wrong with Ian. He's fine. He never acts that way at home."
And the kicker? Federal program.....we're paying for this, guys. We pay these people to make this mess up and impose it. How's that for irony?
Boy, I wish you hadn't posted this message.
The parent in the first paragraph, the one who has a w/c bound child who cannot respond in a typical classroom, has no place in your school. It isn't the mother who is at fault for getting her six hour break (8?? how?); it's the current system that doesn't allow for enough education and/or respite for a child who is this disabled. Why has this child not been classified to be sent to a program that will work for her, or get an in-home tutor/therapist to work with her? Somebody dropped the ball here. It's not a federal program working as it should; it's someone who didn't do what he should have done to get that child placed appropriately.
The parent in the second paragraph needs to be educated regarding what her child can and cannot do, and whether he is or is not autistic. The child you described OBVIOUSLY acts that way at home, and no one is stepping up to get that child classified as having a disability and placed in an appropriate educational setting. Probably one NOT within your school walls, I would guess. Clearly the "aide" is useless at this time. This child has no IEP in place; why not? It's the law.
It isn't that "an autistic child has no place in a mainstream classroom". That sentence is absurd. It's that a child who is too severely impacted to learn in a typical classroom has no place in a mainstream classroom, and the only way to determine that is with testing--the results of which would require your school to place that child appropriately. There's no classroom for him to be in at your school? Ok, that's reasonable...but the school IS REQUIRED to either get the teacher he needs or place him where the teacher is who CAN educate him. That's the law.
That child needs special therapies, and the school is failing him in that regard. But the blanket statement that "an autistic child has no place in a mainstream classroom" does a great disservice to those children (and parents, and teachers) who have busted their butts getting ready for that mainstream classroom, and do fine--albeit with support services, typically.
Do I sound sensitive? Maybe it's because I'm tired of seeing special needs children viewed as an impediment to those around them. Tired of seeing schools blame a system that doesn't work (as it frequently doesn't) when they have NOT utilized all that they can to make it work better.
pagandeva2000, LPN
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