Hospitalist Short Staffing

[FireStarterRN, BSN, RN]

I'm finding where I am working now that the hospitalists are totally overwhelmed with patients. They are not providing adequete oversight and the patients are being treated on an assemblyline basis, with many things falling through the cracks.

The patients feel as if their care is totally disjointed, which it is. The hospitalists work in shifts like nurses do. I notice that they are not coming on shift with any sense of what's happening to the patient, which makes me doubt the adequecy of how they are reporting off to one another.

[racing-mom4, BSN, RN]

Ditto to the above!!!! To make it worse the family docs and the speciality docs seem to be having a "urinating" war against the hospitilist right now!! One changes orders to only 4 hours later have the other change the orders again!! we are talking small changes that truly only effect nursing and pharmacy to implement and document the changes and then all it does is tick the original order writer off!!!

Then we as nurses call family doc who tells us to call hospitilist since he wrote the latest order!!!

We have one family doc who writes an order for hospitilist to be a consult on every single one of his pts, I swear to just tick hospitilist off, then hospitlist will come see pt and question nursing staff why he was consulted??? Who loses here? the pt that now has the bill from the hospitilist!!!

I think having a hospitilist is a good idea in theory, but it is not working the way it was intended.

FYI we have 3. They work during day hours 8-4ish, and then trade off being on call, so many times hospitilist A wrote and order, family doc changes order, then A changes again, we call family doc who now tells us to call A, but A is no longer on call, B is, B has never laid eyes on pt, so why should he change orders or give new orders in the night, so we are back to calling family doc. MESS MESS MESS.

Two weeks ago surgeon got on me for not calling him about XYZ problem even though I called him earlier in the night for an ABC problem and he told me Hospitilist was now handling that, so I called hospitilist through out the night and he did give new orders, so next day surgeon comes in and wonders why i didnt call him about 2nd issue, well because you pretty much let me know that Hospitilist was handleing this--I am sick of making multiple phone calls and wasting my precious busy time away from my job to only be told call the other guy!!!!

Can you tell I am pretty passionate and upset about this???

[cpnegrad07]

Ditto, here. Just like us, they are being pushed too far. Eventually it will catch up to one of them. Unlike us, i think they have more power to say "No" than we do. Why don't they?

BTW, had a chat with my MD during an annual last month. He doesn't like the Hospitalist system because he says their underlying loyalty is to their employer, not the pt. (Same is true of my MD, but his employer is me, the pt.) I'm not agreeing with either, necessarily, but just throwing it out there for you to chew on.

In any case, woe be to the patient in the hospital. I tell my friends they have as good a chance curing themselves at home as they do getting an incidental problem in the hospital. (Usually i'm joking, but there is a lot of truth to that, too.) I can't believe that we are doing such a poor job of addressing the total patient, and this after what, 100 years!!!? Would love to see how other scientific countries do it.

[FireStarterRN, BSN, RN]

racing mom, I totally agree with you. I'm finding a lack of clarity as to whom to call for orders or problems. There are definate territorial issues coming up, with doctors either encroaching on turf, or pawning responsiblity on to another doctor because they don't want to be bothered. It's a mess. Also, the hospitalists become overwhelmed when the census is up.

[racing-mom4, BSN, RN]

Not to mention how confusing it is for the patients!!! One day they see family Dr, and Hospitilist A. Next day Hospitlist B comes in, and changes meds/tx, then Family Dr is now off so the Family Dr who is on call for original family Dr now rounds. So in as little as 24 hours they can literally see 4 MDs. And we can have 4 MDs writing orders. Then at 36 hours we can have a new hospitilist on call, so if something happens in the night we are now calling Dr #5 who may have yet to ever see pt!!

Throw a surgery or a specialist in there and good lord---One night I literally had hospitlist want me to call the on call neph Dr who has never ever seen my patient at midnight and question them about Bumex order that was written by family Dr. I did make the phone call, I called the oncall nephro Dr and gave him hospitlist home phone number. With in 15 min hospitlist called me back and apologized for asking me to make that phone call and then gave me new orders.

[wooh, BSN, RN]

I did make the phone call, I called the oncall nephro Dr and gave him hospitlist home phone number.

I'm quickly learning that the only way to avoid the turf wars making my day miserable is to just put my foot down when they start wanting ME to make the phone calls and tell them, "Here's Dr. X's number, YOU need to discuss it with him."

[santhony44, MSN, RN, NP]

That's not the way I've seen the hospitalists work in my limited experience (I don't work in the hospital myself). What I'm hearing is that the hospitalist acts as the primary care doctor while the patient is in the hospital; the family doc doesn't see the patient at all. The hospitalist will consult specialists as needed, just as the family practice docs would. The patient, when discharged, then goes back to the family practice doc (or internist, or whomever the PCP was). A lot of family practice and internal medicine docs like this very much because it frees them up to take care of their clinic patients. The hospitalists also take care of patients admitted through the ER who don't have a provider, who aren't from the area, and so forth.

If this kind of "fighting" is going on, then the whole program apparently wasn't thought out nor set up well to start with.