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

[RunningSoLate]

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 ]

[Zee_RN, BSN, 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.

[imaRN]

RunningSoLate, Is your hosp. so stupid that they have to PAY for a time study? (mine waists lots of $ on programs too)and what about they just forget the "number on your back" and go right to a "TATTOO on your forehead" For God's sake, when will people in management LEARN how to NOT piss off and demoralize their employees, My suggestion is just go ahead and RUNNNNNN with their idea of a "good thing"! You can make stats, say anything you want, so have fun with it, and they will have waisted tons of money for such a poorly executed program.I wonder how many more times hospitals will try to run a patient care system like a manufacturing industry!......laughing at the Pencil Pushing Morons..imaRN

[Stargazer]

Originally posted by RunningSoLate:

We were told in a recent meeting that "no nurse was worth $50.00 an hour"

Wow, I would've been hard-pressed not to turn in my resignation immediately following that meeting, and going to work for an agency that paid exactly that much!

*cough* bite me *cough*

[canoehead, BSN, RN]

It sounds like a good idea too me. I agree that it seems they could get the information more directly but perhaps having an independent third party assessing the situation will give your claims of short staffing more weight.

My only suggestion that could be forwarded to your admin is that if 5 nurses work the floor utilizing their time at 100% (which is probably the facility goal) it doesn't show the work that had to be skipped because everyone was too busy to do it, or the treatments or meds administered in a rush. Will they be watching for moments when a nurse is doing two things at once(giving report and pt care at the same time) and score that time as 200%.

Ask admin how a score of greater than 100% will be shown in the company numbers, or if it is even possible. Their answer will be a good indication of how valid the study will be.

[NursePooh]

[quote

[*]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. [/b]

____________________________________________

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 ][/QB]

Just had to pick out my "favorite" part of this asinine memo. "Idle time"? "IDLE TIME"?!!!!! Who out there has EVER sat on their ass next to a phone or a tube system waiting for anything???? When I worked in a facility that had us carrying spectralink phones, at least I didn't have to worry about some snotty doc hanging up if he got put on hold because I went to try and get some work done while waiting for him to decide I was worth calling back. Time management studies work great on assembly lines, but these management morons will never understand that they DO NOT APPLY when caring for human beings. They can decide all they want that it should take x number of minutes to perform daily care...then you get hit with a code blue or even a code brown and the whole shebang is in the hopper. Oh yeah, you lack flexibility, all right...they want you to bend over and grab your ankles on a daily basis, and you know what for. They are blaming their own nurses for the bad morale? Reminds me of the military- "the floggings shall continue until morale improves".

Any place I have ever seen institute acuity levels did it hoping that it would support downsizing. When they found out the results indicated they needed MORE staff rather than less, the acuity levels faded away like they never existed.

I realize I am ranting, and I must now go and dry the foam off my keyboard. I must be out of my mind to even be considering a return to the bedside. I think I'll just go practice saying "would you like fries with that?"

[RunningSoLate]

I never thought about it that way, canoehead, but I have given report while at the patient's bedside, titrating drips, giving FFP and platelets and running in blood. How DO you measure 200%?????????

And to answer NursePooh, well I have never waited by a phone for a doctor to answer back or a tube system to return stuff to me either. I think you are exactly right when you said that the only reason for these time management studies is to show US how wrong we are--that downsizing is feasible. Then when the study shows they need more nurses--you don't hear another thing about the study.

[nursejanedough]

The nursing home where I worked would implement the "time study" every couple of months to the "management team". We all hated it. I was an MDS/PPS nurse and was able to "fine tune" my creative writing skills. Time study: 2PM - 3PM: Reviewing medical chart for # of falls on Mr. Jones and assessing for appropriate preventative measures to prevent further falls. The truth: I was sitting with Mr. Jones talking to him about how sore the big bump on his head was and giving him hugs and telling him we were going to put a soft belt around his waist to keep him safe, etc. Also, going to get a big bowl of vanilla ice cream for Mr. Jones. Those time studies suck. I admire my Director of Nursing (DON) for refusing to do her time study one time. She had guts and did not get fired. Us wimps continued to do our "creative writing". A lot of Christian groups are focusing on "absolute truth" these days. All I can think of is Jesus telling certain people who he healed to tell no one. What were they supposed to say if they were lame one day and walking the next?

"Hey, man, I just figgered out how to use these things."?

[hoolahan, ASN, RN]

Zee, I love you, but I respectfully disagree, basically for one simple bottom line reason, who is paying for this study? Management! The results will be manipulated to serve their purposes. Now, if the memo was saying that your nursing union, or an independent group of nurses, or a nursing research org were funding the study, I would feel more inclined to believe that the results would be used to serve nursing's purpose and demostrate unsafe levels of staffing, unsafe nurse : pt ratios, and maybe even more $$!!

[ June 09, 2001: Message edited by: hoolahan ]

[Mijourney]

Hi colleagues. All of you make valid points. Management wants a way to measure our productivity to justify how and why resources are being used. I agree we don't want to be wasteful with the resources, and we don't want to continue to burn ourselves out with inefficient use of time. But, is the tool being used patient-centered or focused? What about time that may be needed to sit and let the patient or family vent? What about time to show the patient or family that you are a caring human being? It's the "little things" that really count for our patients and families that I fear are being left out of this time analysis tool.

[kimberlope]

I'm a case manager in home health. We don't punch a clock but our time sheets are "time studys" We have to write down what we are doing in 30 min increments. No way can the time sheet actully reflect everything we do in one day. Our area Administrator who reviews the sheets is not a nurse and has no understanding of how many multiple tasks that can be done in 30 minutes or the waste of time filling out the time sheets are when you have much more important documentation to do.

[NursePooh]

I read a blurb in a magazine the other day that each 30 minutes of patient care generates as much as 90 additional minutes of paperwork. I don't know about the rest of you, but I didn't go into nursing so I could end up with carpal tunnel from filling out tons of redundant documentation

[prmenrs, RN]

Every body is saying great things; I just wanted to add a visual about how it will look to patients, families, other health care professionals, etc., to walk around all shift with a number on your back!! That alone is unbelievably degrading.

Makes me think of a bank commercial they're running lately where the customers get a bar code stapled [painfully] to their foreheads, then have to go stand in another line for their transaction where the teller takes a hold of their head and "scans" them!! You hear her say as she passes the guys head back and forth, "I just hate when it won't scan!".

What'll they think of next?