Preferential Treatment for Certain Patients

[purplegal]

So, at one of my jobs, I have noticed a coworker who seem to show preference for certain patients when rooming. In addition to our outpatient procedure, rooming is part of our job.

When we room, males go into one dressing room area and have their procedure done on one side of the lab, while females have their own dressing room area and are on the other side of the lab. In addition, we have a special room for people who cannot walk and must have the procedure done in a wheelchair and for very young children (under age 5 or so).

While rooming, we are supposed to take the patients back in the order that they arrived in, and when they are waiting for their procedure, we are supposed to see them in the order of which they were roomed.

However, I have noticed that a coworker seems to have "odd" rooming habits. First, I have noticed that she always rooms the male patients first, even if the females have been waiting longer. Even if she is assigned to work on the female side of the lab, any chance she gets, she switches over to work on the male side. Males are easier and quicker, so that may be part of it.

Also, sometimes in the afternoon, the number of patients dwindles down, so sometimes there are only patients of one gender arriving. When they are male patients, they are brought back and seen right away. When the only patients out there are female, she pretends as if there are no patients waiting to be seen and/or waits until a male patient arrives before she brings any patients back. Sometimes, this means the females are waiting 25 or 30 minutes for their appointment because this is the time it takes for either a male patient to show up, or for someone else to room the females.

Additionally, we often see Muslim/Arabic patients. Regardless of gender, they are always brought back and seen last. If the patient is female, she ends up waiting for a significant amount of time. One time, a Muslim lady was waiting for an hour before she was seen. In the meantime, other patients who had arrived after her had come and gone.

Also, if a patient shows up in a wheelchair, they are often ignored for a significant amount of time.

Obviously, this is wrong, but what are your thoughts? How would you approach this coworker?

[Double-Helix, BSN, RN]

It sounds like your facility has some serious problems related to scheduling and check in. Are there appointment times assigned? Do the patients sign in when they arrive? How is their arrival communicated to the staff who then bring them to the rooms?

If the policy is to room patients in the order they arrived, then it makes sense to have a sign-in sheet including time of arrival. Then it is obvious whether patients are being brought back in the correct order. Bring your concerns to your manager with a solution. Don't make it about this one staff member, but tell you manager that you've noticed some disorganization related to check-in and rooming that is resulting in procedures getting delayed and excessive wait times. Suggest a method for tracking when patients arrive, when they are roomed, and when the procedure is begun. This will identify trends and either prove or disprove your observations. After the data has proven the inefficiencies, steps can be taken to correct it.

[caliotter3]

My thoughts are not much different than what I felt when about six or seven customers that came in after I did, were served their fast food before me. One family was distinctly laughing at their table, I felt they were laughing at me. What was really striking about the whole thing, was the behavior of the workers when they were quizzically looking around and acting like chickens with their heads cut off, when I continued to stand there alone right in front of them. I purposely refused to walk up to request my order. I just stood there and stared at them. Eventually they had to serve me, because I doubt they knew how to get me to leave the restaurant.

How you treat someone at a place of business is a reflection of the entire process and that information gets around. While I will never go back to that fast food place, I certainly have the means to tell everyone I know how I was treated there. I am certain that some of those patients noticed, and they won't keep quiet about it either.

[TheCommuter, BSN, RN]

How would you approach this coworker?

"Hey, I notice you usually room our male patients first, even if female patients have been waiting longer. Tell me the method to your madness. I really want to learn from you."

"Is there any particular reason you room our Muslim/Arabic patients much later than others? Again, I really want to learn your efficient approach to rooming."

Not everyone will agree to my roundabout, underhanded tactic of calling a coworker out on his/her questionable work habits. However, even if the coworker does not feel comfortable answering me, at least the reality that his/her rooming practices are scrutinized may prompt him/her to be more equitable in the near future.

After all, now the coworker knows he/she is being watched.

[purplegal]

It sounds like your facility has some serious problems related to scheduling and check in. Are there appointment times assigned? Do the patients sign in when they arrive? How is their arrival communicated to the staff who then bring them to the rooms?

If the policy is to room patients in the order they arrived, then it makes sense to have a sign-in sheet including time of arrival. Then it is obvious whether patients are being brought back in the correct order. Bring your concerns to your manager with a solution. Don't make it about this one staff member, but tell you manager that you've noticed some disorganization related to check-in and rooming that is resulting in procedures getting delayed and excessive wait times. Suggest a method for tracking when patients arrive, when they are roomed, and when the procedure is begun. This will identify trends and either prove or disprove your observations. After the data has proven the inefficiencies, steps can be taken to correct it.

Appointments are assigned, but since our procedure is quick, generally less than 5 minutes, patients are generally free to come at any time we are open, regardless of when their appointment was scheduled. We receive a printed out notification whenever a patient arrives, which includes the time of the arrival. These notifications are stored in a "box" and we are all responsible for going out to the lobby to check for these notifications. In the mornings, when it is busy, it may not be efficient to look at the time each person arrives, as we need to get patients in and out quickly. During the morning, it would be too obvious to leave 20 ladies while rooming all of the men.

However, when it gets slower, it can become obvious when certain patients are not being roomed, as there are generally only about five or less at once. For instance, if there are 3 ladies in box, but no men, and the ladies are not being roomed until a male shows up later on, that seems to signal that the ladies who arrived first are being ignored. When there are fewer patients like this, it is a good idea to look at the notification slip to see who arrived first.

[purplegal]

"Hey, I notice you usually room our male patients first, even if female patients have been waiting longer. Tell me the method to your madness. I really want to learn from you."

"Is there any particular reason you room our Muslim/Arabic patients much later than others? Again, I really want to learn your efficient approach to rooming."

Not everyone will agree to my roundabout, underhanded tactic of calling a coworker out on his/her questionable work habits. However, even if the coworker does not feel comfortable answering me, at least the reality that his/her rooming practices are scrutinized may prompt him/her to be more equitable in the near future.

After all, now the coworker knows he/she is being watched.

Actually, those questions don't seem bad to ask at all. It does give the person a chance to explain his or her actions while letting them know that people have noticed their behavior. It may give them a chance to change that behavior before any other warnings are needed. I would probably leave out the word "madness," though from the first paragraph. Seems like using that word could be too provocative.