1Tulip

Look... #1) Life is short... too short to hate your work. #2) Some units s*ck because they have snarky, back-biting, catty, clique-y people working there. #3) I have worked on those types of units, and on great units with fabulous team spirit. #4) I'm the same person. I didn't make the bad places bad, I can't take credit for making the good ones good. So... Set your own standards for how you expect to be treated. If you're being abused some place, leave. (Most good hospitals will keep track of new staff members and when they request a transfer w/in a short period of time, they will do some follow-up. You can't make a bad unit bad by staying there and being a martyr. You might make it better by seeking a better place for yourself.) And... The reason there are snarky, back-biting, catty, clique-y places, is because the leadership is poor. Fish rot from the head down.

It is so unfair and unjust. If they happen to ask you something and you say "I don't know"... in our hospital, you can pack your bag and leave. BUT THAT's NOT ALL!!! They are going to go into our patient's rooms and ask them... Did your nurse introduce herself to you this morning? What did the nurse do before she gave you your medications? Did she ask you what your birthday is? Did she look at your wrist band? Now folks... I work on a neuro unit and my back surgery patients are on heavy pain meds, and my stroke/dementia patients have no short term memory! And they are going to look around the room for any infraction. Can't have extra linen in the room. Water pitcher must be labeled with patient's room and bed number Water pitcher has to have iced water in it (or at least cool water.) IV bags have to be labeled with the time they were hung, and all the tubing has to have date stickers. Better hope your patient hasn't just p'sd and put his urinal on his bedside table. They will blame US if the MD's didn't sign, date and TIME the restraint orders. (That's HUGE with them.) How realistic is this?

The problem with our current set up down here is that the government doesn't go to the trouble of determining the standards and enforcing them. They contract out their responsibility to this agency that has to prove they matter by finding "dangerous deficiencies" here and there. If the government was involved it could be argued that voters would get the chance to "veto" them by agitating and lobbying congress. (This is only theoretical, you understand.) I think our system is sort of bastardized, if you will. The government regulates and interferes, but can keep an arms length away from being responsible for the consequences.

They are unelected, unaccountable, almost unlimited in what they can decide to require. I spoke with a well-known expert on clinical research. They contracted her to advise them on evidence based practice. She quit in disgust after a short time because their interest in evidence was only superficial. They wanted to do what they wanted to do whether they had data for it or not.

They made the OR team where my daughter works have a little ringy-dingy bell (like the kind they use at the meat counter in the grocery store) to announce it is time for the "time out." They made us change our forms that are used by the anesthesiologist to keep the intra-operative vital signs record. The ones they rejected are the very same ones they made us develop after their previous visit. When the nurses passed all the questions they were being asked about our fire protocols, they upped the ante and required us to describe a second exit/evacuation route. Lab jackets on the backs of chairs at the nursing station. Nope. One of our units uses "raspberries" and JC decided they didn't keep charts secure enough. So now they are locked in medication drawers. Physicians, therapists, social workers and case managers have to have the nurse unlock the drawer and then relock the drawer EVERY time anyone needs to see the chart. We have to have someone at all times at the station so that our chart rack is always within the line of sight of one of the staff. The mobil computers that we HAVE to use to manage our patient care are considered "clutter" and if seen in the hall are considered to be blocking the egress. Isolation carts (that are bigger) are not blocking the egress. Go figure. Give me time. I'll think of others.

Our Core Measures are a mixed bag. On AMI we are superb and way beat the national average in door to cath-lab times. Our dicubitus rates are very low. When it comes to Pneumonia and CHF... we're near average, I think. With SCIP, I think we were below average but are making head-way. I had not thought of that business about us being a high cost state. We have challenges that other states don't have... but that's true of lots of states. The crime is in instituting cookie-cutter standards and solutions to every hospital everywhere in the nation. Oh, my... we are sooo tired of this. Our manager and supervisor were in tears last week, just SURE that they were going to be fired. (Like that would really help us pass!) How long can you hold up under this kind of tension. Just trying to give care when we are understaffed is tough enough... we had no vacancies on our unit, were down 2 RN's and 2 CNA's. We all started the day with 6 patients, and ER was trying to send up admissions. And in all of that, we are supposed to have PERFECT documentation, clean and tidy rooms, happy patients, label all IV tubing, keep clutter out of the hallway even though they make us use those mobile computers which cannot stand in the hallway... foam in/foam out, don't just know the fire evacuation route... you have to know 2 evacuation routes, know where in the chart every conceivable piece of information is, secure the charts at all times... Aaaaaach! Maybe we should start a thread "Stupid and Impossible things Joint Commission makes us do".

Just talked to my daughter who is an anesthesiologist. JC made them put a ringy-dingy bell in each OR room. Circulating nurse rings the bell and everyone stops and does their little final check. Maybe JC hasn't told us about the little bell and that's what they're going to fail us on. If only they were consistent! Has anyone had a surveyor hide their name badge and walk off with a chart? Yep. Now the rule in our hospital is that the charts have to be in our line of sight at all times. Not the confused and impulsive patients our unit deals with. No, they can be outside of our peripheral vision. But the charts, THOSE we have to watch at all times. The chart rack!!! Can you believe this is how they improve patient safety!!!!! (Yes, of course privacy is important. But how can I keep my eyes on the charts when my brain injured patient is half-way over the side-rails?) If a bunch of people die in our area as a result of a bad decision by JC, I swear I will contact the lawyers to take them down in a class action law-suit.

I'm just a peon, of course, and am not privy to all that transpires, but I'm on a shared governance council and we're the first clinical faces that see the most recent changes. I believe that the hospital administration has groveled, and promised, and performed everything they have been told to do. There has been a bunch of communication back and forth with the JC, in terms of filing their action plans and also explaining why certain things may not be infractions given our particular hospital situation and locality. (However, very little of the latter... mostly the groveling.) Our hospital has some significant strengths. We have been working out rear-ends off. It's all we've thought about for months and months and months. With the exception of two much smaller hospitals, we are IT for a huge geographical area. Our mock surveyor found a whole long list of things that are outstanding, but found 13 areas that would flunk us (in their view.) 75% or more of all the operating rooms will be gone. I KNOW that if they shut us down, surgeons will be doing stuff in stand-alone surgi-centers that they have no business doing. Patients will have to travel at least 2 hours to the nearest medical center which is, itself stretched to the limit. Our state is one of the worst in nursing shortages. If our hospital closes down any nurse that can leave the area for work will. We'll never get those nurses back. Dear God help us and thousands of ill patients if they shut us down. Oh, I forgot. Joint Commission just appointed themselves to be God.

Based upon everything the hospital suits are saying, we will not be allowed to bill Medicare/Medicaid for care we give if we lose accreditation. We had a visit some time ago and go provisional status, with requirement that we develop an "action plan" for each issue they raised. I can assure you we had plans coming out our ears. Anything that was extreme (whatever that would be) was dealt with a long time ago. But the seem to 1. keep moving the goal posts with each return visit and 2. demand perfection. For instance (and i'm not making this up...) they said our Anesthesia interoperative documentation was wrong and insisted we change them. (However, these forms were the ones we corrected pursuant to a previous visit.) We got dinged for lab-jackets on our chairs at the nursing station. We have just changed from paper to e-records and you know what? JC is finding deficiencies in our nsg. records/documentation. We've worked really hard filling in the holes, getting everyone solid on documentation of pain measures and assessments as well as restraint flowsheets. (But criminny, perfection doesn't exist this side of heaven, come on folks!) The thing that is the latest is that EVERYTHING the doctors put on paper has to be signed, TIMED, and dated. Do you know how much time we spend calling them and saying "yes, you have to come and fix it and NO we cannot take a verbal order on it. Almost 90% of the stuff we're having to fix in the documentation is NOT us, it's the MD's. And all I can tell you is that the mock survey consultants said we are not going to pass and the real surveyors can come any time.

I am not saying that I work in the world's greatest hospital. But I've been a nurse for 38 years and it's the best one I've ever worked in. Have you ever worked in one that didn't sometimes make you crazy???? I live in a not so densely populated area of the country. Our chachement area covers three states. If all those areas are surveyed, it is clear that they are significantly under-bedded. Joint Commission has been on our case for several years. They found problems they wanted fixed. The hospital fixed them, but not in a way that JC apparently wanted. It's been like playing a game where every time you get the ball, they move the goal line. We were informed last week that statistically, a hospital that has run the string out as far as we have does not pass. I've been in on the Quality efforts that have been made, and the extensive staff training that has gone on. Our hospital exceeds standards in so many ways it's rediculous. But here's the bottom line. Joint Commission is crazy enough to essentially close a hospital that provides over 75% of the operating rooms for this huge area. The only trauma ER. We do the heart caths and have the interventional radiology. We bring the technology that keeps people alive, while the other hospitals are small and colloquial, though also very good. AND we're going into a flu season where we KNOW the area hospitals have a serious shortage of ventilators. (There have been meetings among the hospitals to develop action plans for the conventional and H1N1 flu.) They don't care if my neighbor's kid gets hit by a car and there isn't any place to take her. The next gaggle of surveyors that probably live in other places like Nebraska or Missouri or whatever. A surveyor that lives in Atlanta doesn't care if my mother in law gets the flu and there are no ICU beds to support her when she gets pneumonia. This is nuts! If the place was a snake pit... I'd be the first one to say it should be shut down. But in our state, we KNOW there have been seriously deficient places that were fiscally poorly run and in decline but they did NOT lose their accreditation. Would they close us down and give no thought to the immediate public health crisis they create? I think they would. They are unelected, unaccountable and so powerful I think they are dangerous.

You folks have really provided some good information. I do think we're getting distorted images about your system. Our system has some real problems. The political furor has arisen because there are (according to the Democrat party) "45 million uninsured Americans". Well, yeah... about 13 - 15 of these Americans aren't Americans. They're here illegally. (On my unit about 10% of my patients speak no English and have no familly members who can.) Most of the other Americans finance their middle class life-style by not paying for health insurance. They've made a choice. Buy a brand new recreational vehicle, or pay health premiums... hmm... guess which one they choose? About half the patients on the neuroscience unit where I work are uninsured. Because these people get first rate care and don't pay for it, I pay for it through my state taxes (if they are qualified to be put on Medicaid) or by huge hospital bills if I have to be admitted. It's frustrating. Does the UK have anything like our Departments of Motor Vehicles? It's a running joke that no matter what state you live in, you have to deal with this immensely tedious, inefficient bureaucracy. That's what Americans fear our health care would be like if we become a single payer system.

Thank you. that is very helpful. I know we are getting facts about national health care that are "spun" to fit a narrative. Some of the negative things that are mentioned: (and apologies, we're talking about politicians here, OK? Not sure how your political campaigns are done, but ours are rarely civil. Here goes... "You're going to have to wait for (insert number here) months to get an MRI and even longer for elective surgery." I've already mentioned "we have medicines that citizens in the UK can't access". "It's sinking the British economy" (Who can tell what's sinking economies around the world... this may not be answerable.) "People have no 'skin in the game', no reason to have good life habits because they don't have economic consequences of seeing a doctor or being a patient in the hospital. (Again... these are the politicians' lines...) "If Britain and Canada have such wonderful health care, why are their rich citizens coming here for their heart surgeries?" "There are fewer and fewer people willing to become RN's and MD's to work in the national system and the hospitals are going to third world countries for nurses and physicians" (But then... so do we, and ours are really excellent.) This is a longish list and I'm sure that both sides on our health care controversy will come up with lots more "information" that they'll use to move the debate their way. Please take up any of them or all. I just appreciate you're real life experience. BTW: Once (when I still had money) I visited the UK. I started having problems with asthma. The B&B owner told me to go around the corner to a clinic (and I had trouble finding it because it wasn't all steel and glass with a big sign in front!) and speak to the M.D. Wow! I probably waited all of 15 minutes and I got a prescription in a snap. She was really nice I had to buy the inhalers of course, but so what...

You may be right. Our facility will get a big increase in their budget and build offices for more bureaucrats. Meanwhile their MRI machine has been down for over a year. Maybe in Houston there are more eyes on what's going on, more vocal veterans who won't put up with shoddy treatment. I don't know who should be held accountable for the state our hospital is in. (The population of our town/burbs/near-by towns together is probably under 500,000 people. Way teenier than Houston.) It's a heated debate. I don't know about Britain, but here the arguments get really hot, so I don't want to make this to be a Red State/Blue State kind of post. You know... I just want to know if when I'm 75 and come down with breast cancer, (God forbid) will I get shuffled to the side, or given cheaper treatment because my productive years are behind me and it wouldn't "pay off" in government calculus to give me the expensive chemo drugs. I guess if you strip the politics away, Americans (folks like me and I think I'm pretty average) want to get good health care, when they want it, at an affordable price. That's about it. I thought a nurse who lives with a system like that, as a patient a professional and a tax payer, could provide information and opinion we don't get over here. The discussion here is just so heated... both sides have vilified each other and no one is genuinely asking and listening.

Health care in the US has phenomenal strengths and profound weaknesses. (A genuinely American trait, I think.) We have very strong voices (the majority party now) favoring the centralization of medical decision-making and payment. We have some government health care systems in the country and they are not terribly good. Specifically, the VA system and the Indian Public Health Service. For example, my daughter who was a resident physician doing a rotation at the VA had a veteran walk into her clinic in the middle of an MI. The man had the EKG changes, the classic symptoms, the crushing chest pain and my daughter could not get him emergency treatment. (Inside the VA facility!!!) She came home furious. Said the next time that happened, she'd stick the guy in a wheel chair, roll him to the curb, call 911 and stay with him until an ambulance arrived to take him to a real hospital. Though the VA delivers some valuable services to veterans, (mostly in terms of outpatient treatment and some prescriptions) you'll not find anyone in the nation who would want it to be their sole source of care. Most veterans (and I am one) use it as a care giver of last resort. So here we Americans are debating a big policy step in that kind of direction. Please give me your opinions. If you were the ruler of the universe, would you want to alter the system you have now? Disclaimer: I am a staunch Republican who would prefer to find a way to empower patients, not the government. There are lots of ideas on how to do that, but because my party is not in power, they aren't getting much discussion. Thanks so much.

Agree with the above. Bag Balm and gloves over night (and I truly smear my hands) are the only thing that has worked for me. Came home last night with a painful split at the edge of one of my thumb nails. This morning, it's just about healed.