The top 5 irritating policies I’ve heard of (in the last week or so)
You guys know how hospital administrations are. In attempting to combine efficiency with higher patient satisfaction scores, they sometimes do really silly, irritating things. Here are five I’ve heard of in the last week or two that range from the merely laughable to the head-scratchingly moronic.
5. Block assignments.
In a block assignment, a nurse is assigned a certain block of rooms. Every shift, every day, no matter the acuity of the patients in question. Given how some hospital floors are laid out, with the nurses’ station at one end of a long hallway or two, that means the nurses assigned to the rooms nearest the patients get the toughest assignments day after day, as those patients have to be watched closely. In my own facility, it means the nurses at the far end of the hallway would have more than one patient in isolation, as all of our negative-pressure rooms make up one block.
4. Floor-wide report after individual report.
It’s nice to know who’s a fall risk, just like it’s nice to know whose family members are prone to cause trouble. When you’re working in a place that has an average of 40 patients in one unit, though, it’s a little pointless to go over every single patient with all the nurses present, just so the nurse who’s minding one end of the unit knows that somebody a quarter mile away is a fall risk. Block reporting, along the lines of the assignment grid I talked about above, might work better here.
3. Sudden changes in dress code.
A friend of mine told me that with not quite two weeks’ warning, her hospital changed the colors of everybody’s scrubs. They already had mandated colors—ciel blue for nurses, for instance—but the Powers That Be decided they liked other colors better. Everybody in the facility had to scramble for new scrubs in between paychecks, a situation that left them disgruntled at least and broke at worst.
2. Sudden changes in parking and transportation policies.
This happened to me, actually: I arrived at work one day to find the parking lot I normally use was closed, and everybody was redirected to another parking lot three blocks away. The only warning we got was a hand-lettered cardboard sign at the gate, which was padlocked. That was better than what happened to the folks from other buildings in the district: They got sent to parking lots a half mile or more away, then told that shuttles would not be running to and from those lots any longer.
And the policy that makes me foam at the mouth the most?
1. “Smart” badges.
We’re getting these soon. Chips in our badges will communicate with a sensor in every patient’s room, letting anybody who cares to access the information know how often we go in and how long we spend when we’re there. The same chips will monitor how often we go to the bathroom, how long we spend in there, how long we spend at lunch, how often we pass by the alcohol foam dispensers or go to the sinks…the list is fairly long, and pretty humiliating.
Because, really? I am a grown-up. More than that, I’m a nurse. I am here for my patients, not to do my nails or hang out for hours on end in our luxurious ladies’ room. Sometimes I’ll spend less than the mandated three minutes or more than the mandated 10 minutes in a room if I need to. Some days I might drink a lot of tea and need to hit the head more often. None of this needs to be monitored by some hinky little computer chip that I wear on a plastic tag behind my badge.
There’s an extra level of insult-to-injury for people on the cleaning crews: They already get monitored like crazy, and are allowed only 20 minutes to do a room cleaning, no matter how bad the room is.
I predict that on the first day of the new system’s implementation, we’ll all be trading badges. If not, I plan to leave mine hanging from the ceiling grid of the freight elevator. Let somebody else figure out why I was riding between floors for 12 hours.
Agatha Lellis is a nurse whose coffee is brought to her every morning by a chipmunk. Bluebirds help her to dress, and small woodland creatures sing her to sleep each night. She writes a monthly advice column, "Ask Aunt Agatha," here on Scrubs; you can send her questions to be answered at firstname.lastname@example.org.
By Agatha Lellis