An open letter to hospital administrators

Thinkstock | iStock

Thinkstock | iStock

I love you guys. I really do. You keep the lights on, you sign my paycheck. But I’ve noticed something that disturbs me: your fondness for Initiatives.

It’s not an exaggeration to say that if I hear the word “initiative” (especially if it’s delivered in an excited tone of voice) one more time, I will start screaming. And I doubt I will be able to stop.

How do you know if your Initiative is a good one? Ask yourself these three questions:

1. Is it for the benefit of the patient, or is it merely busywork?
Double-signing narcotic wastes and potentially dangerous IV drips is good.

Creating work for somebody by changing the call system from a pager that any nurse can call to a system in which the nurse has to notify the charge, the charge has to notify a “go-to guy,” that person has to page the original person on call…that’s bad.

2. Does it involve duplicating information found elsewhere?
Every unit in my facility has a communication board. Everything that’s important goes up there. If you don’t read it, it’s your own fault. Every patient in my facility with a Foley catheter or pneumonia has computer alerts popping up several times a shift to ensure that nurses are following protocol for those things. Every patient in our facility is color-coded on a central monitor in each unit; the colors tell us if that patient is being discharged or having tests done or is in isolation or a fall risk.

And yet…our newest Initiative is a 10-minute meeting that falls in the exact middle of report, during which some poor sap has to read out the room numbers being discharged, those that are fall risks, those in isolation, those with Foley catheters and pneumonia, and those having tests. That’s bad.

3. Does it involve a script?
If it involves scripted communication, it is by definition bad. I am not a salesperson; I refuse on the basis of my shredded dignity to preface every interaction with a patient with a phrase containing the words “excellent care.” Those words are used in our post-visit surveys, and you’re basically asking me to indoctrinate my patients.

I introduce myself and tell the patient why I’m doing what I’m doing anyhow. That’s part of being a barely-competent nurse. It’s already drilled into us in nursing school. Don’t make the mistake of thinking that an obviously stilted, obviously scripted set of sentences repeated ad nauseam by every caregiver in exactly the same way is fooling anybody. We can’t change patient perceptions of care unless we change how we care for them. In short, no script will make up for a lack of staff.

Please, if you have any questions, feel free to come work a shift or two with us as we implement all of your fine ideas. We’d be grateful for the extra warm bodies.

Agatha Lellis
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

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