The top 5 irritating policies I’ve heard of (in the last week or so)

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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.

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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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6 Responses to The top 5 irritating policies I’ve heard of (in the last week or so)

  1. It’s amazing some of the ridiculous rules that nurses have to put up with. I get more and more aggravated every day at the silliness that ‘patient satisfaction’ has imposed on us and how we perform our job. Too bad patient outcomes are not as important to the hospital administrators…

  2. idaanderson RN

    #5 Block assignments: it sounds difficult in theory, but its actually best practice. Nurses and techs get report together, hand-offs are safer with everyone getting the same report. There is a ton of data showing this is evidence based practice. The blocks can be rotated so one team is not always at the end of the hall. There will be times where one block is heavier than another, but that’s when others need to step up and pitch in when needed, because they could easily be in that position the next day. I encourage you to support it on your unit.

  3. OBRN

    How about 2 lab errors (like mislabeling a lab) and you are done, as in fired despite the fact that you are understaffed and running around like an idiot. We now have duties of secretary, housekeeping, security, dietary, phlebotomy, IV therapy, social work, data entry, patient transport, are doing double charting, have to do mandatory education and somewhere in there have to find time for patient care. Talk about burn out. I have seen such a down turn in the progress that has been made in nursing over the years and it breaks my heart. This is all in a place that thinks they are going to get magnet status.

  4. bettymerchen RN

    The chips in badges is disconcerting on a Civil Rights level, but I would love to know the number of breaks and grand total of time our smokers spend outside ( on our ” smoke-free campus).

    • varnjosie

      I agree the chips in badges is a questionable practice. What I’d like to know is whether physicians will also have these on their badges. I find that most of the time physicians are the main culprits in not adhering to hand-washing guidelines.

  5. Abby Student

    Some of the hospitals where I do clinical mandate flu shots. This is, I understand a public health concern, but just like patients have the right to refuse, so should students and heathcare workers