What do you WANT? June 8, 2008
Posted by keepbreathing in Business, Career Advice, criminal negligence, death, disaster, medicine, opinion, patient safety, respiratory therapists, respiratory therapy, work.trackback
You may have noticed that I am not posting quite as much lately. That is because the RT Burnout Meter is about to burst through the roof. The pressure is building and the waters are getting high here at Sunny Flats, and the dam is about to burst open.
My goal is not to be standing in front of the dam when the water breaks through.
The cause of all this pressure lately is management. Specifically our managers have been under a lot of pressure to cut costs. Since we already own most of our equipment and we get most of our disposable stuff on the cheap, the only places remaining to cut costs are staff and administrative overhead. Cutting administrative overhead would be the managerial equivalent of hara-kiri, and so the only place left for cost cutting measures is…the staff.
Yes. Our management has decided that they are going to reduce our minimum staffing requirements. They have decided that instead of the 25 therapists we normally staff between the ICUs and the medical floors, they will slash our daily operating numbers to a maximum of 18 therapists, which is a 28% reduction in daily staffing.
The big giant obvious problem with this is that we have not reduced our workload by a similar percentage. So what you end up with is a respiratory care department that is chronically understaffed and overworked even beyond the usual. The reduction in therapists per day has affected our daily operations. While we normally staff 2 therapists per ICU we are down to about 1.5 on average; one therapist to a unit plus a couple of drifters who float between units. We have cut our ER staffing in half. We have cut floor staffing and people are routinely going out with 25, 30, 40 patients to see. This is a huge problem not just for respiratory therapists but for PATIENTS, whose care is going to suffer.
Working in the ER with 50% fewer therapists means more missed therapy, more missed diagnostics, more delays in an already slow ER. Critically or seriously ill patients are not being seen as rapidly. The quality of our assessments and interventions is diminishing because we are being asked to do the same amount of work with half as many people. I have personally been on the receiving end of rage from ER doctors and supervisors who are pissed that we are slower and less efficient than usual, and all I can do is shrug and tell them that we’ll do what we can. They hate that but it’s all I can do.
In the ICU, patients are being seen but therapists are being stretched too thin. Thorough assessments and the time to perform quality work are considered luxuries where they once were considered necessities. A distraction such as an emergency bronchoscopy or a trip to the CT scanner would once have been considered a mere nuisance. Those things now are day-killers that will put an RT so far behind that there is no hope of catching up. We can no longer be proactive members of the team; we have been reduced to running between rooms and trying to get everything done without missing something important.
On the floors…well, people just aren’t getting seen. The apathy is unbelievable and I can’t say I blame the floor therapists: there comes a point when you are so overburdened that you can no longer care.
On top of all this, management continues to add paperwork and administration to our job. We now have equipment checks to document, “safety rounds” to complete (a particularly bitter irony, as conditions are rapidly becoming less and less safe despite cubic tons of paperwork), and we must track our time in 15-minute increments as if we worked at a law firm and not a hospital.
The bottom line is this: management is asking us to do more with less and it can not be done. They can either spend money and have quality patient care, or they can cut their budget and demand more from us and get shitty patient care. Unfortunately our managers have chosen the second path. They have been warned of the errors of their ways and they have ignored increasingly frantic pleas from the staff, the doctors, and even other administrators. They insist that The Numbers work out, that it will all be ok, that we RTs are just lazy whiners. It saddens me that we have forsaken the patients and the staff in favor of The Numbers, but so be it.
I only regret that this will not change until a patient is killed or harmed by our unsafe working conditions. I hope and pray that something will change before somebody dies…
…but I am not optimistic.
I think all hospitals are feeling a similar crunch. At our hosp it its not so much a staffing issue as added pressure to make sure we document everything accurately so we get billed for as much as possible. It doesn’t matter how hard we work, so long as the admins get paid.
So sorry. We are the same way. Luckily, we are only talking 3 therapists instead of 4. But we get a bad baby & we are SOL. I feel your pain. If we have something unexpected (bad baby, two hour code,etc), then we are screwed. And its the patients who suffer.
Gosh, I’d rather have good patient care. I hate that healthcare is coming down to dollars and cents instead of the best possible care.
I hope that you are not in front of the dam when it breaks
It sucks because it really comes down to the patients. And unfortunately, when the proverbial brown stuff hits the fan with a less than stellar outcome, it won’t be admin’s head that will roll, but the RT who was trying to cope and deliver the care our patients deserve.
I rely on the help and expertise of our RTs when I’m at my wits end, respiratory-wise and can’t imagine not having their help around when I need it.
Hope you’re able to stay afloat…
Sad but true, and anyone that thinks that hospital administration cares about the patients is sadly delusional.
For some reason, the bosses of the world have many of the rest of us brainwashed into believing that the bosses are not responsible for the results of their reckless and irresponsible decisions.
Unrecognized esophageal intubation? Only the medic is at fault. Never mind that the medical director’s job is oversight of patient care.
It could have been prevented with waveform capnography, but that costs too much, according to management. Your life is not worth that much.
Feedback from the hospital staff about the quality of care of intubated patients transported to the hospital? Why would anyone do that? That would make it seem as if we want to recognize dangerous providers before they kill someone.
Imagine if we had a logical approach to risk management in patient care. Nah! Just trust the bosses, they will take care of us.
Healthcare has always come down to dollars and cents–what I can never get is how admin types think that safety is about education and filling out all the forms to “make sure” we do everything the right way, but they don’t get that if you don’t have enough people, the situation is inherently unsafe! I’m sure there’s some insurance actuarial formula that allows them to determine the relative costs of understaffing and dealing with deaths and lawsuits, vs. paying for staffing and ensuring patient safety. You know, like when a building gets built, they factor in how many construction workers will die during it’s construction.
We’ve been working like this for a little over a year now. For our 300 or so bed hospital we have 2-3(on a good day) therapists on DAY SHIFT. I’ve missed whole wings of people’s treatments. It’s not uncommon for us to start with 50-60 patients and several vents. It’s just not safe!
I used to work with a few RTs when I was pre-med…they dealt with EXACTLY the same things you are going through ! It was my first rude wake-up call to the realities of dealing with hospital admin.
Yeah, I really relate too. It’s everywhere. Plus we have the problem of having lost a lot of our night staff so we’re chronically understaffed which makes us terminally cranky and feeling abused by every faction. I work with great people but between all the pressures: billing, computer charting, corporate compliance, staffing, etc., it can be really difficult to remain a shiny happy therapist.
Have you pointed out to management that they could achieve even more savings if they reduced the number of therapists to 5 instead of 18. Or even better –how about none! And while they’re at it, doctors are expensive too – best get rid of all them.
[...] and as many of the RTs as can show up. We suspect that the meeting will be held to address the grievances and complaints of and about the RT department. However, knowing our management team like I do, I suspect they will [...]