Friday, March 02, 2007

Death-sent, not Essent...3/8

Ok, tell me what kind of drugs these people are on.... Does anyone else remember a certain post last year at about this time? Hint: Was about the Cath lab. Yep, a whole series of comments and another post were generated by the hit and run techniques of the cardiologists.

Well, if that made you leary of hitting our "Welcome to McDonalds, may I take your order" type of medicine, this ought to have you running screaming down the streets.:

The cath lab secretary is going to be reading telemetry and pulling sheaths!
This is not to occur immediately, they are going to train her. Essent-ial training. Wonder how many minutes...or hours...she'll get.

I for one, have some serious reservations. And, all concerned better have their malpractice insurance paid up as well.... Too bad she won't be able to get some. It all falls to the Dr's and hospital's liability. But, she'll certainly be named in the lawsuit.

I can just see it now: "Cath lab, can you hold? I'm holding pressure on a cath site so we don't end up with a pseudoaneurysm, and watching a monitor, but I'll be glad to schedule a day you can bring lunch...."

Yep, just where I want to go, the Chest Pain Center. Would you like fries with that?

You might wonder why the video? Because we don't want those patients to miss waking up to the sound of your voice....frank


Anonymous said...

When getting my CEU's this time, I read an abstract that has made me question even being a nurse anymore.

As a nurse, we are supposed to directly observe the people we delegate to and we are responsible if they mess up as well. We too would be named in the law suit, if we delegate the responsibility, and they mess up.

If they teach you how to do the proceedure, and you do it well, it can still go wrong, and just because you don't have credintials behind your name, they will think you don't know what you are doing.

Back to the delegation issue, I can't directly observe everyone I delegate to, and get my job done as well. I would rather not delegate and do the job myself.

So if we assign a travel nurse, and we have not directly observed their knowledge, and we assign them pt.s and something goes wrong, it appears to me that we are responsible.

Yet we have no control of the decisions that the hospital is making. We are responsible--we have no control of the situation, and we have our own jobs that we are accountable for, with not enough time to carry it out.

If we see an unsafe practice, we are supposed to go to our chain of command, and if nothing gets done, we are supposed to blow the whistle. In this day and time, if you go to the chain of command, you will get the axe before you can blow the whistle, and if you blow the whistle after you get the axe--you look like a disgruntled employee.

To me--it just seems like an impossible situation.

Anonymous said...

Ok, so the hospital is doing away with jobs, and giving people the option of doing something they aren't trained for and do not feel comfortable with, or starving-and being out of a job.

How can the hospital do this? How can they do this to people that have been loyal for so long?

They have no loyalty, and in return, they are getting no loyalty from the community.

Anonymous said...

Oy vey! The secretary removing sheaths? Good God Almighty. Are you kidding?

Anonymous said...

Should I ever have to get a cath, I don't want a secretary within 50 feet of the procedure room, much less participating.

What's next- housekeeping suturing patients in surgery? Volunteers starting IVs in a code? The local mechanic doing a CABG (come to think of it, that would be a better choice that Dr. Lui is/was, but I digress)?

This is crosstraining at its worst, and that way lies madness.

For you cardiac cath RNs, I wouldn't want you to crossmatch blood & prep components any more than you want me to monitor a patient during the proecdure. We're each trained in our own fields, and are good at what we do. Same for the housekeepers, volunteers, and the local mechanic- all good in their specific jobs.

I can hardly wait for rhe next cost-cutting moves- replacing scalpels with Xacto knives. If a blade goes dull, hey, run over to the Wal*Mart & buy a fresh pack of blades. And fergit that there sterilizatin', jest rinse 'em off in hot water and dry 'em real good.

Sutures- we don't need no steenking sutures! Use the "handyman's secret weapon"- duct tape! Just call Maintenance- they have plenty (in another cost-saving move, it's about all they're budgeted for these days, bless their hearts).

And no shock paddles for Code Blues- the crash carts will all be equipped with a pair of cattle prods. Oh yeah- cover that "Radio Flyer" lettering on the wagon-er, crash cart, so the patients don't get nervous. This is assuming there are any patients around, of course........

fac_p said...

There are limitations as to who you can delegate to, far less than a Dr. has.

In a lawsuit, they will go for the deep pockets. Just wonder how deep Essent's are....frank

Anonymous said...

We are seeing incarnations of newly skilled people pop up all over the hospital! The infamous second string typist ,now personnel director has been named the director of nursing education!The new head of information technology is the newly hired director of medical records and coding!This cross training of a unit sectary to watch telemetry( what do all those sqiggly lines on that monitor mean anyway?)while she helps to withdraw the heart cath sheath and afterward holds pressure on the artery while answe ring the phone should not be too hard to teach.Why did anyone ever invent cath lab technitions anyway,
they are obiously not that needed!

Anonymous said...

I've just read on scope of practice, that discontinuation of arterial lines may not be delegated to LVN's or UAP's.

Along with other things--that is a big NO NO.

Anonymous said...

They may go for the deep pockets, but the lawyer could be sued for malpractice if he doesn't name everyone from top to bottom. Because you can bet, that whoever is named in the lawsuit, will blame whoever is not included.

So and so pulled the line, who was in charge of the training, who was over the cath lab, the doctor of whom the pt. was, whoever was involved in the case, CEO, and the hospital. And if the individuals don't have their own malpractice insurance, they will be at the mercy of the hospitals attorney. Alot of people think, well they can't get anything from me, because I don't have anything, but they can garnish wages forever and ever.

The board of nurses spells out that arterial line pulling may not be delegated to LVN's or unlicensed assistants. So it would be a blatant case of malpractice.

fac_p said...

For the RNs involved in the 'retraining' of unlicensed personnel for tasks outside their normal duties, try this link....frank....and thanks....

Anonymous said...

Yep, another mind bending decision by E$$ent. Save 'em some bucks, but at what cost (to the patient and their families)?

What's next, supplying cadavers for medical schools? Why beat around the bush about it, after all, you're in it for the money right Hud?

Anonymous said...

6:43 and 11:04,

Perhaps this peoposed breach of practice needs to be brought to the attention of the proper agencies, including any documentation from administration covering such proposed violations.

A warning shot fired across the bow by a regulatory agency may just get their attention.

Anonymous said...

Well they're gonna try not staffing radiology after 5pm again on North Campus. A tech will be on call from South Campus if North has a stat xray. It may work but I sure wouldn't want to be the one blamed if a premie doesn't get its chest film because the techs are tied up on South with multiple MVAs...

Anonymous said...

These bunch of number crunching monkeys need to get it all on one campus. 1 town + 2 hospitals = NOT WORKING. So let's refigure. 1 town + 1 non ESSENT hospital = BETTER!!!!!!!

Anonymous said...

RE: 12:46

"When Christus tried that, they just about had a revolt on their hands. I imagine turn around time from the time a STAT xray is ordered until the time the tech drives across town and takes it will be about an hour. Then transmit time to the remote radiologist (if they even do)...who knows.

If the tech/techs are tied up doing portables/ICU's or tied up in the ER, the delay could run into several hours. So much for STAT.

I hope the pediatricians have honed their clinical skills. They'll probably be making major decisions without the benefit of a routine chest xray."

Infants can crash too fast for that much delay. Who knows how much time has already passed before the 'stat xray' was ordered?...frank

Anonymous said...

Yep, their getting mighty dangerous with our children. Who's stepping up? I hope the pediatricians are.

Anonymous said...

Rumor has it that Nashoba Valley Medical Centers Doc Simpson {orthopedic surgeon) is moving into Essent's new medical office building and will be having his own radiology equipment.He is looking to hire a Rad Tech but he is known for his "Disruptive Physician Behavior." There isn't a tech at the hospital that would work for him. Sounds like Essent will be losing money on this deal. Essent will let him get away with it just like they did when cardiologist, Dr.Adam Cerel went and purchased his own echo machine for his office. Having diagnostic eqipment in his office was a violation of his lease agreemnet but what did Soran do about it. NOTHING !!!! GREEDY PHYSICIANS and and an administration that doesn't have a back bone.

Anonymous said...

Also consider the libility if the tech is in or causes an accident on the way to north. Wouldn't the hospital be liable?
I can understand that it seems a waste to have a tech on duty with only a few films to do each shift as opposed south that has higher numbers. The thing is they're just going to move the north tech to the south so they're still paying that person. What have they gained?
Consider as it stands now--if south gets overwhelmed with MVAs the north tech can go south to help and take call for north. But to ignore the "worst case scenarios" in this is...well...pretty much what we can expect from Essent.

Anonymous said...

Your supposed to clock out at one campus, and clock back in at the other. They would probably use this as a technical issue, and you would be considered off the clock.

Anonymous said...

Don't think so--If you're using YOUR car for Hospital business they can't make you clock out. They also SHOULD pay you mileage but you can forget that. Theorhetically you could use one of the PRMC vehicles but that would still make PRMC liable in an accident and employee would be workman's comp.

Anonymous said...

Think about this, what if you are raped or robbed in the middle of the night going from one place to the other. When I was campus hopping, I know I felt eyes on my back many times, and was very scared on a couple of occasions.

But I was made to clock out and clock back in at my final destination, because they said they were trying to keep the money divided between the departments. Big ole BS. I was still in the same department, just a different location of it.

They did pay me milage, but I showed the milage to be 4 miles, and I think the hospital paid me something like 2 miles.

We would be doing a case at one campus, then the other campus would call us in for an acute, with policy stating that we had 30 min to respond, but the case we were in might just be beginning, and you can't just stop once you get started, and its going to take at least an hour to get done on the non acute.

Impossible situations. And the big thing that really bothers me, is if something goes wrong, and you do end up getting sued because something went wrong at the campus, you were not at, because of a delay---you get to explain this to people who does not have a clue what your going through and what your choices were. If you leave in the middle of something its abandonment, if you don't go when your called because you can't leave a situation right then, then it could be neglect of duty.