Staffing Matters
I cannot get around it anymore.
I've known, for a long time, that the bottom line issue in health care is poor staffing coupled with a growing gap between those who own the system and those who man and use the system.
The fact is a few people can only do so much when caring for a group of individuals. There is no way around this problem but be prepared, always, to be told otherwise when you say "If you want that, we need more staff.", be prepared to be told to "live with it", to "get over it" to "forget it, it isn't going to happen", or, worse yet "You just aren't working efficiently."
This is not factory work. During one recent medication pass, I made a mark each time the phone rang and I had to lock up, leave the cart and go down the hall to answer the phone. (understand that when the state survey team comes through they will follow a nurse on a med pass and expect perfect compliance with best practice guidelines and time---meds may be given within a certain time of the written administration time, running late is not considered an option ---and you can bet that on that day, that one day, the phone will not ring, people you rarely see will be feeding residents and helping out with answering lights and doing transfers...)
That day, the one I tracked, there were 15 phone calls for me during the morning medication pass. Another day, the phone only rang a few times but I answered a dozen bed or chair alarms (these alarms are to be responded to with urgency, someone could be falling) and I was interrupted (and needed to be) to do three skin checks (a weekly full body skin assessment done after a bath by the nurse) and to see and assess several problems. (an oxygen concentrator not working, a fall with injury that involves assessment, first aide and lots of paperwork and phone calls, a new admission...you get the picture) The variables are numerous. The place is hot summer and winter. No A/C. At times patients come to the cart to discuss a concern, family members have questions or need information. Meanwhile the monthly summaries , follow-up paperwork and conferencing with other providers just gets pushed aside.
In my experience the "shortage" of health care workers is a self-made and self-perpetuated industry-wide phenomena. It is a great excuse for a lot of ills. I also note that many employers, inside a place, will claim to be "fully" or even "overly" staffed at the "bottom" while adding more layers to administration.
This results in some bizarre practices. People whose jobs involve little to no direct care and little to no real communication with those who do the work or receive the services are on the committees responsible for improving the quality of care. Makes sense to them. Go figure. I can't.
And still, I know I am doing a necessary job and that the health care system is in trouble from top to bottom. Those above me have their own issues no less valid than my own. This is a system in deep trouble but we seem to be digging ourselves a bigger hole and becoming more and more distanced from each-other----we are all too damn busy to talk, too busy to problem solve and to communicate in meaningful ways. It isn't working. It isn't going to get better any time soon because we are all invested in hanging on to old ideas and refuse to know that taking care of people costs money; it doesn't make money. (except in the elective surgery department perhaps)
There is also a failure to promote healthy behaviors across the board. Lots of talk, little action. Number one reason for falls is deconditioning. This means we need more people to help the elderly and disabled recondition. They need to walk, to strength train. It works. Again, it takes more staff. Positive social interactions are vital to health. People needed.
......I am drifting off...thank goodness I will be camping in the woods for a week....maybe I will have a great idea...
Health care, elder care,
Health care, elder care, child care...they aren't glamorous jobs. I work in health care in a private practice and even in our office it is hard to keep the proper staffing, and we're considered a "cushy" job because we have "normal" work hours. Although some of us have been with this office for years, even decades, often times our technicians (medical assistants) and front desk staff come and go. Caring for the populace doesn't always pay well, there's the high stress of dealing with not only all the issues you bring up, but all the issues that come with caring for people in need, and for all the "rewarding" work done, there is just as much frustrating work to overcome. Although there are grateful, appreciable people who will acknowledge your efforts and sing your praises, there are also those who will turn around and threaten lawsuit at any opportunity.
Our government and insurance companies increase the stress placed on the health care system. They are the ones who determine the level of care and what can and can't be done by how much they support the system. A new fangled drug out on the market that will help patients lead a healthier life will take months to be supported by the insurance companies, even after the FDA approves it.
In the meantime, I hear everyday from our patients the needs they have, and the inability of our health care system to step up to the plate. More often then not, we are doing only the bare minimum rather then providing "quality" care. It is rare to find a provider who has the manpower and resources needed to dispense premium care. It's not that we don't want to. Many of us got into this line of work because we want to provide quality care to our fellow man. But we are not taffy, the more we are stretched and pulled, the lower the quality. I think of a young doctor fresh off his residency at Concord Hospital who opened his own practice in a community in need of a provider. Within a couple of years, he had to close the office. He now works an administrative job. He had high hopes of providing quality care to people in need and found he couldn't pay the bills incurred by his level of care.
We ask for assistance from the government, but we are one of many crying for aid and we are also the taxpayers complaining about how much we are already giving. I believe health care, child care and elder care should all be priorities. I believe for all the money we are pouring into a campaign in another country, we should be using those resources to help our own. But our government has put itself in this sticky situation and will have trouble disengaging itself. In the meantime, it is the lonely, needy, elderly patient in our office who is suffering, who can't afford the drugs, the nursing home, the transportation to get to their appointments. How is this right?
Hi Sarah, I agree with you whole heartedly. Especially the problem with the making of decisions by those who have no direct contact with conditions on the "front lines". People who have no idea what the employees are going through. I was at a meeting recently where a fellow colleage was being promoted. She looked at the two decision makers present and asked for resources so that she can do her job. They both looked in the opposite direction and said nothing to her. I don't blame them. I blame the people who they work for, and their bosses happen to work at the state house. I don't know much. Maybe the people at the state house can't be blamed. Where is the money to do what is needed? If one judges the health of the state by the price of housing, one would have to assume that New hampshire has some very wealthy people living in it. Maybe they have money because they don't have to send much of it to Concord? Maybe their parents don't need assisted care? Maybe their kids can go to private schools and rich colleges? Maybe they have second houses on the lake? maybe they can send their addicted relatives to nice expensive treatment centers out of state?
And, you have no air conditioning. What kind of environment must that be? Terrible. I bet none of the high and mighty do without air conditioning. You are also right about the inspections. On that day everything will look great. The next day, back to the same poor conditions.
They say what comes around goes around. Sometimes, that is the only comforting thought I have. Keep up the good work. dan