Covid has shone a bright light on the many, many broken parts of the American healthcare system. Insiders have known this for years, but now the world knows. The following solutions will never get any play, but I assure you they would work.
In 2010, the iom recommended that hospitals have 80% BSN prepared nurses by 2020. Systems got a major boner for this so they started to only hire BSNs, no ADNs or LPNs. Nurses were already in short supply. Who in the hell thought it was a good idea to require them to have MORE schooling? BSN programs are hard and they cost anywhere from $40,000 to 80,000. Ridiculous. Bring back ADNs and LPNs.
Hire more techs. The difference between a shift with a tech and a shift without is huge. They take excellent care of patients and they make it possible to do the little things that people need while they are hospitalized. And let them do more stuff!
Utilize technology. Get rid of all the wires. Part of why the work itself is difficult is that things are broken half the time and we are climbing over things. Hire IT people who actually come and fix things in the moment-we do not have time to spend an hour on the phone troubleshooting.
Look at workflows. Workflows are super inefficient in almost every unit I have ever worked. Don’t just say you are going to improve things-actually do it. I spend a ridiculous amount of time looking for stuff. Example: I needed a sprite for a patient the other day. I went into the galley and there were no sprites, so I went to the other galley way down the hall. I grabbed the sprite out of the fridge and went to grab a cup and straw. There were no cups and straws in that galley so I had to go to the first galley to get a cup. They probably paid me $7 just to get that soda.
Stop interrupting nurses during report and during med pulls/passes. This should be sacred time. Interruptions create the perfect opportunity to make a mistake. I got 11 phone calls the other day when I was trying to pass my morning meds to one person. I also had two separate people come in to my patients room while I was passing meds to ask me about a patient in another room. It’s like we have forgotten there are humans in the beds and they deserve our attention as well as a little privacy.
Physicians need to be a part of the care team and not work in silos. Talk to families, talk to each other, stop putting nurses in the middle. Don’t round at 8am, do it at night when the nurse actually knows the patient. Stop taking patients to surgery at 7:30am. If you are in a patient room and they need their bedside table moved closer to the bed, you don’t have to go out in the hallway to find the nurse to move it. You are allowed to move it yourself. This actually happened to me the other day.
Scribes for nurses. This would be an excellent opportunity for the tele health community. *mic drop*
Pay employees what they are worth.
Trust your on the ground employees. If they tell you something is wrong, it is.
We want to do a good job, but this system makes that extremely difficult.