Sunday, September 25, 2016

Nursing Staffing Levels Threaten Patient Care

On the day that I penned this post, I rounded at our community hospital.   My first patient was in the step-down unit, which houses patients who are too ill for the regular hospital floor.   I spoke to the nurse in order to be briefed on my patient’s status.  I learned that this nurse was assigned 6 patients to care for – an absurd patient volume for a step-down unit.  “Why so many patients?” I asked.  She explained that some nurses called off work and the patients had to be spread around among the existing nurses.

This occurs every day in every hospital in the country.  Nurses are routinely required to care for more patients than they should because there is a nursing shortage on a particular day.  Why do hospital administrators allow this to happen?  If any are reading this post, I invite your response.  Enlighten us.  When a nurse is overburdened, how do you think this affects quality of care and nursing morale?

I suppose it saves a few bucks on payroll, but this strikes me as very short term gain that risks medical and financial consequences.   Providing high quality medical care can’t be a rushed effort.  If a nurse’s job description increases by 30%, do you think the quality of care and patient/family satisfaction won’t decline?   Don’t administrators fear the risk of medical errors from overworked nurses?  Would any of them like to be patients under these circumstances?

Nurses Need Help

Nurses have confided to me for years how demoralized they are that no one speaks for them.  Instead of watching their backs, they often feel that they are stabbed in the back.

I do not have warm feelings for labor unions and I support right to work initiatives.  But, when I see what nurses endure and the lack of support that they receive, I would support them if they moved to organize.

If a 3rd grade teacher is ill, we expect a substitute teacher to be called in.  The third graders are not simply herded into another classroom expecting one teacher to handle a double load. 
Many of us today are asked to do more with less.  Teachers, law enforcement, businessmen and government program administrators know this well.  At some point, you aren’t cutting fat anymore, but are slicing into bone. We are not taking proper care of those who have dedicated their lives to care for us.  Who will heal the healers?

Sunday, September 18, 2016

Why I'm Against Medical Marijuana

I have already opined on my disapproval of a medical marijuana law recently passed in Ohio.  Once of my points in that piece is that I did not want legislators making medical decisions for us.  They can’t even do their own jobs.

I am not against medical marijuana; I am for science.  The currency of determining the safety and efficacy of a medicine should be medical evidence, not faith, hope or belief.

Marijuana is a Drug Enforcement Agency (DEA) Schedule 1 drug, alongside heroin, LSD and Ecstasy.  I realize this seems odd since most of us do not believe that marijuana has the health or addictive risks of the other agents on the list.  It doesn’t.  But, danger is not the only criteria used in determining which category a drug belongs in, a point often misunderstood or ignored by medical marijuana enthusiasts.  An important criterion of Schedule 1 drugs is that they are deemed to have no proven medical use.

The federal government recently affirmed marijuana’s Schedule 1 status, which disappointed those who argue that this agent is the panacea, or at least an effective treatment, for dozens of ailments.  The government disagreed.  It reviewed several hundred medical studies and only identified 11 of them that were of sufficient scientific quality worthy of consideration.  None of them demonstrated a salutary effect of marijuana.

DEA Holds Firm 

An advocate of medical marijuana use was railing against this decision and stated that 80% of Americans believed marijuana had medical value.  His point demonstrates the vacuousness of his argument.  He might support letting polling determine if a drug is safe and effective; but I trust the FDA and hard science to make these determinations.

I am sure that if we polled the public on the medical benefits of probiotics, gluten restriction, GMO foods,  organic foods, radiated foods, colonic detoxification, yoga, veganism and meditation that we might find that the public’s belief in these practices doesn’t have firm scientific support.   I do not argue that these dietary and lifestyle practices do not have health benefits or enhance life in other ways, only that they are either unproven or disproven.  There are still folks out there who believe that the measles vaccine causes autism, even though this theory has been thoroughly debunked. In my view, releasing a medicine to market requires firm scientific support.  Anecdotes and low quality ‘studies’ should be afforded the weight they deserve.

Should we open up the gates to all kinds of potions and elixirs that are unproven for the public?  We do!  They are called dietary supplements.  These agents are considered safe until they are proven to be dangerous.  Is this the standard we want for prescription drugs?

Sunday, September 11, 2016

Nursing Documentation vs Patient Care - Who's Leading?

I work with nurses every day.  Anyone who doesn’t realize how hard these professionals work, has never been in a hospital.  Their job descriptions have expanded along with their work load.  This is not your father’s hospital ward.  Hospitalized patients today are older and sicker than ever before.  It takes a seasoned nursing professional to manage the care of these complex patients.   Their work days are full simply managing the expected tasks of dispensing medications, coordinating diagnostic tests and assessing their patients.  There is no time scheduled for unexpected events, which are expected as sick people’s conditions may change at any moment.  In other words, if a nurse must attend immediately to a patient with chest pain, then his or her other more mundane tasks are delayed or shifted over to another busy nurse.

I believe that the most potent barrier that is separating nurses from their patients today is the ferocious documentation mandates that nurses are required to perform.  The hospital corridors are clogged with nurses hovering over computers entering all kinds of data, most of which will never be viewed by physicians.   These nurses are not techies who want to be palpating a keyboard.  They are compassionate caregivers who want to be in their patients’ rooms caring for them.

Tomorrow's Nurse?

If you suspect that I am exaggerating here, then go ask a nurse.

Moreover, the hospital’s electronic medical record system has become deeply layered and complex. Often I can’t find the specific data I need.  Just last week, a couple of senior nurses and I were scouring through the computer to find a patient’s result of stool testing for blood.  We simply couldn’t find it, and these nurses are pros.  At that point we were left with the following options:
  • Reorder the test
  • Make up the result
  • Quit the profession and become an Uber driver
  • Ask the patient what the result was
  • Hire a 12-year-old who could find the results in a few seconds.
While the computer record is packed with data concerning every aspect of the patient's medical experience, I have my own approach to find out what’s going on.  Pay close attention here.  Read the next sentence very slowly as I want readers to grasp the complex process I use each day as I approach the nurse.

“Hi.  What’s going on with my patient?”

Sunday, September 4, 2016