change is a coming

our little facility will see changes coming in our OR capacity, and maybe some renos sometime soon. the alberta health care system will likely see catastropic failure. ER wait times in cities are unbelievable, LTC wait times and closings are ridiculous. old people will die because of both, a lot sooner than they were meant to. ADL's are not the way to go - pay for service model - do you want breakfast, lunch or both? your laundry done? a tv? bathed once a week? toileted once a day? (yikes!) if you get sick all the pca can do is call 911 - be it you threw up, scraped your elbow, or are having a heart attack - they dont know shit from shinola (well maybe that, but not much else, no offence) in proper LTC you have LPN's and RN's 24/7 to help you if you are sick. throw-up, they can do an abdominal assessment and vitals, give you a gravol if warranted. Scrape your elbow, a fancy dressing will be applied, and the wound monitored for healing and signs of infection. having a heart attack - they can do vitals, give you oxygen, nitro, aspirin and morphine, all while waiting for an ambulance...or respecting your chosen level of care or code status (dnr). Who would you have? Who do you want for your loved one?

Come on, Be a Team Player!

One weekend morning my first three ER patients were there only because "the doctor told me to meet him here." They know not why or what for, just to be there at 0800h. Now, weekends are staffed more lightly than during the week, making the inpatient load heavier. Because of this the ER nurse helps on the floor until patients (real patients hopefully) show up. So when I get three people in, not knowing why, it really gets me. I sent an email complaint to my two supervisors, voicing my concern, along with my rationale as to why this is inappropriate: wasting health care dollars by paying ER wages to Dr's for clinic visits, wasting nursing time with clinic visits, delaying treatment of real ER patients due to backlog created by clinic visits in the ER. One response I got was, thank you for bringing this to my attention, it has been an ongoing issue we would like to resolve, thank you for having the courage to standup for what is right. The other response I got was, I don't see an issue with this, you should try to be more of a team player. Yup, by calling out an abuse of the system I am not being a team player. Apparently I need to show up and shut up, and let the docs carry on anyway they please.

it's contagious...

So, my fave doc and I were off to a great start the other day. While I had a cardiac patient waiting to be seen, and listed as my first priority, he was off in the waiting room seeing his biggest priority. The patient he was seeing was brought in by his wife. The wife had a scheduled appointment at the clinic the day before, and was told by my fave doctor, who couldn't see him at the clinic "bring him to ER in the morning for an ECG and lab work and I will see him then." Heaven forbid the doc write out a requisition for lab work and an ECG to be done by the community lab whenever the patients can make it. Nope, need that ER visit to get those extra $$. Wasting nursing staff time and $, making sick patients wait, all because of greed and an inability to know when the clinic load is too heavy. Needless to say I was livid....so close to telling this Dr off, and he knew it, I had to started to with Dr.Fave, you know what... stopped myself... he says what, i thought you were going to say something... nope i'm good, i reply... are you sure, he asks.. yup, i forgot, is my response. He reads the ER sheet where I had written what I was told by the patients as to why they were here, ie. "Wife in to see Dr yesterday, told by Dr to bring pt here for lab work and ecg" He looks up at me after reading this, and I say what? He replies, "It's contagious." "What's contagious," I ask. "Forgetting," he says. I thought this was quite funny, as we were both quite pissed at one another, and yet, were able to keep it in, smile, and continue on, even if it was a bit of a tension filled day from there...not bad, but both of us trying to get over our anger.

oh dear.

As we have moved further and further into the mess of a health care system I am finding myself ashamed to be a part of it. Grandparents are being discharged without any teaching of their new conditions, being forced to wait longer for important tests because they once had cancer. And those in charge say nothing is wrong with the system. How much are they being paid to say that, to stay oblivious? We have patients in our hospital stay for weeks on end when they are perfectly healthy. Rich old ladies who get lonely when their kids go out of town. Wives dumping husbands in hospital so they can vacation overseas. Children "needing to clean her house and buy groceries" before mom or dad can be discharged. Total and utter abuse of the system. Dr's on call leaving the hospital, greeting incoming patients as they go, so the ER nurse has no choice but to "call them back", which they then write on the ER sheet for an extra few hundred dollars for that visit. Patients coming to ER to get their blood pressure checked - "just thought I should", or for their "sore throat the last 3 weeks" or the "knee has been bothering me for a few years" or to "have my ears rinsed out." As much as the government and officials are the main and biggest part of the problem, it is then Dr's who are all about the $$, and then patients, who do not realize how much they are costing the system for their inappropriate visits to ER. Where do we go from here? I am afraid to find out.