The Enemies of Flow

[EvoDevo]

Been there, done that. Not fun. No incentive to move the meat or treat anyone nicely.

While I've never done it directly, I've rotated at EDs run by military types. Lots of 'Giterdone" attitude, less (but never absent) whining.

I dunno. I also think that it's a crime that ED nurses don't get paid more than floor nurses. With what they put up with...maybe ED RNs could have some sort of productivity model too...

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[Tiger26]

While I've never done it directly, I've rotated at EDs run by military types. Lots of 'Giterdone" attitude, less (but never absent) whining.

I dunno. I also think that it's a crime that ED nurses don't get paid more than floor nurses. With what they put up with...maybe ED RNs could have some sort of productivity model too...

They get 6 figures at my shop, which makes me feel less sorry for them in certain instances. . .

 

[GeneralVeers]

They get 6 figures at my shop, which makes me feel less sorry for them in certain instances. . .

Ours make about 70K (which is more than floor nurses). A few of our nurses who do extra overtime hours are making 6 figures as well.

 

[EvoDevo]

HOLY MOLY!

Guess I should be less concerned about so-called "poor pay."

 

[StevieStud]

They get 6 figures at my shop, which makes me feel less sorry for them in certain instances. . .

I stopped feeling sorry for them a long time ago when I realized they have basically zero liability and are paid ~30% of my salary for ~16% of my academic and professional education and I ultimately absorb all the liability.

Of course they occassionally have to mop up some **** (if they can't find housekeeping or an able bodied tech) but what the heck, thems some big bucks for not much effort.

Oh, and the union and/or hospital guarantees them donut breaks and I can't even take a whiz on the job without taking a performance hit.

 

[leorl]

Thumbs up for the original post. We call it "bolusing" patients. You can hear cries of "G__ DAMN it I got bolused AGAIN???!" with then angry call to the triage nurse. High turnover is good, but getting bolused with 10 patients instead of having them spaced out puts me into cursing mode. We do have computer work stations in each room on our non-acute side, which helps the whole not having to go back and forth to the computer issue. But it doesn't take care of the nurse on that particular side still having batching problems because usually they're in the room getting monitors set up, initial vitals, etc. as the physician is talking to the patient. What I don't understand is that the same nurses rotate through triage, and they hate getting bolused, so then why do they do it when they're triage?

 

[jonmadden]

I hope you realize they want people that should be at a primary clinic there and you to attend

They can bill $50 for hangnail in a clinic next store made out of gold 24 hrs a day and save money. But why bring costs down to 25% there when you can billl 1000% more in an ED at $500. Even if the patient pays its loss deduction and balances there bottom line and tool to get state money.

And empty hospital bed is one thats not making money in a CEOs mind without that patient pool they wouldnt have as many admits as some may for litigious reasons

Tell them to do or they are going to work you like idiots for ever. They will stilll need an ED attending after.

It was a great tool at one BOD meeting when a CEOs multi million bonus was based on making the ED profitable, wow score dont factor in receivables that wont come you will deduct.

a non profit hospital can not make a profit on a 1000% margin on the going rate for hangnail repair

They know the solution

 

[Arcan57]

Bizarre rantings... words.... vague exhortations

The general consensus is that this thread is a useful look at how to succeed at community EM. We all appreciate you not posting random nonsense. Thank you.

 

[The White Coat Investor]

Your right, but when the stuff hits the fan the GI will go above and beyond to do what needs to be done. Compare the gung-ho attitude with Mrs. 220 lbs, Union Specialist who requires 3 donut, 7 cigarette, 9 coffee and a full 1 hour lunch break or she gets cranky and calls her delegate.

People are people. I've had both types of staff both in and out of the military (2 branches.) There are gung-ho civilians and there are lazy-arsed fatsos in the military.

One of the reasons I left the military was the poorly trained staff I had to work with. Every time a nurse was just figuring out how to work in an ED she got promoted, handed a clipboard, and moved into admin. I didn't have a single working nurse in the ED with more than 3 years of nursing experience (except the civilian contractors.) The techs were good, but also inexperienced. Every time they got good they were transferred to L&D or the OR or somewhere else. They don't like specialists in military health care. Heaven forbid someone figure out how to make me more efficient.

 

[Old_Mil]

Excellent post arcan, this really does a nice of job summarizing one of the reasons I am a strong advocate of real time emr based in room charting and CPOE at the bedside.

 

[Arcan57]

Excellent post arcan, this really does a nice of job summarizing one of the reasons I am a strong advocate of real time emr based in room charting and CPOE at the bedside.

How does your set-up accomodate this? We currently struggling with this, to the point were our director (who always entered orders at the bedside) started making the walk back to the work room after we moved to electronic T-sheets. We have computers in each pt. room, but the sign-in process is prohibitively long (~90s) and whenever we log into one computer it automatically kicks us off of any other we are logged into. We're getting stylus based notebook computers for our scribes so they can sit in the same area we do (currently they are on these 80lb COWs that won't fit into the cramped little area we have to work in), but this isn't really helping with bed-side CPOE since they can't enter orders.