Completely idiotic things admin are capable of

Discussion in 'Emergency Medicine' started by TrumpetDoc, Feb 25, 2017.

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  1. TrumpetDoc

    TrumpetDoc 7+ Year Member

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    Here's an excellent idea. Let's take an emergency department that sees almost 70,000 patients per year with a ridiculous amount of urgent care and fast track/lac repairs and take away the laceration carts and Place all materials in an Omni cell (same as Pyxis) storage system that needs fingerprint to access! Lets also put all IV start supplies in their too.
    What's next, get my DL stuff and ETTs there too?

    However, the ED throughput is seemingly their most important metric!


    Let's get a list going of more examples of the brilliant business intellects of the healthcare field showing how well they can run an emergency department.
     
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  3. bravotwozero

    bravotwozero Chronically ambitious 10+ Year Member

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    The real question is, what idiotic things is admin NOT capable of?


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  4. GeneralVeers

    GeneralVeers Globus Hystericus 10+ Year Member

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    "Direct Bedding" of patients without triage to improve throughput times. Sounds great in theory, but when you have no beds to put people in, they end up sitting around in an internal waiting room for hours with no vitals, or triage at all. In many cases even when a bed is available, the nurse assigned to that bed is busy, and the patient still sits around for hours with no triage or vitals. We are told that we should still "go see" these un-triaged patients who do not even have a documented complaint, and that if any of them are "sick" we should notify the charge nurse. Essentially they want doctors to now become triage nurses too.
     
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  5. RustedFox

    RustedFox We're all stars now. In the GOAT RODEO. 7+ Year Member

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    AHhhhHhhH!

    I wanna play, I wanna play.

    *Goes to a corner to think*.
     
  6. mcworbust

    mcworbust 5+ Year Member

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    In my limited experience, the two most idiotic things an admin can do are as follows:
    1. Deciding to become an admin
    2. Hiring more admins
     
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  7. TrumpetDoc

    TrumpetDoc 7+ Year Member

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    The equating the verbal order with acts of treason!
     
  8. RustedFox

    RustedFox We're all stars now. In the GOAT RODEO. 7+ Year Member

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    - and some on here wonder why my fur stands on end when I hear someone mention interest in an administrative fellowship.
     
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  9. Dr.McNinja

    Dr.McNinja Nobel War Prize Winner SDN Moderator 10+ Year Member

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    Edwin Leap mentioned that.
    "Resume CPR"
    "Doctor, you need to put that in the computer"
     
  10. mcworbust

    mcworbust 5+ Year Member

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    I recently heard an M1 at my school discuss how they are now more interested in administration/running a hospital, and after they were done talking I realized I had backed away about 3 feet from them while they were talking haha
     
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  11. RustedFox

    RustedFox We're all stars now. In the GOAT RODEO. 7+ Year Member

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    It's like hearing someone say: "I'd like to learn to be as agitating to you as possible... How might I go about doing that?"
     
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  12. Psai

    Psai Account on Hold 2+ Year Member

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    Taking away physician computers and making more space for the secretaries because that's who is important in the ed
     
  13. DissocativFugue

    DissocativFugue 5+ Year Member

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    Once upon a time when I was still single I met up with a friend who "had someone for me to meet." They already had quite a few and my friend introduced me as a physician. The other person immediately scoffed and told me she was in admin and that we were all her b!tches. I had some choice words for her and told my friend to never try to set me up again. That lady definitely had resting b!tch face. Really illuminates the psyche of someone who wants to go into that position.

    That being said I am thanking my lucky stars that my current hospital admin is very reasonable.


    Sent from my iPhone using Tapatalk
     
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  14. RustedFox

    RustedFox We're all stars now. In the GOAT RODEO. 7+ Year Member

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    Great idea: eliminate the unit clerk position... The charge nurse can do that job when she's not also being a floor nurse to cover for predictably sky high seasonal volume surges... Then, wonder why the LOS goes up and patients end up boarding in the Dept for unpalatably long times.
     
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  15. Birdstrike

    Birdstrike 5+ Year Member

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    I'd be curious what administrators say when b*****ing about doctors. What do they say?

    I imagine something like this, "These idiot doctors on our staff have have no clue. I mean, we can't possibly keep this department open. It's not making enough money. How dare they always play the 'We must save lives" card. Pffttfttt....
    Lives schmives. I'm all about profits, bruh."


    Sent from my iPhone using SDN mobile
     
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  16. Arcan57

    Arcan57 Junior Member 10+ Year Member

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    Volume jumps 50% in the ED but staffing gets cut because the system decided to adjust it's Truvan number. Cue rounds of meetings about why our patient sat and metrics went from amazing to deplorable.

    All RNs have same scope of practice. Newly minted RNs cost less than experienced nurses. Therefore it doesn't make sense to spend money to retain your seasoned nursing staff. Bonus points if you can get rid of them via intrasystem transfer so it doesn't count against your retention metrics.

    Probably the number one "stepping on rake that hit you in face" move is installing management teams that are good at making budget but have no people skills. If you ever just want to completely torpedo a department, put in a competent but unlikable nurse director while simultaneously raising your benchmarks and freezing or even lowering the budget. Watch as your experienced core of nurses starts to melt away like a snowman in the Sahara. With that, stare in wonder as metrics go into a free fall as the goal shifts from excellent service to "please God don't let them kill any more patients this shift".
     
  17. RustedFox

    RustedFox We're all stars now. In the GOAT RODEO. 7+ Year Member

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    This thread is so much funnnn..... I want to play more, but y'all keep taking my ideas.
     
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  18. GeneralVeers

    GeneralVeers Globus Hystericus 10+ Year Member

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    In addition to the 30 patients the doctors are seeing on their own in a shift, the doctors MUST see all 20 PA/NP patients as well including the level 4-5. This is of course necessary to meet patient satisfaction metrics, and make sure any administrator's family/friends who show up in the ER actually "see a doctor".
     
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  19. TrumpetDoc

    TrumpetDoc 7+ Year Member

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    Last night: RN night admin come over letting me know that another doc "messed" up. He lost the Ph paper!!! This has to be taken from lab and they are irate.
    Why don't we have some here? I ask.
    We can't! RN said.
    Why? It's a "diagnostic test!" You guys aren't even qualified to use it. You don't go through the required competency training....

    Long story short that crap is $7 on amazon. I bought two!
    Problem solved.
    Move on.
     
  20. DocEspana

    DocEspana Bullish! 7+ Year Member

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    Lets see. Just recently:

    The no water in the ED rule became a no personal property at all in the ED because they were suspicious we might be hiding water in our jackets.

    In order to prevent any drinking in the ED they moved the water to the pyxis room, which is locked in a way that physicians cant even enter the room. So not only can WE not get water without a nurse letting us in, but only nurses can get patients water. (to be fair, this occurred a long time ago)

    They decided to remove all of the guaiac solution from the ED despite us (6 months ago) going through extensive and annoying color vision checks to prove we were allowed to do guaiac in the ED. So we had no stocks of it. So we went to the back stock room to see if there were any more back there and they CLEARED OUT THE BACK STOCK ROOM stating that if we need any extra equipment or supplies that arent kept in the pyxis room (again, which only nurses can get into) we should send a courrier down to the basement to find it. This obviously goes extremely poorly nearly 100% of the time, so recently we have had to go down ourselves for it (we like to send the administrator themself down when we can to show them how dumb it is).

    Lube is now a controlled substance and needs a pyxis order. This includes taking all the lube out of the rescusitation bays, a real pain in the ass for people like me who like to lube their ET tubes.

    An ER director at a nearby hospital got fired because they had no ER physicians seeing the psych ER patients despite it being under the ER's umbrella and eventually one with a blatantly obvious medical complaint went back to psych ED and croaked. Now admittedly this was sort of a big deal, but the level of f*** up here wasnt "bad stuff happens" it was "there was no attempt to identify if this guy had any medical complaints and he clearly did". So the response from our ED director was a bit.... heavy handed. We now had to see and fully evaluate, with a full written note, every single psych patient who arrives including medication refills and blatantly obvious "these guys have no medical issues." As we simply did not have a staff to do this without our efficiency grinding to a halt, we asked them to rethink the policy or hire a PA or something to assist with this. Their decision instead was to pull a provider from the regular staffing and place them in a side room where their only job was to watch the intoxicated patients (not joking. Not evaluate them. Not write a note on them. Literally baby sit them) and be available at all times to see every psych patient and they were not allowed to see regular patients during this time, and the lost staffing was not replaced, the main ED just had to bare the load of one less provider than normal during day time hours.

    Sunday is a relatively slow day for us as far as ill patients go and nearly all of our patient load is nonsense 4/5 ESIs. Because the ill patient load is low the administration long ago decided to not have the urgent care open that day and just let us bear the brunt. Still the sheer numbr of nonsense 4/5 ESIs is crazy at times, so we got a bit spoiled and asked that it be open so that our sundays can be a breeze. The administration listened (!!) and actually hired an additional PA just so they could flex the PA schedule around and staff the urgent care area on sundays. But the administration did not hire any new nurses nor did they change the nursing assignments so the urgent care center has never had a nurse available. So far 100% of sundays the PA has come in, found no nurse available to work the urgent care area, found nursing management was unwilling to flex a nurse to them, and then the PA went home and the second PA who was to come in later was told not to come in as "the urgent care area is closed today". Collective facepalms have ensued from that lack of thinking through an idea completely. Im sure they will soon complain back to the physician staff how we mislead them and tricked them into hiring a new PA that never gets used.
     
  21. Psai

    Psai Account on Hold 2+ Year Member

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    Okay I know that the title of the thread is about completely idiotic things but this story just get stupider and stupider

    Why do "ed admins" even exist?
     
  22. RustedFox

    RustedFox We're all stars now. In the GOAT RODEO. 7+ Year Member

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    Psst... It's so they can collect the extra 15% reimbursement (physician vs. MLP patient)
     
  23. GeneralVeers

    GeneralVeers Globus Hystericus 10+ Year Member

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    Only extra 15% for Medicare patients as far as I know. Most level 4-5 patients are young and on Medicaid/uninsured. Also the group is the one who would get the 15% reimbursement, and the group including medical directors were against it. They caved because hospital threatened the contract over it.
     
  24. RustedFox

    RustedFox We're all stars now. In the GOAT RODEO. 7+ Year Member

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    Touché. I work in Medicare City, FL - so it's a much bigger percent to me.
     
  25. RustedFox

    RustedFox We're all stars now. In the GOAT RODEO. 7+ Year Member

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    "These idiot doctors have no clue. I mean, we can't possibly keep this department open. It's not making enough money ... (for us to steal)."

    [​IMG]
     
  26. engineeredout

    engineeredout Lightning Ballseeker 7+ Year Member

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    I like the push to eprescribe without the responsibility assigned to anyone (except us) of adding the patients pharmacy into the computer.

    Bonus points when the patient tells you "It's the one on that corner downtown"
     
  27. BoardingDoc

    BoardingDoc Don't worry. I've got my towel. 7+ Year Member

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    Everyone gets a paper Rx.
     
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  28. RustedFox

    RustedFox We're all stars now. In the GOAT RODEO. 7+ Year Member

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    ePrescrIdontwastetime.kthxbye.
     
  29. DocEspana

    DocEspana Bullish! 7+ Year Member

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    Required by 'law' in NY State. First state to require 100% compliance (except to nursing homes who can still get paper ones). Its a nightmare.
     
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  30. Hercules

    Hercules Son of Zeus 10+ Year Member

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    It's BCBS in my state as well as Medicare. And BCBS makes up 80% of the private insurance in my state (can you say monopoly?)


    Sent from my iPhone using SDN mobile
     
  31. HooliganSnail

    HooliganSnail 5+ Year Member

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    I think you might work in my hospital......because that is exactly what they did!

    Caveat....the nursing admin isn't actually even that competent
     
  32. HooliganSnail

    HooliganSnail 5+ Year Member

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    This is the most amazing series of mind boggling stupid decisions I have ever read about.

    I would seriously consider leaving...it sound terrible

    You win
     
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  33. RustedFox

    RustedFox We're all stars now. In the GOAT RODEO. 7+ Year Member

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    Reason #68 why NY is teh suck.
     
  34. Spectre of Ockham

    Spectre of Ockham

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    I would have nuked her career by talking with high-ups , shareholders and press . Nothing like a "Monstrous administrator believes doctors are plantation slaves" "Incompetent admin forces staff to treat patients as cattle". Two can play the "Who's your daddy" game.
     
    Last edited: Feb 28, 2017
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  35. Spectre of Ockham

    Spectre of Ockham

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    How is this person still alive ? How in the world do you keep hydrated during a 12 hour shift ? How come your haven't formed a lynch mob against this ?
     
  36. DocEspana

    DocEspana Bullish! 7+ Year Member

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    It's why I'm on my way out and off to the land of eternal summers and methamphetamines.
     
  37. DocEspana

    DocEspana Bullish! 7+ Year Member

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    It's multiple people. And looking at hospitals around us it could be *much* worse. You might not believe me, but it's hard to understand how dysfunctional the NYC environment is for EDs. But for all the good they do, and it's plenty, their authority is almost unchecked. So they do many things either for a) protecting their own ass from threats that don't exist like OSHA or JCAHO commission standards that don't actually exist and they just imagined or b) just improvising policies on the fly and judging their merits based on how miserable they make us or (occasionally) if they work.

    It's the refusal to ask the clinical teams their opinion, and to rather just create policy on the fly and evaluate in retrospect (thank God they do evaluate so most of these are short lived) that leads to most of this nonsense.
     
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  38. Spectre of Ockham

    Spectre of Ockham

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    A case of such incompetence over here would have prompted a ER MD walk-out. That usually makes heads roll and summons 5 TV vans.

    Unfortunately in the US stupid admins have declared war on MDs and recruited extremists RNs and NPs into the fold. Our only weapons are close ranks , media coverage and business acumen (being able to jump over their heads and expose their stupidity in economic terms to their higher-ups) . Otherwise we risk getting toast and I for one have no intention of jumping out the window due to a community college MBA graduate that i can run circles around when it comes to economics and profits.
     
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  39. TrumpetDoc

    TrumpetDoc 7+ Year Member

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    This!
     
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  40. DarioArgento

    DarioArgento

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    Maybe if you check in after a shift for dehydration and make a complaint as a patient the admins will start to give a crap about the water thing...
     
  41. WilcoWorld

    WilcoWorld Senior Member 10+ Year Member

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    With the weather this winter that describes most of the US. Please be more specific.
     
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  42. WilcoWorld

    WilcoWorld Senior Member 10+ Year Member

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    If I had a dime for every time some mythical OSHA/JCAHO rule impeded patient care I could probably open my own hospital.
     
  43. WilcoWorld

    WilcoWorld Senior Member 10+ Year Member

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    Sorry if I missed this earlier. Where are you?
     
  44. GeneralVeers

    GeneralVeers Globus Hystericus 10+ Year Member

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    At one of my hospitals the nurse administrators kept threatening the nursing staff with having "drinks in a patient care area". They wouldn't even allow them to drink bottled water, and it got to the point that nurses were getting dehydrated on shift. The excuse they used was "It's a JCAHO rule".

    I went to the Joint Commission website, and printed out the page where it says "Joint Commission does not have a policy on food and drink in the ER" and gave it to the charge nurses. The next time they were given the stupid excuse of "It's because of JCAHO", the nurses showed the administrators the paper, and sheepishly had to admit that there was no such policy. Drinking of water resumed.

    I find that challenging these idiots with facts, and actual written policy is the most effective way to fight them.
     
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  45. DocEspana

    DocEspana Bullish! 7+ Year Member

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    I did exactly this. Without batting an eyelash the administrators said "oh did we say Joint Commission? We we meant OSHA." I was ready for this and printed them the OSHA opinion on this that at long as reasonable attempts are made to prevent blood contamination, all workers should have access to hydration at their work site. They furrowed their brows and told me that they'd get back to me.

    The next day they told me it was an infection control hospital policy. So fast forward a few months and I find infection control wandering by and they go "we have no such policy. You can defintiely drink in the ER. Just place some tape on the ground to identify exactly where you cant bring blood because you want water". I literally grabbed this woman and ran to the administrators who just frowned at me and said "oh this again. We told you. Its Joint Commission rules." "No its not <hands paper again>" "We mean OSHA" "again no <second paper>" "Well infection..." "IC Lady: no its not this is all you guys" The temporal artery on the two admins were both about to blow. they just decided to say that they will think about it. Its been two months. They hav literally cracked down MORE on water since then, not less.
     
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  46. Dr.McNinja

    Dr.McNinja Nobel War Prize Winner SDN Moderator 10+ Year Member

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    Take a break every 15 minutes to go drink in their office. Make sure and interrupt them as much as possible in the process. Maybe even store a drink there, or bring a friend and chat.
    Enough people do it, and either the admin quits, or the rule changes.
     
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  47. littlejuan

    littlejuan 7+ Year Member

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    I am looking for this and can't find it. I need to shove this into many faces :(

    EDIT: Found it. Mother f*ckers
     
    Last edited: Feb 28, 2017
  48. RustedFox

    RustedFox We're all stars now. In the GOAT RODEO. 7+ Year Member

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    I am in agreement.
     
  49. RustedFox

    RustedFox We're all stars now. In the GOAT RODEO. 7+ Year Member

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    McNinja has a black belt in passive aggression.
     
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  50. Dr.McNinja

    Dr.McNinja Nobel War Prize Winner SDN Moderator 10+ Year Member

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    So I've used this, and the relevant OSHA documents (https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=INTERPRETATIONS&p_id=25506).
    I'm just curious as to where the wording "patient care area" came from. It's like all the admins had a meeting one day and decided to use that lingo. It's literally not in any federal document anywhere.
    Allow me to continue jousting windmills.
     
  51. GeneralVeers

    GeneralVeers Globus Hystericus 10+ Year Member

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    When administrators/nurse managers around, I always make sure to have a big cup of coffee in my hand or proudly displayed on my workstation. Usually I am munching a bag of chips at the same time. For some reason they never say anything to me......
     
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