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Follow the Money

At the end of my rant about sloppy physician’s orders, I asked the question, “How do you get beyond that kind of apathy?”

May, whom I have a great deal of admiration for, said,

“i know that clearly looks like apathy, but it could also mean something else. i maybe apathetic about the issue, but i know i still want to take care of sick people most of the time, despite the challenges…”

May, I want to thank you for reminding me that the nurses I work with are very caring and compassionate people, and so apathy may not be the right word to use at all.

Perhaps it’s simply a matter of economics.

So the nurses have voiced their complaints. They have staff meetings, they have a nurse manager who supposedly advocates for them. So why does nothing change? Perhaps it’s just the balance of economic power that exists within the hospital.

Doctors who do expensive procedures bring big gobs of money to the hospital, therefore they have power. Nurses, on the other hand, don’t really bring any money into the hospital and so they have very little power.

It’s a very simple concept: money equals power. You can complain all day long about doctors who are sloppy about writing orders, but what incentive to they have to listen to you? I suppose one incentive is that they might miss out on having a top-notch nursing staff, because they will only attract nurses who will put up with sloppy orders, but does that really matter to a radiologist or an interventional cardiologist?

Maybe not. It doesn’t take much to do my current job. I monitor vital signs, and I tell people to lie flat until their groin site heals. I hand out generic discharge instructions. I occasionally transport a patient to the floor. It’s pretty simple stuff.

That’s not to say that I don’t work with some top-notch nurses in the recovery room. Quite a few of them are excellent. But I think the reason that most of them work there is because it’s a wonderful thing to have a nursing job with no night or weekend requirements.

So what’s my point anyway? Why am I complaining? Why am I so frustrated?

Mark Graban made an interesting point: “It requires Leadership! This isn’t something that Lean can solve if there’s not leadership and a drive to fix problems like this.”

Unfortunately, I have no desire to be some sort of visionary leader who will solve all of the problems in the recovery room. Rather, my instincts are telling me to get as far away from the recovery room as possible. Maybe the answer lies in the fact that my job would be vastly improved if we used a CPOE system. And yes, I have thought about working for a company that sells CPOE programs, because I am truly an evangelist when it comes to using them.

Hmmm. Now there’s something to think about.