After working the past three days (Fri, Sat, and Sun) I have a couple of issues that I am concerned about. I know that some of these areas of concern are already being looked at by upper management, but I would still like to put in my two cents. And feel free to share this e-mail to whomever it is relevant to.
On being a charge therapist – After this past weekend, I’m really not interested in filling this particular role as the work load stands now. When we are staffed accordingly, I will be more than pleased to assist in being charge therapist again. I love helping my co-workers and have said before, I do not mind pushing a vent all over the hospital when someone calls me and needs one right away! As you know, on Sunday, I was taking care of the patient on 3 North ICU who is on HFOV, had my own ICU duties on 3 Truett, covering Roberts PACU, on Rapid Response Team, and charge therapist. This is extremely overwhelming! The quality of patient care I gave was not my standard of care. And there were numerous treatments I marked as not done due to “therapist unavailable”. There was no one else to call on, as all ten of us on staff Sunday could not be spread any thinner. There is a safety issue here, not only for the patients but for us as teammates. From my observation, when there is plenty of staff during the week, the charge/RRT therapist usually does not have an area to cover. This should be across the board. I would also like to see the charge therapist be compensated monetarily for the role they fill (not clinical ladder). As far as scheduling, maybe it would be beneficial to have one person on Saturday and one on Sunday, instead of being in charge the whole weekend. Just a suggestion and I’m not sure how the other therapist would feel about this.
On Staffing – Simply put, we do not have enough on the weekends! I do understand the need to cut back on hours for the therapists who work over a 60 hour week on a regular basis, and I agree with that being dangerous. However, these are the therapist who would pick up a shift here and there to help the TDA staff out. And as I previously stated, I believe it’s a safety issue the way we are understaffed presently. I have several solutions that would work in my mind. One being that the straight PRN staff we currently have (as small as it is) is used as just that. As it stands now, these therapist sign up for shifts Monday through Friday, and then are unavailable when you ask them to work on Saturday and Sunday. Another option would be to have our ICU therapist rotate mandatory on-call and be compensated accordingly when called upon to work. Or maybe hiring more PRN staff and once our FTE schedule is complete, calling them with the options of dates to work. This would also help with the weekend FTE’s who are unable to pick up extra shifts during the week because it is fully staffed by PRN staff. One thing I would like to have cleared up is this, when I am in charge on the weekend, is it my responsibility to find staff? When I don’t work on Friday’s, I don’t know who has called in or who’s on FMLA, or who’s off on PTO and if anyone has found a replacement. This is one area I need clarification. I’m not always available to stop and make phone calls to find staff for the weekend if I am at home taking care of kids and such.
On HFOV’s – Where can I find the policy and procedure on the HFOV? I looked several places and can’t find anything. Maybe it’s because I’m trying to read it from home, maybe it’s due to the new policy and procedure library, but I don’t know where to look. Is it in the policy that a therapist must be available in that ICU at all times? Anyway, you know and I know that everyone has been in serviced on the HFOV. We had three running this past weekend. Just because someone has been in serviced does not mean they can run a HFOV. As I have said before, if there is a HFOV on 4North and I need to train someone or even move to a different ICU for other therapist to become more familiar with this intimidating machine, then I will do so. The TDA staff needs more exposure and hands on, but basically this also boils down to a staffing issue. We don’t have the staff to pull someone and train them on the HFOV therefore Becky and I will continue to be the ones running them. And that’s fine with me, I like taking care of these critical patients. But we won’t always be here. All of this to say that this was another issue raised over the weekend. And in fact if the policy does state a therapist must be present on the unit at all times, then again, we have a safety issue, because this simply could not happen this past weekend.
Now, for the miscellaneous questions and concerns – Why is an ICU therapist covering the comprehensive care portion of 3 Truett? I can see where this may be a non-issue during the week, but on the weekend it would be very beneficial for comp care to cover this area. Consider it a trickle down of sorts. We take on the responsibility of BHVH and they take on the responsibility of 3 Truett. Checklist…I’m a rule follower, so I will be doing this mandatory check list, but I have to tell you that between the computer charting and the checklist and other things that are “mandatory”, we are stretched too thin as therapist. Actual patient care is going down the drain. And it doesn’t matter how many oral care protocols you have in place, or ventilator weaning protocols, or even VAP protocols…when it comes down to it we need to be able to take care of the patients and quit checking so many boxes. I also think there needs to be a reminder sent out to the ICU therapist about the re-taping schedule. There should not be any reason for a nurse to stop me on Sunday October 2 and say “Will you re-tape this patient? The date on the old tape says Sept 29!” I mean, come on friends. We are adults. The nursing staff should not remind us to do our JOB.
Thank you for letting me vent my concerns and feelings!
See you Saturday,
Dona
And there you have it! My frustrations in a nutshell from this past weekend at work and the e-mail that addresses them sent to my supervisor and manager. Will anything change? Probably not, but we'll see.
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