My God! This is brilliant. Rocking Horses of the Apocalypse.

Thank you, doctors who do stuff like this. Thank you for not assuming I’m an idiot or don’t want to learn (or am unable to do so). Thank you for treating me like I’m an intellectually curious professional.

I like this so much better than “just carry out my orders, you vapid handmaiden.” I actually have a feeling of deep affection for this doctor. I’d never met him before (on nights, you don’t meet a lot of specialists).

Possibly I’m a knowledge junkie.

The problem: We are have shift-retention issues on night shift. It’s not necessarily staff retention (I continue to maintain that my hospital is A Good Place to Work™). People just move to other shifts, with the result being that we on night shift have a few experienced nurses (the few, the proud) and a bunch of rapidly rotating new grads or new ER nurses who scatter as soon as another shift comes open. The staffing situation therefore ranges from a simple lack of enough bodies to having enough bodies but not enough experience to go around.

The factors: The one at hand involves scheduling and pay—this has to be a common issue for nurses everywhere and is the one I seek ideas for solving. Our shift differential sucks. It is in no way competitive with other area hospitals and completely removes any financial incentive to stay on night shift. I’m told that the budget is in a sad state because of all the callback pay for filling empty shifts and the huge costs for continually training new nurses (which costs result from people moving off the shift because of the lack of a decent differential, the lack of which causes MORE nurses to move off the shift, thus causing more costs to replace them and pay callback in the meanwhile, and so on), so the differential will not be changing.

Side note: IMHO, this is an infuriating but common example of false economy. If institutions would spend some money up front on nurse retention, it would pay off and everyone would be a lot happier. But this is why I’m not in management.

The solutions: I’m all full of problems and short on solutions. They can’t just pay us more, so we have to get creative. What have other hospitals done? Here are a few ideas I’ve come up with.

• Incentivize seniority. Right now, there’s absolutely no reason to stay on this shift. Not even scheduling priority. In fact, those of us with experience have the opposite of an incentive because in order to spread around the experience we’re made to fit the schedules of the new people. We’re told we need to do this just for reasons of esprit de corps. Few people are that generous, not even me, if you can believe that, and with some other issues going on, there isn’t much esprit de corps anyway. I need more than “take one for the team,” and so does everyone else. The practical result is that the longer you stay, the LESS scheduling flexibility you have, and you spend all your time training and mentoring new nurses who immediately leave when they’re trained and able to go.

  The last hospital where I worked provided the incentive of schedule priority to those who had been there longer, and if nurses were needed on shifts they didn’t want, they got paid more. And the shifts were all covered, and nobody was pissed off about the schedule. New nurses just walk in and start demanding a “fair” schedule here (meaning “exactly what they want”), which I don’t understand. When I was new, they gave me a schedule, and I moved my life around to fit it with the understanding that as I gained seniority I would have a better schedule. Guess what? I don’t. Giving schedule priority to those who stay would, I think, make existing staff happy and persuade newer ones to stay with the promise that by not leaving, they too could work toward the schedule they want.

• Cut deals with people. Most nurses seem to have some THING that they would like a break on. They don’t want to work on Tuesday nights, ever, because that’s when their husband is available for date night. They want to take a class that meets on Thursdays so they need a guarantee that they’ll be free EVERY Thursday night. They despise Monday nights because of the postweekend rush. They hate call. Whatever. Mine is I hate taking call. I don’t mind working weekends, whatever, but I HATE call. What if management cut deals with us? Such as:
  • You will never have to work Tuesday nights if you agree to working every single Friday night.
  • If you agree to work [some awful schedule no one else wants], you don’t have to take call.
  • If you switch a scheduled night to fill in when they need experience, you get callback pay. (I become much more flexible when I’m paid for it, I find.)
  • If a dayshifter flips to nights for a while, he or she will receive a thank-you bonus, and one that makes it worthwhile. These last two, although necessitating budgetary changes, would, I think, ultimately be MUCH cheaper than paying callback all the time on the spot because there’s a sudden shortage and, again, training new people all the time.

That’s pretty much all I’ve got. Who has other ideas? What has your hospital done? Please add a comment or send me an e-mail.

The MacSparky Paperless Field Guide. You can find it on iTunes. It’s one of those fancy new “books” with movies and stuff.

That would make it cool enough, but it also has a metric ton of handy tips for, well, going paperless, as the discerning reader has probably figured out. I’ve had a ScanSnap for years and use Evernote and Dropbox like crazy, so I consider myself more knowledgeable than your average person, but I still found a lot of clever new ideas.

It’s also costing me money because having tried several of the applications he demonstrates in the book, I could no longer do without them. Like Bartleby the Scrivener, I continue to maintain that the easiest way is always the best way.

Bottom line: if you use a Mac and iOS devices and have any interest in ridding yourself of paper clutter, buy this “book.” Then get ready to buy some more applications.

I hate it when RN’s grab me to drop everything to go and see a patient in distress…..and then you go see the person and they are not sick.

Whoever wrote it (no author was supplied) did backtrack a bit:

Still, I guess it’d be worse if they missed the real sick ones so I guess I’ll tolerate the over calling.

Thanks, you patronizing bastion of saintly tolerance. Some nurses are just stupid, and I’ll give you that. So, however, are some doctors. Stupidity aside, here are some totally possible and reasonable scenarios that would cause nurses to alert a physician to a potentially sick patient:

• The nurse missed something recently, the physician didn’t open the chart and get in there fast enough, the patient crumped, and the physician passed the buck so the nurse got her butt chewed. Because poo still rolls downhill.
• The patient told a totally different story in triage.
• The patient actually is sick and the doctor is wrong.
• The patient meets some esoteric criteria that meet a policy warranting immediate pulling of the panic plug—with reimbursement tied to sepsis protocols, door-to-EKG times, etc., we aren’t allowed to use our brains and are required to alert physicians at once regardless of whether the patient actually looks sick.

Logic aside, y’all don’t get our workflows either, so rest assured this annoyance is mutual. “I NEED YOU IN HERE RIGHT NOW” when on arrival I find that all you need is for the patient to be discharged so you can go eat your dinner/watch YouTube/leave an hour early because it’s your last signout, when I’ve just left the bedside of an actual sick person you didn’t know about because another physician is responsible for their care, similarly disrupts my workflow and patient-care timeliness. The point here is that you have your reasons, and we have ours, and most of the time they probably even out.

So, nameless irritated physician, please consider all this the next time you get all ticked off at your nursing colleagues who have probably saved your behind more than once by summoning you to the bedside of a sick patient whom you probably wouldn’t have seen in time otherwise. M’kay? I’m guessing you whined on your blog instead of talking to the nurse, too, but that’s just an educated guess.

“I’m in Salt Lake City airport. Do you need any jacked-up-on-Jesus jewelry?”

Obviously I was immediately intrigued. “Out of sheer curiosity,” I wrote, “I’m interested to see what jacked-up-on-Jesus jewelry would even look like.”

My curiosity went unassuaged: her next text read, “Sorry, guess I over-promised on the jewelry. Not to disappoint, though, here is a photo of a frog dismembering a yard art flamingo. Note his cousin at left flipping you off.”

Indeed:

After admiring this display, I responded, “By the way, Utah is not between Kansas and Arizona.” I’m nothing if not helpful.

True genetics. Right after cardiac cath, dad checking netbook. Flat on his back. So glad he is OK.

OMG it's Nurses Week. My nips are tingling in anticipation. Will it be ADA/Cardiac/Vegan cake or a badge holder? Too much to think about!

Nurses Week = “for one week out of the whole entire year, we will recognize that an entire profession of people work their butts off wiping and kissing yours. The rest of the time…eh.”