Going to the hospital is scary because everyone knows doctors only practice medicine; they haven’t perfected it yet. Furthermore, doctors are not all-knowing like God, even though some have a God complex. Therefore, entering the hospital for care assumes an element of risk. In my opinion, the risk increased significantly after COVID-19 for the following reasons.
- During COVID-19, many healthcare workers felt mistreated. Employers asked them to put their safety and that of their families at risk while demanding that they work long hours, restrict access to their families, and take a vaccine whose actual side effects were unknown at that time. Refusal to comply with mandates cost them their jobs.
Staff felt betrayed, unappreciated, and disrespected after their sacrifices. Many left their jobs and professions. Furthermore, colleges received fewer applicants for their healthcare careers, resulting in a deficit in the number of replacement professionals for the vacated healthcare positions noted above. Thus, healthcare faced a severe staffing crisis in all healthcare markets.
To fill their empty positions, healthcare organizations began bidding wars to entice staff to work for them instead of their competitors. Salaries escalated, with offers including housing, travel costs, and other perks for short-term assignments. Healthcare professionals saw it as a way to make money quickly while seeing the country.
Unfortunately, quality care suffered. Traveling nurses received limited orientation and knew almost nothing about their new assignment’s practices or the protocol. Teamwork suffered. Travelers often got the most challenging patients and worked more hours, coming to work exhausted and maybe even a little confused regarding which place they were that day. Commitment to their jobs or the organization was non-existent. They came to work and moved on to the next assignment. Patient care rarely improved or saw progress, and more patient care errors occurred due to travelers not knowing the patients under their care or being familiar with their work areas.
- Regulatory agencies seem to think that the best way to fix problems in healthcare is to identify the root cause of a problem and create a strict protocol to prevent it from happening again. If they create detailed policies outlining every process step, everyone will know what to do, and there will be no errors. Requiring everyone from the president to the parking attendant to take a class on the new process and signing an affidavit that they completed the training confirms competency training, thus solving the problem that people don’t know what to do. Problem solved.
It is not that they are trying to micromanage, but they think that structures produce results. However, the unintended consequence of this well-intended plan is that healthcare professionals spend so much time documenting the work they do related to these new standards that little time is left to provide patient care. Failure to document is like the kiss of death in the medical field. The mantra in healthcare is, “If it’s not documented, you didn’t do it.” Organizations receive significant demerits when they fail to document information.
- My final concern concerns documentation, but it’s entangled with the other two. Due to the staffing shortage, a staff member might be assigned 6-7 patients on a shift, each needing significant help. Documenting care for that many patients could take hours. However, many organizations prefill information to assist staff in keeping up with the demands of charting. For example, the patient’s demographic information may be on all the sheets, but the information from his last shift may also be present, so the nurse only has to change it if it is different. Another example is checkboxes, where the usual answer is pre-checked, and the nurse only has to uncheck the box if the negative is true. In both examples, the risk is that the nurse overlooks removing the inaccurate details, and it appears something is true that is not.
A surveyor who discovers missing documentation three times during a survey can fail a facility on that particular standard. Or, if they find documentation on the wrong patient in a different file, the surveyor issues a demerit for violation of confidentiality. It only takes a minimal number of inaccuracies to be found (something like 14, I think) for an organization to lose accreditation. If they lose accreditation, they can lose the ability to get reimbursement from insurance companies. It’s a huge deal.
Therefore, staff give so much attention to documenting standard compliance that they pay little attention to other patient care needs that are not standards.
All hospitals must be licensed or have a conditional accreditation to be open; therefore, you can know they are somewhat safe if their doors are open. However, safety is only as good as the person in front of you is at what they do. If the person standing before you does not care about you or what they are doing, then it doesn’t matter how much the organization strives to do the right thing; that person doesn’t care what happens, so you are not safe. Consequently, you are always responsible for your safety.
In the next few posts, I’ll go over specific ways to say no and who to call for help if you don’t feel safe. I will do my best to arm you with defenses you can use, but they don’t always work. I knew what to do, and I used all I knew, but my husband still died, I believe, from incompetent care. I can’t make guarantees, but I can help you fight.
