Kimber Wooten 
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Re: “The Trouble with Kaiser's Technology

I have worked for ten years as a nurse in ICU and then Post Operative Recovery and I get to see what the conditions are like on medical surgical floors when I am bringing my patients to these departments.
The electronic chart which has some great benefits to look at a patients history and most pertinent problem but it is a very time consuming task though to input nursing assessments, chart medications, clean up old information and input things that do not describe the patients condition or response. I can easily say my charting which was previously on paper allowed me most of my time with my patients and I could easily describe pertinent information along with vital signs. Now I am filling in boxes in an excel spreadsheet that have preset descriptions and multiple selections that require me to scroll up and down for each box to find the right assessment descriptor. I can easily fill out on each patient at least 50+ or these rows in one flow sheet and then they have added for many reasons additional flow sheets to chart additional information on. If I want to add a comment to the flow sheet description I am limited to 5-7 words and I would have to write a note in another section of the chart which would require someone to research through multiple notes to find what I was addressing. This additional time has not been accounted for in our work day and when we have asked to have additional time for charting it is managements response generally that somehow we are inflating the numbers.

Regarding the cardiac monitor system, it is written in the manual that the monitor is not even a first line response system it is a secondary response system for heart monitoring. The system alarms to the nurse as she is passing medications, speaking with families, ambulating a patient, on the phone with the physician, when charting, when responding to a call light. Basically the pager system goes off constantly while the nurse is trying to care for immediate needs. Most of the alarms are yellow, which means not clinically dangerous but to be monitored, there is little you can do to adjust some of these alarms to not go off because the system is already pre-set and there is basically no intervention needed. Also patients do not just lay in bed so when they are moving around it has false alarms then also. In addition the system when you receive the alarm does not show you the rhythm you need to look at just the alarm so you have to stop what your doing and go to the central monitor to find out what was the problem. The problem with this is that the system just causes alarm fatigue because if you could easily just sit with the monitor and acknowledge these alarms all day but there is nothing clinically we would do with most of the information. What a nurse wants to know is a change in rhythm, beats that were not present before, lethal arrhythmia. What this requires is for a trained telemetry technician to be focused on the monitor and to alert you to something requiring intervention because there is so much information and we are required to do 2-5 tasks at a time that all require our full attention, which is just not possible. This issues has been brought to managements attention for years and the response that it is lacking is to blame the nurse for every mishap not to bring in someone to physically watch cardiac monitors which is the standard in many hospitals.

On chronic under-staffing we have reached a point where we have not trained new staff for years, we are expected do more with less. Positions when nurses retire or transfer are not replaced in many places. They choose to take travel nurses who are from out of state and give them 12 week contracts that get extended multiple times, many of them do not pay taxes in our state or own homes so they do not invest in our communities. Even with them we still do not have enough staff to take care of the patients we have. Staffing also does not have a back up system for when census's fluctuate, we will accept what one shift can manage with no concrete plan to staff for the next 16 hours. So then they email and text what staff we still have to come in for extra shifts which many of them do because they want their colleagues and patients to have enough help. These nurses get tired and sick after being stretched so thin for so long. I always thought when people paid for insurance they were paying for the what if? What if I get sick? I personally want to know my hospital is ready to take care of me and has the power to do so. Especially when the company is so profitable, using the cost-effective care argument for why we don't have the ability to provide staffing is not being backed up by a decrease in administration or decrease in patients premiums. Many hospital floors now have employed 3-5 assistant nurse managers who do no patient care, I have witnessed situations where we have 2 managers on site for one floor while two bedside nurses are taking care of 10 patients while the other nurse is on a break? How is that cost effective to have 2 people combing through charts to tell someone they forgot to document a pain re-assessment while they are moving nonstop to just provide the care needed to their patients?

38 likes, 3 dislikes
Posted by Kimber Wooten on 09/10/2014 at 10:52 AM

Re: “Nurses Say Kaiser Oakland Is Shortchanging Patients

I am a Kaiser Nurse in San Rafael and we deal daily with doing a great deal with very limited resources. I hate to hear patients say "I am sorry to bother you, I can see how busy you are." Patients can see how overwhelmed and understaffed we are but they don't realize how much this system is being setup to give them such minimal or inadequate care and all while they have charged people a lifetime of premiums. Nurses and patients are noticing the rapid rate of discharge and no I do not see any amazing technology or medication that has caused this other than the doctor using a computer to write a discharge to home order...

I would like to point out in the article Kaiser dared to say that they only have 500 incidents of Assignments Despite Objection and not 1,400.. well that is very easily proven because there are copies of those and I think if people who were admitted to the hospital were able to read them they would demand to decrease the bloated amount of management and outrageous CEO salaries and increase real healthcare services. I appreciate the brave nurses who are speaking the absolute truth in this article.

45 likes, 0 dislikes
Posted by Kimber Wooten on 01/15/2014 at 12:12 AM

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