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Comment by Negitivefrags | Hacker News Reader

I don’t think the problem is cost cutting. I think the problem is just the same problem that every human enterprise has.

Most people just don’t give a shit outside thier immediate responsibility.

Looking at the global view and actually making changes that require persuading other people is a hard and often thankless task.

Many people who do give a shit get this crushed out of them early in their career by the negativity you will face if you try.

Much easier to just accept the status quo.

Occasionally you get a group of people who really care and come together determined not to let things be crappy and they can form an organisation that is significantly more effective for a time. But once the rot of “We can’t fix things” sets in, it’s really really hard to turn things around.

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I work in a hospital, and occasionally in ICUs. You're wrong. Most workers are very much jaded, but they do care. Problem is, the system crushes you to death if you don't set pretty harsh limits to protect yourself. In a lot of cases, that means de-humanizing your work, put your feelings aside and work like a machine. Good little machines are just what management wants, right? Now higher management... wow, those people really don't give a hoot about anything that's not themselves!

A second major contributor to inertia, is that the initiatives from lower echelons are usually set for failure by the intricacies of bureaucracy. And said bureaucrats are completely unimaginative about what they could do to fix things, because they never leave their office to see what's really happening in the trenches. So yes, in fine the problem is the extreme stupidity stemming from human collective behaviour. Complain, and suddenly _you_ are the problem!

What percent of patients have a medical need to be woken up every few hours then?

You'd be surprised to see what happens to staff going against waking up patients all night. You get the "dangerous sloth" sticker on your forehead real quick on the morning grand rounds.

With all the focus on EHR and billing, they can't have all the machines taking vitals hooked up and in a ready only state thats sent to the nursing station?

This is the type of stuff I have a gripe with. Sinecure and fiefdoms of power.

Silencing monitors is actually forbidden by law in many places. Staff is supposed to be near the patient at all times => monitors beeping. That's certainly a bad state of things, but not a "fiefdom of power". It's so ingrained in our education that most staff don't even think about it but would certainly agree if asked whether the patient would sleep better without it.

Not saying monitors should be silenced. You can monitor someone without waking them up.

Fiefdoms of power - nursing union not wanting to give up the night shift premium pay when the job description changes to monitoring a screen and half the physical workload vs. day shift.

I’m not sure where you’re getting this from. I / my nurses silence alarms at literally every hospital I’ve ever worked at (granted they’re temporary silences by design so you have to hit silence q1h/q30mins depending on the alarm).

Stanford Healthcare recently installed a system where all alarms/notifications get sent to a hospital assigned device the nurse carries rather blasting in the sleeping patients room as 90%+ are false alarms (aka IV or SpO2 sensors).

The real issue is that hospital technology is outdated and most places don’t have the option for this level of telemetry.

I’ve never been told / instructed my staff to “be near the patient at all times”.

In fact, most places have 1:8 nursing coverage on the ward…

You're right that silencing alarms is strictly forbidden in anesthetic territory only, not ICU. I'm biased bc I'm in Switzerland, and here the coverage ratio is usually 1:1. The country is so rich, that many things are different here... they really are near the patient at all times. To give you an idea: the day COVID really hit, we received 180 shiny new Hamilton respirators complete with additional staff overnight, in an ICU that's usually ~30 beds. And you can't order "your nurses" around, because they've got a lot more power. Yes, in most places it's different and I should have mentioned that.

I want to clarify two points given the language used in your response:

1. I used the possessive “my” in reference to nursing staff for simplicity in writing and clarity to the reader rather than to indicate ownership, we are on a team. This is akin to saying “my goalkeeper wears Nike soccer cleats”.

2. I do not “order nurses around.” I verbally communicate and leave medical orders in the chart that nurses act on. It is not about a power struggle, we are all trying to do our jobs and do what’s right by the patient. I’m grateful when nurses question my medical orders (as long as it’s a positive/educational discussion, which it is 99% of the time) as they catch my mistakes and we all learn together.

If you are concerned that you can’t order nurses around, I strongly suggest reflecting on whether this leadership style is the most conducive to providing quality patient care as this can increase barriers and hostilities in the workplace resulting in communication breakdown and adverse events.

Thanks for the lesson, mate. I'll be strongly reflecting over the past 15 years of clinical practice and see the errors in my ways.

Any doctor who says they treat nurses as valued professional colleagues should be presumed to be lying unless you have seen it yourself, in person. Doctors treating nurses like shit is the norm, not the exception. How badly varies a lot.

pretty much every patient in the intensive care unit - that’s kind of what the “intensive” is referring to.

If nothing else, you either take the blood pressure the normal way with a pressure cuff, which is going to wake you up. Or you put an intra arterial catheter, which reads continuously without bothering the patient, but has a small risk of damage to the vessel, infection etc

Based on my knowledge of US based urban (downtown) / suburban metro hospitals - vast majority of beds / patients aren't in ICU/CCU beds. I would say only 30% are in a critical state under observation - ICU/CCU/post-op/etc.

Cost cutting is definitely to blame for how understaffed hospitals are. Then Covid happened and it got even worse. It's definitely not all due to Covid though. Even the "not-for-profit" medical group in my area has been pushing doctors and PAs to take more and more patients, well past what they're comfortable with. Nursing staff has been cut down to nothing compared to 10 years ago. Wages haven't gone up to match the increase in workload.

Again, this started before Covid, the pandemic just highlighted how much these cuts screwed over both healthcare professionals and patients.

Everything you said is spot-on, but, brining things full circle, the lack of “shit giving” could be due to cost cutting. People don’t have an incentive to care. The end result, vis-a-vis their personal situation, is unchanged whether or not they go the extra mile. Part of this is because they exist in a rigid corporate structure hyper-focused on value extraction and not at all focused on the development of human capital.

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