Thursday, April 14, 2005

The "30 Minute Promise" and the Broken Nurses It Leaves Behind

"Patients love anything that keeps them from waiting,” Pugh says. “They don’t really care what you did to make that happen, but it leaves them with a much better feeling about your Emergency Department."

-- Dayle Pugh, RN, BSN, CEN, Clinical Director, Emergency Services, St. Charles Mercy Hospital, Oregon, OH
I wouldn't be so sure about that after the patients read the letter from an R.N. reprinted below. Among all of the stories I've heard over the years in the workplace safety field, this is one of the most disturbing.

As anyone who’s recently had the misfortune of going to an emergency room knows, you're probably in for a long wait. With health care costs rising and the E.R. being the primary health care destination for the growing number of Americans without health care insurance, the situation promises to get worse.

One hospital in Ohio has decided to do something about it – with disastrous results for hospital workers and patients. Instead of dealing with the root causes of the problem (underfunding, understaffing, too many patients), the hospital had a brilliant idea: attract more patients and make the staff work harder.

How did they do it?

The "30 minute Promise" policy. The hospital promises E.R. patients that "If you are not seen within 30 minutes of your arrival by an ER doctor that you will receive a $15.00 coupon for gas, movie tickets or a gift certificate to a store."
Domino's Pizza tried this a few years back (Pizza delivered in 30 minutes or it's free), but the policy put so much pressure on the delivery drivers that they were getting into accidents rushing to get the pizzas delivered on time. After losing a $78 million lawsuit, the pizza company dropped the policy.

This hospital apparently failed to learn the pizza lesson. And at least one worker will pay for their negligence for the rest of her life. This is her story:
On March 7,2004, I was injured at work because of a horrible policy set forth by my hospital. This policy is known as the "30 minute Promise" policy. It says to patients that come to our ER, "If you are not seen within 30 minutes of your arrival by an ER doctor that you will receive a $15.00 coupon for gas, movie tickets or a gift certificate to a store."

As nurses and doctors, our requirement is to meet this 30 minute requirement or face the consequences. Physicians have been told that they would lose their jobs if they did not abide by this policy. I have seen many ER doctors and residents leave the side of a critically ill patient to quickly run over to another room to see a sprained ankle because the sprained ankle patient only had 2 more minutes left before he or she would be given a $15.00 coupon. How can this be a safe and appropriate policy for any administration to consider? How can ER residents and student nurses truly learn anything in an environment that supports quantity rather than quality patient care?

I have actually had people come in off the street and ask, "What is the prize today?". We have had entire families come in and expect "a prize" for each family member because they where not all seen within the 30 Minute Promise policy. How sad!!!

My injury occurred because of this "30 minute Promise" policy in March of this year. I had taken a patient up to CCU from the ER. This patient weighed about 250lbs and I along with another ER nurse waited for the CCU nurses to come and help transfer the patient to the CCU bed from the ER cart. In my mind I was considering the 30 minute policy and that there were many patients in the ER yet to be seen. I was conscious about the fact that this lost time of waiting for the appropriate amount of nurses to safely transfer this patient was going to certainly cost me and the hospital a $15.00 movie ticket or gas coupon. Finally, one CCU nurse showed up. She announced that the other nurses where not available to help. She was way to small to really help and the ER nurse with me already had a back injury and so she took the patients feet. I was left to take the rest of this patients body weight. As I pulled on the sheet to bring the patient over to the CCU bed, I felt two incredible pops in my lower back with pain, numbness and tingling down into both my legs and feet. Later MRI showed that I had herniated my L3-L4 and my L-5 - S-1 with severe impingement of those nerve roots. I have had 2 major back surgeries since then with little hope of returning to hands on patient care again.

ER nursing was my life and I loved my career. But I do not love where I have seen nursing going. I did not go into nursing to hand out coupons or to work in a "fast food ER" environment. Where has the professionalism gone? Where has safe and appropriate care lost way to commercialism? My greatest question to my hospital and any other hospital administration that has adopted such a policy as this: "Was it worth it for you to lose a highly skilled RN for the sake of a $15.00 coupon?" I'm trying to understand. I have lost so much for so little gain by this hospital's decision to implement this 30 minute promise.

I have written this with hopes that any Nursing Administrator, Director or Clinical supervisor will see that there is absolutely no justification for choosing thoughtless policies over care and safety of your highly skilled nurses.

But wait, there's more. Just as I was about to publish this, I thought, "Hey, I wonder if this hospital is uniquely stupid." So I googled "30 Minute Promise" and guess what? A bunch of hits. The "30 Minute Promise" seems to be quite popular, at least among a number of Ohio hospitals. One article in "Hot Topics in Health Care," published by Thomas American Health Consultants boasts of the efficiency gains that this policy forced.

Another article concluded that the program had produced "dramatic results," faster service, happier patients, fewer walk-outs and more "business."

One Ohio emergency room doctor, writing in 2003, had major reservations, but he was concerned mainly with quality of patient care and professional satisfaction. Not a word on the toll it takes on the health care workers who literally do the heavy lifting.

One thing I don't understand is that one of the purposes of this program is to attract more patients when there's already a problem dealing in a timely manner with the ones they have. So they introduce a program that attracts more volume to be dealt with by the same staff in a shorter amount of time.

I'm not sure if it's the total ignorance of worker safety that I find most astounding, or perhaps just the indifference -- the fact that these policies can be implemented, studied, analyzed and measured without even taking a moment to consider the impact on the workers doing the job. And the pure lack of common sense and knowledge about how the job is done among managers who are supposed to be able to run organizations is perplexing and distressing.

There ought to be a law, or at least an OSHA standard.

Oh wait, we had one ... until George Bush and his industry friends took it away. Compassionate conservatism rears its ugly head again.