Are these really the people that should be required to work so much? Isn’t their job about handling life and death daily? Wouldn’t we want exactly these people to come fully rested to work every single day and be fully staffed?
I don’t know if there are jobs with similar stakes that are so carelessly staffed and disgustingly paid.
No we’re not. But generally governments everywhere want to starve the medical industry to make it generate profit for the wealthy. The US is their role model.
Glares at Doug Ford
Glares at Tim Houston
Tries to glare at Tim Hortons but it is not available in my region
I mean they deserve it too…
ಠ_ಠ
Honestly, I don’t think it’s even about profit everywhere.
I obviously don’t know what it’s like in Canada, but in my country, we also have socialized healthcare (like Canada), we have a shortage of some specialty doctors because they’re expensive to train and expensive to hire, and many go to other, richer countries instead (Finland in particular, as it’s close by). But nobody works huge amounts of overtime usually. Nurses work double or triple shifts, but mostly overtime is voluntary, and the only reason they work 16 or 24 hours in a row is because of stupid traditions and the slight risk of information going missing with the shift change.
The one upside is that they get a bunch of days off after each shift since you only need 2 shifts a week, and actually get to skip one shift every now and then if you don’t want to do overtime.
they kinda are doing that, by UNDERSTAFFING everywhere, replacing expensive MDs for NP/ or even nurses, and PAs. PAs are useful if they can spend time with your medical history like 30min+, anything less than that they are only slighty better than NP/nurses.
Because the alternative is the rich paying more in taxes, and we can’t have that obviously.
Not really.
Universal healthcare could be more than paid for just with what we pay in insurance.
It’s still money, but in this case it’s that profit healthcare is tied to employment causing employers across all industries to want less employees, which means a lot of overtime.
The real solution was shortening the work week to spread the labor around while keeping salaries high.
That seems very US specific. In Europe, we have universal healthcare, but it’s chronically underfunded.
sounds like a billionaire problem
It damn well is, no doubt about it.
always is. Universal healthcare is a reality. We just have a billionaire problem
Mods, jail.
I don’t understand why people aren’t voting for the uber-rich to pay their fair share. Billionaires pay less tax percentage-wise than any worker out there and it’s all because we focus so much on income tax. The uberrich don’t have income - the have wealth, which isn’t taxed.
the rich hospital admins, they skimp out on hiring more mds to rotate the burnouts.
We aren’t. But it’s generally better for patient care. It’s the same nurse/doctor seeing through more of the care of a patient with less handovers.
Handovers are where minor details or context can be forgotten, dropped or misunderstood - especially after a really tough shift.
Patients also get to see the same faces more often, which makes them feel like they are being taken care of - as opposed to a part being made in a machine.But it’s wrong. It would be better to have 8 hour shifts with 2-4 hour overlaps between shifts. So it’s not a handover, it’s an actual rounds, it’s actually servicing patients and so on.
But that is likely very intrusive for patients, and 4-8 hours of the shift is with someone else (who you might not like or agree with) and communicating (which can be tiring).So yeh, it’s not great. Understaffing doesn’t help, especially since these are people that genuinely care about their work. It’s pure exploitation, because it is cheaper and hospital administration can justify it and get away with it (or whatever is higher that hospital admin in the case of free healthcare).
In some cases, it’s budget and exploitation. And it’s bullshit.
But there is a genuine argument that a doctor who is fully informed and tired is better than a doctor who is fresh and oblivious.I’m always slightly skeptical of this answer just because residency pretty much intentionally gaslights doctors into thinking that exhausted decision making is normal and unavoidable… All because the guy who started medical residencies had a massive cocaine addiction and it was 1900.
I’d be curious to see a study with data on patient outcome, wait time, use of resources etc, that measures exhausted double shifted doctors, vs fresh doctors with more context switching, vs fresh doctors + appropriate overlap to avoid context switching.
They’ve done those studies and context switching has historically been where the most problems occur. Whether they’ve repeated them with modern electronic medical records and systems, I don’t know. I think most people agree there’s probably a better middle ground between 8 hr shifts (3 handoffs a day) and the standards set by a dude who liked to experiment with coke and meth.
One of the big issues that I feel like doesn’t get touched on as much is longer shifts allow less doctors, which reinforces the artificially low doctor graduation rates. The national board in the US pegs the graduation at X thousand new doctors every year and that number is mostly tradition / vibes. No we don’t want to compromise on the ability of new doctors, but “gestures vaguely to US healthcare” good lord do we need more of them. Much the same could be said for nurses.
And all of that circles back around to not wanting to dilute traditionally higher paying job markets with more practitioners because the for-profit system will try to wring out every cent they can.
There are probably many more minds that could hack being a good doctor, but are smart enough to go into a field where the work-life balance hasn’t been a terrible trope since 1900. I think I could have been a good doctor but from a very young age I remember it seeming like the time wasn’t worth it.
That being said, I did end up becoming an RN, and I’ll say that my program is probably not unlike others in the US where sacrifice and fucking martyrdom reign supreme. Like wouldn’t you do anything to help your patient? Lose sleep, skip breaks, skip meals? If you don’t, whooo wiiiiilll???
There are probably many more minds that could hack being a good doctor, but are smart enough to go into a field where the work-life balance hasn’t been a terrible trope since 1900.
This was me. Studied for and did well on the required exams, interviewed at a couple of schools, and in between my interviews and acceptance letter I talked to a couple of people in residency at my university. The descriptions of their work-life balance was so atrocious, and the altruism of the profession so stomped out of their mentality that I decided I could probably help people in other ways.
As I watched a couple of my close friends battle depression all through medical school and residency with very little institutional or mentor support, I decided I absolutely made the right choice. I really respect you for staying within the system and becoming an RN, because you guys also have it just as rough, along with the added disrespect of “But you’re not a DOCTOR.”
I don’t know why medicine is so gatekeepy in it’s processes. Being strict in education and procedures I understand. But the heirarchy, egoism, and political games to grind down all these young trainees is quite archaic.
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Yeh, same. Which is why I said ideally there would be 100% overlap with shifts. Always 2 doctors, offset by half a shift.
Like, that is the fix. Peer review of decisions, easy conference/council/whatever-the-word-is, context can be handed over better (outgoings doc/nurse briefs incoming doc/nurse while remaining doc/nurse listens & supplements)But I have also been on gigs (I work in events) where there is a rig crew, a show crew and a derig crew.
When everything is meticulously planned out and everything goes according to plan with all the communications in advance, it works. It does. (As a tech, I’d rather set up the kit I’m using). If I know it has been set up according to pre-communicated spec then I can work it. If it deviates and I have been in the loop, I can work with it. But if it turn up and it doesn’t make immediate sense then it is many times harder. If I am rigging kit without a clear concrete plan, then I am guessing what the tech wants.
And I also know 2 lampies can’t co-light a gig unless they take turns.
Someone has to be incharge, someone has to take responsibility.But I don’t think (and from what I have read, and I’m sure I have been somewhat misinformed) that applies directly to healthcare. Meticulous plans don’t exist. Every patient is different. Something minor reported and expected to go away on the last visit of the leaving doc that is then reported as slightly-more on the new docs visit… That could be significant. And a few extra hours on a shift could save a life, because of that easily dismissed/forgotten context/knowledge during a handover.
2 doctors at all times is the fix. Or, actually, a voice-to-text and an LLM… Likely a decent usage of an LLM.
It doesn’t need to know who/what the patient is. It doesn’t need to know co-morbidities, existing conditions, medications, treatmens etc. Just that the doctor is interacting with patient A, and here is a summary.
Patent A is the same patient that a nurse interacts with.
Helps with hangovers and context.
Patient A is still in the hospital? Patient A still has a transcribed record that can be quickly summarised by a local (or onsite) LLM.
Using onsite LLMs is no different than using a database. And it doesn’t have to be massive. 30m before a shift change, there can be a “notes after this time will not be summarised during handover so previous context can be summarised”. So doctors only have to remember the last 30m during a handover, and the rest of the context (even transcripts) are provided to prompt their memory for a better handover. It’s an information tool for doctors, not a crutch.
And now I sound like an AI shill.Sorry for the wall of text. I’ve been drinking. I hate the “just use LLMs bro”, but think they have genuine utility when applied safely and locally.
And I want doctors and nurses and janitors/cleaners/sterilisers/techs of hospitals to be treated like the fucking heros they are.That does seem like a reasonable use for an LLM, but it’s very important to realize that an LLM is not a database. You don’t necessarily get out what you put in. LLMs can lose context, they can hallucinate, and they can make all sorts of weird decisions that might compromise the quality of your data. There’s no workaround for actually checking on that information when the stakes are high.
An automated system that isn’t an LLM would be more reliable.
I’m going to disagree with you on the “better for patient care”, as the study I saw was not good. I remember the study being put forward by a party that had a significant interest in having people work longer shifts, which amused me when that’s exactly what they found was better. Your study might be a different one that has actual methodology done after the one we liked to make fun of because it was a shit study with a conflict of interest (even if it may have shown something that may be true that I disagree with, I haven’t gotten around to granting that I’m wrong yet I still have two full paragraphs of bullshit in me).
Aside from becoming a valuable piece of medical evidence I’ve done a fair amount of MD education and worked in the office side. I know my own icd 9, 10, and 11. To give my credentials without doxxing myself (I could just show my famous anatomical abnormalities, the ones that got photos sent around to every medical schools in the world, but like then EVERYONE would know who I am. I might have just doxxed myself just saying that I haven’t had privacy for a while)
This is what I feel is the
gold[ew that feels wrong now.] prime bean standard of hospital care: the lead doctor needs to be able to explain to the patient and the nurses what is going on in their care such that they understaffed it. You have handoff happen in front of the patient and have the patient explain (as concisely as possible. Under 30 seconds if you can, you have all day to practice) their upcoming routine medications/appointments/therapies/allergies/dreams/hopes/eyeshadow/steam engine kebab designs and then the nurse/aide explains any additional procedures/steam engine kebab design competitions that have been scheduled during the shift. If there’s anything else that you need to cover during handoff, like the location of the nearest Turkish or Afghan restaurant and a handy menu, that’s easy enough to cover.Your downvotes are all nurse administrators and bed control. Bullies. Because who else would argue that hospital staff is not exploited, honestly.
I wonder if less workdays alongside higher staffing would be a better way of reducing burnout while preventing handovers
A combination of a few things.
First, the founder of modern medical teaching was a man who loved cocaine and created a fairly aggressive education program which fed into a profession without work-life balance. The profession hasn’t self-reformed while cases where skilled labor has massive overtime is generally more regulated.
Second, the cost of education is enormous. Medical training for a doctor costs north of half a million dollars, so there is a high cost to training an additional doctor. Because of that, it is more cost effective to add additional shifts to existing doctors and nurses.
Third, a lot of doctors have a god complex and don’t want to admit they are fallible people. Because of this, they resist a lot of best practices other industries; checklists for operations are a 21st century “medical technology”. There isn’t a push within the industry to study how people fail like there is in other industries.
on the third point the it was the anesthiesa professional group which made the push for the much more rigorous process that greatly improved outcomes. So there is some precedence for the profession realizing it needs to improve processes.
Yes, and it is important that those doctors advocated for better patient care and that the desire to develop procedures are somewhat there. However, the medical profession as a whole seems to be less focused on procedures than others.
Because of this, they resist a lot of best practices other industries; checklists for operations are a 21st century “medical technology”.
When I was an electronics technician in the Air Force, ‘tool accountability’ was huge. All toolboxes were arranged with individual foam cutouts for every individual tool, no matter how small, so it would be quickly and easily obvious from a mere glance if a tool was missing from the toolbox, leaving an empty cutout behind. (Like this.) Paperwork was required to check tools out of and into tool boxes. At the end of every job, the toolbox had to be checked – both the paperwork and visually – to ensure no tools were missing. (And if tools were missing, the job wasn’t done until those tools were found and accounted for.)
And that’s because aircraft in general – and jet engines in particular – really don’t like lost tools banging around loose inside. I didn’t even work on engines, or even on aircraft, but the Air Force had adopted these policies service-wide to prevent accidents resulting from lost tools left inside engines.
Which is why it baffles me that surgeons can sometimes accidentally leave a tool inside a patient. Working on a real human body is way more important than anything I worked on … and human bodies don’t like foreign objects left behind any more than jet engines do. Plus, those surgeons are getting paid so much more than I did, and they even have assistants in the room to handle the tools for them. How the fuck have they not managed to have a similar system of tool accountability, preventing them from leaving tools behind inside patients?
Surgeons are considered money makers in hospitals, literally “the talent.” If a surgeon punches a nurse, the nurse will be the one fired. If a surgeon sexually harasses a tech, even rapes a tech, the tech will be fired. If a surgeon makes life difficult for everyone in his department, they will work around him like a missing stair. If the surgeon comes in drunk or impaired, this “working around” gets tripled into direct coverup, where no one sees anything and no one knows anything. Reports are rote fabrications, as are incident reports; Joint Commission visits are scheduled in advance and prepared for (and their results kept non-public); when an incident occurs family members are routinely bullied; and god help you if you are an employee and you have a problem with any of this: whatever keeps the money coming.
Hospital HR departments are set up to maintain exactly this situation, to the point that even the internal complaint process is rigged, for example in a situation where per the employee handbook you as an employee must submit ALL your evidence up front, and no evidence added later will be considered. You might think, “Well, that’s harmless enough, right?” No. What this does is game any complaint from the start: you as an employee generally can’t sue successfully unless you have tried internal solutions first, and this way the hospital gets to see everything you have upfront, create a defense and/or coverup tailored to your proof, and then counter-accuse you with bullshit you cannot rebut because you never saw it coming and are not allowed to submit anything further. So you either have to sue, or accept being fired at some point, if you’re not fired outright with whatever fabricated misconduct you get charged with as a result of bringing the complaint. Or you can just drop it and try to get on with your career somewhere else.
I have more, but you get the idea. These true experiences come straight from a very large hospital in the southeast US, one that would be considered “award-winning” in a major combined metropolitan area and is considered a “great place to work” based on salary rates. But inside those walls, people who work there usually and very quietly go to the smaller hospital across town when they need their own surgical healthcare. There are many, many great people that work there who are every bit people you would want on your own healthcare team should you need it. But in many departments, the ones that demonstrably aren’t great are not the ones who get fired.
I’m sure other hospitals are better, but many are even worse. The very rare surgeon who does lose their job for cause anywhere in the US is out only because after a years-long road of internal complaints and related witness/complainant firings and employee harassment, one person, at great cost to their own career, doesn’t back down, OR by a stroke of circumstance a patient who is harmed has the right connections to make some kind of justice happen, and then the surgeon moves to another hospital in another state. But that’s rare.
And it’s all about the money: surgeons bring in lots of cash, like oncologists and cardiologists do, and elective surgeries bring in even more. Who pays for all that cushy hospital administration? Surgeons, specifically, among others. You’re 100% right that surgical mistakes can be eliminated, but not in a healthcare system that prioritizes profit over all else. If that surgeon has a pulse and can get to the hospital without getting arrested for DUI, guess who’s doing your surgery? Hospital HR departments protect “the talent,” simple as, and state licensing boards aren’t any guarantee either: they’re staffed with MDs who all went to the same schools as the people whose professional conduct they are entrusted with overseeing.
specifically elective surgeries is the money maker, like cosmetic or minor reasons, not a serious condition.
Gallbladders would like a word. Those things are made of gold.
But pee is stored in the balls
Solid post. #2 stings extra, extra hard when you learn that in the USA doctors spend on average somewhere between a quarter and half their time (studies vary) with insurance nonsense. We could potentially DOUBLE (or, low end, increase by 1/3 which is still insane) the number of useful doctor hours tomorrow, but we don’t. U$A
i assume you meant the residency program, yea that is such an abusive program that should be revised decades ago. i wonder if the medical admissions remain constant to med school or it declined. i know some people try different ways to get into the MD industry in AMERICA, EITHER AS foreigner/immigrant MD, or go to a questionable foreign medical school, apparently its tougher if you come from a foreign country as an MD.
I’m not OK with it and I vote with this specifically in mind.
my gf is a nurse and it is absolutely bonkers how the healthcare system works at all, shit is very run down and society as a whole needs a lot of shifting for how taxation affects the health care system. tax the fucking rich and make them pay their fair share and siphon that into healthcare.
gop states are poorly funded i assume, since they have on or few large hospitals that accomadate your needs
The greatest fear of capitalist administrators is that there might be a slow night in the hospital and a few employees have some down time to take a breath where no “production” is taking place. The shareholders would not be amused. That’s why they staff hospitals with the bare minimum, paying them as little as possible and using them as much as possible.
A lot of people have alluded to this already, but I’ll simplify.
“We” are not OK with it. “We” are not the ones making the decisions
Hospitals and such are fine with it because they’re a business now and not as much involved in the health of the public beyond making sure they can still pay them.
Because one lunatic doctor had a cocaine addiction and could go days at a time without sleep, so he demanded the same from all his students who werent riding the white lightning, which inevitably left a deep cultural impact and expectation for everyone that followed to do the same, because “I suffered, so you suffer too”
Yeah but now they don’t even really let them have cocaine anymore so it’s just the bad parts left.
Huh, I forgot about this bit of history. What was his name again?
William Halsted if my sleep deprived memory serves me.
Excuse me, but what?
Halstead was a brilliant surgeon who decided to replace sleep with cocaine, would stay up for a week straight then berate his students for not having the same “work ethic.” Over the years it’s morphed into kind of an initiation ritual where new doctors are forced to work, ironically, medically inadvisably long shifts to prove their dedication to the job. It’s insane and has led to countless injury and deaths from sleep deprived staff, but that’s just The Way Things Are Done.
‘How does capitalism keep the unemployed on hand?’ you ask.
Simply by compelling you to work long hours and as hard as possible, so as to produce the greatest amount. All the modern schemes of ‘efficiency’, the Taylor and other systems of ‘economy’ and ‘rationalization’ serve only to squeeze greater profits out of the worker. It is economy in the interest of the employer only. But as concerns you, the worker, this ‘economy’ spells the greatest expenditure of your effort and energy, a fatal waste of your vitality.
It pays the employer to use up and exploit your strength and ability at the highest tension. True, it ruins your health and breaks down your nervous system, makes you a prey to illness and disease (there are even special proletarian diseases), cripples you and brings you to an early grave — but what does your boss care? Are there not thousands of unemployed waiting for your job and ready to take it the moment you are disabled or dead?
That is why it is to the profit of the capitalist to keep an army of unemployed ready at hand. It is part and parcel of the wage system, a necessary and inevitable characteristic of it.
It is in the interest of the people that there should be no unemployed, that all should have an opportunity to work and earn their living; that all should help, each according to his ability and strength, to increase the wealth of the country, so that each should be able to have a greater share of it.
But capitalism is not interested in the welfare of the people. Capitalism, as I have shown before, is interested only in profits. By employing less people and working them long hours larger profits can be made than by giving work to more people at shorter hours. That is why it is to the interest of your employer, for instance, to have 100 people work 10 hours daily rather than to employ 200 at 5 hours. He would need more room for 200 than for 100 persons — a larger factory, more tools and machinery, and so on. That is, he would require a greater investment of capital. The employment of a larger force at less hours would bring less profits, and that is why your boss will not run his factory or shop on such a plan. Which means that a system of profit-making is not compatible with considerations of humanity and the well-being of the workers. On the contrary, the harder and more ‘efficiently’ you work and the longer hours you stay at it, the better for your employer and the greater his profits.
You can therefore see that capitalism is not interested in employing all those who want and are able to work. On the contrary: a minimum of ‘hands’ and a maximum of effort is the principle and the profit of the capitalist system. This is the whole secret of all ‘rationalization’ schemes. And that is why you will find thousands of people in every capitalist country willing and anxious to work, yet unable to get employment. This army of unemployed is a constant threat to your standard of living. They are ready to take your place at lower pay, because necessity compels them to it. That is, of course, very advantageous to the boss: it is a whip in his hands constantly held over you, so you will slave hard for him and ‘behave’ yourself.
from Now and After by Alexander Berkman, Chapter 5: Unemployment. Available to read for free here.
Even in countries where healthcare is socialised, they are run “efficiently” like a capitalist business by administrators who care not for healthcare but for finances, “balancing the books”, and bean counting.
We’re not. But, just like AI, executives with the ideology of rapists don’t care about our consent.
Who would’ve thought that running every industry and business like mini dictatorships would backfire? Thanks capitalism!
More like the ideology of slave masters, which includes rapists plus oh so much more.
You know, healthcare jobs are the only ones I see “advertised” here in the Southwest. There are billboards for all sorts of medical careers. I’ve had friends and acquaintances talk about being a nurse as a backup career plan.
Nursing is a career path where you cannot rise to the top ranks. Nurses cannot ever rise above doctors, because the next step up is a doctor. The repeat clients in a hospital setting in the southwest are drug addicts or psych patients. The “average” person going to the hospital is going there with something severe. Not to say that everyone doesn’t deserve care, but know your patient base. Nurses are strapped in the entire shift, and being late from lunch is like being late to work. It’s incredibly stressful, and there are studies that essentially show that nurses are worked to the mental and physical limit in their lifetime.
Nurses are treated like shit, and there’s a steady stream of them leaving the profession or moving into admin positions where they’ll settle in; you’re way better off in every way to just aspire to the admin jobs with a master’s of public health. Tell your friends. You’re welcome.
i think its because GOP constantly attack healthcare funding, or it scares away potential health employees from working in those states, thats why they dont go to the red states, plus, they are now so desperate they are willing to pay MDs and some nurses to work there some bank apparently. i dont think they care about getting promotions, if thier COL is met, in many places they are making bank from just working shifts in the region(travelling nurses). i notice obesity related clinics(surgeries, do make bank there because the south is so overweight). seems healthcare quality in the south is quite lacking in non-affluent or blue areas.
My personal take is that since doctors are all paid commensurate with the cost of housing, they can go literally anywhere they want.
I’ve noticed over the years that here in AZ, many doctors here long term are centrist politically, unless they’re working for an aid organization like the AIDS foundation or a clinic that caters to the “needy”. Those that live here, want to live here. That said, the ones that aren’t in love with AZ dip out with no warning lol. Me personally, I’d move to Cali with zero hesitation. When abortion was momentarily made illegal here a few years ago, doctors just fucking left, mine included lol.
Nursing can advance quite a bit. A nurse can become a nurse practitioner, for instance. NPs can even open their own practice in some places. Or get a DNP, become a doctor nurse. Sure that pushes one more towards the admin side, but that doesn’t mean it’s removed from the world of nursing either.
But I guess one could say the same about being a physician as well. Where is there to go? It’s not really about advancing positions, but just doing more stuff that gets you paid more. Whether that be research/education/administration/specializing/whatever else.
How is nursing a backup? Are the requirements that low in the US (I’m assuming “Southwest” is in the US?)
No, the requirements aren’t that low. But there are levels of nursing. Each requiring different levels of education and licensing. From LPN, Licensed Practical Nurse the entry level that takes about a year, to RN, Registered Nurse, can take 2 to 4 years. A 4 year BS degree is a degreed RN. Then you can continue to other licensing degrees like RN-P, Registered Nurse Practitioner-- with a limited doctor scope of medicine to take the pressure off of General Practitioner doctors. And a host of specialties nurses can go into. With median wages around $90,000US. And easy opportunities to earn well over $100,00US per year.
Much of the staffing issues centers around many nurses wanting to only work 20 to 25 hours a week. I have a friend that was head of a nursing department in a hospital for many years, and she was always complaining that she couldn’t get nurses to work more than 30 hours a week. And most refused to work more than 25 hours.
With how hard nurses work, I wouldn’t work more than 30 either lol. I’m willing to bet they’re doing 3 10s, some overnight. My aunt does 3 12s in 3 days then takes 4 days off.
dint know they all wanted part time statuses, it make sense since they had to work 40+ for a long time. plus nursing seems stressfull , if you give your bosses an inch they will take a mile with your hours.
We’re not.
We’re just powerless to change it outside of our local jurisdiction.
We aren’t “powerless”. Every time we go to the voting booth we can change things a little. If people vote for a conservative party that keeps wanting to move the needle backwards to “the good old days”, this is the shit we will get: underfunded healthcare, an ever-hotter world, war in the Middle East, untaxed uber-rich, and overworked essential workers.
Most of them actually. Am a nurse and was once psychiatrically hospitalized alongside a train conductor and we really bonded over our ridiculous and yet supposedly “high reliability industry” jobs. She actually got hooked on speedballs because there’s some weird loophole in our state where the train conductors need to give something like 48–72h notice or something to take sick leave so most of them just show up for their 16h shifts fucked up on amphetamines to stay awake then benzos so the amphetamines don’t give them tachycardia and one of her managers actually basically gave her a pep talk on which doctors to go to and what to say to get them prescribed legally but given that they’re both extremely addictive substances her dosages spiraled wildly out of control extremely quickly such that she was only able to get effective doses extralegally. On the plus side though losing that job and getting shipped to the other end of the state just to find a bed got her away from both her dealer and her cartoonishly abusive ex (even a week into her stay the bruising was pretty wild). And then actually when I left the hospital my third time I met my now husband in partial although we lost touch for like a year until we ran into each other again and he helped me escape my much more subtly shitty relationship and actually graduate / get licensed (if you think nurse pay is shit I was getting paid $12.50 as a nursing assistant working with criminally insane men and that was after the promotion).
that train disaster in '23 is telling how badly understaffed purposely the trains are in america, that companies that own these are unwilling to pay for more staff, or give any time off in short notice to people. is that a CNA job? that is not even worth the stress, might as well work for a grocery chain or walmart at that point.
This was back in 2015ish, they’re probably making ~$20/h these days but still. Yeah some people had a CNA but a lot of that job was people that were unemployable elsewhere for reasons other than straight up crime (for the most part, anyway. There were a few employees with DUIs, public intoxication, etc). I was young and had found out about the job from being hospitalized there and went back because from the care I received I figured it couldn’t be that hard to be better at that job (it wasn’t, but not by as much as I would have hoped) and, most importantly, I wanted to #HelpPeople.
The upside is that job on a psych nurse resume is basically an instant callback. I might get paid shit but as long as I’m upright and don’t have too bad of a TBI I’ll basically never be jobless. I’ve gotten callbacks within 12h of applying, one of them I didn’t even finish / submit. I also graduated early into COVID then worked straight through so my resume is just overall fucking baller. If I wasn’t too AuDHD to deal with learning a new hospital every 12 weeks I could probably make bank as a travel nurse. I really enjoyed teaching self defense and restraint classes this last year so I really just need to go back to school and get my masters.
And compared to when I was young and stupid people listen when I start telling stories so that’s been somewhat affirming. It’ll probably make an utterly wild memoir if I live about 30 more years. Hubs says he wants to take me to one of those crowd work shows because siccing me on people at parties is starting to get boring.
If I recall, most medical mistakes take place over shift changes. Things like a patient getting a double dose of meds because they didn’t realize the prior shift already gave them. The idea is that minimizing the number of shift changes reduces the number of mistakes.
This is accurate. It has to do with minimizing handoff risk.
https://pmc.ncbi.nlm.nih.gov/articles/PMC7539758/
Lots of uneducated responses in this thread that are pure conjecture and drivel.
When I worked as a nurse in CA, the standard for shifts was 8 hours, we had 3 shifts in 24h. Some travel nurses took 12h shifts, but staff RN had 8s. Not saying we never made mistakes, but it can be done with proper staffing (4 patients to hand off instead of say, 7) and a culture that respects the handoff time. We did it at the bedside in most cases so the patient could hear what was going on. In CA there are strong unions advocating for patient safety, and as a result, minimizing exploitive working conditions. We were still exploited to be sure, but not like if you’d dropped that hospital in any other state without those protections. Pay was outstanding as well.
Strong unions are the answer to this problem, at least for nurses/support staff. Idk about docs and residency but that is a big part of why becoming a doc never seemed attainable to me.
As a patient I really liked bedside handoff. Because I’m supposed to theoretically be in charge of my own care, right? Can’t do that unless you tell me what’s going on.
do the travelling make more than the ones staffed in the hospitals, i heard they do in some areas.
It depends on several factors, the staffing company, specialty, etc. but yeah they probably make a little more, but there is the trade-off of longer shifts, health coverage (mine was 100% covered by the HMO I worked for), and workplace culture. But even staff nurses had opportunities for extra shifts or staying extra to make a little more money. My base pay was good enough the thought of staying one more minute over almost never appealed to me, though.
that make sense, if there is a region that is very understaffed i assume those place would pay alot more too.
Yeah during Covid you should have seen my inbox, recruiters offering like $12000 sign on bonus for 9 week contracts, like $4000 a week in rural New York or Florida. But I had fucked off to Norway by then so, wasn’t for me. And I’ll never work as a nurse anywhere but California anyway (until the other states follow suit and mandate safe staffing by law).
yeah our unit recently started a “quiet hours during handoff” policy. Patients kept coming up to the window to ask for drinks which is both a privacy thing and a more interruptions = more mistakes thing. Patients hate getting told to keep it moving but like. Trying not to kill you here bud.
I’ve never known a thirstier bunch of people until I was a nurse, and I used to wait tables. Like surely you’re not going through this much liquid at home.
That study doesn’t really address the issue here though. That study demonstrated hand-off risks. But as far as I can read, it didn’t address shift length at all. All the providers in question had 8 hour shifts.
Obviously hand-offs produce certain risks. But that’s a trivial question. Obviously changing shifts will have some negative effect as providers must get up to speed. But the right question to ask isn’t “do hand-offs produce risks?” The right question to ask is, “if long shifts are used, do the reduced medical mistakes from the shift change counteract the increased medical mistakes from fatigue and unreasonable shift length?”
Do you have any studies that show this? Otherwise the benefits of long shifts are pure conjecture and drivel.
It’s a balance between minimizing handoffs and ensuring fatigue is managed appropriately.
https://www.nurseregistry.com/blog/12-hour-nursing-shifts-pros-and-cons/
https://www.hseblog.com/frms/#%3A~%3Atext=Healthcare+has+long%2Cthe+key+benefits
Yeah but those studies are about longer shifts (12 or 13 hours), not doubles or triples as OP asked. I don’t know how common it is for nurses to have 16-24 hour shifts, but it seems like that was the original question.
The study only concludes that this manner of handing off is risky, nothing more. Going “our method of handing off is bad, so we will extend work hours and continue handing off in the same way” is piss-poor conclusion. Change the way things are handed off e.g let the physician tail the other physician for 1hour to 30 minutes into their shift, improve the data collection and data display methods to allow a clear patient status to be shown, etc.
Additionally, the study doesn’t compare handoff risk to work-length risk. You’re taking one single data point and drawing wide-ranging conclusions from it.
This is the explanation I’ve heard. It seems like someone should have thought of a better solution by now, though.
I mean, in my experience a lot of those “mistakes” are kind nurses saying “fuck this idiotic Emergency Department Physicians Assistant. Someone go get the MD. This patient is in a shitton of pain why did they only prescribe a half a milligram of relief? I cannot find the patient’s face or butt or really tell the difference to tell how much pain they are in exactly though so I will just write down a 7. Whoopsie poopsie they just got the dose twice oh no look at them they are not screaming anymore we will call treatment a success” type mistakes.
But I have also had some very excellent nurses
This! The long shift benefits the patients.
The number of hours worked per week is what should be reduced (without loss of pay).
