What do you WANT?

You may have noticed that I am not posting quite as much lately. That is because the RT Burnout Meter is about to burst through the roof. The pressure is building and the waters are getting high here at Sunny Flats, and the dam is about to burst open.

My goal is not to be standing in front of the dam when the water breaks through.

The cause of all this pressure lately is management. Specifically our managers have been under a lot of pressure to cut costs. Since we already own most of our equipment and we get most of our disposable stuff on the cheap, the only places remaining to cut costs are staff and administrative overhead. Cutting administrative overhead would be the managerial equivalent of hara-kiri, and so the only place left for cost cutting measures is…the staff.

Yes. Our management has decided that they are going to reduce our minimum staffing requirements. They have decided that instead of the 25 therapists we normally staff between the ICUs and the medical floors, they will slash our daily operating numbers to a maximum of 18 therapists, which is a 28% reduction in daily staffing.

The big giant obvious problem with this is that we have not reduced our workload by a similar percentage. So what you end up with is a respiratory care department that is chronically understaffed and overworkedeven beyond the usual. The reduction in therapists per day has affected our daily operations. While we normally staff 2 therapists per ICU we are down to about 1.5 on average; one therapist to a unit plus a couple of drifters who float between units. We have cut our ER staffing in half. We have cut floor staffing and people are routinely going out with 25, 30, 40 patients to see. This is a huge problem not just for respiratory therapists but for PATIENTS, whose care is going to suffer.

Working in the ER with 50% fewer therapists means more missed therapy, more missed diagnostics, more delays in an already slow ER. Critically or seriously ill patients are not being seen as rapidly. The quality of our assessments and interventions is diminishing because we are being asked to do the same amount of work with half as many people. I have personally been on the receiving end of rage from ER doctors and supervisors who are pissed that we are slower and less efficient than usual, and all I can do is shrug and tell them that we’ll do what we can. They hate that but it’s all I can do.

In the ICU, patients are being seen but therapists are being stretched too thin. Thorough assessments and the time to perform quality work are considered luxuries where they once were considered necessities. A distraction such as an emergency bronchoscopy or a trip to the CT scanner would once have been considered a mere nuisance. Those things now are day-killers that will put an RT so far behind that there is no hope of catching up. We can no longer be proactive members of the team; we have been reduced to running between rooms and trying to get everything done without missing something important.

On the floors…well, people just aren’t getting seen. The apathy isunbelievableand I can’t say I blame the floor therapists: there comes a point when you are so overburdened that you can no longer care.

On top of all this, management continues to add paperwork and administration to our job. We now have equipment checks to document, “safety rounds” to complete(a particularly bitter irony, as conditions are rapidly becoming less and less safe despite cubic tons of paperwork), and we must track our time in 15-minute increments as if we worked at a law firm and not a hospital.

The bottom line is this: management is asking us to do more with less and it can not be done. They can either spend money and have quality patient care, or they can cut their budget and demand more from us and get shitty patient care. Unfortunately our managers have chosen the second path. They have been warned of the errors of their ways and they have ignored increasingly frantic pleas from the staff, the doctors, and even other administrators. They insist that The Numbers work out, that it will all be ok, that we RTs are just lazy whiners. It saddens me that we have forsaken the patients and the staff in favor of The Numbers, but so be it.

I only regret that this will not change until a patient is killed or harmed by our unsafe working conditions. I hope and pray that something will change before somebody dies…

…but I am not optimistic.