Work Stuff

Nursing Shortage – Bracing for Impact

Let’s talk about work –  bae-bee … (referencing this song)

I haven’t talked about work for a while so let’s bring you up-to-date on the madness that is my 40-plus hour work weeks ..

For those of you that don’t know, I’m a (reluctant) medical assistant. I say reluctant because I never, not once, as in, it never crossed my mind, had any desire to work in the medical field. I never had any aspirations to be a nurse or anything else inside the field but it just sort of happened and before long, I found myself eyeball deep in a “career” not-by-choice. If you’re interested in hearing/listening to how I stumbled into the medical field, you can click on these links: Podcast: Being a Medical AssistantI Got a Promotion! (Sort of)Accidental Health Care Career

But suffice it to say, I’m here and I’m giving my job 150% of myself. It’s exhausting, challenging and rewarding every day. I don’t see myself doing anything else (I have about ten years until I retire – but don’t quote me on that – you never know what life will throw at you), nor making an effort to be anything more than a medical assistant. (Again, don’t hold me to that).

This past year has been tough, I don’t have to tell you that. We’ve all had challenges but I’ll be honest, it’s been especially challenging for healthcare workers.

I have it easy, honestly. I work in an outpatient clinic for Neurosurgery. There are nine surgeons in my office and though I help wherever and whenever I’m needed, I work primarily for Dr. M. Dr. M’s team consists of him, his PA, his nurse, me and his medical secretary. And if you think that’s a lot of people surrounding one doctor, you would be right, but he needs all of us to handle the work load he alone generates.

He’s not special (though I think he’s pretty special – ha!), all of the doctors in our clinic have the same number of staff. Our jobs, broken down are as follows:

  • Dr. M evaluates patients in clinic and does surgery. (duh)
  • Physician’s Assistant (PA) or Nurse Practitioner (NP) compiles detailed information on patients in clinic and assists with surgeries.
  • Nurse sets up the surgeries and are available to patients after surgery to help manage post-op questions/pain and after care.
  • Medical Assistants (Me) set up his clinics (appointments, making sure patients have images and everything is ready for clinic) and clean up clinics, meaning patients are scheduled for testing and any follow up appointments.
  • Medical Secretaries help answer phones, request images from other facilities, fill out FMLA paperwork, etc.

These duties are simplified, of course, as we all have many other duties that we’re in charge of but you get the gist of what we do and what we’re responsible for.

We are a unique group. We’re not any more special than anyone else but I mean we’re unique in the way we’re set up when compared to other outpatient clinics.

Most clinics only have one nurse and the doctors have their own MA’s. Not very many clinics have both both a nurse and an MA for each doctor. Our clinic started out as an independent clinic from the hospital and that is how the doctors wanted it when they structured their practice. But then the hospital bought the practice and we integrated into the hospital structure and though the hospital wanted our clinic to get rid of the nurses (thereby saving them a ton of money), the doctors said no and kept their nurses.

I’m very thankful for that fact as again, I wouldn’t want to be my doctor’s sole “go to” clinic person and quite frankly, I don’t want that responsibility.

COVID changed the way we see patients. Our doctors never once even entertained the thought of offering Telemedicine visits. But then COVID hit and we were left with the challenge of how are we going to keep seeing patients, thereby keeping everyone employed and generating money for the hospital by continuing to do surgeries if we weren’t allowed to actually SEE anyone?

Enter, telemedicine.

To say it’s been a challenge, and continues to be a challenge, would be sugar coating it. I have grown to hate Telemedicine with a passion. At first, I loved it – I didn’t have to actually deal with patients in-person and it was a challenge. Now, I’m over the challenge and frustration and I’m MORE than ready to go back to in-person visits. But alas, my doctor is not ready for that and he continues to insist on only offering Telemedicine visits. So. I continue to grit my teeth and practice more patience that I ever thought I was capable of and somehow we get through the technical difficulties of Telemedicine.

There have been times, (and continue to be times), I just want to throw my headset down and walk away. Seriously. I can’t tell you the number of times I have allllllmost walked out. Screw this, I can make more money at Hobby Lobby and have a lot less stress. There have been times, (and continue to be times), that I want to throw my laptop through a window, but of course, I haven’t. I have stayed because ultimately I didn’t want to upset and disappoint my team. I’m quite attached to them and I genuinely like them. It’s a good thing too because honestly, and I’m being dead honest here, I would have left a long time ago if I wasn’t so attached to everyone.

We’re now to a point that I’ve gotten pretty good at Telemedicine visits. I have clawed my way through troubleshooting moments and I can pretty much talk a patient through anything. The only line I draw is when a patient tells me they don’t know how to access his/her email. If you don’t know how to access your email, I can’t help you. I’m done. My doctor continues to insist on Telemedicine visits and doesn’t want to see anyone in the office until the vaccine is being widely distributed to the general public. I can respect his decision but it doesn’t mean I have to like it. Luckily, or unluckily, due to the rising cases of the disease and the fact that we’ve had 150 patients with COVID in the hospital and a number of employees out because of being positive for COVID, it hasn’t been a hard sell at this point. However, there will come a time that selling Telemedicine to patients will become harder and harder. I don’t think Telemedicine will ever go away entirely, it’s really handy for patients who live hours away and it saves them a trip to town, but locals will not likely accept it as easily.

But I’ll cross that bridge when I come to it. We’re not there yet.

My nurse and her entire family had COVID. She was out for three weeks. She was very sick for about two weeks of it and too weak to come to work the third week so she worked from home. That was a long three weeks for me and gave me a small taste of how my working life would be different if we didn’t have nurses.

I could handle it. It would take some (major) adjusting, but I could do it. I couldn’t do all of it, obviously, I’m not licensed and do not have the authority to give medical advice when it comes to medications but I could certainly put in meds in a patient’s chart with the PA’s guidance. And I could learn to put in surgery orders. But I wouldn’t have the knowledge to round or visit patients in their rooms nor the knowledge to give medical advice to patients with various medical issues. Not having a nurse could be done but thankfully, we don’t have to deal with that.

But with that said ….

We are about to be down five nurses. F.I.V.E. We currently have nine nurses, one for each surgeon, well, ideally we have nine nurses. We’ve been down two nurses for quite some time. Another one quit (being a clinic nurse is not for the faint of heart), another one is going PRN (which is Latin for “as needed”) to go to nurse practitioner school and another one is retiring.

Big deal, you’re thinking, just hire more nurses.

Sounds easy, doesn’t it? Except the big challenge is – we haven’t had any applications. NOT ONE. And the positions have been posted for MONTHS. In fact, when speaking to the charge nurse on the floor we send our patients to after surgery, she hasn’t had any applications, either.

There are simply no nurses to be had.

I don’t know if this means there is a nursing shortage overall, or if every available nurse out there is being utilized to take care of the influx of COVID patients.

Maybe both.

When speaking to my nurse about this, she poo-poos the notion that there might be a nursing shortage.

According to the American Association of Colleges of Nursing site:

I think a lot of people who thought about going to nursing school has declined in recent years because of the threat of socialized medicine programs (which means less money and more work), the cost of schooling, which has skyrocketed in the past few years alone, and the fact that most people want a quick buck and don’t want to work for it and let’s face it, nursing is HARD.

So yes, I think the nursing shortage is going to be more keenly felt now more than ever – COVID just pushed it down the hill much sooner than anticipated.

Once again, screw you COVID.

All of this to say, we’re coming up on yet another hard curve in the working road. Hopefully, we can take the turn slow enough that we don’t skid off the side and careen down the cliff exploding at the bottom into a fiery ball of skin and bones.

How’s them visuals?

Our clinic is finally fully staffed with medical assistants. There for a while, we were down a few MA’s and we had to all work together to cover each other. But now, it’s the nurses’ turn to be short staffed and we’re going to all have to work together to help them out as much as we can. Each nurse is going to have to consistently cover two doctors and that is going to take a lot of patience and cooperation from us.

It’s so weird, because this situation used to be exactly opposite. We couldn’t find decent MA’s for YEARS. It wasn’t a field that people went into, let alone really knew about. And many people think you have to go to school to become an MA – not true. A lot of places will hire you and train you on the job – at least, it used to be like that. But now that more people are going into the field, employers might be a little more choosy on who they hire and NOT hire someone who hasn’t had any schooling.

Being a medical assistant isn’t hard, but you do have to have a lot of patience, superior multi-tasking, communication, and time management skills, If you’re not very good at juggling several balls in the air at the same time, being a medical assistant is not the job for you. I’m just keeping it real.

So. Once again, our clinic is getting ready to enter a challenging time. It’s rare to have a time period where everything is going great and we’re fully staffed before one domino falls over and before long, we’re scrambling to rebuild the entire thing. But I supposed that is the case for every industry in one form or another.

Anyway. All of this to say, that’s the biggest reason I haven’t posted in a while. I’ve been busy working overtime and filling in for my nurse. But now that my nurse is back, the challenge has shifted and who knows how much I will be needed with the upcoming nursing shortage.

I guess, all we can do is live our lives one day at a time, right?

I can say this for our clinic though, we are a tough crowd. We have been through some CRAZY hard transitions over the years and most of us are still standing. Yes. We’ve lost a few people over the years but the majority of us have stayed.

That says a lot about us, I think.

Politics

Another Lockdown?

The thought of another lockdown makes me physically sick.

If you haven’t heard, France, Germany and I think Belgium is locking down for a 2nd time. It’s because the number of COVID cases has risen substantially. And hospital admissions have gone up.

Here’s the thing …

So what?

I don’t mean to sound callous, that is not my intention, but COVID is not going away. Neither is the common cold or the flu. It’s something we must live with and thankfully, thank GOD, contracting COVID doesn’t mean a death sentence for most people, in fact 99.9% of people fully recover.

But when the media reports on such-and-such number I think people automatically assume that means deaths. No. That means these people test positive for the illness, it doesn’t mean they have died or are going to die. The numbers are not great. But I’m betting the numbers for cancer, heart disease, pneumonia are not great, either. It’s another sickness that we must learn to adapt to and live with, unfortunately.

I get why these governments are locking down, especially if the hospitals are close to capacity, but instead of shutting everything down, how about we erect temporary units to house the overflow? Because hiding from this thing only prolongs the inevitable – IT’S. NOT. GOING. AWAY.

I even talked to a patient the other day who said he has had COVID twice. Apparently, there are six strands of COVID, so it’s possible to get this thing again. So logically, does it make sense to hide from six different monsters? Eventually, you’re going to be caught. And since it’s not as deadly, overall, as the “experts” first thought it was, how about we go about living our lives and allow this thing to burn off? Why must we disrupt people’s lives again?!

And I want to know who the hell is testing for COVID? It annoys me when I hear on the radio a call to action – “come to the fairgrounds and be tested for COVID – FOR FREE!” What? Why? Are you curious? If you feel sick, stay home. Why must anyone test for COVID? The only time I understand being tested for COVID is if you’re gearing up for surgery, or you’re sick and your doctor recommends it. Who are all of these people getting tested?? To me, it sounds like this: “Come on down and get tested for COVID! Our numbers are down and we must get them up so we can continue scaring the crap out of people and we need to keep this momentum going so that we can more easily control them.”

That’s what I hear whenever I hear announcements about “free” testing. I just don’t get people going to a drive-in testing spot to be tested. I’m not that curious, thanks.

I hope I’ve had it. I want to have had it so that I can go about my business. But unfortunately, it doesn’t work that way.

It’s likely a matter of time before someone from our clinic gets COVID. Actually, that’s not true. We’ve already had a few people in my clinic come down with the virus. They stayed home and they are back to work.

As with any sickness, it sucks and no one wants to be down and out but being sick is part of being alive. I don’t understand our unwillingness to just treat COVID like we do the flu. Be careful. Wash your hands. Don’t touch your face when you’re out. Stay away from people who are hacking out a lung or sneezing. We should all be doing these things anyway. COVID is really not that special. Not now. And again, I’m grateful for that. But we need to stop thinking of COVID as a death sentence. It’s no more a death sentence than coming down with the flu. Here is what to look out for:

Symptoms may appear 2-14 days after exposure to the virus. People with these symptoms may have COVID-19:
Fever or chills
Cough
Shortness of breath or difficulty breathing
Fatigue
Muscle or body aches
Headache
New loss of taste or smell
Sore throat
Congestion or runny nose
Nausea or vomiting
Diarrhea
Look for emergency warning signs for COVID-19. If someone is showing any of these signs, seek emergency medical care immediately:
Trouble breathing
Persistent pain or pressure in the chest
New confusion
Inability to wake or stay awake
Bluish lips or face

Sound familiar?? That could literally apply to any other disease out there. Now, if it was common to bleed from your eyeballs or you were expected to die within 24 hours of contracting it, we would be having a vastly different conversation, but those are not the symptoms. We are destroying ourselves for THIS??

France has gotten so strict with this new lockdown that you must present a certificate of permission to leave your house.

Dude, what the hell?! Who wants to live like that?? Well actually, most of the French people don’t want to live like that, as a matter of fact. And they were so anxious to leave the city after the announcement that traffic was blocked and backed up for 400 miles. People were rushing around getting their haircut because hair dressers, once again, will be not allowed to operate. And the stores were ransacked because people once again went to the stores in a panic to buy toilet paper. Which sounds stupid on the surface but dude, if you have to have a certificate to present to the police, if stopped and questioned and you want to avoid jail time or a fine, I would be buying toilet paper, too, because who knows when you’ll have permission from the almighty government to go out and get more.

This is madness. I don’t know what else to call it. We have crossed over the threshold and are now living in the Twilight Zone.

And you can bet your bottom dollar if Biden wins, America will be implementing the same Draconian measures as the French have done.

If that doesn’t concern you then IT SHOULD.

Roman Catholic Archbishop Carlo Vigano wrote an open letter to President Trump where he warned of an initiative of the World Economic Forum that has emerged in reaction to COVID-19 for a “Great Reset” of capitalism and a “health dictatorship” to combat the virus, warning the plan threatens the sovereignty of nations and religious freedom.

“Vigano wrote a letter to Trump in May warning that the COVID-19 pandemic was being used to user in a “world government” stripping people of their freedoms. We see heads of nations and religious leaders pandering to this suicide of Western culture and its Christian soul, while the fundamental rights of citizens and believers are denied in the name of a health emergency that is revealing itself more and more fully as instrumental to the establishment of inhuman, faceless tyranny, Vigano wrote.” Source

In other words, Vigano is saying that government leaders, from all over the globe, are using this pandemic as an excuse to get rid of capitalism and to implement a world government. And they are continuing to use fear to manipulate people into submission. It’s sick and wrong and it frustrates me that we the people have been reduced to a rat running a maze waiting for the next buzzer to train us how to react and where to go.

It must stop.

I don’t know the political climate enough to give advice to France but here in America, we have to start putting our foot down. Stand up and say NO MORE. Stop allowing these power-hungry politicians to dictate our lives. COVID is not that bad – again THANK GOD – but we know enough about it now to learn to live with it and combat it if it happens to come knocking on our door. Hiding from it and living in fear does nothing but destroy us. And for what?? The virus remains and will continue to remain for quite some time.<

It’s not going away any time soon.

I don’t say that to frighten anyone but we have to face facts.

And Dr. Fauci says the first vaccine will not kill the virus, it will only prevent symptoms. Again, let’s be realistic about this. The flu vaccine? It doesn’t kill the virus, it simply tricks your body into thinking it’s already had it so if you’re exposed, the symptoms you experience will be minimal.

The same thing with COVID.

And by the way, I know Dr. Fauci is simply doing his job but I’m OVER his continued fear mongering. Give it a rest, Fauci.

The Daily Mail reports: US reports single-day record of 88,500 coronavirus cases with states like Illinois nad North Dakota reporting all-time highs – but one NYC hospital says death rate for severely ill has fallen by 70%.

Again, GOOD NEWS. And that 88,500 record number of cases are CASES, NOT DEATHS. I really think that is what people are seeing when they see headlines like that. And the death rate going down makes sense to me because we know more about the disease and we have medications for treatment.

Let’s take a breath and stop allowing the media to scare the bejeebus out of us.

And if you want to wear a mask, wear a mask. I don’t care. However, again, what’s the objective here?

Control.

Continue reading “Another Lockdown?”

In the News

My COVID-19 Experience and Thoughts

“In the face of a novel virus threat, China clamped down on its citizens. Academics used faulty information to build faulty models. Leaders relied on these faulty models. Dissenting views were suppressed. The media flamed fears and the world panicked.

The current coronavirus disease has been called a once-in-a-century pandemic. But it may also be a once-in-a-century evidence fiasco.”

Two questions: how did we let it go so far? And what can we do to ensure it doesn’t happen again?

How are you, really? This whole Coronavirus experience has been a bit of a shit storm, wouldn’t you agree? I feel like I’m stuck in a Draconian nightmare and I can’t seem to wake up. There is light at the end of the tunnel, so we’ve been told, but I wonder how getting back to normal is going to actually work. Our government has dug us into a hole, I’m not sure I trust them enough to get us out of it. And the longer we put off opening our country, the harder it’s going to be to dig ourselves out.

My head is spinning with so much data and thoughts about things I’ve heard and watched that I truly don’t know where to start, so I guess I’ll just start at the beginning. Please note, these are my thoughts and opinions. These thoughts in no way reflect how the hospital I work for, nor the people I work with, think or feel. This is my experience, it’s unique to me, everyone has their own unique experiences. You are free to disagree, it’s okay. We can agree to disagree. In return, I will work hard to remain fair and objective about this whole situation as the goal of this post is to record my thoughts and experience and to hopefully give you another perspective, or, to perhaps confirm thoughts you have but are too scared to admit out loud.

And isn’t that a sad state of affairs when you are afraid to voice your thoughts for fear of being attacked and ostracized?

Here’s how it began for me: This nightmare for me began the week the doctor I normally work with was on vacation with his family. He was out-of-the country. Two days into his vacation, shit hit the fan. The COVID-19 scare began and since none of us knew what it was or how severe it would be, we all freaked out, myself included. But still, I’m the sort of person who tends to downplay something, to not panic, until facts present themselves and the situation truly turns dire. THEN I would panic. But I would lying if other people’s fears didn’t affect me. What exactly are we dealing with? How serious was this virus? The fact that no one had ever seen anything like this before, and it was HIGHLY contagious, was … concerning.

The hospital responded the moment it became a pandemic. Most of the entrances were shut down leaving two main entrances and the ER open. We had to stop and have our temperatures taken and elective surgeries were shut down. The hospital also published travel restrictions stating that if you had traveled outside the country you had to be quarantined for 14 days either using ETO (which is estimated time off) or unpaid time, regardless of whether you tested positive for the virus.

When the cases exploded in New York, the hospital put up a tent outside of the ER and patients had to be screened for the virus in the tent first before they were allowed into the tent. (That tent is still up, by the way). A local business donated money to the hospital and they built a COVID wing in preparation of COVID patients. To my knowledge, they’ve only had a few patients use the wing, thank God.

(Update: that wing is about half full now and has been consistently half full for a few weeks now).

We all started worrying that the hospital wouldn’t allow our doctor back to work since he traveled out of the country. We were super worried when the hospital starting furloughing employees – they gave us the option of either working from home, if we could, or staying home using ETO or unpaid time. The hospital’s response to all of this was to try and protect the employees, which was actually pretty great – they worked very hard to put employees in other departments in order to try and avoid sending anyone home because let’s face it, who can afford to stay home without pay?

Oh right, millions of non-essential workers, that’s who.

I don’t know how, and it’s really none of my business on the details, but the hospital allowed my doctor to come back to work. Never one to be idle, he and his mid-level started coming up with a plan B because when he returned, we were essentially shut down and not seeing patients – at all. God bless my team because they come up with a plan to keep people working: They suggested Telemedicine.

I have worked for this clinic for almost nine years and we have never, not once, ever considered offering Telemedicine visits. It couldn’t be done, we were told. Our doctors needed to examine the patients to determine if surgery was a viable option for them. But now, given the option of either trying it or doing nothing, my team started really breaking down the details and asking questions on how we could make it happen. We were willing to try anything at this point, anything to keep the lights on.

We were especially motivated because we were hearing stories of entire departments being shut down simply because we weren’t seeing patients outside an emergent situation and we were scared we would be the next department to get the ax. We hurriedly came up with a plan and started using a program that worked, but was sort of clunky. But again, at least we were moving forward and not sitting idle. We then quickly shifted to using Microsoft Teams since it was a program that the hospital had purchased a license for and if it wasn’t for my lovely nurse and an administrator figuring out the details, how it worked and how it should all come together, we probably would have been told to stay home sooner.

Patients were reluctant at first. And setting up the visits was pretty stressful at first, but we have since figured it out and have come up with enough troubleshooting solutions that we have a pretty good handle on it now. However, it was slow going and instead of seeing 40 patients a week, we were seeing about twelve. And not all of the doctors were on board with this option at first. A few of them fought the option and refused to participate which ultimately led to management calling an emergency meeting letting us know that they were going to have to ask all of us to stay home at least one day of the week – we could use ETO or just not be paid.

It was a sobering meeting and one I will not soon forget. We all gathered in the main lobby, all standing six feet apart, of course, looking serious and crestfallen knowing what was coming but not sure how it would logistically pan out. Our director had tears in her eyes when she told us and though it was shocking to hear it was happening, none of us were surprised. We all saw it coming, and honestly, we were more surprised it hadn’t happened sooner.

When this was asked of us, the providers that weren’t on board with Telemedicine were suddenly on board. I think they felt bad for us, quite frankly. Even though it was in no way their fault, I think they felt a bit responsible for us because let’s face it, our jobs are solely dependent on how many patients and surgeries they do.

Fortunately, this new “normal” only lasted two weeks. Since we were one of the last departments to make any staff changes, it happened shortly before the hospital started allowing elective surgeries again, which was the first part of May. In the meantime, patients started being more receptive to the whole Telemedicine thing and we were “seeing” more patients at one time. In fact, in some ways, it’s been working out better than actually seeing patients in the office because it’s allowed us to really focus on the patients that truly need to be seen for various problems. I know my doctor has been getting quite a few surgeries and he’s been very happy with the process so far. And to be fair, I think the patients have been happy with it as well. My doctor has the ability to share his screen with his patients and he’s able to pull up their images and go over them with the patients so the patients can see what is going on with their spines. Our mid-level has thought of creative ways to do exams over web cam and except for being able to do vitals on the patients, honestly, our process hasn’t changed all that much. I mean, it has, but we have just found a new way to treat patients.

As of this post, the tent is still out in front of ER, we are still only seeing patients via Telemedicine but the city and the hospital are getting ready to implement phase 2 of this process starting June 1st, which means we can see a handful of patients in our clinic but everyone has to wear a mask and we have to space the patients out in the waiting rooms and/or put them in an exam room as soon as possible.

Though we’ve been given the green light to do so, my doctor doesn’t want to see patients in the office yet. He would prefer to only still do Telemedicine which … is fine with me, it means I have a job and it keeps the lights on, but it is a lot of extra work on my part to get it set up because it’s not a quick get them on the schedule and be done with it, a two minute phone call turns into ten minutes, then I have to put them on the Teams schedule, then the normal schedule. Then I’m on the phone with them on the day of their appointment for 15 minutes updating their chart and talking them through establishing a connection. Our doctor doesn’t want to start seeing patients in the office until we have a vaccine, but let’s be honest, that could be 18 months from now, or never, quite frankly. I’m sure he’ll cave once he sees his partners allowing patients back in the office. But who knows, I’ve gotten so good going with the flow lately that I’m sure I’ll deal with whatever new challenge is thrown at me next.

Now on to my thoughts about this mess …

Continue reading “My COVID-19 Experience and Thoughts”