The Assembly Line. Time is Money.

By: Debbie Moore-Black, RN

After 45 years as an ICU nurse with specialties in surgical-trauma ICU and eventually PACU nursing, Marsha wasn’t ready to throw in the torch.
She was restless and bored and thought she would continue her PACU expertise at a free standing surgical center. As she Juggled that job and an endoscopy center she started to realize the same theme.

Time is money.

The Endoscopy free standing clinic did colonoscopies, EGD’s, sigmoidoscopies. Up to 42 procedures a day. More endoscopy procedures per day meant more money for the system. The procedures were big money makers.

Marsha prepared the patients for both free standing centers. She would start IV’s, give meds, get their medical history, allergies and have consents signed.

After the procedures she would wait for the patient to wake up post anesthesia. She would discontinue their IV, discharge the patient, and escort them to their car via wheelchair. Other duties included sanitizing the stretcher, new linens applied and get it ready for the next patient while 2 other patients would be waiting in the PACU for Marsha to recover them.

She was responsible for making sure all systems were good. EKG rhythm. Respiratory and heart rate. Lungs clear. Patient awake and cognitive and then validating a discharge for that patient.

As we all know, we’re not created equal. Some patients take more time in recovering. Some with many co-morbidities which makes discharge time more complicated.

The supervisor would occasionally reprimand Marsha for taking too long in getting the patients discharged. She was told “you talk too much”, or “you’re not fast enough”. We have 42 patients today. The physicians will be upset if you don’t move faster.

What she realized was that some patients at the surgical center were not always ready to be discharged.
Shortness of breath, arrhythmias, surgeries lasting over 6 hours in the free standing surgical center but needing the patient to recover in 20 minutes tops.
She was called into the office again and she realized that patients were only a number. That they had dollar signs on their foreheads.

Hospitals turned into money making corporations over 10 years ago.
It was no longer valid to put the patient first.
Get them in and get them out.

And the CEO’s and Board members and bean counters behind their mahogany desks were counting. Counting the cases in record time. More patients in a quick turnover easily meant more money.

Trisha loved being a CRNA. Her expertise was in pediatrics. She was professional, diligent and considered an expert in her many years of giving anesthesia. Her little patients adored her as did the parents of these patients.
Trisha was a veteran. Old school. She knew the value of a good surgery, anesthesia and post operative time. She was quick to find anything out of place. Stalling surgery due to missed data on the patients or incorrect name bands were only a few to name mistakes. Surgeons getting angry at Trisha as they felt she was delaying surgery due to her findings that eventually would save a patient’s life.

Surgeons would never blame patients for coming to surgery late but they would easily throw blame on nurse anesthesia.
That repeated stanza: you’re not fast enough.
Though she was precise and accurate in her findings of patients, like medications not documented, uncontrollable vomiting due to chemotherapy, arrhythmias not caught or documented, she was told that she was too “picky” that some things are not a big deal. Like the name on the patient’s arm band that was incorrect but upper staff felt it was acceptable.

Trisha, after 40 plus years of her life being a CRNA decided to retire. She realized that the hospital systems she worked for were too dangerous. Too haphazard.

The blame game. Surgeons getting angry because they weren’t able to start surgery on time.
PACU managers would become upset because the anesthetist or PACU nurse were not able to transfer a patient to his hospital room or discharge to home due to complications from surgery.
Some patients were not ready to be discharged.
That theme repeated over and over again: Time is money.

And the patients that we learned to love and that we valued their health and their life, was now considered a footnote.

Nurses, CRNA’s, AA’s, Physicians, PA’s, and NP’s who felt their licenses were threatened because of lack of support from their higher ups started to leave the hospital systems.

Trisha, CRNA, retired. She sadly decided that the healthcare system had lost their roots. Their allegiance that the patient comes first.

Marsha left her two jobs and joined Hospice.
She realized that there was no “time management” with hospice.
When patients are ready to die, they’ll do it on their own time.
Instead of always wanting to save a life after so many years, she decided to hold the hand of a patient and allow the patient to comfortably and peacefully leave this earth.

The hospital systems and free standing surgeries of yesteryear were now extinct.

Trisha, Marsha and many other healthcare professionals no longer fear the stopwatch, the urgency and that assembly line manufactured by Healthcare CEO’s, Board members and their bean counters.