I know that ridiculousness probably is not a word. It should be. Our census was horribly low this weekend. By the time I left tonight we had 9 patients. 9 on a floor that holds 22. We had 4 nurses today, which for a floor that does total care makes it a little difficult to find someone to help you when you need an extra set of hands for a boost. Most of the time ICU is begging us to send someone home so that we can take someone, but we are packed to the rafters.
So since we had nurses on standby in case of admissions we were praying for cardiac rain. Doing rain dances. Those of us who were scheduled in the next couple of days and didn't want to get cancelled were making bargains with children future or not.
And what shows up in the ER? Ingrown chin hair. Patient concerned about mole on leg. A bike vs skateboard accident. Undescribed male genital problem. Any chest pain you ask? Yep, 28 year old female. Did they admit? Of course not.
Like I said ridiculousness.
Showing posts with label cardiac patients. Show all posts
Showing posts with label cardiac patients. Show all posts
Sunday, July 19, 2009
Sunday, July 12, 2009
Where have all the PA's gone?
The big HMO across town has decided to open their own cardiac surgery program so that they don't have to keep paying other hospital systems to manage the care of their cardiac patients. As a result they need skilled staff to work on these units and to work with the surgeons that they have lured to run this program.
As a result they have agressively recruited the Physician's Assistants that work with our Cardiac Surgery group and have apparently made offers that are very hard to resist. Near impossible it seems as most of our PA's have jumped ship, leaving us with a measely 3 PA's.
You may not think that this would be a problem, but look at it this way. For every surgery there is a PA scrubbed in to assist. We have 3 Cardiac Surgeons, one of which has been known to do 3 cases a day. We have 2 cardiac OR's, so we are capable of doing simultaneous first case OHS. On any given day 2 of the surgeons will schedule cases, and the third will have office hours. A PA has to be available in the office for wound checks and suture removal, and another PA will round on patients in the ICU and on the floor, writing orders and taking pages from nursing staff. They will also round with the surgeon to address any current concerns.
Is it starting to sound as if the PA's are being spread a little thin? On top of that, about 6 months ago the physicans stopped taking their own overnight call for routine matters and started funneling calls through the PA's first. If the call was for an acute matter, the surgeon would then be notified, but the PA would be notified first. The PA's received no extra compensation for this new responsibility.
While I never understood why the physicians took all of their own call in the first place, I think that the call issue is the major reason that it was so easy for Major HMO XYZ to sweep in and recruit 4 of our 7 PA's. One of the PA's that just left said that any time that they spend working while on call is paid for at an hourly rate in addition to their salary. I have also heard that our physican group made no counter offer to keep the PA's that left.
I hope that they do something soon. The PA's that are left are visibly tired. They are taking overnight call every 2-3 days, in the OR almost every day plus trying to cover all of the patients in the hospital plus all of the clinic patients. This is a recipe for bad, bad things..... and I will be watching orders carefully
As a result they have agressively recruited the Physician's Assistants that work with our Cardiac Surgery group and have apparently made offers that are very hard to resist. Near impossible it seems as most of our PA's have jumped ship, leaving us with a measely 3 PA's.
You may not think that this would be a problem, but look at it this way. For every surgery there is a PA scrubbed in to assist. We have 3 Cardiac Surgeons, one of which has been known to do 3 cases a day. We have 2 cardiac OR's, so we are capable of doing simultaneous first case OHS. On any given day 2 of the surgeons will schedule cases, and the third will have office hours. A PA has to be available in the office for wound checks and suture removal, and another PA will round on patients in the ICU and on the floor, writing orders and taking pages from nursing staff. They will also round with the surgeon to address any current concerns.
Is it starting to sound as if the PA's are being spread a little thin? On top of that, about 6 months ago the physicans stopped taking their own overnight call for routine matters and started funneling calls through the PA's first. If the call was for an acute matter, the surgeon would then be notified, but the PA would be notified first. The PA's received no extra compensation for this new responsibility.
While I never understood why the physicians took all of their own call in the first place, I think that the call issue is the major reason that it was so easy for Major HMO XYZ to sweep in and recruit 4 of our 7 PA's. One of the PA's that just left said that any time that they spend working while on call is paid for at an hourly rate in addition to their salary. I have also heard that our physican group made no counter offer to keep the PA's that left.
I hope that they do something soon. The PA's that are left are visibly tired. They are taking overnight call every 2-3 days, in the OR almost every day plus trying to cover all of the patients in the hospital plus all of the clinic patients. This is a recipe for bad, bad things..... and I will be watching orders carefully
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