Picture that you are an operating room nurse going about your day, doing cases, preparing for the next case, taking patients through the entire process of the case, induction of anesthesia, case, emergence from anesthesia, and taking patients to the recovery room. The entire gamut.
Suddenly management appears with what seems to you to be a new nonsensical rule.
Let’s use the example of not having bottles of saline in the warmer above 104 degrees Fahrenheit.
They leave you to your own devices.
You continue on with your shift, cases, lunch, more cases. The usual, you know.
When suddenly a surgeon says out of the blue that they wish the saline that was being used to wash out this patient’s abdomen were a little warmer. They don’t think that 104 degrees Fahrenheit is warm enough. After all, the saline doesn’t feel warm to their gloved fingers. Everyone knows it cools off during pouring and as it sits in the pitcher on the back table. Can’t they just have a little warmer saline? For the patient.
The work-around is used to circumvent the rules. Because the rules don’t make sense to you or to your coworkers. You think to yourself, why should the saline only be at 104, the blankets are heated to 130. I can just stick the bottle of saline in the blanket warmer. The patient will be warmer, the surgeon will get off my case, and everyone wins.
You continue to put the saline bottles in the blanket warmer. The surgeon is happier. Because what is the harm?
That’s the lure of the work-around. Standing up against the nonsensical new rule. Or finding a way to do a task a little faster than the last time. It can feel good to find a useable work-around, kind of like a dopamine hit.
But…
You have to consider why the rules exist. In the litigious realm of healthcare, it usually is because someone fucked up. Somewhere else. And the powers that be overreacted and made a new rule. But the rule is impacting you now. However, consider the possibility that there is danger behind the rule and that management and leadership are trying to protect you and the patient.
Going back to the saline bottle that has been warmed, routinely, 26 degrees more than the rule says. Ever consider that the rule change wasn’t arbitrary? That warming the bottles to 130 degrees had the potential to cause real and considerable negative impacts on the patient. Maybe it was discovered that the plastic of the bottle leached into the saline and therefore into the patient at temperatures above 120 degrees. Maybe there had been a reformulation of the bottle’s chemical formula that let this happen and the company found out about it and was just trying to protect the patient.
Is this scenario unlikely? No, more than likely.
Are the kudos and the dopamine you get from the surgeon enough to risk the patient?
That is why work-arounds, although sometimes useful and needed, are dangerous. Rarely do they give up all the facts when making a change, they may not even think about it because they, as leadership and management, know the reason behind the change. I’ve only met a few management-type people who offer up the reasons behind the change, instead of taking the hard line of “because I said so.”
Even before I went back to school I was always the one who needed the data behind the decision. Nothing has changed.
After all, the patient on the OR table is the reason for our job.
Dispatches from the Evening Shift 