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Saturday, November 29, 2008

Rules must be enforced with common sense

Some people take things in stride & prefer to use their individual freedom to solve problems. Some people are tense and have so many rules that in order to keep them happy you have to follow all the rules.

I think some rules are important, but too many rules merely take away individual freedom. And, absent individual freedom, new innovations are stifled. In my humble opinion, this merely stifles creativity.

One of my co-workers took what I thought was a great idea and to the bosses, who promptly heralded it and then brushed it under the carpet. Five years later the promised changes have still not been made.

In essence, my co-workers, tired of being ignored eventually decided to keep their mouths shut and "grin and bear" the status quo. The result here is a bunch of happy workers with no one willing to stand up to fix problem areas. Hence, you either hear grumbling in the RT Cave or, in my case, facetious RT Cave humor.

I hear this a lot: "Why should I go out of my way to share my ideas to make the department better when all I get is ridicule or ignored?"

My co-workers, and myself included, and perhaps even you, are written up when we make serious errors. Of course even the gravest errors are learning experiences, assuming we don't repeat them. Those are acceptable write ups.

Major write-ups are rare. Yet pidly write-ups seem to be a common feature here in the RT Cave. And that, my friends, is one of the problems of working for a small town hospital. Most bigger hospitals have bigger fish to fry, so creating rules for paltry things is not a priority.

One of the best parts of working nights is the freedom of working by myself and prioritizing therapies. Still, the powers that be that set and enforce the rules can make life very stressful for you when they come in and tell you all the "minor" rules you broke, like forgetting to chart, "No treatment indicated" for a prn order.

I say this knowing my greatest priority is not giving treatments that aren't' needed, but saving lives. But, when it comes to the bosses of small town RT caves, they have little else to think about than the things that the larger hospitals WOULD brush under the carpet and not worry about.

That is exactly why large hospitals have protocols that allow us RTs to decide who needs our therapy and who doesn't. Smaller hospitals need the money from all those frivolous therapies to stay in business.

So, the whiny RT says, "Hey, boss, that treatment isn't needed. That patient has never had a bronchospasm in his life."

The boss says, "Whiney, if the doctor ordered it, it's needed."

Hence, whiny finds solace complaining about the "stupid rule," as opposed to making an effort to change it. Still, in my opinion, it's better to be humble. Take your lickin' and keep on tickin.

Whether you like the beast of politics or not, it shows its ugly head around every corner. So you might as well just grin and bear it. Even if it's rules that take away our individual freedoms.

So, I suppose you wonder what my point is. I simply think bosses should think about the rules they make, and have a little leeway in how they enforce the piddly ones like, "Did I dot all the i's and cross all the t's."

Or, said another way: they should encourage a little common sense.

I say this because I'm certainly not going to rush upstairs to do the seven treatments that are due on people who have never had a bronchospasm in their lives, when I have a patient who really does need me in the ER.

But that's common sense.

It is true that absent rules people are lazy. Yet rules must be enforced with some common sense. And that, my friends, is the thought of the day.

Note: The leading hospitals in the world did not get where they are today by stifling creativity.


Trauma Junkie said...

That sounds awful. A few things are different than what the RTs are used to where I work. The RTs can decide whether the treatment is indicated and use their judgment when deciding whether or not to administer it. After all, isn't this why you guys are considered "therapists," and no longer referred to as "techs." One of the RTs at work that the difference between a therapist and a tech is that if both were flying in a plane, and an alarm started going off in the cockpit, the tech would say, "The alarm is going off," but the therapist would know how to fix it. Lol. (I really don't mean to offend anyone by this...not talking about CRT's-- but the older CRTT title).

For some reason, I can hear all of this and still want to be an RT. What does that mean? lol

Freadom said...

Awesome analogy Trauma Junkie. I might have to use that some day. This was not meant to be a knock on the profession. It's more of a wake up call. Like, come on! We have all this knowledge, all this experience, and yet we aren't allowed to use it because the admins are more concerned with making money, and keeping doctors happy, than doing what's right.

Freadom said...

Here's a good example. I have a friend who works for Big City hospital. He said he never gets noes because he forgets to chart a prn treatment wasn't done. "There are more important things to worry about there," he said. At Shoreline, however, you get written up because of this. That's not right, but how it is.

InterNetStar said...

As an RT in training in SE Michigan, I hear from our instructors (ALL the time) about how far behind MI is with regard to treating RCP's as Professionals!

Michigan is one of a few states that (for the most part) RCP's do not intubate.

Sad to say, but, if the trend of being caught between a PCT/PCA and a nurse (and closer to the PCT/PCA) continues in Michigan for RCP's - me and my fresh degree WILL head for another state....