Life in Emergistan: Lessons for Administrators: Pay Nurses More, Don't Bring Us Doughnuts, and Back Off! : Emergency Medicine News

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Life in Emergistan

Life in Emergistan

Lessons for Administrators: Pay Nurses More, Don't Bring Us Doughnuts, and Back Off!

Leap, Edwin MD

Emergency Medicine News 44(12):p 1,29, December 2022. | DOI: 10.1097/01.EEM.0000904596.76811.fb
    continuing education, hospital administration

    If you work in a hospital that is part of any health care system or for any staffing company (and between the two, that's most of us), you're familiar with the continuing education lessons that regularly show up in your inbox.

    “Dr. X. Please don't forget to complete your latest education module on (topic).” It's also a thing for nurses, who are often seen between patients and crises trying to catch up on what seems like endless continuing education.

    Some of these are benign enough. Learn to use the fire extinguisher; that's reasonable. Updates on stroke care are timely. Bloodborne pathogen training is a staple. Sepsis care is always relevant because it seems like every other patient meets the sepsis criteria.

    Others are more about codes of behavior, sensitivity, or reminders of how to be courteous. “Remember to smile and look your patients in the eye.” (“Remember not to make sudden moves, and don't leave food or drugs lying around.”)

    From what I've seen, if there is a productivity bonus for those who create mandatory lessons for physicians and nurses, then business must be good. I suspect that some of these stem from surveying bodies or state boards or who knows what. But it sure seems like you can't catch up with the mandated education passed down from those in offices who know what you need to know no matter how hard you work or how much time you spend at the bedside accruing knowledge and experience.

    But as they say, if you can't beat ‘em, join ‘em. So, I'd like to use my years of experience to offer ideas for a few modules that might be beneficial in the current, rather discouraging state of affairs.

    Module 1: Finding beds for EMS patients when there aren't any beds to be had. I recall being reminded during the pandemic that EMS should not have to wait for beds, and that we should find beds if there are none. Even when all the rooms and halls are full. I think that could be a very helpful guide. I trust someone smarter than me is working on it by manipulating the space-time continuum.

    Module 2: Arranging transfers when all hospitals in a 250-mile radius are full, and there aren't any ambulances. Admitting physicians frequently tell me they aren't comfortable with a patient and that said patient should be transferred to a higher level of care even when there aren't any places to send them. Administration generally agrees. And basically says, “Good luck!” I'm open to suggestions on this one. (Let's see; if Timmy has 100 beds and 200 patients....)

    Module 3: Ensuring that antibiotics and fluids are given within the proper time for sepsis when your nurses each have 10 patients. This is pretty tricky, especially because the nurses are already worn to a frazzle and the charge nurse has that expression that seems to say, “I will shank you if you remind me again.”

    Module 4: Being kind and professional to the patient who calls you profane names. A nurse I work with was recently called a wench. I didn't know we were still talking like pirates! Everyone knows that violent assaults and episodes of verbal abuse are way up. Learning to embrace the abuse would be a very helpful lesson. Or maybe learning to embrace the abuse without developing PTSD or going home to another bottle of Chardonnay. That's a more specific way to word it.

    Module 5: Clever places to hide your food and drink when surveyors are in the building. As if we need a lesson on this, right? We pretend not to eat and drink, and they pretend not to know that we eat and drink. Then they drive away, and we all pull a bag of Reese's Peanut Butter Cups and an entire pizza out from under our desks.

    On the other hand, I could probably make some of these for administrators who might be interested in doing mandated education while they are trying to get things done at working lunches.

    Module 1:The mathematics of throughput times in a department where people are literally being treated and discharged in the waiting room. And why you need to BACK OFF.

    Module 2:Carbs aren't the answer to PTSD. Understanding why doughnuts don't seem to comfort people who have spent 12 hours watching people die.

    Module 3:Why do nurses and physicians cry in their cars? Finding creative ways to solve emotional crises arising from stressful work (and maintain productivity).

    Module 4: Videos of people being attacked and nearly killed at work. A short lesson on how some people are actually dangerous and why staff keep asking for more security.

    Module 5: The remarkable complexity of mental illness. Why restraints are sometimes the only possible solution to keep everyone safe.

    Module 6: Money talks. Paying nurses better so that you don't have to pay even more for travelers. This one is pretty confusing in its profound and subtle simplicity.

    Module 7:The patient is the human being on the stretcher. A short reminder that the computer and chart are not the reason we're all here.

    Look, I have plenty to learn. I'm not opposed to learning new things. I mean, every day I learn something new that annoys the aging curmudgeon who now lives inside my brain! I just think in these already stressful days that administrators need to try harder to respect their workers' precious resource of time. And treat their staff more compassionately.

    As I said before, the old paradigms are changing, and it's high time employee relations caught up.

    Dr. Leappractices emergency medicine in rural South Carolina, and is the author of the column, Life and Limb ( and a blog ( Follow him on Twitter@edwin_leap, and read his past EMN columns at

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