Our nurses are inundated with ‘must read’ memos. These cover everything from the wishes of physicians to have temperatures taken on every patient, to the way drugs are mixed and the way report is called to other nurses on admission. Memos fall down on our emergency department like snow from the top of Mount Olympus. In fact, it strikes me that the balance of medicine and nursing is slowly but surely drifting from the droll reality of patient care to the elevated calling of administration; from practicalities and concrete facts like bleeding, disease, violence and payment to the ethereal realm of ‘good ideas.’ Blame no less than every hospital, the current legal climate and Joint Commission. ‘Good ideas,’ for safety and patient happiness, and for every inane bit of regulatory compliance, are fast becoming ‘the boulder that breaks the camel’s back.’ Our staff sometimes seems to spend as much time looking at computer screens and reading memos as actually touching real humans.

Furthermore, some of our good ideas simply make life that much more difficult. Case-in-point: while looking for plastic spoons with which to hastily consume calories betwixt patients, we were informed that the large box of spoons we once had was now a thing of the past. Allegedly, the state has ruled that such large boxes are a hazard, since we put our grubby hands into them and pull spoons out. Now, in the interest of our health, the ER is allotted ten spoons at a time from the kitchen. Not individually wrapped, and probably put into their container by someone reaching their hand into a big box of spoons, but nonetheless, we’re allegedly safer, healthier and happier than before. Mind you, we could never get plastic forks or knives. (Presumably we would have poked ourselves or attempted to cut someone’s throat with a tiny piece of plastic). I have to say, in the great scheme of health, in the great drama of modern medicine, ‘Bravo!’ Finally, someone has taken the bull by the horns and solved a problem. Mind you, we still have EMTALA, no mental health coverage, gaps in call, inadequate staff and myriad other issues.  But we’re not being killed by spoon-born infections.  Hallelujah!
So, in the interest of more good ideas, I’ve decided on some ‘must read memos’ of my own for our emergency department staff:
From here on out, patients are forbidden from the ER. They are sick and dirty and pose enormous financial and logistic difficulties. Medicine will be faster and more efficient, not to mention safer for everyone, without them.

Staff will stop drinking fluids or eating while working. First of all, we won’t have to deal with dirty spoons. Second, with MRSA and other infectious diseases suddenly lurking about (over the last millennium), the risk of having food within 300 meters of the emergency department is just too great. Staff will be issued sterilized protein drinks on an absolutely as needed basis. Finally, this should cut down on annoying and inefficient restroom use.
Staff must not, at any time, leave their computer screens for more than 30 seconds. This is to avoid any interruption in constant, ‘state of consciousness documentation’ of medical/nursing interactions. This will be easier with no patients.

Should a patient slip through, at no time will staff actually document an illness or wound. All documentation is to be directed at interventions for the patient’s emotional well-being, and screening for life crises like malnutrition, obesity, immunizations, abuse, language use, education, general state of happiness, fashion sense, political orientation and religious affiliation.

Staff will cease to make any snide remarks about other staff or the state of medicine as a whole, as it may make the staff less happy.

Staff will hereby communicate only via pager, cell phone and computer, to avoid airborne spread of disease, information, affirmation or aforesaid ‘humor,’ via the airborne route.

Staff will be happy, cheery and provide joyous customer satisfaction. Or else.

Staff will be rewarded for any and all good ideas that become implemented as ‘must read memos.’

Now, go read a memo!

Edwin

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