Unfortunately this hospital has succumbed to believing that hospitals are ran like 5-star hotels, and have created a rating system that is constantly abused by patrons, or patients as they were once called. Nursing staff are measured not on the level of care given, but if their pain was alleviated, if the nurse responded to a call button within 20 seconds, if they felt they had to wait too long, if the nurse retrieved food for them if they were hungry, and many other factors that are not only out of the control of nursing staff, but also require them to jeopardize the quality of care given. When a nurse receives bad reviews, a mass email is sent out criticizing nurses and their "lack of compassion". The nurse then has a 1 on 1 meeting with their PCC and is berated instead of being asked to explain the situation. In fact, they are usually told how they could be fired.
The year is 2014 and the ED is paper charting - why you may ask? The hospital was talked into a new charting system called Paragon. The launch was such a failure, despite warnings from staff early on the in the training process, that the ED has decided that paper charting is more efficient than dealing with this failure; other departments have not been as lucky. Highlighting just a few features of Paragon: It looks like Windows Paint on an old Windows 2000 system with less than intuitive icons, there is not a free-text area - let me say that again, you cannot simply write anything - a user must select predefined terms and ailments, these pre-defined terms and conditions were written by programmers who have never once stepped foot in a hospital; especially an ER. Also, Nurses must scan medications, patient’s arm bands, which may work on a floor, but when John Doe is bleeding out there is no time to be scanning medications. To validate how serious of a failure Paragon is, the Chief Information Officer was fired/resigned over the incident, and the new hospital in Braselton will not be using Paragon. However, you can expect to continue to see the system in use at the Gainesville location.
The first two paragraphs highlight the wonderful culture there at NGHS, which has in turn resulted in a "Mass Exitus". In fact the primary reason that the ED chose to go to paper charting vs Paragon, was because more than half of the ED staff turned in notices they were quitting, many of these nurses simply to go work in retail or another non-medical field rather than stay and lose their license from Paragon. However, this decision to drop Paragon came much too late, so the ED was forced to eat the cost of Travel nurses for the next 6 months. Despite many offering to stay thru the holidays, the hospital let the travel nurses go before the new hires were even on their first day without a shadow, which leads us to our next problem.
Such a protest by the nurses must obviously be punished, so the ED issued a decree in early October stating that if you are absent or tardy more than twice (2 times) in 6 months, you will be fired. Let me elaborate, this is ANY absence or ANY tardy, not just unexcused. So going into November, if you get pneumonia or the flu (from those pesky sick patients in the ER), don't worry about coming to work when you feel better, you'll be fired. As if that was ludicrous enough, this decree was not just for the 6 months going forward, they looked at the 6 months prior to the rule and if you had more than 2 absences or tardy days (again even sick days, leave early for emergencies, or forgot to clock in, or flat tires) you were warned not to miss or be late another day for 6 months. How serious are they, I know of a few people who have already been fired. Two of these ladies because of the "backdating" I just mentioned. So here we are with 100's of PDO hours in case we get sick that we cannot use.
So just to recap, the thoughts going through a Nurse's mind at any given time is: I have 4 patients, 2 are stable and need to be discharged, we can't make them wait too long to be discharged because they will give me a bad review. I have had them all of 1 hour, but they spent 3 hours in the waiting room because they only have a cough, I hope I don't catch that because I can't be out sick or I will get fired, oh and they will give me a bad review for their wait time. Also I need to be 1 on 1 for the next 30 minutes with this patient while I start Levo in case they start to bleed, but then there's that other patient they just bedded back here I have not even seen yet. If she has to wait too long to see me they may give me a bad review. The printer is out of ink again, need to get that replaced because we are still paper charting, so I can't chart the procedures I am about to do or print discharge papers. I guess I will introduce myself and get vitals on this new patient; hopefully the Levo patient's BP doesn't spiral down.
I could go on, but these are the most asinine of the offenses which I think do a good job of conveying the culture you are in for if you come to the NGHS Emergency Department. However, staffing is a problem everywhere in the hospital thanks to Paragon and the Hotel satisfaction surveys. Also, note I only highlighted the failures of Paragon specific to ED, but the system itself is constantly down and just as buggy as the old system.