Barnett, Lambert discuss nursing issues
Officials of Newman Regional Health and internal medicine physician Jim Barnett are working toward a solution to a problem Barnett mentioned at a public health forum on April 24.
Barnett said at the meeting that he was concerned for the quality of care given and that he perceived an antagonism between the hospital and physicians.
Barnett’s physician group — Internal Medicine Associates — and Newman’s leadership team met on Monday to discuss ways that need could be met.
“We had a very open and good discussion about concerns with the hospital, which mainly center around physician-hospital relationships, for present and future, along with concerns I have,” Barnett said.
“… They used to always have a charge nurse and now, there are many times it’s really hard to know who is truly in charge. And I believe there has to be some system of authority, system of responsibility and accountability to the process. They have just told me today that they’re going to make changes, so I’m very hopeful for that.”
Newman Administrator Terry Lambert said he had spoken approximately two weeks ago with Barnett and his group about a team nursing concept that the hospital plans to initiate on May 21.
“We talked about this and just some other things,” Lambert said of Monday’s meeting. “I guess I would say that I’m optimistic that we can get some resolution with this.”
Under the new process, a registered nurse, licensed practical nurse and an aide would be assigned to patients in a specific geographic location, such as a specific part of a hospital wing.
“Then when a doctor comes on that unit, then the RN, LPN, or aide could help that particular doctor; that’s the team,” he said.
Barnett explained Monday afternoon that his greatest concern, which he termed a quality of care issue, was having a nurse familiar with the patients’ cases consistently making rounds with him to visit patients.
“That issue has been long-standing with me at the hospital,” Barnett said. “They are making some changes with their nursing plans, which I’m hopeful for. I also voiced to them that I would like to meet face-to-face with the board.”
Barnett said that the issue is “very much a community issue and should be a community discussion.”
“I think this is an extremely important issue for the community for now and for years to come,” he said. “I know there are other people interested. I’ve had other physicians tell me they share my concern, but I’m not sure they’re willing to speak publicly.”
Barnett said that that he long has asked to have a nurse knowledgeable about the patients to make rounds with him.
“It is a partnership,” he said. “One of the best parts of my day is to round with nurses, but it can’t be a partnership if the nurses are not present.”
He said that he has no problem with the quality of the nursing care as given to his patients, and said that he realizes nurses are overworked and understaffed.
Barnett said the physician-nurses team is particularly important for elderly patients whose memories may not always be perfect.
“I can’t rely on a patient’s history alone, or as has turned out to be many times, the patient’s family in the room” who provides information about the patient.
He said he needed a report from the nurse for important reasons.
“The patient may tell the nurse one thing and the doctor just the opposite,” he said. “We, meaning the nurse and the doctor, need to hear both. We need to hear both sides and be effective as a team and work as a team and improve communication.”
Lambert said that the new system that will begin later this month may require more than one nurse to make portions of the rounds with Barnett.
“It could easily be three different nurses that are taking care of his patients on one unit,” Lambert said. “… We try our best to have a nurse to make rounds with Dr. Barnett. We’ve done that for years.”
The hospital also has used a case manager, who is a nurse, for rounds, and that is a situation Barnett would like to have changed.
“I like them very much, but they are nurses who have gotten out of bed at the same time I did and do not know what has happened to the patient during the night,” Barnett said. “Often when I ask them questions, they’re going to the charge nurse to get the answer.”
Barnett said that while he appreciated their professionalism, he believes case managers should not be “part of the team that I think should be involved with the doctors and nurses when they’re rounded.”
Lambert said that the changes are being made “not just for Dr. Barnett, but for all of our doctors, and to make sure our patients are confident we’re taking very good care of (them). We try our best to accommodate that, and we’re working towards those resolutions. … We’re going to make a concerted effort to make that happen.”
Barnett said he also believes the hospital’s move to electronic medical records for medical staff has been sluggish. He said he was concerned that Quorum Management, which manages the hospital, receives rebates from preferred vendors.
“So I’m concerned there is a monetary incentive for administration to select certain vendors based on a rebate that will go to the management company,” Barnett said.
Lambert said that would not happen.
“The electronic records purchases that we make, that we have made, that company is not a strategic partner of Quorum and they’re not under contract,” Lambert said, adding that no rebates would be involved in the purchase from Valco, the company that will provide the electronic equipment.
“We chose them because we thought that they would do the best job overall,” Lambert said.
Wednesday: Why doctors leave Emporia.
Comments
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Posted by under_score (anonymous) on May 6, 2008 at 2:37 p.m.
(This comment was removed by the site staff.)
Posted by orlando (anonymous) on May 6, 2008 at 2:45 p.m. (Suggest removal)
Interesting that they are looking at team nursing as something new and special. I have been a nurse for over 30 years, and this was used "way back then in the old days"! It promotes continuity of care which is important to provide good care to the patient. It promotes good doctor/nurse/patient relationships as the communication is definitely improved all the way around. Problems are communicated to the nurse who then deals with them, the next day this nurse is assigned to the same area hopefully with the same staff, and can do followup and communicate effectively with the physician. When a nurse has to tell the doctor "I don't know, I worked on the other wing yesterday", this interrupts the process and has to be very frustrating to the physician. Team nursing also should involve the other ancillary staff (dietary, social service, pastoral, etc.) to get really effective patient centered care. Hospitals are there for the patient, and as such the work should all be patient centered. This all comes back to having enough nurses to do their job as they were taught and as they want to do it. Bedside nursing has become less patient centered, and more task centered. A backrub at bedtime---what is that? Who has the time? A backrub, a few minutes to allow the patient to connect--this can do more good than a lot of the medicines we give.
Posted by hjcary (anonymous) on May 6, 2008 at 4:10 p.m. (Suggest removal)
Orlando,
You brought back some memories of nursing school. I distinctly remember being trained to do back rubs in nursing school. Then I got into the real world and was so disappointed at my first nursing job in a hospital setting and realized that I was running my behind off and there was no time for backrubs and most nights I stood at the time clock at 11:30 pm filling out the little sheet of paper stating why I did not get a dinner break so that they would pay me for that time as well. Our ratio on the floor (not at Newman’s) was 8patients to me an LPN. Often we had 7 patients on the unit which would just be me. If we had 8 I got a CNA to help me. I will have been an LPN for 13 yrs this fall. I am not in the hospital setting anymore I do home care now which pays much better and I only have one patient.
It takes a very special person to be a "good nurse" I have worked with and been a patient with good nurses and bad nurses. It was the bad ones that drove me into the profession and because I always strived to be a good, happy smiling nurse when I was in the hospital setting my patients loved me and since I was in the rehab setting formed friendships with many that now 10yrs later still am in contact with some. I had patients that would request me when numbers were high and staffing was high enough that I had an RN on as charge nurse. Sometimes they would stick me with a perdium charge RN over me and I distinctly remember a patient named Maggie that the RN had assigned to herself and Maggie cussed the RN out of her room saying not to come back that she would only let me do her dressing change because I knew how to do it. That is continuity of patient care, knowledgeable staff.
The poor quality of care I saw last time I was at Newman’s, my grandma being the patient, was from the doctors not the nurses. The nurses were very kind to her the dr.s screwed up her care and now she is with the Lord and not with us any more.
Posted by eiggohp (anonymous) on May 6, 2008 at 4:29 p.m. (Suggest removal)
Thank heavens that Dr. Barnett has FINALLY taken the initiative to do something about this. Too often, I have had the "opportunity" to observe that no two nurses could give me the same answer to a question concerning a loved one of mine. And yes, I do remember those wonderful backrubs that they no longer do...now some of them would rather be at the nurses station visiting, chatting on the phone (personal), or eating!
Posted by eiggohp (anonymous) on May 6, 2008 at 6:26 p.m. (Suggest removal)
The article about the nurses at Newman's Hospital brought back a memory of what happened to me. My mother had Alzheimer's Disease and had been brought from the nursing home to the emergency room at Newman's. The "nurse" on duty started asking my mother questions....What day is it? (well when one is in a nursing home, every day is the same)..Who is the president? (of course, she didn't know...she hardly knew me)...and Where was she?..and she answered, "in this building"...which was correct. He then said to me, "She doesn't know a damn thing, does she?" I was furious....she might now have the full use of her brain, but her ears were fine! I should have reported him and it might have saved this from happening to someone else's loved one.
Posted by benhorse3 (anonymous) on May 6, 2008 at 11:20 p.m. (Suggest removal)
Where to begin? I have been a patient at NRH numerous times, and I have yet to discover a serious cause for complaint with the quality of care I received there. On the other hand, I can say with some authority that doctors are akin to auto mechanics inasmuch as they are dealing with a highly complex system of moving, interactive parts that are subject to a plethora of misalignments and malfunctions; when faced with a particular situation, they apply their training and their experience and then they... guess. That is their vocation and that is their plight. But they augment their difficulties by trotting out their wildly over inflated egos and generally making themselves unavailable to a patient who is personally enduring some dozens of discomforts and diseases... dis-ease, indicating discomfort and the lack of the absence of pain... which is the ultimate definition of pleasure, by the way.
In a strangely convoluted way, I can understand Jim Barnett's desire to have one or more nurses holding his hand while he makes his untimely rounds. How can he know what transpired during the night or while he was away in government service? Well, he might read and digest the chart that is meticulously kept and then apply his very expensive skills to the problem. Or, he could cast irresponsible aspersions at the only health care facility that this community is awfully doggone fortunate to have. I come from a small town that sold bumper stickers pleading doctors to come there and practice their art (for apparently, it is not a skill)... those poor folks would've sacrificed a limb for the availability of professional health care that you fine examples of intellectual humanity are actively undermining. Hate the hospital? Keep behaving in this irrational fashion and you can kiss your local hospital good-bye and look forward to an $8,000 cab ride to Topeka, Kansas City or Wichita for every little thing that befalls you. NRH is self sustaining, provides quality, professional short-term care, employs hundreds at above average wage and. while not perfect, is worlds better than nothing in this county at all. Dr. Barnett, you are a fine, talented Christian man; Emporia is lucky to have you, as Kansas is to have you in the governmental process. But you are a grown man and a trained professional; you do not need a nurse to continually hold your hand, nor do you need to eviscerate the body that pays your BMW payment. This controversy needs to end now, with your genuine and gentle relinquishment of a stand wrongly taken. Let us move forward and abandon our petty egocentricities... for the betterment of the community.
Posted by create (anonymous) on May 7, 2008 at 5:30 a.m. (Suggest removal)
Simple. It was not "a stand wrongly taken." The complaint was about the hospital administration and has weight to it. In fact, Dr.Barnett's commentary began what has become a very necessary discussion in this community. It is easy to see that you are anti-Barnett. Hand holding by a nurse and BMW payments? Indeed!!! Condescending to say the least!!!
That hospital is not going to disappear just because a few "fine examples of intellectual humanity" are having their say. Be careful, when you always agree with others; that becomes your prison. Choose your jailers carefully!
Posted by created (anonymous) on May 7, 2008 at 7:39 a.m. (Suggest removal)
Having been a hospital employee I know that very good care is provided. I also know that sometimes bad things can happen that were not intended and many of those have been mentioned in these blogs. However, hundreds or thousands of great things happened for everyone of those. Hospital employees and doctors are human just like everyone else. I also know that employees are disciplined or terminated for many events also. People just do not know what happened because that is and should be confidential. I also know that hospital employees "cover" for doctors every day. Not saying that the doctors did something wrong but hospital staff "catch" things before they happen which often protect the patient and the doctor!
It is also interesting that since Dr. Barnett is taking some heat for his harsh words that he is now trying to say that the nurses are great but they are over worked and under staffed. That is not what he originally stated.
Emporia has a good hospital. You can find bad comments about every hospital in Kansas and the United States if you put them in a fish bowl!
Posted by under_score (anonymous) on May 7, 2008 at 9:50 a.m.
(This comment was removed by the site staff.)
Posted by benhorse3 (anonymous) on May 7, 2008 at 5:59 p.m. (Suggest removal)
Hmmm... yes, I must concede that my comments were somewhat provocative and very much pro-hospital. For the former, I do apologize. I am not, in fact, anti-Barnett but am very pro-NRH. Physicians, like hospital administrators, come and go. We have seen good and bad examples of both, and the fact that these two camps seem forever locked in conflict and turmoil result in only one loser: the good people of Emporia and Lyon County. Since you are clearly a patient of the good doctor, and since, judging by the time of your post, a senior citizen, I will respectfully decline to cross swords with you. I hope this most recent faldarah can resolve itself without too much more rancor and divisiveness. I wish Jim hadn't taken this to the streets.
Posted by create (anonymous) on May 8, 2008 at 8 a.m. (Suggest removal)
My, but you take considerable liberties in assuming I am a senior citizen just because of the time of my post, Benhorse3. Stereotyping are we? Argumentum ad hominem. Don't other people post at 5:30 in the mornings? For that matter, how do you know I hadn't been out partying all night long and was just getting in at that hour?
For the record, I am not a patient of "the good doctor." Another assumption! I was merely stating my opinion with regard to the importance of Dr. Barnett introducing this discussion to our community. It's a ball that needs to be played, and the game is not yet over.
In addition, you have insulted me by saying that you decline to "cross swords" with me because you believe me to be a senior citizen. Another insult! What if I were? That makes me worthless and unable to defend myself? Stupid even?
The crux of this issue is that the people of Lyon County are being cheated out of having a well-run hospital if what Dr. Barnett says is true. I seriously doubt a professional with his credentials would seek to cut his own throat by crying foul, particularly in public.
The differences between administration and physicians need to be addressed by an outside entity so this issue can be put to rest. If it takes a change in administration, so be it.
Posted by Deepthoughts (anonymous) on May 8, 2008 at 11:42 a.m. (Suggest removal)
I just wanted to comment on the post about Dr. Barnett wanting nurses to hold his hands during rounds because it was implied that he wasn't applying his "expensive skill" to read the "meticulously" kept charts that apparently never have errors (even though we can all admit humans make mistakes).
In any business or life for that matter, communication is key. Holding his hand on rounds, well I don't know about that, but if a Dr. (any Dr.) wants a nurse who has been with a patient and seen changes in their health, reaction to meds, etc. during that Dr.'s absence, then I am all for it - who wouldn't be?! As we all know, translation can be lost in the written word, so proper communication is pertinent and if that requires conversations to clarify questions on charts, then what is wrong with that?
Yes, we are all human and people make mistakes, but I would think open communication and double-checking, especially in the health care arena where people's lives could be at stake, could help catch those mistakes instead of ending in tragedy, more pain or a lawsuit. Everyone benefits (Dr.'s, nurses, hospital & patients) when there is a good level of communication.
Better safe than sorry.
Posted by benhorse3 (anonymous) on May 9, 2008 at 10:01 p.m. (Suggest removal)
Well, create, your demonstration of just how thin the human skin can be is a wonderful prediction of how this controversy is going to play out; full of rancor and divisiveness. I choose not to be argumentative with senior citizens out of respect. If you were out partying and just getting in to do a little casual computing at 5:30 AM, then I must grant you even more respect than the most senior of my senior citizen friends. Oh, and by the bye... I'm no spring chicken, myself!
And please, don't try and make this seem that my comments about Jim are somehow steeped in hatred by putting quotations around my term, good doctor. He is a good doctor! For gosh sakes, take a breath... and get some sleep: you've got to get up early.
This is good-bye, my young aquaintenance. My sharp tongue and your thin skin do not make for a fortuitous meeting. No doubt you will find someone else upon which to wage an internet flame-war. I wish you the best of luck. Meanwhile, back to the real issue... I hope this can be resolved without our much-valued and highly awarded local health care facility being further sullied or damaged...by anyone. Finis!
Posted by create (anonymous) on May 10, 2008 at 7:50 a.m. (Suggest removal)
Oh, okay your Grace.
(With thin skin pierced beyond repair, Create drags self out of forum, vowing to never again wage war of words...on Saturdays at 7:47 AM)
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