The Customer is NEVER Right - A Nurse Practitioner's Perspective
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The First Report Card. YIKES!





























After being at the new job for two months the Vice President (VP) for Strategy, not sure what that is, showed up to pay me a visit. Never met this VP, or any VPs, before so when the VP introduced himself one afternoon my first thought was, “The end has arrived.” Surprisingly, the VP had some productivity numbers he wanted to share with me and the reason for his introduction and visit. How nice (nauseating).
 
A couple firsts! In 30+ jobs as a nurse practitioner I have NEVER met a VP, will NEVER be able to say that again. In 30+ jobs as a nurse practitioner I have NEVER been shown individualized productivity numbers, will NEVER be able to say that again either. At least NEVER been shown those number that I can recall. However, after writing that I find it hard to believe I have NEVER been told before as that is what healthcare has become, a numbers game. That said, this formal presentation by the VP must then be the first that I can recall. However, with some more thought, it might NOT be the first but instead the first one I recall as the first thing that came to mind as he showed me the numbers was that I would post them in the blog for others to see. As these or any other numbers for that matter are insignificant to me, as I show up to work, get the work I am paid to do done and when the shift is over I go home.
 
On that note, it appears my FIRST month on the job had been documented in great detail. Despite not surprised someone somewhere was keeping tabs I did not expect the first month would be of any significance. And much less that the a VP, whatever that is or means, would come and share with me, and one on one even. Despite for me, medicine is medicine is medicine wherever I go, ALL new jobs come with a significant learning curve. That learning curve being how things are done or not done at any new job. And that is most notable with regard to getting a handle on a new electronic health record (EHR) system. Even with over 30 jobs under my belt as a nurse practitioner learning and operating a new EHR comes with practice and time, even with similar systems as even similar systems are NOT so similar.
 
Anyhow, these are my report cards with only eight shifts worked, yes, eight, like ocho, 8, during the recorded thirty day. Because for someone, like the VP I guess, eight shifts are enough to reach some conclusion.

This first one being how many patients per hour.






























According to the VP, my random code is JJ (the one outlined) on these graphs where, in eight shifts, I saw 1.84 patients per hour. What does that mean? When compared in my peer group (SC) the average was 1.85 patients per hour. Of eight in my peer group I was the fourth most productive, despite I was the newest kid on the block and only worked eight shifts during the recorded period. Granted, group SC is the lowest acuity in this emergency department. Having said that, within those eight shifts in the lowest acuity of this department, I MEDVAC (transferred via helicopter-something I had NEVER done before in 16 years working as a nurse practitioner in the emergency department) two patients, during the same shift, and I admitted another two patients, on different shifts but during the same eight shifts. Again, the newest kid on the block and still managed to see about average of what my more senior peers were seeing during the same thirty-day period.





























The second graph shows the average length of stay (ALOS) in minutes in what is defined as door to discharge (the time from when the patient checks into the emergency department until their dispositions {discharged, transferred, admitted, etc.}). Again, my only eight shift of a thirty-day period are represented in the graph as JJ. My ALOS was 135 minutes where the average ALOS was 208 minutes. Among my peers, me being the newest kid on the block, I was the second lowest time, which is a good thing. Again, for me medicine is medicine is medicine. In other words, experience is not where I lack thus how I am able to move patients.

These two graphs clearly showing I am an asset to any organization and NOT a burden as I can move patients even when what slows me down is the new EHR documentation. However, that is NOT what matters. What matters, sadly, are satisfaction scores! Having said that, now that I see this organization’s obsession with numbers, I will NOT be surprised when the VP shows up next with satisfaction scores. Sad! Very SAD! But true.

Although NOT me in the picture, I have a shirt, somewhere, just like the one the kid in the picture is wearing too. I am NOT kidding!

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