I work in an ICU at a large teaching hospital. I am being told that the administation is "happy" and doesn't expect any problems. But, I am also being told that we will staff extra heavy the last week in December until1-5-2000. I don't think "happy" and extra staff goes together. Does any one have any reliable information on what to expect on 12-31-99 in the ICU?

-- nurse (RNCCRN@hospital.com), October 08, 1999

Answers

Yes, Two things:

1: A lot of gunshot wounds coming in late in the evening..(but then, this is normal, especially if you work at Cook County Hospital)

2: A lot of pregnant women becoming increasingly irate when they are told they all can't have cesareans at 12:00:01 am.

I swear i just read this story in the paper a week or so ago. All these families that are trying to have "Millenium" Babies and are willing to force it to happen.

the hospital in the story said they absolutely would do no unncecessary c-sections.

-- plonk! (realaddress@hotmail.com), October 08, 1999.

RNCCRN,

I was in the health care 'racket' for years and years; in fact, my last 'career' position was Regional Director for a supplemental nurse staffing agency (per diem). I have *many* contacts still in the business and will ask around. Believe it or not, it wasn't that unusual to start work on a 'staffing plan' for the holidays about this time of the year. Traditionally, census goes down, even in critical care (which just happened to be my agency's specialty). Most facilities wanted to cover their bases, though, so they staffed heavier with nurses who had critical care experience, but 'floated' these folks to other units if/when the need arose. Staffing in this area for critical care units is *optimally* 1:2, maybe 1:3. My nurses who had worked *only* critical care for years did not like, nor adapt well, to the increased patient load of 1:6 (and more!)

Are they considering extra staff facility-wide, or just for the critical care units?

Did you work at this hospital last year during the holidays? Did their census remain static, or did you experience a decrease? If it was slower than usual, I'd be very interested in hearing their reasons for extra staff.

But, to tell you the truth, I never heard a nurse worry about having extra staff on board -- just the opposite! : )

-- Wilferd (WilferdW@aol.com), October 08, 1999.

Yes, I have worked there for many years.This staffing plan is very unusual, that's why it makes me so nervous.The staffing plan mainly involves the critical care units, ie; 6 ICU's,2 ICN's,a BU, CCU, BMTthe excuse we have been given is so there will be one care giver for every patient on life support, to manually bag them if necessary, but again this doesn't jive with "happy".

-- nurse (RNCCRN@hospital.com), October 08, 1999.

The large hospital system for which I work has denied vacations from 12/27 - 1/4. Key personnel have been informed that their presence is expected during the rollover. They're still trying to locate/repair/replace all the defective equipment in the central hospital. Expect the unexpected. Get lots of rest and good nutrition between now and then. Make sure you have a plan for getting home and predetermined guidelines for when you need to head there.

-- Faith Weaver (suzsolutions@yahoo.com), October 08, 1999.

>> They're still trying to locate/repair/replace all the defective equipment in the central hospital. <<

Interestingly, I was just in the hospital caring for my sick daughter this week (kidney infection). The IV pump had a little, red sticker on it that simply said "Y2K". When I saw it I thought, if I wanted to mark a piece of equipment as Y2K compliant, I'd use green stickers, not red ones...

I was distracted enough by my daughter's problems that I never asked about it, though.

-- Brian McLaughlin (brianm@ims.com), October 09, 1999.

WAIT A MINUTE!! AH..... RNCCRN UMMMMMmmmmm.... having been a medic in a CCU/ICU for a while, I can understand what you may be thinking about where the mgt's heads are at. Let's try a different place for a while. Let's look at the cost/costs of the situation.

first, let's look at the cost for that many trained folks. Let's assume that you are going to increaswe the staff level by, oh, 25 nurses at something like 14 or well let's dream a bit and make it wildly out of line and say 20 bucks per nurse per hour, 3 shifts.

25 X 20 X 24 = 12,000 bucks a day.

WOWSER!!! LOTS O MONEY!!! OUCH!!!

Well, that turns out to be a quarter mill over 20 days.

HOW MUCH does it cost to defend 1 *JUST ONE* malpractice suit? What happens if, for some reason the backup power does NOT come on in 30 seconds like it has every other time, and Gramm doesn't make it out in a vertical position?? HOW MUCH can I GET FROM THE HOSPITAL for this????

A quarter mill is CHEAP contingency insurance, even if I think I have ALL of the bases covered in terms of what may happen. If I don't cover THIS LAST BASE, I'm NOT doing my JOB as hosp administrator.

Chuck

Alternatively, there may be a suspicion of coming problems. Pays yo money and plays yo choice, but the above scenario is probably much more likely the case. After all, don't we all say it ain't the probabilities it's the STAKES that matter??

C

-- Chuck, a night driver (rienzoo@en.com), October 09, 1999.

I will tell you what makes me nervous. The fellow that is responsible for y2k remediation at one of our large local hospitals does some work on the side. I got him to come out and "clean up" my computer and test to see that it was compliant. Well...he cleaned it up alright. I no longer can open many of the download files, plus everyday is a new trip down the rabbit hole with this unit. He date forwarded on this unit and claimed it was compliant. When I went into Compaq's web site and gave my model and serial #, its NOT compliant. THIS GUY IS IN CHARGE OF REMEDIATION at the hospital. I spent many years running life support and heart bypass machines. I would take my chances with a para medic and a first aid kit before I would go into a hospital at roll over. Futhermore, if they want more RNS so that they can "bag" those patients on life support, who is going to relieve them" Oh...FEMA will be there in 3 days, I forgot!! In the meantime, I will turn on the computer Jan 1, let it do its final blow up and toss it in the trash barrel. If the world/internet is up and running next year I will buy a new computer.

Taz

-- Taz (Taz@aol.com), October 09, 1999.

In my hospital, an unknown mgt Y2K fairy came around in the middle of the night and put green Y2K-OK stickers on every visible piece of electronic equipment. No testing, no discussion with the techies, nada.... just stickers saying all is well. Even put stickers on the 386 clones running Windows 3.1. Generator test last week failed because they actually tried to have it supply full load (previous "tests" were just start the genny and see if it runs!!) Inventory lists have been progressively screwier as JAE grows, and lastly, patient billing is being run through an ancient version of CICS that I am certain is toast. Oh yeah, no problem, just put the stickers on and tell management to be happy!

-- RDH (drherr@erols.com), October 09, 1999.

Plonk,

The hospitals in my area are worried about the thousands of people that would show up if the power goes out. The hospitals have backup generators and would be a warm place to go. I guess they would need the extra personal for crowd control..

-- y2k dave (xsdaa111@hotmail.com), October 09, 1999.

RNCCRN-our hospitals (two hosp network) have had BioMed check every monitor, vent, etc for date sensitivity. Some of the hype about non- Y2K compliant medical equipment is overblown to say the least. Do you have spacelabs, HP, or whoever monitors? Find out if they are date sensitive to operate. Most of the equipment in our facilities will "run", but several may have the printed date/time incorrect. You can always cross out the bogus date and write the correct time/date for record purposes, but it is the info on the monitor that is of course the most important. As to preparations with staff, it's everything will be "normal" at our facilities. However, key management folks will be in the hospitals at midnight by dictate, staff who are assigned "call" will be sleeping on stretchers in PACU and Ambulatory, no management is "allowed" travel from 12-20-1999 through 01-15-2000, extra diesel has been contracted for prolonged generator use, and the poor VP of MIS is looking more stressed every day. Oh, yeah--everything will be fine!!!

-- RNCNOR (Bill@SHF.com), October 09, 1999.

GE tells our Level I trauma hospital that all our scanners are compliant. Philips had said the same thing about our angio suites, but now is telling us they need 40 hours/room to make it so. 40 hours! For one angio room! Makes we wonder about GE. I do know that the GE service rep is a way-GI...generator, woodstove, food, well, and I haven't asked about weaponry.

-- Spidey (in@jam.session), October 09, 1999.

I'm An ED physician. I anticipate that in the week before the roll over we will be swamped with elderly and chronically ill requesting hospitalization because of worries over loss of power, heat etc. Not sure how we will address this. "May you live in interesting times ", the ancient Chinese curse...

-- kozak (kozak@formerusaf.guv), October 09, 1999.

Chuck, I did the math and for my hospital the bill for the extra staff came to 1.4mil! (using your formula).That is quite impressive. I'll have to think about that for a while. RDH, We got the green & orange stickers also, we know our defibrillator will not work after the date change and have been waiting for a new one, which has been promised for a while. RNCNOR, We use HP's in my unit, they are 10 years old, they were supposed to have been upgraded this past summer, but has not happened yet. Kozak, We have been told to expect a 15% increase in patient admits, ( patients requiring life support).WE already know that many small hospitlas that are not ready will close and transfer their patients elsewhere, to us. Does any body have an opinion on the RN's that will be at the bedside and the liability issue. Will we be draged into court. I have always had hi-tech equipment and I don't know if I can do Florence Nightinggale nursing. Having manual equipment would probably make me feel a little more confident.

-- nurse (RNCCRN@hospital.com), October 09, 1999.

Kozak: bradycardic and hypotensive: quick, an amp of ???

-- Spidey (in@jam.doubtful), October 09, 1999.

i have been on the y2k committee for over a year, did our inventory in january, identified noncompliant equipment the last of which will be replaced this month, had full power generator test a month ago, found a few things to add to the gen circuits, this will be done this month, will do a full power test in about a month, all critical equipment checked out by our people and the manufacturers people.

we are about as ready as we can be, fuel tanks are topped off, we can run 30 days without power less if we have to heat with fuel oil, will have an additional fuel tanker on the hospital grounds for the rollover.

we have double checked every piece of equipment in the inventory. the bad side of this is when our engineer went to a regional hospital y2k meeting in may not only hadent most of them started, they asked our guys where to start!!!

if TSHTF we have done everything to minimize the impact to our patients.

staff man

-- staff man (lookingahead@rollover.com), October 09, 1999.

RNCCRN, when a code was called in our units (Cancer Care & BMT), it took every single worker on the floor, plus the specialty team which rushed in, to do the work. Talk about schedule/routine/rounds disruption! Course the lab tube system was always down, had to run the blood manually, blood & needles everywhere, not enough room bedside for all the pokers, prodders, pumpers, baggers, readers, thumpers, zappers, etc. 1:1 is NOT enough if that patient crumps. Keeping somebody alive manually while documenting is exhausting! And it seems the other patients sense what's up and all start spiking and needing extra care ...

Got lotsa nightmare stories but they're posted on threads long ago. Roundabouts here folks think automatically hospital = shelter, and that's going to be interesting. Not enough room in waiting lobbies as is. And guess what? The "diversion" part of the 911 system is not compliant and won't be before Rollover, last we heard. How will they route? Or will it matter? By 12/31, every hospital will be full.

Last year, around Christmas-New Year's our census went way down, and still they had trouble staffing. Holiday flu rampant. Then the snow storm came, had to keep staff overnight, but wouldn't let them use the beds ... earning lots of future good will ...

Hospitals need to have realistic contingency plans. They have to be able to be considerate of the workers. Take care of the staff so they can take care of the patients. Duh. This is a big hole in current practice hereabouts. Hope you do well at Rollover! Bring your camcorder. Best CYA along with documentation is to train that video on your own bedside job performance in ICU. No way you're gonna take the heat from mis-remediated management!

-- Ashton & Leska in Cascadia (allaha@earthlink.net), October 11, 1999.

Ashton & Leska,

I was on a cancer ward and there was a code. There were a lot of nurses *gawking* and ignoring their own patients. So much so that they ended up forgetting about one that was in for chemo at 11 am and ended up still waiting for them to order it at 10 PM. Until the doctor came in and reminded them. A lot of the staff appeared to be newbies. The experienced ones were frazzeled and appeared to be trying to compensate for the newbies.

Patients families should not have to do most of the caretaking at a hospital, but they need to at a lot of places.

Guess it is cheaper to hire newbies at lower pay so the stockholders in the HMO's can make a bigger profit.

Maybe they can get away with that forever in most businesses but when it comes to where even the stockholders loved ones are impacted the tide will turn eventually.

(For information or educational purposes only)

10.36 a.m. ET (1436 GMT) October 11, 1999

By Doug Willis

SACRAMENTO, Calif.  Gov. Gray Davis signed a bill requiring hospitals to meet minimum staffing levels for nurses, a move hailed by a nurses group as the first of its kind in the nation.

The text of the nursing law does not specify minimum nurse-to-patient ratios, but instead requires the state Department of Health Services to set those standards. Davis said he signed the bill with the understanding implementation will be delayed until 2002.

Currently, the state sets nurse-patient ratios only for critical care units and for intensive care units for newborns.

"This is one of the most significant days in the history of nursing," said Kay McVay, president of the California Nurses Association. The group said the bill "will make California the first state in the nation to require safe hospital staffing."

Health industry lobbyists had strenuously opposed the bill, arguing that hospitals should make staffing decisions and that state intervention would only drive up costs.

The measure also will bar hospitals from assigning unlicensed workers to perform certain procedures, including administering medication, and it will prohibit hospitals from shifting nurses trained in one unit to another unit without adequate preparation.

Davis vetoed a related measure that would have increased nursing home patient-staff ratios and training requirements. The governor said the new requirements would "place a significant burden on the state," which pays through Medi-Cal for tens of thousands of patients in long-term care nursing homes.

-- Cherri (sams@brigadoon.com), October 11, 1999.

Cherri, your observations are right on-target. It's hard to see, witness. It's hard to work there. It's hard to quit and leave the patients at the mercy of the callous frazzled ones who stay on. But the errors and oversights we saw haunted us, and it actually became hazardous to stay.

As awful as this sounds, we were so happy when family did caregiving at the hospital. One room less to worry about. Only 2 eyes each, only 2 legs, can't cover pts adequately. And patients prefer their own loved ones. Sometimes there were family caregivers who did really odd things, not so good for the patients, and there were some obnoxious family members who would march up to the nursing desk every five minutes complaining about water temperature in the pitchers or something equally earthshattering while 23 other patients were having seizures, cardiac arrest, allergic reactions, etc. The fact is, those patients who have family members who insist on staying with them around the clock, and who actively advocate for them, get better care.

"The measure also will bar hospitals from assigning unlicensed workers to perform certain procedures, including administering medication, and it will prohibit hospitals from shifting nurses trained in one unit to another unit without adequate preparation."

Yes! Kill floating! And you wouldn't believe the "delegation" that gets passed around ... yikes! Good measure there.

Will restrain ourselves on this topic -- get riled just thinking about certain things.

Folks, please, DON'T NEED HOSPITALIZATION ANYWHERE NEAR ROLLOVER!

-- Ashton & Leska in Cascadia (allaha@earthlink.net), October 11, 1999.

Ashton & Leska,

It took one hospital visit that was supposed to last 4 hours and ended up being an over nighter for me to pack an overnight bag and make childcare arrangements every week after. I also arranged blood tests, hand carried the results, roamed empty rooms-some on other floors to find a spare recliner and fan and chose rooms with a view and ordered extra large meals and snacks due to the extra long stay. You understand I do not begrudge one second of the time or effort I gave. What sucks is that for those who do not have a family member to do it, (or do not realise that it needs to be done) the care (or lack thereof) borders on criminal.

-- Cherri (sams@brigadoon.com), October 11, 1999.

Agreed and aggrieved, Cherri. Sounds like you learned *exactly* what is necessary. The labs must be baby-sat and hand-carried, equipment scrounged from any possible corner and cleaned, menus circled with phone follow-ups, Drs watched with eagle eye, RNs tracked when IV beepers go off, etc. Thought maybe our big prestigious university hospital was especially dullard, but the lapses sound a bit more universal. Sad. Kudos to you for caring and taking the draining time and effort to ensure care was arranged/delivered.

During Y2K, if HORRORS anybody you love must be hospitalized, be sure to have 24/7 "bodyguard" there to protect them!

-- Ashton & Leska in Cascadia (allaha@earthlink.net), October 11, 1999.