I completed twelve hours of clinical time following the house supervisor at Timpanogos Hospital today. My goals for today include learning about budgeting, conflict resolution, managing staffing, the leadership role of the house supervisor, and how to positively interact with employees.
The tube system went down (again), and we went to see if it could be fixed without calling engineering. The engineering department is on-call on the weekends. If they are called in, they are automatically paid for at least two hours, even if the repair takes fifteen minutes to complete. The house supervisor could not complete the repair, and engineering was called. However, the attempt to save the hospital money was notable. This was about as close to a budgeting lesson as I could get due to the fact that the house supervisor is not actually in charge of a specific budget.
There was a situation regarding conflict resolution. A 95 year-old patient with a decreased mental status was supposed to have a diagnostic test yesterday but the machine broke down in the middle of the test. The patient was dying, and the daughter wanted to have another test done (the machine had since been fixed), a lumbar puncture, an autopsy ordered for after the patient's death, and she wanted the hospital to pay for the autopsy because there was no diagnosed cause for the patient's impending demise. She also wanted the last day of the patient's hospitalization free of charge. The house supervisor and the physician spoke to the daughter regarding the testing options. After talking to the daughter about the rigors of the tests and the potential inconclusiveness of the autopsy, she decided against all testing and opted instead for comfort measures. The chief nursing officer was notified about the situation, and she gave permission for the last day of the hospitalization to be free of charge. Talking to the daughter and attempting to understand the cause of her demands helped to diffuse a potential future lawsuit for the hospital. Paying for the final day of hospitalization is also much less expensive than paying for a lawsuit. The daughter may still choose to file a lawsuit, but now she is much less likely to do so. Remembering this situation and the way it was handled may help me in the future to please my patients and their families, and to possibly avoid litigation.
Managing staffing was a shift-long process. There were some procedures and surgeries that required on-call staff to be called in. Some staff called in sick, and there were six anticipated admissions near the end of the shift. I think that was the most admissions in a shift I have witnessed since my clinical experience at this hospital. My mentor spent a lot of time of the phone arranging staffing for various units. I have a lot of respect for the effort that it takes to keep each unit properly staffed, and I will try to incorporate the knowledge that I gained by watching my mentor in the future if I am ever in charge of staffing.
My mentor serves well in his leadership role. He sets a good example, and helps out when the occasion arises. He arranged to have me watch a cardiac catheterization, which I found fascinating. He also arranged to have me watch most of a CT-assisted abscess drainage procedure. When we arrived and he asked the physician for permission to observe, it was discovered that one team member was missing in order for the procedure to be performed. He volunteered himself to fulfill the role, which pleased the previously-cranky physician. He also assisted a code in the Emergency Department, among other duties. He performed all of his tasks effectively and he made a point to be as helpful as possible to all staff members and patients. I hope that I can gain the skills and confidence to be as effective as my mentor is in a leadership position.
My mentor always interacts with employees in a positive manner. We made rounds to each floor, and greeted each employee. He calls everyone by name, and makes an effort to have a pleasant conversation with everyone. This makes him approachable and more informed. During down time, staff will often come to see him to chat or to voice concerns. I hope that I can learn from his example and be a kind and approachable leader in the future by positively interacting with all staff members.
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