Today is a sad day for the nursing profession. And I feel bad for them. Why? Nurses have officially been demoted to robot status. It's not just hospitals that bury them with obscene amounts of ludicrous documentation that prevents them from actually caring for patients at the bedside, it is our bureaucratic regulatory environment developing safety standards from people without the experience of bedside care. For example, I have recently learned that The Joint Commission, the accreditation company for hospitals, has determined that patients at hospitals are in grave danger of immediate harm and require a massive retooling of hospital policies. Could it be sloppy transfusion protocols that are giving patients hepatitis? Could it be large quantities of narcotic pain medication being lost with out a trace? Could it be doctors aren't signing their verbal orders within 24 hours, even though 99.999999999999999999% of all the orders have already been carried out by the time the 24 hours is up?
Nope, folks. It turns out that nurses are incapable of using critical thinking when presented with more than one prn medication and for them to pick one medication over another is considered practicing medicine and The Joint Commission feels nurses are illegally practicing medicine. That's right folks, hospital nurses are no longer allowed to treat patients for pain, prevent constipation, help them sleep, calm them if they are agitated or bring down a patient's blood pressure with as needed medications if they are presented with more than one option and there is no order defining to them which medication to use first, which medication to use second, which medication to use third and on and on and on.
The Joint Commission has lost touch with reality. Does the Joint Commission have any recommendations for implementing their policy. The answer was no, they do not have any programs to guide hospitals on implementation. It just needs to happen. Least we forget there are over 500 order sets at many hospitals that probably contain assorted prn medications, my admission order set included. You have doctors from every medical specialty with order sets all customized to their patient population. You have some patients that can take IV meds on some days but not on others. You have some patients that are NPO for surgery that need IV formulations on some days but not others. You have some patients that become delirious and can't take any meds at one hour but can on another.
Having a prn order for IV morphine and oral percocet will not be allowed and nurses will not be allowed to give either without an order that places them in the order for which that are allowed to be given. This is going to generate pages and pages of standing if X then Y orders which are frowned upon. It's going to generate thousands of pages and phone calls worth of verbal orders which the Joint Commission is trying to eliminate. It's going to immediately pull limited hospital resources away from projects which are actually worthy for patient care in order to create policies for our new hospital robot nurses. Ultimately, it's going to demoralize the nursing profession and make them feel like robots. And they're going to start acting like robots because they are treated like robots. Patients don't want robots. They want nurses. Doctors don't want nurses acting like robots. They want nurses capable of making patients better at the bedside.
This is a sad day for nurses. College educated nurses who are being told they are not allowed to pick and choose, when given a choice, between two medications to alleviate patient suffering. This makes me wonder why we need nurses at all. They certainly don't have time to nurse patients anymore. They're too busy complying with all the Joint Commission requirements. If we all take a step back and look at what the Joint Commission has done for us, we have to wonder whether they are an effective tool in patient safety. The Hospital Accreditation Program has been around for more than 60 years with approximately 88% of this nation's hospitals receiving their seal of approval.
Yet, after 60 years of patient advocacy, our hospitals are a top five cause of death in this country. For a public safety organization who's mission statement is to continuously improve health care for the public, I would have to argue that their mission has been a failure. I believe it is because they are demanding their clients devote limited and valuable resources in a declining payment environment away from things that have value for patient care and redirecting them to useless projects that have no basis in evidence. Turning nurses into robots will not make patients safer. It will turn nurses into robots. And a robot nurse is ten times more dangerous than one that is allowed to think because robot nurses spend all their time hiding behind hospital policy while nurses who think spend their time advocating for patient care. Here is one 2008 hospital take on The Joint Commission's prn policy.