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I've spent a fair amount of time talking with nurses about the problems. I'm related to a bunch of people who are nurses across disciplines (ER, ICU, med/surg,

• strangattractor 4y ago
  I always want to quit my job and I'm not a nurse. I think it is a growing trend. I spend more time typing in Slack than typing in code:)
• xyzzyz 4y ago
  > 2. Patients in COVID have become downright mean. Add this to the problems nurses have management and doctors (who are often rude and arrogant) and it's a poor culture. The quality of the environment, from a mental health standpoint, is on the decline. Mean customers, and rude coworkers? I sympathize, but this is a reality in a lot of industries. I have no reason to believe that healthcare here is worse than average.
  • germinalphrase 4y ago
    People who are sick, in pain, or possibly dying might be slightly less emotionally regulated than your typical customer.
    • brimble 4y ago
      It doesn't help that hospital systems tend to be garbage at customer service, so the person's been told to wait an indefinite (but always very long) period without any indication of how long it'll be, and asked to tediously fill out the same information five different times on five different pieces of paper and iPads, all while feeling terrible, before they finally snap at a poor nurse who isn't to blame for their hospital being an uncaring money-making machine with little regard for humanity.
      • alostpuppy 4y ago
        You didn’t even mention the anxiety patients are enduring over the billing the entire time.
        • MomoXenosaga 4y ago
          And now they will be billed even more because nobody wants to do the job anymore! Healthcare workers are not slaves they can quit after all.
          • 2000UltraDeluxe 4y ago
            Incidentally, Nurses organized by Finnish labour unions are currenlty planning to quit en masse since they weren't allowed to go on strike. Forecasts indicate we'll have a total collapse of the healthcare system by summer unless negotiators manage some kind of breakthrough in the negotiations.
            • MomoXenosaga 4y ago
              Good on them. It is terrible for society when nurses, fire department and police officers go on strike but it is the only way to change the system. And in my experience it is not even about the money most of the time but more the work pressure and conditions.
• tmp_anon_22 4y ago
  > This one is big for product designers. I think this is looking at the problem wrong. The problem is that implementing positive change in these systems is impossible for reasons far outside the control of any product designer or developer currently on the team. This software is old, has byzantine requirements, probably cut costs all over the place, and conceived in a board room without the benefit of an adequate development lifecycle or stakeholders advocating for the users. It probably takes 3 months to move a button around, and instead of moving that button executives are having them push a feature that earns a few more million, or a feature that the customers want more then a UX improvement.
  • citizenpaul 4y ago
    >executives are having them push a feature that earns a few more million I've worked here before... Half our customers are complaining about feature X that doesn't work right/ is inconvenient. Exec: we don't care they are already paying us on a 3 year contract. Hack this new feature into the program that a potential new customer wants. Horrible places to work they are. Thats why I avoid using any long term contracts like the plague. The second I see call for pricing I close the window.
  • mfer 4y ago
    > I think this is looking at the problem wrong. The problem is that implementing positive change in these systems is impossible for reasons far outside the control of any product designer or developer currently on the team. A developer working on something is different from a product designer. For product designer I don't mean a UI/UX developer. I mean someone empowered to design the thing. This is often a leader or product manager. Product design isn't something taught well in most schools. It's often out of sight and mind. An engineer who was good at building hardware or writing code didn't learn the skills needed for product design through that. Product design requires looking at the whole system differently. > It probably takes 3 months to move a button around, and instead of moving that button executives are having them push a feature that earns a few more million, or a feature that the customers want more then a UX improvement. A better UX would reduce the amount of time nurses spend using these systems. That productivity could be used to do more other work (like taking on more patients). I don't like this argument but it's easy to make in terms of cost effectiveness. I don't think the cost effective conversations are happening. I expect there isn't that level of depth to these. It's hard to do when a purchasing organization (like a hospital) only have a few options and they are all bad. This is an opportunity. To build software that is both compliant and has a good UX. There's an opportunity to disrupt all the crap software here.
• woodruffw 4y ago
  This is a good summary, and it corresponds to what I've heard from friends and acquaintances that are currently nurses (or left recently). (2) is a really perverse statistical phenomenon, and it's unfortunate that nurses are bearing the brunt of our civic and public information failures. It must be particularly soul-draining to heal someone who resents the single thing that would have protected them the most from needing hospitalization in the first place.
• zdragnar 4y ago
  Back in the days before cell phones, my mom would wind up being on call for overnight labor & delivery. The final straw (certainly not the first) was that they got a call in the middle of the night that a woman came in in labor, and she had to drive in to work (a half hour drive). This woke up my dad, who also happened to be a light sleeper and worked a day shift. 20 minutes later (while my mom was well on her way into work) the phone rang again- it was a false alarm, she didn't need to come in anymore. Naturally, it was my (not so happy) dad who answered. By the time she got in, they didn't have anything for her, so sent her back home. At the time, there wasn't quite such a crunch in nursing, so the pay part wasn't accurate yet, but everything else you listed (substitute COVID for %50+ of patients) was already true 30 years ago.
  • odysseus 4y ago
    I would think some hospitals have rooms dedicated for the on-call nurse(s) to sleep in. Especially with something as common and false alarm prone as overnight labor & delivery. Pretty sure the midwifery I went to had this.
    • ikiris 4y ago
      or... better yet.... 24 hour staffing. like a functioning 24 hour service should be. This is just abusing the nurse to save a buck.
• tristor 4y ago
  > This one is big for product designers. You're right that there are definitely opportunities for improvement here. As a Product person that has worked in EMR/Healthcare IT systems, I can tell you the biggest challenge is most of the decisions are driven by legally-required compliance. In many cases, you literally cannot make it better because the brokenness is /by design/ to comply with the law. Nearly across the board, especially in the US, our legal and regulatory climate has not kept up with technology and often actively works to the detriment of technical innovation and improving our systems.
  • artful-hacker 4y ago
    I'm in this business too, and it's not just the direct features supporting the law, its the law driving out time and talent trying to make things better. We don't have time to improve systems because we are all too concerned with meeting the latest regulatory pipe dream of interoperable systems. Systems that nobody has ever asked us to use. Entire APIs with full access to key data, that nobody uses.
    • tristor 4y ago
      Yes, this is probably the bigger impact, to be honest. Teams have limited resources and more and more of it is cannibalized by regulatory compliance work.
      • giantg2 4y ago
        We've created so much regulation that no one person can know it all - not the legislators, not the agents/bureaucrats, not the judges, and certainly not the workers or patients who would be most affected by them.
        • killjoywashere 4y ago
          I was just on a 40-person call with Micky Tripathi today. I was on a gov-only call with his minions yesterday. They mean well, but they're policy people, they don't promote by repealing policy (remember, the boss promoting them wrote that policy). No programmer will stoop to a government salary to clean up the mess. Something has to give, and we've decided to break the doctors and nurses until the patients die. Things might change once a few major city trauma systems implode. Keep in mind, the boomers are retiring and there aren't enough Gen X to replace them. Here's the graph of job postings for my specialty (takes a bit of finagling for it to render, esp. mobile, but suffice to say the system is going bonkers): https://www.pathologyoutlines.com/jobs?jbl=1 https://www.pathologyoutlines.com/jobs?jbl=1
• balozi 4y ago
  > 4. Nurses are the catch all for jobs. Not enough aides? Nurses do the work.... The nurses aides would argue that they do the majority of the frontline work while getting paid a fraction of what the nurses make, and get even less credit.
  • mfer 4y ago
    Most of the nurses I talk with speak about a lack of nurse aides. When there isn't a nurse aide the nurses have to do that work. When I speak of a lack of them I know nurses who can go multiple consecutive shifts without an aide working the floor. When they do work there is 1 aide to a floor and can't cover everyone so the nurses do that work.
• mikemac 4y ago
  Agree with all of this, and just to add one thing: liability. Look at the RaDonda Vaught case or the Michelle Heughins case; terrifying to be looking at jail time for a med error. Many nurses are watching these cases more closely and deciding that since staffing isn't getting any better and they won't be protected, it's not worth the risk.
  • giantg2 4y ago
    I believe you can even be personally liable for HIPPA security violations as a user or dev of a healthcare system. That seems a bit scary. I agree that regulation persuades people not to do things out of fear of breaking the law. We see this in it's intentional form with regulation of other things such as abortion, guns, etc. Put so many laws in place that risk of accidentally breaking one and receiving an extensive punishment isn't worth it.
    • throwawayboise 4y ago
      > I believe you can even be personally liable for HIPPA security violations as a user or dev of a healthcare system. Welcome to being an engineer, if that's what you want to call yourself. The engineer who approves a bridge design can be held liable if it collapses due to a design fault.
      • initplus 4y ago
        Lot's of better paid gigs with better working conditions where you aren't personally legally liable if you write a bug. I don't especially care about what job title some board thinks I'm allowed to use.
        • giantg2 4y ago
          Yep. I believe that's really the core of the article - overhead like regulation and liability on top of working conditions have people looking to other professions.
      • giantg2 4y ago
• pvarangot 4y ago
  I have training similar to a WFR that I got in Argentina. I wanted to certify as an EMT in California because why not? It's 160 hours of classes plus 24 hours or practical or something like that for the national exam and then it's the state requirements. Private training is around 2000 dollars. Ok I'm cool with that. There's no way to get a certification with online learning or with any kind of in person time schedule compatible with my job... ok... maybe I can get time off? I have to re-get all sorts of immunizations I already have and re-do medical checks that I already had to get for my green card, like a year ago... ok... that's a lot more time off. Oh, they drug check me! well... I guess even I would work on healthcare more for vocational reasons I'm not doing it while I'm in California. It's just too much of a hassle and with the staff shortages I feel I'm just being taken advantage off. In Nevada it's only take the course, pass the exam and you can already go on an ambulance, so are most other states.
• elhudy 4y ago
  Don't forget that nurses can now legally be thrown under the bus with criminal charges for malpractice while hospitals walk away scotch-free [1]. This is huge in the nursing community right now. [1]https://www.npr.org/sections/health-shots/2022/03/24/1088397359/in-nurses-trial-witness-says-hospital-bears-heavy-responsibility-for-patient-dea https://www.npr.org/sections/health-shots/2022/03/24/1088397...
  • Wistar 4y ago
    And, alas, found guilty: https://www.npr.org/sections/health-shots/2022/03/25/1088902487/former-nurse-found-guilty-in-accidental-injection-death-of-75-year-old-patient https://www.npr.org/sections/health-shots/2022/03/25/1088902...
    • aiisjustanif 4y ago
      Jfc that is terrible.
      • rectang 4y ago
        But the electorate continues to reward "tough on crime" prosecutors. Their incentives are all towards maxing out the savagery towards defendants, systemic repercussions be damned. From the article: > Janie Harvey Garner, the founder of Show Me Your Stethoscope, a nursing group on Facebook with more than 600,000 members, worries the conviction will have a chilling effect on nurses disclosing their own errors or near errors, which could have a detrimental effect on the quality of patient care. > "Health care just changed forever," she said after the verdict. "You can no longer trust people to tell the truth because they will be incriminating themselves." That's the exact opposite of how the NTSB operates. It satisfies the infantile urge to blame and shame a supposed evildoer, to the great detriment of everybody in the long run.
        • PaulDavisThe1st 4y ago
          > That's the exact opposite of how the NTSB operates. Bingo! I have a friend in the UK who organizes "post-mortem" (no pun intended) workshops and process training for hospital staff, precisely to do the NTSB-like thing after medical procedure errors occur. Rather than trying to point fingers and identify scapegoats, the central question is: "what went wrong here, and how do we reduce the chances of that happening again?" Of course, occasionally the answer might be "We hired the wrong person, and we should fire them", but that seems to be only very rarely true.
• cogman10 4y ago
  The one I think you are missing is that nurses are and have been overworked for a WHILE now. (that's what I get from /r/nursing) Hospitals have made sure they hire JUST ENOUGH nurses to cover shifts and no more. With covid hitting, this blew out the number of nurses needed resulting in a lot of "I know you've already worked 60 hours, but can you do another 20? we are short!". Rather than hiring permanent people or upping salary, Hospitals have instead elected to just use travel nurses and an extreme premium so as to avoid any salary increases. The fix is one that Hospital admins don't want. Pay your nurses more and hire more than the minimum to cover shifts so a nurse being out sick doesn't result in another working a 80 hour week. So, instead it's been day old pizza with superhero stickers.
  • 14 4y ago
    From a Canadian stand point you American nurses are already highly paid. My brother works in the US and was recently thinking of coming back to work closer to where he grew up. The best deal he could get here was $20usd less then what he makes there. So on top of making $20 more then a nurse here he is also making it in USD. He is making huge amounts of cash as a nurse down there. How much more do nurses need?
    • callmeal 4y ago
      >How much more do nurses need? Something something freemarket no longer applies when it comes to paying peons?
      • sophacles 4y ago
        > Something something freemarket no longer applies when it comes to paying peons? It never did.
      • conductr 4y ago
        The nursing labor market is so fluid, so much turnover, it operates much more like a commodity exchange where prices are concerned. This doesn't apply to people to refuse to change employers so incentivizes short term rate chasing
• peoplefromibiza 4y ago
  preface: my parents are retired nurses and a big chunk of my family works in healthcare. It sounds like the issues nurses face are global and do not significantly change across different systems (the system in my country is completely different from USA) It probably comes down to the fact that this is a human problem and to solve it we must radically change the expectations around care and primarily being taken care of. There's no technological deus ex machina or amount of training that can change the situation without shifting the POV. IMO people working in HC are subject to a lot of stress and must be protected at the cost of making it a bit unpleasant for the patients to be cured. It's such a fundamental foundation of our lives that the system should be calibrated to create the best possible working environment for those who are working instead of moving it toward a customer reviewd activity that focuses on their satisfaction. I know it can sound unpopular, but receiving the best medical care possible is not a right, it's a goal that more often than not it's almost impossible to achieve, so let's improve the working conditions so that the workers can give their best without questioning too much all the sacrifices that the job requires.
  • lazide 4y ago
    Well, first you’d need to get over the idea it’s oriented around customer satisfaction or outcomes, which it doesn’t seem to be here in the US.
    • peoplefromibiza 4y ago
      I don't know the US system so well to argue, I can only expand on what I meant: the job of healthcare is not to make people comfortable or make their wishes come true, HC, unfortunately, it's not a democracy. What I've seen in the past 30 years is a gradual shift towards becoming some sort of wellness centers for disease: patients that complain about other patients, patients that complain about their accomodations, patients that complain about therapies, most of all patients relatives that want to have a say on everything that's going on up to the point that doctors simply do what asked to not waste too much time with them. And to add insult to injury, all the legalities that made taking a decision virtually impossible without risking too much. Of course there are situations were malpractice causes more damages than the illness itself and those must be reprimanded, we can't afford to disrupt trust in medicine in any way, but the results should be taken into higher consideration than the opinions. ER, intensive care and other kinds of "hardcore" department should also be judged differently, just like it happens to military personnel who are not subject to regular justice while on duty.
• safdahfslh23s 4y ago
  My partner is a physician in an ICU and a lot of her colleagues have talked about leaving the field as well. Their complaints are #2 & #3 along with: 5. Pay cuts - Most of the critical doctor specialties (ER, ICU, primary) that were the backbone of the pandemic got "raises" that were less than inflation (hers was 1.5%) while profitable elective specialties got big raises. The root cause is the billing system where elective surgeries bill pay out more than critical roles. Still, it's extremely demoralizing to be called a "pandemic hero" and have your pay get cut. 6. Criminal and Financial Liablity - Healthcare is delivered by a team yet the financial and criminal penalties for mistakes are assessed at the individual level. Recently a nurse was given a criminal sentence for a drug mistake which many believe was systematic failure (bad UI / IT systems, bad hospital practices, AND negligence on the nurse). Imagine getting sued or jail time as an engineer for dropping a production database. The few malpractice cases my partner has been involved in, it was very clear that the issues were systematic and perpetuated by hospital practices. However, if they had gone to trial, an arbitrary worked would d have been sued and the hospital wouldn't change its crappy practices. Institutions have effectively dodged liability in many cases. 7. Chronic understaffing and burnout - most ICUs have been understaffed throughout the pandemic. From an economics POV it seems crazy that their is a labor shortage but salaries are effectively dropping.
  • killjoywashere 4y ago
    Thank the hero of Medicare, Lyndon Johnson. When CMS actually needed to start pricing things, he directed them to his old buddy, the famous heart surgeon, Michael DeBakey. DeBakey sent a couple fellows of his to DC to write up the price list for CMS. Shockingly, surgical procedures got a lot of money and office visits got approximately nothing. This has propogated for 60 years now with increasing precision as the rate of inflation gets applied over and over. A WAG of "10,000 for bypass" is now "57,348.32 +/- 343.43" but the error represents the uncertainty in inflation over time, not any better resolution on the cost of the procedure.
    • freddie_mercury 4y ago
      Why are you so quick to assign blame to the first actors? This expectation that the first people to do something need to make it perfect in every way is completely toxic and one reason for the total paralysis of America. The majority of the blame here lies with the thousands of politicians, bureaucrats, and administrators who haven't reformed the system in *sixty years*. Not the people who were doing their best with much less information than their successors have had.
• e40 4y ago
  On (3), Kaiser seems to be the exception to this. Their systems, on the nurse/Dr side seem very easy to use and the connections between different departments work seamlessly. At least, from what I've noticed as a 10+ yr Kaiser patient in the Bay Area.
• MomoXenosaga 4y ago
  Dont forget the sexual harassment. Twenty two year old nurse and boomer men don't mix.
  • maestroia 4y ago
    Someone I dated last year has worked on the administrative side of hospitals for years. Her statement was "everyone is hooking up in them, and it's typically ignored. Unless they use a patient bed, then all hell breaks loose."
• rectang 4y ago
  > 3. IT systems that they have to use were designed by people who have not talked with the workers who use them. They may have been designed with laws and compliance in mind. Nurses aren't the people who choose or pay for these systems. But, they use them a lot (maybe the most) and it's obvious they weren't taken into account when designing the UX. It's maddening for them. > This one is big for product designers. Often we listen to the people who pay for it and miss out on the people who actually have to use it. This resonates with me strongly for two reasons. First my mother is a retired RN, and the electronic record keeping was her biggest frustration. It is hilarious to me how much my mother hates computers, while I make a living in software. Second, I'm now working for a startup, Smarter Dx (we're hiring: https://angel.co/company/smarterdx/jobs https://angel.co/company/smarterdx/jobs ) that works with these records and tries to make better use of them. To the extent that we're successful, incentives are created for the hospital to improve them, conceivably including improving the UX that nurses see. I don't mean to underestimate the difficulty of the problem, but I think it's possible to at least push in the right direction.
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• causality0 4y ago
  3. IT systems that they have to use were designed by people who have not talked with the workers who use them. You couldn't be more right about that. Last week a nurse had to use a computer in my wife's hospital room to log that she'd given her a painkiller. The IT staff had failed to configure the hospital computers to disable windows updates or restrict them to off-hours and the nurse was forced to stand there for ten solid minutes while Update churned, the pc restarted, and Update churned some more.
• vonnik 4y ago
  I work at a startup* trying to tackle nurse burnout, and two of my family members are nurses. Here are a few things I've learned: - Nurses were getting burned out before the pandemic, and the US has a nursing shortage that's been going on for about 90 years (it started with an infrastructure buildout in the 1930s).* So it's a secular problem, with chronic as well as acute causal factors. - There is a ladder of nursing credentials, and the shortage effects them differently. Hiring for roles like CNA and LPN/LVN has exploded because of the shortage of RNs and above. CNAs get trained in 4-12 weeks to do the heavy lifting of care; RNs get ~3 year degrees to perform much more complicated tasks. - Burnout, and the nursing shortage, are in a positive feedback loop/downward spiral. That is, the more nurses burn out, the more they cause other nurses to burn out. Short-staffed facilities have a very hard time pulling back to normal staffing, because nobody wants to join a skeleton crew. (I know of long-term care facilities where the scheduling nurses (the bosses) are working the graveyard shift because they can't fill it.) - Many nurses work rigid schedules on 12-14 shifts, and a lot of medical errors happen at the end of those shifts. * - The hot US job market (Great resignation, great reshuffle) is hitting nursing especially hard; it is very sensitive to external shocks. There are paths to easier work and higher pay. - Many healthcare facilities and systems don't give nurses flexibility or the possibility of advancement. (One family member will need to quit her current job and come back in a year or two to her current employer if she wants to move up a pay grade -- which is like some tech companies -- but slower moving and lower paying.) - Many facilities are run entirely on foreign staff (the H2-B visa allows that). And many nurses are imported from the Philippines. * https://clipboardhealth.com https://clipboardhealth.com * https://www.nursing.upenn.edu/nhhc/workforce-issues/where-di https://www.nursing.upenn.edu/nhhc/workforce-issues/where-di... * https://www.nytimes.com/video/opinion/100000008158650/covid- https://www.nytimes.com/video/opinion/100000008158650/covid-... (plug: if you're interested in this problem, we're hiring: https://culture.clipboardhealth.com https://culture.clipboardhealth.com)
  • clumsysmurf 4y ago
    > Many facilities are run entirely on foreign staff (the H2-B visa allows that). And many nurses are imported from the Philippines. I'm curious what the consequences of this are, how does this impact the profession in the US?
• ikiris 4y ago
  No one cares about ux in hospital purchasing at all unless it’s an admin app.
• ihodes 4y ago
  I think this is a great summary of some of the main challenges nurses are facing. I'd add to #1 that travel (temp) nurses are making 4x+ more than staff nurses, I've heard as high as $13-17k per week in high-demand areas. This exacerbates the problem, as staff nurses hear this, and if they can, they leave. Travel nurses can be great, but they won't know the facility and workflows and people as well as staff nurses: staff nurses now pick up more slack, all while getting paid 1/10th what their new colleagues are. This is more than most doctors. For #3, this problem is made worse by additional compliance burden. Nurses need to document more and more, click more and more, read more and more… with less and less time. And on systems that are unpleasant to use. Among other issues, this leads to problems like these[0], which drive more and more nurses away. I'm working with a badass team on solving some parts of these problems, particularly relating to technology and workflows. If you're interested (across basically any role, but product designers, engineers, product managers are top of mind right now), let me know (email in bio)! [0]: https://www.cbsnews.com/news/radonda-vaught-nurse-guilty-death-wrong-drug-dangerous-precedent-nurses/ https://www.cbsnews.com/news/radonda-vaught-nurse-guilty-dea...
• Soulsbane 4y ago
  Food service workers don't want to take food into a patients room? My mom worked in food service for several years at a hospital and took the food into the rooms. Is this not the norm?
• redwall_hp 4y ago
  > Patients in COVID have become downright mean. Add this to the problems nurses have management and doctors (who are often rude and arrogant) and it's a poor culture. So...this is also the biggest reason (besides lack of pay or basic human dignity) that restaurants and retailers are having a lot more trouble finding employees. Rude (and sometimes violent) customers were already an issue, but they've become absolute animals lately. It's increasingly bad for your own health, mentally and physically, to have any public-facing job. In the last few years, we've let go any pretense of expecting people to be civil and reasonable, and adult children are rewarded for their behavior instead of being trespassed. Teachers are also quitting in droves (and in the middle of the school year, in some cases) for the same reason. Children are awful and the parents are worse. You risk sickness and violence, and are constantly harassed by parents. Then there's the whole attack on the curricula and book banning... The FAA reported 1099 incidents with unruly passengers last year, up from a normal 100-300 in prior years. Because some sorts of people simply won't do what they're told...and disobeying flight crew instructions is generally a federal crime. Everyone's increasingly overworked and underpaid, and they have to deal with degenerates like that daily. Of course they want out. We're having a societal implosion.
  • kenjackson 4y ago
    Everyone thinks that their belligerence makes them Sam Adams or Gandhi rather than just the jerk they likely are. I see this every weekend at youth sporting events. I'm just like, "it doesn't matter why -- if the ump says you need to leave, just leave -- this isn't Game 7 of the World Series".
  • galangalalgol 4y ago
    Those unruly passengers are frontline help desk that had to deal with a elementary teacher that had to deal with kids that had to deal with parents that had to deal with unruly passengers. Everyone is on edge because scarcity is making a comeback, and we are all paying that stress forward.
    • toomanydoubts 4y ago
      I like that view. Most things are shit nowadays and everybody is sick of it. You get pissed on, and then you piss on somebody else because why wouldn't you? Nobody is caring for you, why will you spend the little amount of mhntal resources you have left to care for someone else? It's toxic but it's the direction the world is moving to as long as the people in power keep choking their underlings and taking away every piece of joy they ever had.
• thepasswordis 4y ago
  >Patients in COVID have become downright mean. Maybe, but nurses have also used "because covid" as an excuse to engage in some pretty awful behavior. Fathers have only very recently been allowed in the room during ultrasounds, for instance. NICUs only recently started allowing both parents to visit at the same time.
  • majewsky 4y ago
    Is this because of the whims of individual nurses, or because of policies put forth by the hospital administration?
• robertlagrant 4y ago
  We make really usable software for nurses, and they absolutely love it. I think the effort we go to is totally unnecessary to achieve that, as - just as you say - most medical software is so bad from a user perspective. Anyway, it's nice to make software like that :-)
• meatsauce 4y ago
  How, in your opinion, did the Affordable Care Act affect nursing? Were you in a position to observe then?
• sli 4y ago
  > IT systems that they have to use were designed by people who have not talked with the workers who use them. This was exactly my experience when I worked for a medical software startup. Our (very unfinished) software got deployed in a hospital with no training, no orientation, no nothing, and it was such a disaster that it was a patient safety issue. Mind you, the engineering team had no say in any of this, not that we were even given the chance, and we weren't even aware that the deployment was for real. We were under the impression that the deployment was for testing purposes, because we were aware that the software was unfinished. It was a breathtakingly poor decision purely on the part of managers (and, frankly, sales) on both sides of that deal and it was doctors and patients who suffered because of it. An absolute nightmare all around and I'm glad to no longer be there.
• abeppu 4y ago
  > Many new nurses make the same or more and long time nurses. Is it mainly lack of information (and exhaustion) that prevents these more experienced nurses from negotiating for what they're worth?
• luckydata 4y ago
  about #3 that ain't a design issue, it's a policy issue. Until healthcare in the US is about maximizing profit extraction by every party involved things will not change. For profit healthcare is an abomination and a blight on the very soul of this country. If I believed in religion I would say God will judge us very harshly for allowing this system to stay in place for so long.
• mikewarot 4y ago
  >3. IT systems that they have to use were designed by people who have not talked with the workers who use them. Every time the computers went down at a friends ER, the waiting room emptied out as the staff were able to use paper forms and just get their jobs done, instead of being forced through thousands of menu clicks and choices that made no sense. EVERY SINGLE TIME -- Epic or as I call it... the Epic Failure. I always give my condolences to staff forced to use it.
• AussieWog93 4y ago
  >1. Many new nurses make the same or more and long time nurses. It's frustrating when the nurse in charge with the most experience is making less than new nurses. Some hospitals are even trying to stop nurses from talking about pay. I think non-performance-based pay is something endemic to many female-dominated professions. My wife used to work in childcare, and it did her head in that she was paid less than complete idiots who'd been working there longer than she had.
• Terry_Roll 4y ago
  >3. IT systems that they have to use were designed by people who have not talked with the workers who use them. They may have been designed with laws and compliance in mind. Nurses aren't the people who choose or pay for these systems. But, they use them a lot (maybe the most) and it's obvious they weren't taken into account when designing the UX. It's maddening for them. >This one is big for product designers. Often we listen to the people who pay for it and miss out on the people who actually have to use it. Thats an interesting comment because I know the main developer for one of the most popular hospital systems used throughout Europe and its popular because its good. Saying that, I also know there are medical consultants at a world famous hospital who dont really know how to program but because of their position have got their software in use when it perhaps shouldnt be. I know alot of US programmers doing various medical systems for local hospitals and health care regions with various standards of programming skills. Like you I also know of people in various roles, from world famous multi millionaire consultants to nurses on the front line. Every team & dept is different. Sometimes its a managerial problem at the top of the health trust, other times its just the team and low level management. Saying that there is a culture of taking a sicky probably because they see consultants putting private work before NHS work and they see the wages some of these consultants get paid and Google Scholar, PubMed, DrugBank etc keeps highlighting the inadequacies of the teaching, ie they dont keep up to date, some areas appear to be decades behind the science other areas are within a few years of the latest research. Too much reliance on drug companies when superior non patentable solutions already exist.
• dboreham 4y ago
  >IT systems that they have to use were designed by people who have not talked with the workers who use them. Interesting thread because this is my current $dayjob! I work for an organization that is both a tech company, and a medical services provider, so we can optimize away the boundary between vendor and customer as far as the software is concerned. My particular area of interest is in providing system programmability that can be exploited by tech-capable clinicians to provide both better patient outcomes and more pleasant provider experience. Basically don't try to have software developers understand every last detail of the practice of medicine. Instead provide a programable platform that's usable by a subset of clinicians.
• deleted 4y ago
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• pfisherman 4y ago
  > IT systems that they have to use were designed by people who have not talked with the workers who use them. They may have been designed with laws and compliance in mind. Nurses aren't the people who choose or pay for these systems. But, they use them a lot (maybe the most) and it's obvious they weren't taken into account when designing the UX. It's maddening for them. I can speak to this a bit. After interviewing lots of hospital workers, I can tell you that the hospital quality people love EHRs because the reporting functions actually work. Previously, it was not possible to measure how well the hospital was doing and convince the doctors to improve practices - think washing hands before doing examinations. EHRs are shitty because (1) the big players are entrenched - they are already implemented and the cost / disruption to switch to a new EHR is extremely high, and (2) the market isn’t big enough to justify the level of investment it will take to break through - Apple made more money from one product (AirPods) last year than all the EHR vendors combined. At this point my hope is that mobile devices and meta-EHRs are able to crack this.
  • urthor 4y ago
    Apple made that money from selling Airpods to the entire globe however. Part of EHR's problems are definitely that the market is only one single country, the United States.
    • Master_Odin 4y ago
      And even within that single country, each state and hospital then has their own requirements around EHRs. This ends up being my biggest issue with EHR is that you need to support infinite flexibility for all the unique snowflakes that exist. I'm convinced healthcare would improve in this country if the federal government standardized all of this to a single setup. This also includes the mess that is EHR in EMS.
• aurizon 4y ago
  When I was young, in the 1950's. Nurses were respected, as were teachers and so on - we generally learned from and respected our elders. In the intervening period disrespect has grown, and chastisement has declined. Respect and disrespect are still there - we have Lord of the Flies played out in our school yards daily. The strong and socially facile bully/beat and establish gang structures. When I was young = 95% white, and the weapons were fists. Now gangs are color coded and are better armed. Disrespect a person now = diss someone, and you either yield = be the toad = toady in the manner of toads. Humans seem to need to be closely supervised to forestall this = Big $$ for watchers. Our school was square with long halls with class rooms on each side, wide double run stairs, three floors. Every hall segment between stairs = 1 teacher. Every landing = teacher. Recess was boys and girls apart grades 1-8. Mixed above, but every yard area had 2 teachers. Now these areas are ungoverned and the gang hierarchies rule the areas. I think a computer guided system would help. My experience in lower grades, high school, college and grad school is that there is a consistent lack of showing students the concept of self-study, this is exemplified with the famous self studiers AKA autodidacts, like Newton as a prime example. This skill is a very important one to develop early in children. Sort of give a person a fish a day - or teach him how to fish. Online teaching at all levels up to and perhaps including grad school is well suited to complex programs that show a student a module of this or that. This can be history or mechanics. After the module is presented, the student is queried on the facts of the lesson and then asked what he can deduce from the lesson. Say the 300 against the Persians - why did the Persians fail? The student should then deduce that because the front of battle was only 30 people wide that it was a battle of 30 against 30, and better training, armor, skill and weapons that meant the Persian masses were useless - it was an attritive war of 30:30 until one side lost enough men that it became 30:29, 30:28....30:1 = war over. Some students have greater intelligence and will analyze this aspect correctly. Those that do not are sent to the first fork..... and on to the full analysis. In this case, the Greek better arms/skills may well have endured until the entire 300,000 Persians were killed, via re-supply from various Greek city-states - in this case, the Persians did an end run and were able to change the combat ratio to the point where the Greeks were overwhelmed. Going to the general case:- The auto-didactic skill of the student needs to be developed one-on-one via the skillful design of the course material, with forks and subforks and re-entrant forks into the stream as each student masters an item and proceeds. At every point there should be a fork for every fail point - you can have as many forks as needed to imbue understanding. Modern computer systems are quite capable of this degree of complex interaction - but it requires a good amount of work with both masters in topics(many of them to variegate the forks) and up to now I have seen few produced. Large amounts of $$ and time have been spent on thousands of parallel minimalist approaches - it needs a central command/fund structure. /rant...
• rileymat2 4y ago
  > IT systems that they have to use were designed by people who have not talked with the workers who use them. I worked at a large emr company and the developers had access to nurses and were required to support go lives a few times a year to support nurses on the floor.
• cleandreams 4y ago
  >IT systems that they have to use were designed by people who have not talked with the workers who use them. They may have been designed with laws and compliance in mind. Nurses aren't the people who choose or pay for these systems. But, they use them a lot (maybe the most) and it's obvious they weren't taken into account when designing the UX. It's maddening for them. This one is big for product designers. Often we listen to the people who pay for it and miss out on the people who actually have to use it. This!! I had a friend who retired early because she was literally being worked to death. A big part of that is the hours she spent after hours trying to deal with the new IT system.
  • 1983nurse 4y ago
    Totally and completely agree! I spent hours when hospital I worked for 30 years, made our GI lab use the program for documentation and billing from the OR. It was abysmal. I tried and did the best I could with Cerner, but you can’t fit square peg in round hole- no one designing ever asked those that had the 30+ yrs of knowledge that could have developed a unit or specialty specific program. It just wasn’t THAT hard, but management wanted it to work with what they already paid for!
  • FSU1983nurse 4y ago
• jb1991 4y ago
  > IT systems that they have to use were designed by people who have not talked with the workers who use them. I wonder if you are talking about Eclipse software which seems to be universally frustrating for doctors and nurses across many countries.
• tintor 4y ago
  "3. IT systems that they have to use were designed by people who have not talked with the workers who use them." This is a very common issue with enterprise systems, since incentives aren't aligned. Users of such systems aren't the ones choosing them.
• apflkx 4y ago
  Poor UX for medical systems is something that has always baffled me. I used to work for one of the major CT system manufacturers (although on the firmware end of things). I never understood why a hospital would willingly pay a seven figures price tag for a medical imaging system that comes with an early 90s GUI. Ultimately, it is not the radiologists or technologists who make this decision. From a purely technical point of view, modern systems hardly differ from each other, at least as far as diagnosis is concerned. The fact that a better UX means new users need less training and the time between scan and diagnosis is reduced are hardly taken into account when making a purchase decision.
• wiether 4y ago
  > 3. IT systems that they have to use were designed by people who have not talked with the workers who use them. They may have been designed with laws and compliance in mind. Nurses aren't the people who choose or pay for these systems. But, they use them a lot (maybe the most) and it's obvious they weren't taken into account when designing the UX. It's maddening for them. Working in Healthcare IT I can only concur on this point. For me there's multiple reasons behind this issue : 1. Regulations. First and foremost, IT is here to help/force users in complying to those regulations. So it's the first thing that dictates how you'll develop the piece of software. Those regulations are mostly written by people that aren't Healthcare professionals nor IT professionals. They are regulations people. So they can't produce something that makes sense for Healthcare people and is even harder to _solve_ for IT people. And those regulations are updated quite frequently, most often creating breaking changes. So if you want to keep up (and you have to if you don't want people ending in jail) you must work fast, meaning skipping important steps to produce something user oriented. 2. There isn't much money. At least on my side of the Atlantic. This is not necessarily a huge problem because contrary to people at FAANG-like companies, here most people are focused on helping people to help other people, not on their paycheck. But there's so much middle-men taking their cut that in the end, you only worked understaffed with unrealistic schedules. Meaning the only way to deliver something is to take big shortcuts. And again, leaving UX/UI on the side of the road to reach the main goal : being compliant with regulations. And when I say there isn't much money, it's partially true. When it's about buying a nice startup, there is heaps of cash. Because you need to keep the market as closed as possible. But when it's time to actually invest in making better software, the wallet is empty. 3. There's a weird mindset where in most cases, end-users are simply not considered. At my previous jobs, I always asked to sit with actual users of the software to see how they work and what their actual requirements are. Since I joined Healthcare IT, on the ~20 projects I worked on, there's only one case where I was authorized to do so. On all the other cases, the "IT Project Manager" (whatever this is) just said that they knew exactly what the users needed, even though they never actually worked with them. And on the project I was allowed to work correctly, instead of the original proposal that was agreed on, based on my observations, I came up with a solution that was much simpler for the users, easier to build for the IT team, so delivered faster and at a lower cost. So the customer was happy and decided to sign a contract for another piece of software at the company. Everyone happy in the end. But it's an exception. In the other domains I worked on, it seems obvious to everyone that gathering intel from the actual users was mandatory to produce something valuable. Here, management think they know better. They don't. And honestly I don't see how it can improve since those three points keep getting worse and worse every half-year.
• wink 4y ago
  > Food service workers don't want to take food into a patients room... nurses will do it No idea where you live but in German hospitals I've never been given the food by anyone but a nurse. There are literally zero people/professions besides doctors, nurses, and cleaning staff near patient rooms.
• itsoktocry 4y ago
  >This one is big for product designers. Often we listen to the people who pay for it and miss out on the people who actually have to use it. Pedantic, but: I think it's the responsibility of the people that pay for it to talk to the people who use it, and buy the best software. I have a hard time believing that you can sit a bunch of nurses in a room to talk about the software, and that they'd design and/or elaborate on an awesome UX. Is there an example of that ever working? People have funny ideas about what they want. Homer Simpson's car design is a meme for a reason.
• xyzzy21 4y ago
  A lot of the problem starts with the fact that most hospitals in the USA were taken over and are now owned by "Private Equity". If you know ANYTHING about finance, that should send shivers up your back and also make you realize why this happening with nursing. Private Equity is where you go to get money if: • Your business is floundering and no one will loan to you • Your industry is in the ebbing phase and not growing • You are ignorant or naive about getting money for business • You haven't done your due diligence • Your company is in play for a hostile take-over Having Private Equity getting involved is always a major Red Flag if not Black Flag. In general, Private Equity knows nothing about your business norms or markets - they don't care. They are a one-size-fits-all investor and that primarily means "Cut Costs on Everything". It's very akin to having a lawyer become your CEO (e.g. Sears/Kmart) - it's a omen of VERY BAD things being imminent. A case in point: the COVID bounties from Medicare for testing, admissions, treatment AND DEATH BY COVID are exactly something that Private Equity would love maximally, dream up and probably try to enact with lobbyists.