Healthcare professionals: sticking to working hours

Dinny Byrne has Angina

I had a conversation recently with a doctor who was berating an allied health professional for 'walking off the job' when the shift finished.

This same doctor regularly works for a couple of hours after their shift finishes. They seem to think it's the 'honourable' thing to do, and many of you might agree.

But firstly, not everybody in the system has equal responsibility, and this is largely reflected in pay scales. You can't expect a nurse or physio to assume the same responsibilities as a doctor (not that I think doctors are adequately remunerated, especially NCHDs)

Secondly, and more importantly, I think people who allow a broken system to trundle along by patching it up themselves are perhaps doing serious damage to the organization as a whole.

They might think they are doing the honorable thing by working excessive hours, not taking breaks, and insisting that everyone does the same, but surely this just leads to a culture of burnous, mistakes, and sub-optimum patient outcomes.

Bottom line, shouldn't all healthcare professionals be united in demanding predictable, well-managed staffing levels, even to the point of walking off the job when they are scheduled to?

You wouldn't see airline pilots patching-up shortcomings in air-traffic control, and glossing over serious blunders or mechanical failures.

Should health professionals, and doctors especially, be more assertive?

Why are they not more demanding? A Luas driver wouldn't put up with that.

The approach currently taken does not help patients, it arguably perpetuates weak management. it covers their asses.

dermabrasion

I think there are 2 ways of looking at this. Yes, I think that the over reliance on good will and people filling in the gaps by working more than is safe has undermined the system. This has lead to burn-out, resentment and new graduates running to other countries.
On the other hand, professionals and senior doctors should have the discretion of being able to leave early when things are quiet with the understanding that you have to be able to suck it up and work beyond the expected hours when busy or clinical acuity demands it. This is part of professionalism which we need to have discretion over.
I singled out senior doctors here, as I think juniors need to be be protected from being over worked by the system.

Nonoperational

It's an incredibly difficult position. Generally on call shifts you leave on time when someone comes to relieve you. The day job, I often stay an hour or so to make sure all the work is sorted not to be passing it on to on-call. I don't mind mostly and if I genuinely have to go I usually can.

It's a balance of looking after patients and making sure things are done vs standing up for yourself. It's very hard to stand up for yourself as an NCHD to be honest.

Dingle_berry

Isn't that one of the differences between hourly pay and a salary? Hourly paid workers pay is based mainly on hours worked. Salaried workers pay is based on their set of responsibilities? With due regard to working time legislation etc.

echo beach

Dinny Byrne has Angina wrote: »

They might think they are doing the honorable thing by working excessive hours, not taking breaks, and insisting that everyone does the same, but surely this just leads to a culture of burnous, mistakes, and sub-optimum patient outcomes

You are correct. The culture of long hours and skipping breaks is dangerous for both the professionals involved (in the long term) and for the patients they are treating (in the short term).

Bottom line, shouldn't all healthcare professionals be united in demanding predictable, well-managed staffing levels, even to the point of walking off the job when they are scheduled to?

Yes and no. A professionals can't just walk off and leave a patient in distress or abandon a patient on the operating table. There are emergency situations and pressure points when additional work in required but they should be balanced by quiet times when additional rest can be taken. In practice our health service is permanently in crisis mode and would come to a complete halt if everybody 'worked to rule'.
When professionals ask for more sustainable working conditions they can be seen as 'moaners' or not up the demands of the job. Only when the patients demand change will we see any real moves but healthcare isn't like other consumer services. I can boycott a hairdresser or supermarket that mistreats the staff but I can't pick my hospital based on how well the staff are treated.

Edward Hopper

I take my hat off to interns, if they are lumbered with a poor or lazy Reg and shos they have the weight of the world on their shoulders. Scary the responsibility they have on call for hundreds of patients.

From a nursing point of view, It's 24 hour care, if a nurse is going off shift, a nurse is also coming on shift. Midst of an emergency, like an arrest, most nurses I know will stay behind for a while until things settle. I'd certainly hope my colleagues would anyway. Otherwise clocking off time is clocking off time. You do your best when your in work, then do your best to completely forget work when you leave.
I also know nurses whose time management is poor (imo) and they'll still be at work an hour after they've supposed to be finished but that's something different.