Vanderbilt Hospital In Nashville Has Nurses Doing Housekeeping

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NASHVILLE, TN (WSMV) -

Vanderbilt University Medical Center’s latest budget moves mean nurses will be responsible for a lot more than patient care.>

The Channel 4 I-Team has learned some Vanderbilt nurses will now be in charge of cleaning patients’ rooms, even bathrooms.

Sanitized environments in hospitals are critical to a patient’s health, but the new cost cutting measure has at least one nurse concerned.

“Cleaning the room after the case, including pulling your trash and mopping the floor, are all infection-prevention strategies. And it’s all nursing, and it’s all surgical tech. You may not believe that, but even Florence Nightingale knew that was true,” said a hospital administrator to staff in a video obtained by the Channel 4 I-Team.

The new cleaning changes were also detailed in an email sent to staff of the Vanderbilt Medical Center East team, which – according to a hospital employee – works in surgery areas and patient rooms.

A manager writes in the email, “We have undergone some major budgetary changes … this means we will need to pull together like never before.”

The email says nurses will now have to pull their own trash and linens, sweep up and spot mop. Nurses, care partners and nursing assistants will be responsible for all patient care areas.

“The priority will be what the patient sees,” the email states.

Also, in bold highlighted text, the email says, “Be sure to wear the appropriate [personal protective equipment] when doing any disinfecting – that includes, a cover up gown, gloves, mask and even an eye shield when necessary.”

Nurses were also told to “refrain from speaking negatively about this in an open forum where our customer can hear. If you need to vent come see me.”

The hospital employee did not want to be identified for fear of losing her job but wanted the public to be aware of the changes.

“This is our new reality. The work still must be done. We must still care for patients, and we must do so in an efficient manner,” the hospital administrator told staff in the video obtained by the Channel 4 I-Team.

The nurse to whom we spoke says before these changes, the hospital’s environmental services department was in charge of cleaning those patient areas and that staff does not have interaction with patients.

The nurse is concerned that doing both cleaning and patient care could lead to cross contamination.

The email obtained by the Channel 4 I-Team does say environmental services will still be handling some cleaning.

In a statement, Assistant Vice Chancellor John Howser, said:

“The safety of our patients is always of foremost concern. All decisions about operational process redesign at the Medical Center are being made in a patient-centric manner and will not affect the safety of patient care.”

The Tennessee Department of Health says it does not specify how a hospital chooses to clean, as long as the employees are appropriately trained and follow CDC guidelines.

If they do that, the state says there should not be any increased risk of infection.

We checked with Lipscomb’s nursing staff. The executive associate dean of nursing, who has been a nurse for 25 years, says she hasn’t heard of a hospital doing this before.

Copyright 2013 WSMV (Meredith Corporation). All rights reserved.

This really bothers me. As nurses, we already have hundreds of responsibilities, and I believe Vanderbilt’s choice to have nurses clean toilets and mop floors may lead to cross contamination as well as an increase in patient falls and medical errors. I am certain they are not going to decrease the nurse:patient ratio in order to make this change easier on the nurses. Vanderbilt is looking for ways to slash jobs, so they are getting rid of EVS because they can only legally get rid of so many nurses.

Especially insulting is the implication that Florence Nightingale would have wanted nurses to return to doing housekeeping in the hospital. Nightingale wanted nursing to move forward, not backward.

Please help me get this out on social media! Retweet, reblog. Post it on Facebook. Don’t let Vanderbilt harm patients and nurses this way! Use the #Vanderbilt hashtag.

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About Grimalkin, RN

Trying really hard to be a decent person. Registered Nurse. Intersectional Feminism. Poet. Cat. Political. Original recipes. Original Stories. Occasionally Questionable Judgement. Creator of #cookingwithjoanne and #stopcock. Soulless Unwashed Carrot. This blog is dedicated to my grandmother, my beloved cat Grimalkin, and my patients.

Posted on September 16, 2013, in Nursing and tagged , , , . Bookmark the permalink. 185 Comments.

  1. Glad I left my nursing job!!! Ever heard of NOSOCOMIAL infections??? Its only going to get worse with Obamacare! Wonder how many nurses will be sued for malpractice when they are also forced to do MD procedures?? Nurses get NO respect!

    • And, again, why would you assume that nosocomial infections will get worse due to “Obamacare”?
      Were you under the impression that getting more Americans insured will somehow cause them to get sick and end up in the hospital? Did you think that keeping them uninsured would keep them from getting sick?

  2. In nursing school, they taught us to be advocates for our pt’s. In an ICU setting, our pt’s many times cannot speak for themselves. They or their families often don’t understand what is normal or safe practices in this setting. I find that tests/studies on ICU pt’s are being delayed as much as 3 days. Reason being short-staffing of nurses and radiology staff. If this causes death or serious setbacks, are the families going to know enough to question the delays? The hospital is not tracking the delays so therefore, nothing is getting done about it. Some poor soul will be the unfortunate one to suffer, die, then the family will have to be brave enough to seek legal action. Then this will be repeated many times before any positive may come from it. God help us all, esp the patient! P.S. keep the toilets clean.

  3. Retiring after 45 years of nursing ; just in time to be on the receiving end of this disaster.

  4. I’ve been in nursing 40 years. When I first started as a CNA, the CNA’s did the terminal cleaning of a patient’s room I can still take a bed apart and clean the springs (glad I don’t have to). But I NEVER heard of the nurse’s having to do these duties. Assessments, doctor’s orders, medications, IV’s, charting–theses are things nurses do. .Where and when is the list of things being piled on top of nursing duties going to stop?

  5. I have been in nursing for over 40 years.This is certainly a step back for nursing and will be detrimental to the care of patients. My son was there for 40 days and he was a threat to himself with brain trauma and a fractured leg and ankle (non-weight bearing). There was no way he would have been safe from falls and tearing out lines if we hadn’t stayed with him 24/7. The nurses didn’t even have the time to coax him to eat. The answer to that was to suggest a feeding tube. I wasn’t impressed with the care after the trauma unit. They did a good job in trauma but were strapped there too. Those nurses worked 12 hour shifts and we saw them there well over an hour after their shifts ended. So go figure, they were working 13 – 14 hours shifts. Now doing terminal cleaning?? WTH??

  6. Another insult to nurses. I’ve been a nurse for over 20 years. The hospitals all want to achieve magnet status, and in doing that, they want all nurses to have BSN’s, so we all have BSN’s so that we can now clean toilets and mop the floors? The nursing profession continues to be disrespected!

  7. I was in the Hospital for 11 days in 2013 and my RN nurses
    changed the linen and made my bed. Nothing new here.

    • It is normal for nurses and CNAs to change linens and even to empty the trash and to deal with biohazard materials. What we are discussing here is having the nurses scrubbing the toilets, mopping the floors and taking on duties normally done by housekeeping, all while continuing the duties they are already tasked with as nurses: assessments, wound care, medication administration, therapies, charting, etc.

    • Nam Marine, changing the linen and tidying up is one thing. Mopping floors, scrubbing toilets and scrubbing the beds and sinks and countertops with disinfectant in between patients is quite another.
      There’s also a big difference between pitching in on these tasks when you can, to keep things moving, and being held responsible for them even when you have a load of patient care tasks to do as well.

  8. I almost died in the Hospital from sepsis. It was the Nurses that
    saved my life, not the Dr’s.

  9. What is going to take to stop this disrespect & demoralization of nurses? How do you do patient care with the add-on of cleaning toilets, emptying trash, & mopping floors? The next question, why would you have a nurse do this? I have been a nurse for 39 years. We are going backwards instead of forwards. The only ones really profiting are the CEO’s who are making over $3,000/hour when you break down their million dollar salaries per year. I feel awful that quality patient care is being sacrificed at the expense of these greedy CEO’s & their counterparts. God help us.

  10. Sharon Pokorney

    oliva here goes,this is about the bundled payment system… quote the more treatment hospitals provide their profit margins shrink since the amount they r paid is FIXED. so the hospital will receive financial rewards if the patient recovers quickly and will be punished by getting lower payments for medicare etc.Section 9007, 9015. 10906. In title 1x.. That is the best i can do and it is alot scattered though out the entire law

  11. Sharon Pokorney

    That is why some large places such as Cleveland Clinc, Carle Clinc etc have oped out since they cannot decide what patients should stay or go , yes some will be Ok but not all and that is what is bothering all of us.. you must be for the ACA … I am not but since none of us had a say , only time will tell lhow big a mess this could be…. Good luck with your reading….

    • You know, I’m still trying to figure out why some think the ACA is likely to have a negative impact on hospitals’ Bottom Line. Uninsured patients are admitted to hospitals, too, and have been all along. Some have paid a little bit at a time on their bills; others have gotten the hospital to write off part of the bill; others have just stiffed the hospital, and avoid answering their phone when the collection agencies call.

      So how is it going to reduce the hospital’s revenue if 30 million of these formerly uninsured Americans now have health insurance? It doesn’t make sense.

    • The ACA is only going to help hospitals.

      • Incorrect, Michelle: The ACA is only going to help insurance companies. With the mandate that everyone has insurance coverage, this creates a windfall of newly insured for the insurance companies. A large number of these previously uninsured are otherwise healthy, young adults that are not predicted to utilize resources (thereby increasing the offset of those who are insured and who require expensive healthcare). The ACA includes multiple cuts in hospital reimbursement from Medicare and Medicaid (many of these have already occurred some are still forthcoming).

        On a side note: do you know why your employer (hospital) is so adamant about having every employee vaccinated against flu this year? According to a provision in the ACA, if a hospital does not have at least 90% of their employees vaccinated against influenza, the hospital receives a cut in all Medicare reimbursement. The ACA is full of these little “provisions” that are negatively impacting hospitals on a daily basis.

      • Robert, you’re delivering the usual anti-ACA talking points, but they’re not really relevant here.

        First, tell me why you think an uninsured patient is going to provide more revenue to a hospital than one who’s got Medicaid. Granted, Medicaid reimbutrsement is pretty paltry, but it’s better than nothing, and in many cases currently and recently uninsured patients are paying little or nothing of past hospital bills. What’s more, uninsured people have a tendency NOT to seek treatment until a worrisome symptom has blossomed into a serious problem, which in turn leads to more aggressive (read: more costly) interventions—and the hospital ends up eating the cost. In no way is that a cost-effective approach.

        Second, I don’t know about your hospital, but the hospitals I’ve worked at have always offered annual flu shots to staff as a benefit. They did this long before the ACA was ever heard of. It’s to their economic advantage NOT to have staff getting sick during flu season. So what’s your beef about requiring staff (those who don’t have a medical release, that is) to be properly immunized?

        And, third, it’s simply not true that younger or more able bodied Americans don’t need insurance. At any time, I’d say that AT LEAST half of our patients in the ER are under 50, many under 30. Young people don’t get a lot of heart attacks and strokes, it’s true, but they often present with appendicitis, kidney stones, psychiatric problems, migraines, asthma attacks, pneumonia and traumatic injuries related to car and sports accidents. It’s irresponsible and unrealistic for a health care professional to claim that they’re “not predicted to utilize resources.”

      • Robert, lots of young, uninsured people enter my hospital every day. Have you looked at an emergency room census lately? It can only help hospitals when a higher percentage of it’s patients have insurance. And regarding flu vaccines – if the ACA gives financial

      • Robert, lots of young, uninsured people enter my hospital every day. Have you looked at an emergency room census lately? It can only help hospitals when a higher percentage of it’s patients have insurance. And regarding flu vaccines – if the ACA gives financial incentives to hospitals that have more than 90% of it’s employees vaccinated, that is a good thing. Everyone wins when hospital employees get flu vaccines – the hospital wins financially because it doesn’t have to call in outside staffing to work for sick employees, the staff wins by getting free vaccines which help them and their families stay healthier, and most of all, the patients win for obvious reasons. No brainer. I think it is a great idea to slap the wrists of hospitals that don’t comply with the vaccine requirement.

  12. Sharon, even the reduced payments you’re talking about translate into more revenue than when uninsured patients are admitted, and then don’t pay their bill.

    • Olivia: Interesting that you automatically assume that I am “anti-ACA.” Maybe a more thorough and unbiased reading of my comments would help.

      I agree that an insured (whether it be through private insurance or through the expanded Medicaid program) patient provides more revenue than an uninsured patient. What I am also saying, and this is directly from hospitals that I am working with as a consultant, is that reimbursement rates for Medicare and Medicaid have been significantly cut as part of the ACA. Not offering a biased opinion here, just simply stating the facts. Several of these cuts (especially the Medicare cuts) are hidden within the language of the law (described as “behavioral cuts” due to improved documentation of physician diagnoses which accounted for a 0.5% cut in Medicare reimbursement in 2013 and a yet to be determined cut for 2014, elimination of the disproportionate share reimbursement that the federal government provided to hospitals for care of the uninsured/underinsured–incidentally this was eliminated PRIOR to the implementation date of the individual mandate– which means that the hospitals lost the funding, still had to provide the care, and did not have an increase in the numbers of patients covered by expanded Medicaid or private payors).

      To your second point: I suggest again going to the source, the ACA. There is no provision for medical/nursing/hospital staff to “opt out” of an influenza vaccination due to health reasons, religious objection, etc. If your hospital wishes to receive full Medicare funding, you will have >90% of ALL of your staff immunized (not 90% of eligible staff immunized).

      To your third point: I never once said that younger, able bodied people did NOT need insurance. I would kindly ask you to cease misstating or misquoting me. What I did state (and this is a subject raised by both sides of the ACA debate) is that the ACA actually does benefit insurance agencies. How does this work? It’s simple economics. An insurance company takes in premiums and provides care for a pool of patients based on the premiums collected. It is financially in the best interest of the insurance company to take in more money than is paid out in claims. The primary way this is achieved is to dilute out the high dollar claimants with a large number of lower dollar claimants. A financially viable insurance company would like to see a larger number of younger, able bodied participants in order to dilute out what is being spent on the older, more ill participants. Interestingly enough, you were making my point for me: you cited kidney stones, migraines, asthma attacks, etc., as examples of conditions that younger, more able bodied participants need coverage for. Those conditions (and the other conditions you cited) are much less costly to treat than the more expensive, chronic conditions (diabetes–along with all sequela, cardiac disease, renal failure, etc) which are present in the older population.

      We, as nurses, need to make sure that we read and understand everything about the changes coming about in healthcare and must be instrumental in these changes. Otherwise, we will continue with the age old nursing practice of sitting back, allowing the changes to happen and then complain about the impacts later. Since we didn’t actually participate fully in the development of the ACA (other than to quickly rubber stamp it based on some of the provisions contained in it), we must learn to work within the system we have now while working to advocate for our patients by improving the system.

      • No, Robert, I’m not just “assuming” that you’re opposed to health care reform. I’m observing it, based on several comments you’ve made, as well as comments that you DIDN’T make.

        First, you’re blaming Vanderbilt’s mass layoff on the ACA and its impact on Medicaid and Medicare….but the fact that Tennessee refused to expand Medicaid, which would have had a huge impact on available health care dollars, never got a mention.

        Second, you just contradicted yourself in your point about flu shots. You claimed, “There is no provision for medical/nursing/hospital staff to “opt out” of an influenza vaccination due to health reasons, religious objection, etc.” but then stated that full Medicare/Medicaid funding requires “>90% of ALL of your staff immunized.” Why do you suppose they made it >90%, and not 100%?

        Third, I’ll be glad to stop misquoting you, if you’ll stop accusing other nurses of suggesting that wiping up a coffee spill is “beneath” them. Deal?

        Now that we’ve got that settled, your argument about young people is straight out of the anti-ACA’s latest talking points. OF COURSE I realize that, as a group, younger insurees aren’t likely to make as big or expensive insurance claims as older people do. That, in fact, is why Medicare exists—to address those costly medical problems that tend to pop up in later life. You seem to be doing a bit of backpedaling, so how about just coming out straight and telling us: are you saying you’re opposed to young Americans being required to have their own health insurance? Because, if not, I have no idea why you even brought them up here.

        And, finally, you seem to be suggesting that the existence of the ACA is directly connected with nurses’ cleaning duties being expanded at Vanderbilt. That’s nonsense. That’s a business decision made by some Vanderbilt executives who are (obviously) very far removed from the bedside, and don’t really understand what nurses are doing when they’re not handing out pills. And it’s no accident that it’s happening in a strongly anti-union “right to work” state.

  13. Unless I am missing something here, nothing is mentioned in the post regarding terminally cleaning a room, cleaning toilets, etc. What is mentioned is pulling trash, spot sweeping and spot mopping. This is what would be done by housekeeping in a room currently occupied by a patient (and is now being tasked to nursing). This is something that we used to always do in a high acuity ICU on night shift not even 10 years ago. Instead of taking a “the sky is falling” attitude, we should really research what is occurring a little more thoroughly and then react. Based solely on the information provided in the original post, this isn’t an unreasonable request of nursing staff (note: it does not say NURSES only but also includes all nursing staff in the original post).

    • Well, Robert, first of all, cleaning rooms in “a high acuity ICU,” where one has only two or at the most three patients, is one thing. Cleaning rooms on a busy med/surg or outpatient unit, with high turnover and lots of trash, is quite another.

      And, yes, I think we’re all familiar with the task of “pulling trash, spot sweeping and spot mopping.” If that were all that was being asked, there would have been no reason for a special meeting of these nurses, or of cautioning them not to discuss this with patients or hospital visitors. Nor would it have been brought up at the same time that the hospital was in the process of firing 1000 employees. Nor would the manager in question have needed to trot out the example of Florence Nightingale, who had no dedicated cleaning staff at Scutari.

      Incidentally, in many hospitals, including my own, “nursing staff” usually means nurses, because there are very few CNAs. On my own unit (ER), there is usually only one CNA at night, and s/he is responsible for unit clerk duties, applying splints, transferring patients to the floor, doing EKGs, cleaning and irrigating wounds, stocking rooms, and any other tasks s/he has time for. Like the rest of us, our CNA helps clean rooms, too, in between patients, especially when cleaning staff is tied up on other units, and can’t get down to the ER. But there’s a world of difference between pitching in when we can, and being held responsible for the job of cleaning.

      • Olivia: do you happen to have access to a copy of the email referenced? I went back and re-read the original post in order to make sure I didn’t miss anything that remotely referred to terminal cleaning. The original blog post stated: “The email says nurses will now have to pull their own trash and linens, sweep up and spot mop. Nurses, care partners and nursing assistants will be responsible for all patient care areas.” That does not in any way come close to a terminal cleaning of a patient room (in an ER or any other department).

        I am glad you mentioned your time in the ER. Having been an ER nurse for 17 years and having the opportunity to work in a variety of sizes and “levels” of ERs (from a 6 bed ER to a 75 bed ER…including the busiest ER in New England), we always would strip our beds, wipe our beds down, pull trash,etc. It was just part and parcel of “turning a room over” for the next patient. Yes, we did this with only 4 assigned rooms in the ER, but we did this multiple times in a shift. It is in no way beneath us as nurses to ensure we have done everything possible to make our patients comfortable.

        In the time it takes me to walk out of a patient room, find a housekeeper (or page a housekeeper and wait for them to call me back), I could have “spot mopped” that coffee spill on the floor (and incidentally, if I just left the spill on the floor I am practicing poor nursing judgement as I have set up a safety/risk issue for my patient and their family members).

      • Robert, you’re still not getting it—-probably because you keep trying to sneak in the same arguments that have already been addressed numerous times.

        First of all, yes, we know you don’t mind wiping up spills or bagging up garbage in patient’s rooms. If you’d been paying attention, you would have seen that NONE of us who expressed an opinion on this issue mind tidying up patient’s rooms. Certainly, none of us have stated or implied that such tasks are “beneath” us as you suggested in your post.

        And, second, yes, we know that such tasks are part of our job as nurses. Show me an RN or LPN who’s never cleaned up after a patient, and I’ll show you someone who doesn’t live in the real world. But that’s not what this Vanderbilt manager was referring to.

        How do I know that? BECAUSE, by your own admission, nurses are already doing that. Because there would have been no reason to call a special meeting about cleaning rooms, or to argue that Florence Nightingale did it, too, or to warn nurses not to discuss the new policy with visitors or patients, if it were simply a standard “don’t forget to keep your patients’ rooms neat” reminder.

        I guess it escaped your notice that this new policy just happened to coincide with an announcement that Vanderbilt would be laying off 1000 employees?

      • I almost forgot: here’s the part of the e mail that was publicized. There is also a recording of the manager’s talk with staff somewhere on Youtube, but I’m not going to dig it up right now. I just got off a busy shift, and I’m rather tired—-but I’m sure you can find it, if you just paste the words “Vanderbilt” and “nurses” into your browser:

        …..”Cleaning the room after the case, including pulling your trash and mopping the floor, are all infection-prevention strategies. And it’s all nursing, and it’s all surgical tech. You may not believe that, but even Florence Nightingale knew that was true,” said a hospital administrator to staff in a video obtained by the Channel 4 I-Team.

        The new cleaning changes were also detailed in an email sent to staff of the Vanderbilt Medical Center East team, which – according to a hospital employee – works in surgery areas and patient rooms.

        A manager writes in the email, “We have undergone some major budgetary changes … this means we will need to pull together like never before.”

        The email says nurses will now have to pull their own trash and linens, sweep up and spot mop. Nurses, care partners and nursing assistants will be responsible for all patient care areas.

        “The priority will be what the patient sees,” the email states.

        Also, in bold highlighted text, the email says, “Be sure to wear the appropriate [personal protective equipment] when doing any disinfecting – that includes, a cover up gown, gloves, mask and even an eye shield when necessary.”

        Nurses were also told to “refrain from speaking negatively about this in an open forum where our customer can hear. If you need to vent come see me.”

        The hospital employee did not want to be identified for fear of losing her job but wanted the public to be aware of the changes.

        “This is our new reality. The work still must be done. We must still care for patients, and we must do so in an efficient manner,” the hospital administrator told staff in the video obtained by the Channel 4 I-Team.

        The nurse to whom we spoke says before these changes, the hospital’s environmental services department was in charge of cleaning those patient areas and that staff does not have interaction with patients.

        The nurse is concerned that doing both cleaning and patient care could lead to cross contamination.

        The email obtained by the Channel 4 I-Team does say environmental services will still be handling some cleaning…..

  14. I get so very tired of hearing about budget cuts etc. The upper management continues to make millions on the backs of nurses who work extremely hard already. Cut their salaries. Million dollar salaries including huge bonuses should be cut. Not the housekeeping!

  15. Annette McHan RN

    Why would the hospitals want to pay RN wages to have cleaning done when most housekeeping personal make minimal wages or slightly more.
    There are only so many hours in a day.
    Also nursing is a lot more than providing services to patients, It is taking the time to sit and listen to then. Being a HOSPICE nurse for 20 years I have learned that CARING for patients is the best medication available.
    Oh by the way I did take an early retirement last year. Too much PAPPERWORK, MONEY HUNGRY PEOPLE, AND PRESURE. We are NURSES NOT MIRACLE WORKERS.

  16. I’m clicking on the link to the source provided at the top of this post, but it’s just leading me back to this exact post. Can you please post the correct link? I’d like to read the article myself.

  17. This just in From the Journal of Nursing Bullshit:
    New Infection Control Strategy-nurses mopping the floor has been shown to be a “best practice” proven by evidence-based medicine to reduce infection.
    Lol?

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