I Want to Be a Doctor

Dr. Robin: Welcome back to I Want to Be a Doctor or Something. I'm Dr. Robin. I'm here with my friend Jill, a registered nurse.

Jill: Hi, friends.

Dr. Robin: We're two health care besties sharing the real, wild, and funny side of medicine for anyone who's thought about a career in health care. Ready? Let's go.

Dr. Robin: Jill, I have a question for you. What happened when JCAHO came to your hospital? Was it what happened at the hospitals I've been at, which is they come on the announcement system and they say, ‘We'd like to welcome JCAHO to [the name of the hospital],’ and everyone's like, ‘Oh, shoot,’ and then everyone runs around? Did that happen for you, too?

Jill: Oh, man, yes. It happened at least once a year, but sometimes it would happen more than that. We didn't usually get an announcement because I was on night shift most of the time, so they didn't want to wake the patients or the residents, and so they would just slip in a lot of times.

Jill: The first time it happened, I'd been a nurse at the facility for a little while, and one of the inspectors came up to me and wanted to know my name and things like that. She was like, ‘Well, I'm just gonna follow you for the duration of your med pass,’ which ended up being like two hours. So she followed me. I was so shaky and so scared because I was doing not just medications, but IVs, G-tubes, trach care, things like that, and PICC line care. And I'm like, ‘Oh, I gotta keep it so sterile,’ which we try to do always anyway, but you want to do it by the textbook.

Jill: Thankfully, though, that year everybody did a good job. We got a deficiency-free facility, so that was really good.

Dr. Robin: Oh, that's awesome.

Jill: But usually when they would come in, people would start calling the administrators, and then everybody would flood in. And what some of us nurses would be disappointed at is that we could use a little bit more help at normal times, not just one day, because—

Dr. Robin: The normal times, yeah.

Jill: But when they got there, then everybody's on board. So it was beautiful while it lasted, but what about you?

Dr. Robin: I should probably explain what JCAHO is. They're the accreditation association for hospitals in the United States, and they do these drop-in checks. My understanding is they're only sort of drop-in. You kind of know when it's gonna be-ish. They'll do a little bit of prep, but there are all these rules, and some of them are very, very logical, some of them are less so, and some of them are just impractical.

Dr. Robin: When we were preparing for JCAHO, we couldn't have anything within one foot of the ceiling. We had to go through every office, every— and just make sure that there were no binders on top shelves. Where are you gonna store things?

Jill: Right. You use the top shelf, too, and so we had to go around and empty all the top shelves of everything. And then you couldn't have—this is the worst one—you couldn't have food in the nurses' station. When you're at a rural hospital, especially if you only have two nurses on labor and delivery, that's it. So what are they supposed to do if they can't have food? They can't go down to the cafeteria. It's just not practical. I mean, there are so many places you couldn't have food. The nurses' station just makes the most sense.

Jill: I still remember them coming on overhead: ‘We'd like to welcome JCAHO,’ and everyone being like, ‘Find the food!’ And everyone's opening drawers, dropping food, you know?

Dr. Robin: Yeah, I've been there. I remember throwing stuff away a time or two before.

Jill: Yeah, we would always have our med cart or an IV or the vital sign machine, something like that, in the hallway. You couldn't have anything in the hallway, so we didn't have very much storage either. It's like, ‘Where do you put all that?’

Dr. Robin: Yeah, that whole, like, ‘You can't have it in the hallway’ thing. It's like, ‘Okay, these hospitals were built before any of this existed. Where are we supposed to put it?’ There's just not enough storage, but we made it through.

Dr. Robin: But hats off to all the medical personnel who have to go through that. It's a good thing because it keeps things safe and things like that, but sometimes it is just a little bit overboard.

Jill: Yeah, it can feel really—I mean, it's any time you're being tested, right? I just did my insurance inspection, you know that, and it was an e-inspection. I had to go photograph everything, and we're like, ‘All these little things you don't think about normally.’ And you're like, ‘Oh, there's, like, holes.’ We had electrical stuff, and there's, like, holes around that. I'm like, ‘We have to patch those.’ We were running around—we had 10 days—patching all these holes, which aren't safety issues. No bugs are climbing in them. Insurance just doesn't like holes in your walls, so, no.

Jill: We never use our fireplace because it's a hundred years old, but the top part where the flue is—our cats can climb in there—so we just have cardboard over it. Insurance companies don't like flammable stuff in fireplaces, even if you don't use them. We had to take the cardboard out and make sure no cats got in while we were photographing it. It's so hard to keep cats out of that, too.

Jill: You know, I feel like JCAHO's kind of similar, where there's a lot of really important stuff, and then there are these other things where you're like, ‘Not really practical in real life.’

Dr. Robin: So nitty-gritty, I know, but yeah, I'm kind of glad those days with JCAHO are over. Sorry you had to go through that with your insurance again, but you passed.

Jill: That's what matters. I did. They basically wrote a very nice letter, very professional, but basically said, ‘Wow, we had no idea your house was so nice. We're gonna have to raise your rates.’ You're pouring sweat, and they go, ‘Oh, man.’ I guess I did a good job.

Dr. Robin: Yeah, very good.

Dr. Robin: But I think we're out of time for today, so that's it for today. If you want to be a doctor or something else health care-related, head over to docrobinschool.com/podcast for your goodies. That's docrobinlikethebirdschool.com.

Jill: And don't forget to subscribe so you don't miss the next episode. Thanks for watching, friends. Bye.

Dr. Robin: Bye, friends.