Julianna Paradisi, RN, OCN, writes a monthly post for this blog and works as an infusion nurse in outpatient oncology.
Catch-all: noun
[usu. as modifier]a term or category that includes a variety of different possibilities: ex. the stigmatizing catch-all term “schizophrenia”
American Hospital/by J. Paradisi
The first thought that came to mind after I heard that Vanderbilt University Medical Center had laid off its housekeeping staff and assigned cleaning patient rooms to nursing was this: Has anyone from the hospital’s administration ever looked inside the nursing staff’s refrigerators, microwaves, or sinks?
Universally, nurses’ staff lounge kitchens nearly rank biohazard status. In every unit a single nurse, but often it’s the unit secretary, martyrs herself (or himself) by emptying these refrigerators of forgotten food. She washes the moldy containers and places them on a nearby countertop, with this message scrawled in Sharpie:
CONTAINERS NOT TAKEN HOME BY WEDNESDAY WILL BE THROWN OUT! (Caps intended)
Another sign commonly posted above the staff lounge sink or microwave by this same nurse or unit secretary reads:
CLEAN UP AFTER YOURSELF! YOUR MOTHER DOESN’T LIVE HERE!
Fact: Nurses know a lot about infection control, but this does not automatically make us good housekeepers. Besides, nurses already have a job: keeping hospitalized patients safe while assessing their needs and administering their care.
While Vanderbilt’s decision to lay off its housekeeping staff and assign cleaning patient rooms to nurses may be unprecedented, it is not innovative. Using nurses as catch-alls for various jobs not designated to specific departments is an established tradition of hospital administrations. Obtaining patient meal choices, handing out food trays, distributing patient satisfaction surveys, and wiping down used equipment (including toys in pediatric units) are a few examples of nonnursing tasks I have been assigned during my career. No doubt other nurses can add more to this list.It is not, however, the purpose of this post to call out a single institution. Hospitals around the country are struggling financially. Many are millions of dollars over budget. All are seeking ways to trim their budgets. But why were nurses singled out for shouldering the burden?
As illustrated above, housekeeping does not go hand in hand with nursing skills. All hospital employees can be educated about the various cleaning solutions and regimens for cleaning patient care areas. Nurses were selected because of their proximity to patient rooms. However, housekeeping employees are not stationary fixtures in hospitals. They circulate through various hospital floors, and are summoned to clean patient rooms as needed. Therefore, all hospital employees have the potential for cleaning patient rooms.
Why not share the burden of hospital budget reduction by assigning every department patient room cleaning duties on a rotating basis?
For instance, one week, pharmacy will carry the housekeeping pager and clean patient rooms. The following week, dietary will, and then laboratory, clinical educators, hospitalists (this will probably fall to the residents)—and, in an overwhelming display of support, the hospital administrators can pitch in too.
Now that would be innovation.
Vanderbilt did not lay off all of its cleaning staff! I know that’s what has been reported but its just not true. There were lay offs but not the entire cleaning staff. It mostly pertained to the Operating Rooms. Nurses are now helping with cleaning the room between cases. It’s not that big of a deal, most of us did this anyway. Obviously some didnt and take exception to having to do so. I have worked in several ORs where the nurses/tech had all of the turnover
Responsibilities. Again, this has been blown way out of proportion because of a statement by one person.
Very well stated Angela, and I hope you realize I wrote the post with tongue-in-cheek. I was illustrating that EVS is essential. I am in agreement with you on the significance of Vanderbilt’s precedent setting decision. Yes, nurse need to speak up about it, and you’re comment is an excellent rallying point. Thank you for spelling things out clearly.
Thanks everyone. I can appreciate and respect your insights on the topic.
In my view, I believe this is a high stake and emotionally charged ossue that we must place our emotions aside and address it through the evidence based studies/recommendations from the IOM report that highlights how nurses are inseparably vital to patient safety. Also, the future of nursing report recommends that we practice to out full extent of our education. Having said that, I take the minority view on the solution presented in the blog. I do not believe the solution is having other departments and administrators share the house cleaning responsibility( two wrongs don’t make a right). Eventually, we would still compromise patient care if other vital team members are also burdened by additional ancillary tasks outside of their scope of expertise.
. I do believe that Vanderbilt is a great hospital. Unfortunately, even in the best organizations, inappropriate decisions can be made. However, the hallmark of learning organizations is to reflect on their decisions and evaluate and consider objectively the long term negative consequences of such decisions on patient safety, nurses, and eventually costs, especially with all the evidence from published articles and the IOM findings against adopting such work flow processes.
I also want to make it clear that by sharing my thoughts about such a decision, my intention is not to judge the Vanderbilt organization. My intent is raise awareness and inspire action against the utilization of nurses as ancillary personnel. No doubt, as a nurse,I wipe surfaces in my patient’s room and keep things tidy when feasible. However, this is by no means should give the impression that my role can replace housekeeper and in no way adding EVS role to nursing should be a mandated directive. Yes, Florence emphasized sanitation as a vital component of health, but I believe if Florence could see us now, she would not approve of nurses as ancillary personnel in the face of today’s actual nursing responsibilities. Nurses are now in an unparalleled state of change fatigue and their main priorities should focus on monitoring patients, remaining vigilant to warring signs of illness, coordinating care, and preventing complications. Our main priorities should focus on eliminating dangerous work conditions and fatigue, rather than adding to it. I’m also confident that if organizations truly involved nurses in their decision making process, they will find better and more appropriate solutions to maintain their financial health and become more efficient through critical analysis of their systems. On a daily basis, there are many precious wasted resources, and inefficient processes that are more costly than employing EVS services.
This issue of utilizing nurses as temporary ancillary workers is so pervasive and occurs so frequently whenever there are reactions to budget constraints. Unfortunately, the quick and non-visionary reactions may seem doable if the leaders of an organization do not have a pulse on the magnitude of nursing responsibilities that nurses perform daily. How can we quickly dismiss the lessons leaned from history? How can we ignore the evidence and revert back to the easiest and quick way to a temporary fix ? How can we be so short sided to ignore and disregard the grave consequences of such a decision? Everyone knows what Einstein said ” the definition of insanity is dong the same things over and over and expecting different result”
This is truly an issue that I’m passionate about and believe it is pervasive across the nation. This is why I believe we must confront the elephant in the room and speak up. We must define our role to protect our selves and patients. As a way to halt such decisions, I strongly suggest that this issue be placed on the agenda of all nursing professional associations and even lobby to increase awareness of consequences. We can also join our professional associations to write a position statement that delineate our nursing priorities in the face of the mounting daily responsibilities. As previously mentioned, the intent here is not to say that nurses are above cleaning, it is not our job; or it is the job of some one else from other vital patient care department. The intent is to focus on our main job functions on Providing Safe Patient/ Nurse Centered Care. Only then we can achieve our maximal impact in terms of outcomes, core measures and nursing sensitive indicators.
Even if I ignore our professional role for a moment this idea makes no economic sense to me. Why would I assign a task to a higher paid person if a lower paid person can do it, and probably do it better?
@Mary, no that’s not what I’m saying at all. You have a valid point, but I believe it deserves a separate post. I’m encouraging you to write one, and submit it. I’d like to read more of your viewpoint.
Oh. Well, thank you. That’s an idea. I never thought of submitting an article on it. It seemed to me such an obvious point. Hasn’t a great deal been written on it before already?
I agree about the role of housekeeping/EVS. EVS has an important role in hospitals. In fact, JHACO requires hospitals to keep information on every chemical cleaner used in a facility, readily available to all employees who may have contact with them. There’s different regimens for a “normal” room, c. difficile, MRSA, etc. Patient safety relies on more than a quick wipe down with a rag, and a squirt of 409 cleanser.
In the video link in the post, this is alluded to by the recommendation that nurses wear appropriate personal protection equipment (PPE) when cleaning.
As a former Nurse Manager at a large New York City hospital, I’m outraged that any hospital administration would even suggest that nurse’s take on housekeeping duties without expecting a revolution.
If the Vanderbilt’s nursing staff allow this to happen without a protest, then god help us all! How long do you think it will be before every hospital in the country dumps its housekeeping employees and assigns their duties to nursing. This practice must be stopped and stopped now!
Great point.
Um, not all doctors are men. (?)
Yes, and not all nurses are women! And it seems hard to argue with your assertion that nurses have more patient contact on most days than do the physicians.
Are you trying to say that recent changes in the traditional gender roles have wiped out the generations of sexism that are endemic in medical professions? I wouldn’t agree with that point.
What has happened to common sense and evidenced based practice? Outsourcing and not respecting the vital role hospital EVS workers provide in the war against infection has fueled the MRSA, VRE, and CRE, epidemics. Nurse staffing in most states is not adequate. In many units, to save money, unit secretaries and CNAs or PCTs are cut. The nurse now does everything but the skilled nursing care that s/he is educated and paid to do. EVS or Housekeeping is now a low-wage, minimum benefits job that does not reward personal responsibility, autonomy or innovation.
Years ago I worked in a very busy, open ICU with a very low hospital-acquired infection rate. This was in no small way due to our Head Housekeeper responsible for our ICUs. She was in charge of supplies, cleaning procedures and education of any housekeeping employee (and nurses) working in the units. She was the point person for problems or any needs that the nurses identified. She was paid more and took personal pride in the cleanliness and appearance of our unit.
The time has come again to respect the power of education, responsibility and recognition for the one group of employees who can make a large contribution to infection reduction. The current EVS workers are overworked, treated poorly, paid abysmally and have no idea of the importance of their role in infection control. I would like to see a study of the infection rates in hospitals where EVS workers are respected and treated as a key part of the healthcare team, with budget cuts instead in administration salaries, bonuses and positions, verses those where EVS is unsafely staffed or phased out.
As nurses we need to stand up for our patients by respecting the role EVS workers should have, and say no to adding one more job to nursing that reduces the hours nurses need to perform the skilled care their patients require.
Yet just another reason nurses need to vacate the profession!!!
The only point I strenuously disagree with is your assertion that nurses were chosen to clean because of their proximity to patients and their rooms. You are kidding, right? After all, the doctors go in to see their patients every day, they could easily clean while making their assessments. The nurses were chosen because they are women. If the editors of the leading American nursing publication miss this obvious misogyny, how can we expect anyone else to recognize it?