Wednesday, October 3, 2018 // The Statement
4B
Wednesday, October 3, 2018 // The Statement
5B
Nurses describe cuts to patient care at Michigan Medicine
M
egan Duncan, a cardi-
ology nurse at the Uni-
versity of Michigan
Hospital, began filing reports with
her superiors detailing concerns
with the hospital’s new remote
heartbeat monitoring program in
Summer 2017. She was met with
little-to-no response from the
Michigan Medicine administra-
tion.
Beginning in July 2017, Michi-
gan Medicine moved almost all
cardiology
patients
—
outside
of the intensive care unit — to a
remote heart rate monitoring sys-
tem, referred to as remote telem-
etry, that largely replaced licensed
nurses with technicians. Before
then, almost all hospital patients
with heart monitors had their
heart rates monitored by live nurs-
es; outside of eight patients linked
to a limited remote screening pro-
gram moni-
tored by a single nurse.
As soon as Michigan Medicine
began using remote telemetry was
rolled out in scale, Duncan and
other nurses in her unit began
experiencing issues with the tech-
nicians.
“Sometimes I found
myself having to edu-
cate (the technicians)
when
they
didn’t
report an incident in
time or didn’t report
it at all,” Duncan said.
“We
noticed
lags.
Sometimes
a
heart
rhythm would change
and they would never
call or call much later.
Often,
they
didn’t
know what it was,
which was alarming. They’re sup-
posed to be trained.”
Duncan
explained
technicians
are stationed
in the base-
ment of their
respective
unit to watch
the
heart
monitors and
report
back
to the nurses
when chang-
es occur; she
added
there
were no sen-
tinel
events
in her unit,
but there was
still concern
about
harm
coming to the
patients.
Technicians within the remote
telemetry unit typically monitor 40
patients at a time and are allowed
to monitor up to 64 patients,
according to Duncan, a stark con-
trast to the personalized attention
nurses could offer patients when
they were only able to see three at
a time. Before the hospital began
employing the technicians, only
eight of the unit’s patients were
monitored remotely by a single
nurse in the cardiology unit base-
ment for the cardiology unit, while
all the other patients with heart
monitors had in-person monitor-
ing by nurses.
While the technicians work
in
the
basement,
technicians
and nurses within the hospital
do not interact personally. Dun-
can explained the only contact
the nurses within her unit had
with the technicians was over the
phone. The lack of contact within
the cardiology unit resulted in
hostility between the two groups.
“I think the technicians thought
we didn’t trust them after we
started filing incident reports,”
Duncan said.
Many nurses such as Duncan
believe the hospital’s implemen-
tation of remote telemetry with
technicians reflects a devaluation
of nurses under a management cul-
ture at Michigan Medicine that has
become increasingly profit-driven
at the expense of staff and patients.
Ian Robinson, the president of the
Huron Valley Area Labor Federa-
tion — who was involved in the
recent nurses’ strike — said he
has seen a drastic shift at Michi-
gan Medicine toward a corporate
mindset.
“It’s a new model that is taking
place at the University,” Robinson
said. “It is a model that has moved
from focusing on the interests of
the public to profit.”
In an email statement, Michigan
Medicine senior communications
representative
Beata
Mostafavi
said the hospital’s new remote
telemetry practices were intended
to improve patient care by enabling
immediate, continuous monitoring
and by facilitating greater collabo-
ration across hospital staff.
“Remote
telemetry
provides
real-time monitoring of patients
who are at risk for cardiac events,
significantly improving the ability
to observe and monitor hospital-
ized patients’ hearts around-the-
clock,” Mostafavi wrote. “A skilled,
highly trained team of registered
nurses, cardiac technicians and
other Michigan Medicine staff
monitor patients in every unit that
has cardiac monitoring. These
teams
collaborate
to
interpret
patient cardiac rhythms and iden-
tify patients who require clinical
attention, which helps improve
patient care and outcomes.”
Despite
Michigan
Medicine’s
claims, Duncan fears the practice
has actually created a barrier for
communication at the hospital and
the lapses of communication that
seem to accompany the practice
could negatively impact patients’
health.
“Overall, we feel that remote
telemetry is a barrier to interdis-
ciplinary
communication,
and
can result in delay of care; both of
which can result in negative out-
comes for the patients and family,”
Duncan wrote.
Though the University invested
a significant amount of money in
the change — it remodeled a level
of the basement and purchased
new monitors — Duncan believes
this was part of a long-term strat-
egy by Michigan Medicine to cut
costs by reducing the number of
nurses needed, at the expense of
patient care.
“Remote telemetry isn’t a cut-
back issue,” she said. “They spent a
significant amount of money on it,
but in the long run it’s speculated
they invested in remote telemetry
in order to possibly down-staff
nursing in the future. If they don’t
need a nurse to monitor a patient’s
heart and a technician can monitor
more hearts at once then they can
staff less nurses.”
W
hile staffing has been
a key issue in the 100
days of bargaining-
leading to the University of Michi-
gan Professional Nurse Council’s
tentative contract agreement with
Michigan Medicine, nurses also
cite
cutbacks
Michigan
Medi-
cine has made in other aspects of
patient care.
Allison Carroll, a nurse in the
pediatric hematology and oncology
unit at C.S. Mott Children’s Hospi-
tal, said budget
cuts inhibit her
role as a care-
giver
to
her
patients.
“As
nurses,
we feel deval-
ued,”
Carroll
said. “We real-
ly aren’t asking
for
anything
we didn’t have
before.”
Carroll
explained
the
hospital
used
to keep graham
crackers on her
floor for dia-
betic
patients
or
patients
undergoing
chemotherapy
who struggle to find their appetite,
but the budget cuts have eliminat-
ed important amenities
like this.
“We can order them
through food services
but it can take up to
an hour, and by then
the patient undergoing
chemotherapy
might
have lost their appe-
tite,” Carroll said. “It
sounds insignificant but
patients in the oncology
unit struggle to keep down food.”
Similarly, Lynn Detloff, a nurse
within
the
Brandon
Newborn
Intensive Care unit at Mott Chil-
dren’s Hospital, said Michigan
Medicine’s cutbacks on programs
designed to support nurses in pro-
viding personal care to patients
have negatively impacted her role
as a caregiver.
Detloff explained the hospi-
tal has significantly cut back on
bereavement trays — trays of food
that are brought to families follow-
ing the loss of a loved one.
“If there was a death in our
unit or any other unit, we would
set them up for the family so they
wouldn’t have to leave the bed-
side,” Detloff, the chair of the
bereavement tray committee in her
unit, said.
Until a cutback on bereave-
ment trays in May 2018, nurses
could provide food to up to 15 fam-
ily members per patient. Bereave-
ment trays included anything from
bagels, cereal, pastries, oatmeal or
yogurt and juice for breakfast or
an array of sandwiches and cook-
ies. Now, the nurses are limited to
offering 8 trays with a limited menu
of a blueberry muffin and orange
juice for breakfast or a granola bar
and a piece of fruit. Michigan Med-
icine did not respond to a question
about how much these bereave-
ment trays cost, or how much was
saved in cutting the choice of food.
“The bereavement trays are just
one of the things we do in the hos-
pital to show empathy for families
going through a difficult time,”
Detloff said. “(Michigan Medicine)
has a surplus of $103 million for the
2018 budget. It seems heartless for
them to cut back on bereavement
trays when it is our job to care for
families.”
Bereavement trays are not the
only patient care item Michigan
Medicine has dropped from their
budget.
Danyel Tharakan/Daily
Audience members wear red in support of University hospital nurses in their ongoing labor dispute at the
Regents’ Meeting at the University golf course Thursday.
File Photo/Daily
The University of Michigan hospital.
“Sometimes a heart rhythm would
change and they would never call or
call much later. Often, they didn’t know
what it was, which was alarming.
They’re supposed to be trained.”
“As nurses, we feel devalued. We
really aren’t asking for anything
we didn’t have before.”
Emma Richter/Daily
The University of Michigan hospital.
REMOTE TELEMETRY AND
GRAHAM CRACKERS:
by Grace Kay, Daily Staff Reporter
See NURSES, Page 6B