Process essay

"Marj, can you order me an IV pump for 719? Thanks!", Jess, an RN, asks as she rushes by to check on another patient. Before I can call dispatch, the phone rings. "Grant 7, this is Marj." "Hi!" a voice on the line says. "My friend is having a baby. How is she doing?" I transfer the voice to the labor room. I pick up the phone to call dispatch, and the nurse call goes off, room 711. I hang up the phone, and answer the nurse call phone. "Can I help you?" The patient in room 711 asks for pain meds, so I track down her nurse and pass on the message. I finally call dispatch, order the pump, and attempt to enter doctor's medication orders into the computer. And so begins another day as unit secretary on Grant 7.

7:00 am

A new patient has come over from the labor room. The nurse hands me the chart to enter her postpartum orders into the computer. As I start entering her medication into the computer, Jackie, an RN, walks up to me. "Marj, the printer won't work. Could you come and take a look at it?" I follow her to the back room, open the paper tray to the printer, and discover that it's out of paper. As I'm adding paper, I hear the phone ring up front. I hurry to answer it. "Grant 7, this is Marj." "Hi Marj, this is Kellie. Can you order one of my patients some pancakes?" I look at the caller ID. She's calling me from the room behind me. "Sure Kellie. As soon as I get this patient's orders in." I hang up the phone and work on entering the orders. I'm almost finished when the baby alarm goes off. I check the baby monitor and send a nurse to check the baby's electronic band. The phone rings - it's security asking if everything is OK. The baby is fine - just another safe-place malfunction, but better safe than sorry. I cancel the alarm, finish entering the postpartum's orders, and order Kellie's patient some pancakes. I glance at the clock and realize that an hour has gone by already. I get up from my desk and hurry to the kitchen to get some coffee. As soon as I reach the coffeemaker, I hear the nurse call system going off. I grab some coffee and run back to my desk, answer the call, and then hunt for the nurse to give her the message. By the time I get back to my desk, the phone is ringing and my coffee is cold.

12:00 pm

The recovery room calls. "Hey Marj, it's Linda. We'll be bringing that hysterectomy out in 15 minutes. Where is she going?" I check my list. "Put her in 700A - Kellie will be her nurse. See you in 15!" I hang up the phone and hunt for Kellie. "Kellie, 700A in 15!" After 700A's arrival Linda gives me her chart. Oh, great! Dr. G's patient. His orders are always a pain in the ass to enter, as he varies the medication from the order sets in the computer. All the meds he ordered will have to be entered separately. I stare at the chart and try to decipher his horrible penmanship. Is that phenergan? Is that a 2 or a 7? What kind of a test is that? The phone rings. "Hi. May I speak with Jane Doe?" I look at my patient list. "Is Jane having a baby, or has she already had one?" The voice sighs loudly. "No, she had the baby last week, and the baby had to stay. She's there visiting him." I transfer her to pediatrics. I'm now one half of the way through Dr. G's orders for his hysterectomy patient. Jackie drops off a food order for me to enter. "When you have time, Marj, I'd really appreciate it!" Nurse call goes off for three patients. I answer each call and track down their nurses. I walk back to my computer and discover that it has booted me out of the system, and I will have to re-enter Dr. G's orders.

5:00pm

Right on schedule, nurse call goes off. "Can I help you?", I say. "Yes. I didn't like my supper. Could you order me something else?" I take her order and enter it into the computer as nurse call goes off again, three patients at the same time calling out. All want something different to eat, which I enter while answering phone calls and directing visitors to patient rooms. In the meantime, a new patient has come over from the labor room, along with another chart with medications to enter. I field five phone calls, transfer one to the lactation office, help three with locating patients, and transfer one to the charge nurse. Two nurses stop by and hand me charts of patients they have discharged. Lori from housekeeping walks up. "Marj, 712 and 715 have left. Could you discharge them from the computer so I can clean the rooms?" "Sure thing, Lori!", I say as I discharge the patients. It's almost 7:00 pm now, and I think I'm caught up until I look at the floor's inbox almost overflowing onto the floor. Thirty minutes later, the mail is delivered and I am eagerly awaiting my night replacement.

Unit secretaries are definitely underpaid at the hospital. It is amazing that they have so many simultaneous responsibilities while they are entering medication dosages into the computer. EMMC is trying to rectify this by requiring physicians to enter their own orders. Computerized Physician Order Entry, or CPOE, goes live November 1. It will be good for the secretaries, the hospital pharmacy, and especially the patients.