Nurse viewpoint: 'Workarounds' reveal the dysfunction of American hospitals

Workarounds, in which providers bypass burdensome rules to ensure their patients receive the care they need, are common throughout the American healthcare system and reveal its dysfunction, Theresa Brown, PhD, RN, a clinical faculty member at the University of Pittsburgh School of Nursing, wrote in an op-ed for The New York Times.

Staff use workarounds because they save time, Dr. Brown wrote. Hospital nurses are already stretched to the limit on their shifts, and inefficiencies in the system force them to find creative ways to deliver required care. Some nurses have resorted to hiding drugs, for example, because the hospital pharmacy is too slow and they don't want to keep patients waiting. 

Dr. Brown had her own experience with workarounds when her hospital started requiring nurses to use bar code scanners for medications that did not work with electronic medical records. Checking off the drugs in both systems took up valuable time, and many nurses started ignoring the rules to provide better care.

One can argue the entire American healthcare system is built on workarounds, wrote Dr. Brown, and medical scribes are one example. Doctors are increasingly using medical scribes to keep up with paperwork, and in that sense medical scribes are workarounds for the design flaws of electronic medical records. 

Dr. Brown also wrote that the Affordable Care Act, which she supports, is a workaround. The ACA was not intended to ensure all Americans had affordable care, but rather to work around the nation's failure to provide healthcare to all citizens. 

In sum, workarounds demonstrate how dysfunctional the American healthcare system has become, Dr. Brown wrote. Workarounds represent a "trade-off of values," in which providers are forced to choose between onerous rules and patient safety.

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