Administrative Oversight… You Make the Call

"You can make some of the people happy some of the time, but you can't make all of the people happy all of the time". 

As the old adage goes, the larger the group or population you're serving, the more difficult it becomes to make decisions that are embraced by all those involved and who are impacted by those decisions that you make.  This example is no more exemplified than in recently proposed language released by The Joint Commission on revisions made to Standard/EP: NR.01.01.01,EP2.  If adopted, the revision would read as follows: "Ancillary services such as pharmacy, physical therapy and respiratory therapy will be required to provide services under the coordination of the nurse executive."

While I believe that this is already the case in most hospitals; community hospitals more specifically, current language does allow for "another individual such as a vice president for clinical services who is not a credentialed nurse, but rather holds a graduate degree in health care administration, or another related area" to oversee the administrative functions of these disciplines.  The proposed language does make an awful lot of sense on the surface.  Having one person coordinate the functions of all clinical services would support the Joint Commission's stance that patient care be delivered under a collaborative, interdisciplinary approach in which all caregivers work in concert with one another to optimize care to the patient.

In small hospitals, this is far easier to do, but imagine the difficulties that large academic centers who employ not several hundred, but several thousand caregivers.  Imagine having one person trying to oversee the administrative functions of a respiratory department that employs 300 therapists, a PT department that has 150 FTEs, and a pharmacy department that employees 400 people?  All this, in addition to administrative oversight of a nursing staff that may include as many as 5,000 nurses.  I believe you see my point.

While I am confident that The Joint Commission is attempting to make decisions that are in the best interests of the masses, I believe they have failed to understand the fundamental aspects of large hospital operations or the uniqueness of small hospital growth opportunities for caregivers other than nursing personnel.  For example; a respiratory therapist with a Master's degree in Health Care Administration works at a 350- bed community hospital.  Mentored for over 10-years by administrative personnel, this person is promoted into a Vice-President role.  Under what circumstances would it not suggest that this person is the most qualified to oversee the administrative functions of the respiratory therapy department.  The same correlations could be made regardless of discipline.

If you feel that this new proposed standard lacks the flexibility that all hospitals require to oversee administrative functions of their organization, I would encourage you to contact The Joint Commission and share your thoughts, comments, or concerns.  Your voice is important, and does need to be heard.