Some Days I Feel Like a Rat in a Skinner Box

 If you've ever taken Psych 101 in college you've heard of BF Skinner.  He was a behavioral psychologist who experimented with rats and pigeons.  He used "conditioning" to get the animals to perform tasks by rewarding them with food.  He also used "negative reinforcement" such as an electric shock, to discourage certain behaviors.  There were also mazes in which rats competed for food.  I remember reading endless chapters filled with rat experiments until one day I went a little nuts.  I started ranting that if I read about one more rat I was going to end up in a loony bin!  My roommate had pity on me and dragged me away from my books to a movie.  

BF Skinner and Friend

This morning for some reason old Skinner popped into my brain as I was on my way to work.  I was in the midst of a line of cars that went right from the interstate, through all the stoplights to the parking garage.  We all schlepped in through the access passageway, pushing door buttons, nodding at the security guards, scanning our badges, entering door codes and punching in at the time clock.  It all seemed so mechanized.  

My employee badge has both a bar code and a magnetic strip.  I have to remember which end I'm supposed to use for punching in, opening doors and obtaining medications for dispensing. (all different)  I also now use fingerprint ID for computer sign-on.  I have five or six passwords for different functions some of which need to be changed monthly (more often if I forget it and need to call ITG for a new one).  We just had to learn to use new IV pumps when our old ones were replaced with newer, more complicated models.  Next week we begin using a new automated phone report for transfer of care between nursing units.  I think I feel another rant coming on. 

About 15 years ago our hospital began utilizing robots.  Their names were Roscoe and Rosie (she was nothing like the Rosie on the Jetsons).  The robots were used to deliver food trays or medical supplies.  My reaction was a trifle negative because I felt that I'd rather see a robot that would empty bedpans. Now that's a job I'd happily give away!  Roscoe and Rosie have been replaced by newer models but, like their predecessors, aren't any help in a CODE BROWN (a medical term).  

Actually there really are only three functions at my job that have truly become easier since becoming computerized.  

1. Dispensing narcotics. 

2. Finding my charts.  

3. Deciphering doctor's orders. 

Since narcotics began being locked up someone had to have keys to get to them.  There was only one set of narcotic keys allowed and the usual scenario was that whoever needed the keys didn't have them.  The person who had the keys was the furthest from the cabinet.  Lots of time was wasted in finding out who had the keys.  They were inadvertently brought home, lost in a hamper full of dirty sheets or left hanging in the cabinet door. There was a lot of yelling "WHO'S GOT THE  *#@$^%*X#+{@ keys?".  Now just a badge swipe, a password and a drawer pops open. We don't have to count and reconcile the drugs either. Finding a shortage at the end of the shift meant a lot of harried chart searching to figure out who forgot to sign out a vial of morphine.  Now we are instantly made aware of any discrepancy. 

Charts tended to wander away from the desk.  Doctors got their hands on them and hid them from the nurses.  A chart could end up in doctor's pockets, the dictation room, X ray viewing room, or stuck to the back of another patient's chart.  Some got stained with spilled coffee, blood or worse.  If old charts were needed  we had to wait for a glacially paced courier to deliver them from the file room. It often took days for the dictated charts to be typed.  At one point the dictations were beamed to India by satellite and then the typed charts were faxed back to us.  I AM NOT MAKING THIS UP! (I couldn't  believe this either the first time I heard about it)  So while it is nice to be able to to have a chart at my fingertips any time I need it there is, of course, the down side to computer charting.  We now have to do WAY  more documentation than we ever did before.  

Physicians' handwriting has long been notorious.  I once worked with a surgeon who was so incredibly bad at penmanship that one time he asked me to read something he wrote because HE couldn't decipher it.  His orders were usually easy for me to translate though because he ordered exactly the same things on every patient he had.  I don't know why he didn't just buy a rubber stamp and save himself a lot of time.  Now all our prescriptions completely legible.  It must take all the mystery out of the pharmacists' days.  No more AHA!  I've got it!  But surely a lot safer for everyone.  The advantage of scribbling though meant if you were hauled into court you had carte blanche when you were quoting what you wrote. "Of course I did that.  It says so right here!  (Tlaobyemob slomont0 wa;oxhtbx;l gaodsfjhbasd a'zxc;lgaj[ep)."  

So computers have made some tasks easier.  What wasn't foreseen at the dawn of the computer age was that we were making more, not less, work for ourselves.  We've certainly made more garbage.  Discarded electronics are exponentially increasing our trash.  Maybe that's why all those houses in The Jetson's were high above the ground.  We never knew what lay underneath. 

George Jetson and family

Love to all, 

Marlena of Mohegan