I keep hearing hand-waving stories from right-leaning members of our managerial class about how unemployment benefits are dampening the desire to work among rank-and-file workers. Let me give you a small glimpse into the work ethic of this same managerial class in my own case. I’ll leave you to decide, at least in this case, whose work ethic could use some improvement.
I’ve been writing here since October about the eight month gig I recently did working full time for Operating Room Environmental Services (OR EVS) at Hunterdon Medical Center in Flemington, New Jersey. About seven weeks ago, I gave notice at the hospital, telling both Surgical Services and HR that I would continue to work at HMC’s OR once a month as a per diem worker at the same rate as I’d earned before. They were delighted to hear it; OR EVS has been decimated by turnover, and was practically dying for weekend coverage. I could easily have insisted on a raise, but didn’t. This, by the way, for an institution that failed to give me bereavement leave after the unexpected death of my wife in March.
For the uninitiated: OR EVS is responsible for cleaning and setting up the OR between and after surgical cases. Between cases, we do quick turnover cleanings, setting the OR suites up for imminently forthcoming cases; at end of day, we do deeper terminal cleanings, setting the suites up for the next day’s case. We’re also expected to clean the scrub rooms adjoining each operating suite, along with a series of ancillary areas (offices, workrooms, break rooms, locker rooms, restrooms), as well as the “core,” where surgical cases are set up, and finally, the long hallways, or “raceway,” circling the OR as such.
I worked the evening shift, 3-11:30 pm. Unlike any white collar or academic job I’ve ever done, OR EVS was expected to work essentially without stops or breaks for the entirety of our shift. We were legally entitled to a single half hour break, whose duration was exactly 30 minutes, and, on a discretionary basis, to two fifteen minute breaks which we often missed. The rest of the shift was solid work. My base pay for the evening shift was $14 an hour. Day shift was $13 an hour.
It’s worth bearing in mind that despite our low pay, OR EVS makes surgical services possible: no EVS, no surgery. A truism that also happens to be an undeniable truth: unless EVS cleans and sets up an OR suite, it’s unusable for surgical procedures. Since surgical procedures are the revenue engine of a hospital, it’s no exaggeration to say that by making surgery possible, EVS makes the hospital’s most fundamental revenue stream a reality.
That particular revenue stream aside, in my experience, hurried clinicians in the OR–nurses, anesthesiologists, surgeons–consistently make apparently minor mistakes that violate state or federal regulatory law, most commonly HIPPA rules governing confidential material, or any of the myriad rules governing the disposal of hazardous waste. Each of these “mistakes,” if caught, is worth tens of thousands of dollars in fines. And each, in my experience, was made dozens of times a day. Unlike universities, whose accreditation agencies are a pathetic joke, hospitals are accredited (at a minimum) by the Joint Commission and by both state and local health departments, which are not a joke. It’s EVS that makes the goal-line saves that save the hospital from the fines that these agencies are only too willing to impose.
Finally, EVS, as I’ve argued elsewhere, is the last line of defense against hospital-acquired infections, a perennial problem in contemporary hospitals, and a driver both of cost and of (serious) iatrogenic illness.
In addition to working the regular work week, OR EVS, at least at HMC, “took call” on weekends, just like clinical staff. OR EVS call works as follows: one person is designated as “on call” for 32 hours of a given weekend. In other words, from 8 am to midnight on both Saturday and Sunday of an on-call weekend, the person on call is expected, on receiving a call from the hospital operator, to answer their phone and proceed immediately to the OR to do whatever cleaning is required. If what’s required is a turnaround, this is in effect an emergency call. If what’s requested is a terminal clean, it’s not precisely an emergency call, but still demands speed. (And of course, combinations of both might be requested.) Since only one EVS person is on call during the weekends, there is no EVS team to rely on; you’re on your own. And since tech and transport staff don’t take call, EVS is expected to take on some of their responsibilities.
All of that, in case you’ve forgotten, is being done by people earning a base pay of $13-14 an hour. Those same people are also facilitating the activities (and incomes) of an entire bureaucracy devoted to the rule-governed, revenue-driven side of health care–patient access/scheduling, accounts receivable, revenue cycle management, and the like. To paraphrase Cardi B, it’s the mops that make the money move–just not to the people moving the mops.*
And now, back to my story: Around the end of May, three weeks after I gave notice, the supervisor of OR EVS put me on the OR schedule for this past weekend, the weekend of June 26-27. That was fine by me, but what about the details? How would I transition, bureaucratically, from FT to per diem work?
Over the course of the next several weeks, I repeatedly asked HR, and then Surgical Services, how my transition from full time to per diem work would be handled. I got no acknowledgement or answer. Finally, after a last minute query on Friday afternoon, seven weeks into this drama (and a few hours before I was supposed to go on call), I was told that I was “not in the system” and therefore could not be put on call–despite the fact that I had raised the issue seven weeks ago, and been on the call schedule for almost four.
Pause on this for a minute. The issue is not so much that my being taken off the call schedule deprived me of the munificent $200 or so I would have made had I been working in the OR last weekend. I could use a weekend off. The issue is that no one at HMC realized that no one was available to cover OR EVS for an entire weekend. Put another way: no white collar worker had, in seven weeks’ time, bothered to resolve my transition from full time to per diem status despite my repeated queries, and despite the institution’s own desperation for labor–desperation caused by the turnover experienced by the OR EVS unit.
Put yet another way: had the hospital operator called me last Saturday requesting my presence in the OR, and had I shown up, my ID would, on clocking in, have indicated a lack of authorization to work. And so I’d have faced a dilemma created for me by management: should I bail out on the OR after being called in to, say, an emergency case? Or should I work illegally, despite lack of authorization, despite lack of indemnification for legal liability, and despite the possibility of not being paid?
Pressed to resolve this on the spot, it’s possible that no resolution might have been forthcoming. Had I bailed out and simply walked out of the hospital, no one else might have been willing or available to cover for EVS, and so the OR would have gone without environmental services for a weekend. That might have meant the cancellation of all procedures in the OR for an entire weekend–including emergency procedures–not for my lack of willingness to work, but for management’s failure to put me “in the system.” Imagine a hospital’s having to ship its surgical patients out to another hospital by ambulance for failure to get the OR EVS schedule right. It doesn’t take much imagination in this case. It almost happened. Yet another goal-line save by EVS, this time pro bono.
So here’s one upshot. The next time you hear someone mouthing off about workers’ “unwillingness to work,” consider the number of untold stories by workers about managers’ failure to do their jobs. The reason why such stories aren’t told more often is that managers have control over hiring and firing. Say the wrong thing about them (anywhere, including on a private setting on social media), and you’re headed for unemployment. I could easily lose my job for saying what I’ve said in this post. And yet I stand by every word in it. Every word in it is true, overdue, and needed saying. If anecdotes like this can’t be related in public, discussion of the workplace is effectively off-limits in public discourse. What we’re left with is Delusional Happy Hour with the LinkedIn Cheerleading Squad.
Another upshot: remember cases like this also when people go on and on about left-wing “cancel culture.” In an at-will employment environment, people get fired without notice or cause every day–not for ideological reasons but without any discernible reason at all. Unlike professors made famous by their tribulations with “woke mobs,” none of these terminations ever make the news. I have seen (literally, not hyperbolically) dozens of them at multiple institutions, involving academic, white collar, and blue collar workers. None of the victims ever become celebrities, whether minor or major. They’re simply the casualties of our labor market and our legal system, the human refuse that managers flush out of the corporate system every day with total impunity.
If you find it tiresome to hear me complaining (“ranting,” “bitching”) about these things, think about how tiresome it is to live them, day in and day out. And just to be clear: I don’t live them, not any more. I couldn’t. I got out of full time OR EVS to get a white collar job in hospital revenue management, keeping just one per diem toe in the blue collar world to keep things real. But far too many people (primarily of the white collar managerial class, but some academics as well) dwell perpetually in unreality on the subject of labor relations. Spend some time living it, and I think you’ll change your tune.
“People,” I keep hearing about the unemployed, “don’t want to work.” A suggestion: take a harder at some of the people who have jobs, and ask some hard questions about what they’re doing with the time on their hands.
*Anyone sincerely “offended” by Cardi B’s “Bodak Yellow” (as so many people are) should perhaps stop to ask themselves which is more offensive: a song that parodies the ethos of a high-handed boss, or an actual boss of the sort being parodied?