Does Your Unit Director Do This?



  1. I work nights on a very, very busy and very understaffed med-surg floor.
    Lately, the unit dir. has started coming onto the floor in the mornings, with a detailed list of the patients' complaints (if any), from that night's shift.


    I am just really P.O.'ed that we not only have the take the B.S. we have to take from the patients; but now it seems we are going to have to listen to an "instant replay" from the unit director in the morning and justify ourselves ONCE AGAIN........GUILTY UNTIL PROVEN INNOCENT!!!!!!!!!!!!!

    She brings a list of complaints and we give "our" side of it.

    Note: this hospital is very big on customer satisfaction - to provide for it, last night we started third shift with 28 patients and our staff was 2 RNs splitting the floor, another Rn and a CNA doing floor work!!!!! Mind you.....we got FOUR admissions!

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  2. 39 Comments

  3. by   JennieBSN
    OMG!!! WHAT A B****!!!! Can't say much more, too angry...want to strangle. You have my sympathies. Will think of a smart a** remark to say (or think) next time...
  4. by   RNforLongTime
    Customer Satisfaction important but how about safe staffing? At my hospital if we have 28 pts then we have 4 RN's and 2 or 3 NA's on nights. August 27th they are limiting our census to only 24 pts. Our max is 30 but we are so short of RN's on my unit a medical/telemetry/respiratory unit that the management has decided to limit beds. I can't wait! No more mandation! For a while anyway.

    Did you fill out an Assignment despite Objection form? This sound very dangerous. How can you answer a pt's bell when all the staff is tied up? I'd be VERY angry with this manager. She needs to take a walk in a staff nurses shoes just one time! I feel for you because I used to work in a facility like that and had a head nurse who was just as a$$inine as yours sounds.

    Good Luck!

    Kelly
  5. by   prmenrs
    I think you should fight fire with fire. I'm assuming you want some ways to make your situation better, and get her off your back? If not, don't read the rest of this!

    Whenever you can't get to a call light quickly because you're passing meds, whenever you are late passing meds because of an admission, in other words, whenever you are in a situation that she might get a complaint about (actually it sounds like she's out there looking for them), where the institutions goals of customer service are being compromised because there are not enough staff to do the job, keep track--you could use a little notebook you can keep in your pocket, write just enough down to jog your memory, you may then have to transfer the info to an expanded format after shift. Then, when she comes back to you, you are prepared-- you may even have more than she does if I'm reading the situation right. Then approach it in a constructive manner, i.e., "You are so right, Ms A*s*o*e, how do YOU think we can resolve these problems? The entire night shift is very anxious to have the patients get the best care possible, but we need management's help to acheive these goals."

    You might even invite her to join you one night @ what should be a relatively quiet time in order to have a "brainstorming" session.

    With ANY luck, if you come back to her with info that might turn into justification for more staffing, you might just get it!!

    Don't forget, she has a supervisor, too. Try to find out how they set up the staffing ratios for days, pms, and nights. Do they have a genuine rubrick to compute staffing, or ??? How many hours per pat day are alloted to your unit? These factors influence who they decide to staff you?

    Is there any sort of acuity system? If not, look into some--try searching on the web, also the journal called Nursing Management (hmm...they may have changed their name.) Anyway, if you can, do some sort of lit search for acuity systems. The reason I'm suggesting this? It may be that no one has looked at the acuity on your unit.

    If she just wants to be a pain and make life miserable, she won't work with you on this; If she TRULY wants "customer satisfaction", aka good patient care, she will go out of her way to foster teamwork and problem-solving.

    If something comes back to haunt you @ eval time, your handy dandy documentation notebook will be of immense help. On the other hand, showing this kind of leadership and effort may also pay off.
  6. by   RNforLongTime
    I know at my hospital, they don't take acuity into consideration when they do staffing. All they are concerned about is the number of pt's on the floor, not how much care is required for each patient.

    I agree with prmenrs's suggestion. Carry that little notebook with you and take your suggestions to you unit director.

    Good Luck!
  7. by   Lisamulti
    originally posted by soundslikesirens


    i work nights on a very, very busy and very understaffed med-surg floor.
    lately, the unit dir. has started coming onto the floor in the mornings, with a detailed list of the patients' complaints (if any), from that night's shift.


    i am just really p.o.'ed that we not only have the take the b.s. we have to take from the patients; but now it seems we are going to have to listen to an "instant replay" from the unit director in the morning and justify ourselves once again........guilty until proven innocent!!!!!!!!!!!!!

    she brings a list of complaints and we give "our" side of it.

    note: this hospital is very big on customer satisfaction - to provide for it, last night we started third shift with 28 patients and our staff was 2 rns splitting the floor, another rn and a cna doing floor work!!!!! mind you.....we got four admissions!

    hi
    i think that's ridiculous--no wonder we all have to get malpractice insurance--we're not god......i work in ltc--same thing--and they throw in a picc line--an mva 45 yr old--along with your elderly---what the hell-----i'm joining the navy to learn more------see what i can do. has no one seen my post on the answer to shortage--can't seem to find it------?
  8. by   Rita Marie
    Your post sounds so familiar to me. And those of the others as well.

    I really liked the notebook suggestion. I know that it is a pain in the tushy to do that, but you may very well be protecting yourself in the long run.

    Not that this will make life easier for the others on your floor, but if there is a choice, you could try transferring to another ward. Or you can also note how some of the other wards in your facility are being managed. It seems that in some hospitals, continuity of management is NOT practiced from one floor to the other. This might be a great note to drop into the suggestion box.

    The post about acuity was great. I am amazed to find out that not all hospitals practice this method of staffing or the other with the grid. I guess I was pretty naive.

    I have had head nurse's come to work on a shift, especially if there have been numberous complaints, or because there was no one who could do the overtime for what ever reason. Or there is the old, "we on days must help cover staffing on nights until another nurse is hired" fix.

    I can really appreciate how angry this must make you feel. I would be talking to myself all night long if I knew that I was to face such abuse from the head nurse in the morning. Wow!
  9. by   mustangsheba
    Sirens: Haven't seen you for awhile. Now I know why. Your staffing STINKS!!! Maybe it's time for you to move elsewhere. It's not humanly possible to take care of that many patients with any safety nevermind customer satisfaction. I'm not a very patient person and sometimes not wise, but I think I would tell that supervisor if she wants to know what's happening, she needs to follow you around and not waste your precious sleep time with her investigations. What a nightmare! Keep in touch (in your spare time.)
  10. by   soundsLikesirens
    MORE INFO:

    And our patients: we have CVP's, PICCs, feeding tubes....heparin drips...the other night I was describing, one of the four admits was to receive a unit of blood!

    It is COMPLETELY ridiculous!

    They admit patients until we are full.

    So how the hell are we supposed to meet these impossible customer satisfaction goals?!?!?

    You wouldn't believe it if I told you. I will post more details later....right now, I have to take my little boy to the park!

    (They have already called from the hospital, wanting to know if I can work tonight..................)
  11. by   radnurse2001
    INVITE HER TO WORK A NIGHT SHIFT ON YOUR UNIT. I BET HER ANTICS WOULD STOP. AMAZING ISN"T IT HOW THOSE WHO DON'T KNOW THE SCORE GET PUT IN CHARGE!!!!!!!!
  12. by   Enright
    I second the suggestion that the RN manager should come hang around for a night shift. I was charge on nights at a small rehab hospital where we took fresh CVA's, etc. Some of our older customers were lucid during the day but in another dimension at night. The unit manager kept calling me in with customer complaints that didn't make any sense. There wasn't even an event I could relate them to. I documented my responses and asked that she come in and "spend a night". She was completely dumbfounded at how different the patients' cognition was. Turns out she had never worked nights. I asked and got an apology in writing.

    No I don't think nights is deserving of anything more than other shifts but it does help for managers to see the problems first hand.
  13. by   soundsLikesirens
    She couldn't care less what goes on on night shift - I think she is the Unit Dir. because no one else would take the job.

    I have been there approximately one year - the one and only time I have seen her at night:
    she was there - but didn't tell us why - I wish she had've - I'd have liked to have some warning:
    turns out we had a patient (and family) who'd caused H*LL on the other floor and transferred them (thank you so much) to our floor....the patient's family just verbally abused every nurse who had the temerity to enter the room. Some of the veterans said they thought they were trying to get out of paying the hospital bill by preparing to claim substandard service.
    Anyway, this patient's son, who appeared to be about 35 - 40 years old, verbally assaulted me in front of the unit dr. and the House Supervisor - told me I was "incompetent" and that I was going to be "reported to my supervisors" (mind you, they were standing right there). And never said a word in my defense.........

    ...........do you mean to tell me there's a hospital that limits admissions?
    It's news to me - I've never even heard the phrase!

    Our Unit Dir. doesn't even have a background in Med-Surg and didn't even work on a floor - she had a desk job for years.
    (That's why I say I think she is the only one who'd take the job - )
    As far as filling out a form about objecting to the assignment: you must be kidding. It's unheard of.
    I have two small children who must be supported. I would be fired....or just unemployable. This is the only hospital in the county. I cannot transfer inside it, for reasons I won't go into for brevity's sake, and I am not going to a different hospital because I would have at least an hour's drive, one way.
    I don't imagine they'd be any different, anyway.
    Someone said they read that this other hospital was short 77 nurses!!!!
    Oh - by the way - this family that caused the ruckus: they also called hospital security on the Unit Director!!!!! She didn't jump fast enough to suit them so she got reported, too!!!!! Can you imagine.....

    I tell you...........it boggles my mind......

    I am all for patient satisfaction - but this is verging on the edge of bizarre.

    If the hospital doesn't respect us and back us up, why the h*ll should the patients?
  14. by   soundsLikesirens
    While I'm at it........

    Why the h*ll does she come on the floor with complaints and read them to us?

    What the h*ll does she think we are?
    Does she actually think we would mistreat a patient or family member?????

    Talk about insulting!

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