Knaves, Fools, and the Pitfalls of Micromanagement - page 2

In his brilliant little poem, "The Right Kind of People," Edwin Markham beautifully portrays the power of expectations. A traveler approaches a prophet sitting at a city gate and asks what kind of... Read More

  1. by   Daisy4RN
    Quote from SpankedInPittsburgh
    People do what they get rewarded for. If you are rewarded for checking off all the boxes for the bean-counters that's what one will ant to do as it is incentivized. On the other hand if you actually treat patients like humans and try to apply critical thinking and judgment and are not rewarded for that but in fact punished that leaves the profession in a bad state. Adding to this is that those who know how to "look" good within the system are often the ones promoted to management & care much more about generalized metrics than high quality patient care. It is sad and shows no sign of slowing down
    You are soooo right!
  2. by   Susie2310
    Quote from SpankedInPittsburgh
    On the other hand if you actually treat patients like humans and try to apply critical thinking and judgment and are not rewarded for that but in fact punished that leaves the profession in a bad state. Adding to this is that those who know how to "look" good within the system are often the ones promoted to management & care much more about generalized metrics than high quality patient care. It is sad and shows no sign of slowing down
    Since for a variety of reasons patients needs are often not put first, it seems that patients/family members are well served by hiring a private duty nurse to look out for the patient when they are hospitalized. This is what the situation has devolved to, in my opinion.
    Last edit by Susie2310 on Feb 9
  3. by   maxthecat
    Can't like this enough!
  4. by   OldDude
    Quote from SpankedInPittsburgh
    People do what they get rewarded for. If you are rewarded for checking off all the boxes for the bean-counters that's what one will ant to do as it is incentivized. On the other hand if you actually treat patients like humans and try to apply critical thinking and judgment and are not rewarded for that but in fact punished that leaves the profession in a bad state. Adding to this is that those who know how to "look" good within the system are often the ones promoted to management & care much more about generalized metrics than high quality patient care. It is sad and shows no sign of slowing down
    I know...compassionate, quality, patient advocacy, is such a draw off the system and really gets in the way. Too bad there isn't a way we could just overlay virtual patient care into the matrix so we could always self actualize our goals and performance criteria and sit around and pat each other on the back and tout how satisfied everyone is.
  5. by   OldDude
    Quote from Susie2310
    Since for a variety of reasons patients needs are often not put first, it seems that patients/family members are well served by hiring a private duty nurse to look out for the patient when they are hospitalized. This is what the situation has devolved to, in my opinion.
    Hmmm, you may be on to something.
  6. by   nrsang97
    Quote from klone
    That's why it's so critical for managers to be out on the floor, observing and helping and seeing the day to day operations of the unit. That manager would be aware that you were late with your med pass because you were helping Amber stabilize a sick baby. In fact, the aware, active and engaged manager could pass that med FOR you, or go help Amber herself.
    I wish I could like this a million times. I believe ALL managers need to work the floor, and have an assignment at least a few times a month. I believe they should always be able to help out.
  7. by   Davey Do
    I doff my proverbial hat to hose of you who work in these high acuity areas. At this stage of my life, I could not do it. You have my utmost respect for the jobs you do and the documentation you must follow up on.

    In psych, I am waging my own battle with administration on the redundantly superfluous charting: If it ain't important, I quarter-heart it, as doing it halfheartedly is a quarter-heart too much for me. I click enough buttons to close the assessments.

    My peers have reinforced the fact that my charting is above standards- if it's important, every detail is covered: the assessment, communication, intervention, and outcome.

    I don't know- some day I may just have to deal with the ramifications of my actions or inactions- but for now, I take a certain sense of pride in bucking the bureaucratic system.
  8. by   Jedrnurse
    Honestly, I just love any post with a title that incorporates the word "knave"...
  9. by   3ringnursing
    Quote from Daisy4RN
    I have seen this coming slowly but surely for years. Try to say anything and you are labeled a trouble maker. This is the sad state of the health care environment today and I doubt it will get any better.
    Or "unhappy", and then you are called in for a chat.
  10. by   3ringnursing
    I only wish I could "LOVE" this thread.
  11. by   RobbiRN
    Quote from klone
    That's why it's so critical for managers to be out on the floor, observing and helping and seeing the day to day operations of the unit. That manager would be aware that you were late with your med pass because you were helping Amber stabilize a sick baby. In fact, the aware, active and engaged manager could pass that med FOR you, or go help Amber herself.
    I believe the pressure in the current paradigm comes from higher up, and ground level and mid level managers have their own jobs on the line. They used to act as more of a buffer-- being on the floor, knowing what we do, and being willing to defend us at higher levels. But the pressure from the top is taking them out of that role as the system fosters a paint-by-number definition of success or failure.

    Beyond ground management working a shift once a month, upper management should shadow us for a full 12-hour shift once or twice a year to see how it all plays out in the real world.
  12. by   OldDude
    Quote from RobbiRN
    I believe the pressure in the current paradigm comes from higher up, and ground level and mid level managers have their own jobs on the line. They used to act as more of a buffer-- being on the floor, knowing what we do, and being willing to defend us at higher levels. But the pressure from the top is taking them out of that role as the system fosters a paint-by-number definition of success or failure.

    Beyond ground management working a shift once a month, upper management should shadow us for a full 12-hour shift once or twice a year to see how it all plays out in the real world.
    I disagree...everyone up the chain should pull a full shift 12 times per year.
  13. by   brandy1017
    Wow! The micromanagement you describe is over the top. I'd be looking for a new job! That's one thing we don't have to worry about where we work because we have so few admin staff left! lol

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