Knaves, Fools, and the Pitfalls of Micromanagement - page 3

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   SobreRN
    Memories! Bad memories I'd add, so now they have new grads doing chart audits? You summed it up perfectly, I remember the infection control 'auditor' apprising me that I had not placed the tape on the back of my yellow gown correctly, I had a bit of my hair sticking out.

    I quit working in acute care @ 2014 and they only regret I have is not doing it 10 years sooner. I honestly have to wonder if those who are 'timing' everything have ever even observed the ER/MS/Tele floors at all.
    It will get worse, I feel for new grads but more so for the patients. They are going to need to be tough to 'buck the system' enough to actually care for emergent situations, help colleagues with things like IV starts while knowing they may not measure up on getting that 'rounding, med side effect, discharge etc...' documented in real time.
  2. by   RobbiRN
    Quote from OldDude
    I disagree...everyone up the chain should pull a full shift 12 times per year.
    I agree in theory, but they can't work a shift -- literally. Nursing administration used to come from nursing. That's changing. Once you get past your immediate department manager, some of them are coming from non-nursing, business or other management backgrounds. They have no experience in patient care. They are not licensed or qualified to do what we do, but they are empowered to control our work environment and judge our performance.

    I would still like to have them do that "undercover boss" routine, put on some scrubs, and try to keep up with me for 12 hours. . . at least once.
  3. by   BrandonLPN
    And somewhere, someone with a masters degree got a pat on the back because they cobbled together some study and a pretty PowerPoint stating how beneficial it would be if all patients with a potential long bone fracture got their pain meds within 30 minutes. And then someone else decided it would be "best practice" if all c/o extremity pain be treated as a potential fx because there's a 0.005% chance. And then another one decided compliance rate should be 100% because that's the only acceptable level.

    And that's what's wrong with nursing.
  4. by   Susie2310
    Quote from OldDude
    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.
    The depressing reality is that these sentiments are actually held by a number of people.
  5. by   OldDude
    Quote from RobbiRN
    I agree in theory, but they can't work a shift -- literally. Nursing administration used to come from nursing. That's changing. Once you get past your immediate department manager, some of them are coming from non-nursing, business or other management backgrounds. They have no experience in patient care. They are not licensed or qualified to do what we do, but they are empowered to control our work environment and judge our performance.

    I would still like to have them do that "undercover boss" routine, put on some scrubs, and try to keep up with me for 12 hours. . . at least once.
    Oh yea, I realize that, but as you say, they should still have to go be there for 12 hours, 12 times per year so they could savor the wisdom of their policies.
  6. by   ccharlonne
    Or just be there on off shifts to observe their staff in action. I have worked nights for over 10 years and have NEVER had a manager present on any unit. If we need anything we call the nursing supervisor. Yet my manager does my annual eval! But that is just "how it is" in many places.
    I have had managers who answered call bells and helped out, but they were the exception. They are often dealing with the requirements of the number crunchers above them.
    Patient care suffers and nurses find jobs in other areas, the cycle resumes and more patients are unhappy and more nurses burn out.
  7. by   rnfly29
    I so agree with you! While we work 40 hours plus, nights and on call. The department manager gets to work 9-5 PM M-F. Many of them walk around like they somehow deserve the "good treatment" and somehow the rest of us are beneath.
  8. by   LadysSolo
    The hospital where I used to work was going to cut our staffing per request of the board. I decided to buck the system (there were a group of us but the others backed out) and went to the board meeting and challenged them to come work with us for a day to see how it really is before they cut us. One person agreed. He made it for 4 hours and left saying "I don't know how you do it with the staff you have, there will be no cuts!" And there weren't. Sometimes you have to ruffle a few feathers and granted, I knew when I did what I did I was risking my job. But I did not lose my job.
  9. by   RobbiRN
    Quote from LadysSolo
    The hospital where I used to work was going to cut our staffing per request of the board. I decided to buck the system (there were a group of us but the others backed out) and went to the board meeting and challenged them to come work with us for a day to see how it really is before they cut us. One person agreed. He made it for 4 hours and left saying "I don't know how you do it with the staff you have, there will be no cuts!" And there weren't. Sometimes you have to ruffle a few feathers and granted, I knew when I did what I did I was risking my job. But I did not lose my job.
    Great success story. Many managers and board members are decent people, and they might make better decisions if they had a more realistic view. Your courageous decision to confront the board on your own was well rewarded, and rightfully so. Nursing is full of hard-working, intelligent, dedicated people who regularly go the extra mile. The majority of us don't need the top brass pushing us to increase patient satisfaction. We are driven to care for others; it's why we signed up. But, I suspect, as a profession, there is an overall lack of courage to confront management the way you did -- which leaves us collectively vulnerable and exploitable.
  10. by   TriciaJ
    Quote from LadysSolo
    The hospital where I used to work was going to cut our staffing per request of the board. I decided to buck the system (there were a group of us but the others backed out) and went to the board meeting and challenged them to come work with us for a day to see how it really is before they cut us. One person agreed. He made it for 4 hours and left saying "I don't know how you do it with the staff you have, there will be no cuts!" And there weren't. Sometimes you have to ruffle a few feathers and granted, I knew when I did what I did I was risking my job. But I did not lose my job.
    You deserve an award. I do think the upper echelon should periodically have to strap on skates and follow us around for a shift. You eat when I eat; you pee when I pee. You don't have to do any actual work; just try to keep up.
  11. by   lilmiz
    Awesome article, well written and thought out. I work in ICU and we have been subject to "creative" staffing and outrageous chart scrutiny for quite awhile now, it has caused burnout as well as interdisciplinary feuding and undermining. I am consistently receiving phone calls from "Quality" during my shift about things like ‘ your fall assessment for this shift hasn't been documented'. Never mind that it's 1130am and we walked into a code, then a bedside trach was scheduled for my patient, Oh and my patient assessments, my med pass and patient care needs to be done. Not to mention diagnostics, acute interventions doctors rounding, oh and last but not least communication with ‘helpful" family members. We are constantly receiving emails, calls and and annoying little mandatory "in services" given by a educator who has barely worked the floor for less than 2 years as a Med/ Surg nurse and has no critical care background. In addition we are made to go back and enter "addendums" in patients charts. Our actual assessments are no longer relevant, we are made to chart what "admin" wants. Also patient ratios and staffing are modified according to what administration wants not what's best for the patients. Administration has also put charting guidelines and protocols before true patient care, resulting in robotic staff who have lost their common sense and critical thinking to just blindly following the EMAR. That in itself has caused patients to have adverse consequences during their hospitalization, prolonging their stay, as well as many more patients not receiving the bedside care, as well as the much needed education that nurses provide. This leaves a vast majority of nurses feeling that they weren't able to provide quality patient care, this then leads to lower job satisfaction, and a greater mistrust towards administration and the facility or company they represent. It has become a vicious cycle within health organizations everywhere.
  12. by   Futureapn2
    Well stated!
  13. by   RobbiRN
    Quote from lilmiz
    Awesome article, well written and thought out. I work in ICU and we have been subject to "creative" staffing and outrageous chart scrutiny for quite awhile now, it has caused burnout as well as interdisciplinary feuding and undermining. I am consistently receiving phone calls from "Quality" during my shift about things like ‘ your fall assessment for this shift hasn't been documented'. Never mind that it's 1130am and we walked into a code, then a bedside trach was scheduled for my patient, Oh and my patient assessments, my med pass and patient care needs to be done. Not to mention diagnostics, acute interventions doctors rounding, oh and last but not least communication with ‘helpful" family members. We are constantly receiving emails, calls and and annoying little mandatory "in services" given by a educator who has barely worked the floor for less than 2 years as a Med/ Surg nurse and has no critical care background. In addition we are made to go back and enter "addendums" in patients charts. Our actual assessments are no longer relevant, we are made to chart what "admin" wants. Also patient ratios and staffing are modified according to what administration wants not what's best for the patients. Administration has also put charting guidelines and protocols before true patient care, resulting in robotic staff who have lost their common sense and critical thinking to just blindly following the EMAR. That in itself has caused patients to have adverse consequences during their hospitalization, prolonging their stay, as well as many more patients not receiving the bedside care, as well as the much needed education that nurses provide. This leaves a vast majority of nurses feeling that they weren't able to provide quality patient care, this then leads to lower job satisfaction, and a greater mistrust towards administration and the facility or company they represent. It has become a vicious cycle within health organizations everywhere.
    Well written and well thought out. You point to extreme situations, the code (30 minutes of unplanned, essential intervention?), followed by the bedside trach, while the necessary checkpoint stuff gets pushed out. One previous response noted that my illustrations sounded like every day occurrences. I chose less extreme examples on purpose to clarify that micro-mismanagement creates problems even under "normal" conditions.

    In the ER and ICU, extreme conditions are common. We are often forced into doing what we have to do just to keep people alive while letting charting and every other measure slide. But, I didn't want to be accused of overstating the case, so I used "normal" examples. Even on a medical floor, a patient with persistent diarrhea can burns hours of time that don't show up on a spot check formula.

    Your observation that detached management is creating robotic staff who lack critical thinking is spot on. The system has already created robotic doctors who set aside common sense, leaving nursing as the last hope for common sense to prevent stupid things from happening. If we let them take us out too, it will be a cold, dark, dangerous system.
    Last edit by RobbiRN on Feb 11 : Reason: grammar

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