Private Grumbling but NO Open Discussion!

Nurses General Nursing

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Specializes in Tele/Interventional/Non-Invasive Cardiology.

Okay, so I have to wonder, I hear nurses on my unit complain about working conditions and new (ridiculous) patient satisfaction directives. However, when they are brought up in a group setting with the manager everyone stays silent. Example: we had an staff energizer on our unit to bring up our "pain scores." Two new directives: if a patient calls for pain medication, the unit secretary will call the patient's room after 5 minutes to ensure that the nurse has made it to the room. Then, they will pull reports and if a patient's charted pain level is more than 2 levels above their pain goal, charge or an ANM will meet with the nurse to see if he/she has a plan to control pain.

Frankly, the first directive is insulting. A nurse needs to be "checked up" on? The second directive is bogus because I KNOW that patients will continuously rate their pain as high so the physician does not take their medications away. Of course there are exceptions to that, but in my experience, I have seen many more incidents which I described.

The nurses grumble, complain and gossip (I won't lie, me too) but say NOTHING to make it better or speak up with suggestions to the manager. I did and I felt all alone and left out to dry. I don't know if it is because Florida is a non-union state? Maybe nurses are scared of losing their jobs. Because in NY, this never would have happened.

Why don't nurses speak up? There's supposed to be power in numbers. But yet, it doesn't seem that anyone wants to challenge the status quo. Thoughts?

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I don't say anything about stupid new policies because I've never seen it make any sort of difference.

Here's what happens with managers: they'll get a bug up their butt about something, then send out emails and put up fliers for about a month or so. Then people slowly start going back to the old way and the manager moves onto something else.

People don't say anything because these sort of policies never stick around, and there's no point in getting on the manager's bad side.

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Specializes in Tele/Interventional/Non-Invasive Cardiology.

I understand that to an extent, but it has not led to bad policies not sticking around, it has lead to MORE bad policies. Maybe at your facility that is the case. Yes, people continue with their usual habits, but now managers are coming up to patients, checking charting and harassing nurses to make several phone calls a shift to a physician, despite the physician being aware and already made decisions regarding care. These policies are not going anywhere at my facility. And if they don't see the scores they like, it will continue mount. And this has lead to gross entitlement by patients who will have deplorable behavior until they get their pain medication of choice! Condition be damned.

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Specializes in Family Nurse Practitioner.

Theres only so much dilaudid, morphine, and oxycodone a doctor can order for a patient who continuously rates their pain at a 10/10. I think it will catch up with the patients. If you are maxed out on dilaudid and your pain is still a 10/10 maybe we should put you in a medically induced coma to manage your pain.

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Specializes in Med/Surg, Academics.

I never speak up because it doesn't make a damn bit of difference. These new management initiatives are a flavor of the month that add on work but don't take anything away. If I feel that there is something patient-care oriented in what they are saying, I may make adjustments to my practice, but rarely is it the complete "solution" management has come up with.

How much you wanna bet these pain scoring issues is as a result of the latest survey analysis? There was no root cause analysis, it may have just been a blip for the most recent quarter, but, by golly, management is gonna fix it, and it must be because the nurses aren't medicating appropriately!!

Nevermind that I will medicate, reassess, and the patient will say the pain is better, but give me a pain score that is the same as the premedication score. I then have to remind them what their premedication score was and ask them to Rescore. They then give me a score only one point lower than the previous, possibly because they are a little embarrassed about being unable to score accurately.

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Specializes in Hospice.

I did, and was fired.

ETA: 60 years old at the time, 11 months unemployed and came within one day of defaulting on my mortgage.

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Specializes in Critical Care; Cardiac; Professional Development.

Unfortunately in today's hospital environment speaking up at best gets you ignored and at worst makes you a target. THAT is why people don't speak up.

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Specializes in NICU, ICU, PICU, Academia.
I did, and was fired.

ETA: 60 years old at the time, 11 months unemployed and came within one day of defaulting on my mortgage.

Also fired for speaking up. Never again.

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At my hospital I can say whatever I want, when I want.

We bleed staff so much, it just doesn't matter. They won't fire you.

There is something to be said about working in a crap area with a bad patient population. If you simply don't quit they will love you for it.

Maybe a move is in order op?

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Specializes in Early Intervention, Nsg. Education.

I wish I could say that I did XYZ, led the charge up the hill, and ended irrational, time-consuming, prioritization-defying "pain management directives," (or whatever is the current upper management focus) forever, but I can't. When I was working med/surg several years ago, we had a very similar "Let's get this accomplished, team!" focus challenge on...wait for it...meal tray temperatures. The hot food had to stay hot (but not too hot) and the cold food had to stay cold (despite being right next to the hot food. Physics be damned!). The floor staff had to stop whatever they were doing, whether it was med pass, dressing changes, stat blood draws off a CVL, hanging and monitor PRBC's, toilet/change incontinent patients. Food trays!

The first day of the new policy, the Pumps and Pearls Brigade was on the floor, serving patients as if they were serving prime rib and stuffed lobster claws. Patients who felt that their eggs were a little too cold or toast wasn't crisp enough had entire trays replaced. Obviously, Dietary was completely overwhelmed, so trays were walked back to the kitchen (walked!) so that the life-threatening limp toast or scant secretory scrambled egg was replaced. Made from scratch!

The "super duper patient-friendly dining experience" program, lasted four days. Patient meal complaints went up, not down. The final nail in the culinary coffin? Pain meds were delayed! Gee, imagine that...turn Nurses into waitresses and the nursing tasks don't get done. Shocker! Maybe they should have delegated the med pass to the culinary aides?..

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Lol in the military we always called these boneheaded ideas as good idea fairy BS.

The good idea fairy was in every unit and was always drumming up some stupid idea.

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Specializes in Family practice, emergency.

I wonder how long this will last after charge and ANM see how often they will have to have meetings with "offenders." (rolls eyes)

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