What's WRONG with nursing management?

[VickyRN]

They just DON'T get it. Sort of like talking Chinese to someone who only understands English; not communicating--not even on the same wavelength. Had a bigwig from a neighboring large hospital call the director of our nursing school, asking us in desperation if we could increase enrollment at our small community college nursing school (ADN). Of course we cannot; do not have the nursing instructors and don't have the facility to do so even IF we had the extra help. This administrator told our director that this HUGE hospital is now short XXX nurses. Well, hello, what about RETENTION???? Why are all your nurses leaving??? This particular institution is losing nurses so fast, that it is like a patient who is hemorrhaging, about to code. The administrators seem oblivious to it all. It brings to mind an old quote (don't remember the source), "There is none so blind as one who is willingly so." That about sums it up. You can tell these people what is wrong with their institution until you are blue in the face... WHY all of their nurses are leaving. They just don't hear you because you are telling them something they just DON'T WANT to hear, plain and simple. It is SO very frustrating. I am convinced that the majority of nursing administration in this hospital is STUCK in an 80's and early 90's mindset and can't adapt or accept the nursing situation as it is NOW, in the year 2002. I am further convinced that the nursing problems at this hospital won't be solved until the current "generation" of nursing managers dies off. By then, sadly, it just may be too late...

[pebbles, BSN, RN]

Found this quote in a book, and loved it. If anyone has any others, I'd love to hear them.

THE BEATINGS WILL CONTINUE UNTIL MORALE IMPROVES.

[canoehead, BSN, RN]

I think we should have a nationwide policy forbidding for- profit hospitals and health care clinics, thus putting all out health care dollars where they belong- into better health care.

[Burnt Out, ASN, RN]

VickyRN,

You sure you ain't in Alabama??!! My hospital asks the same thing-why can't we get more nurses-HELLO!!! CAN'T KEEP THE ONES YOU HAVE!!!

They ACT like they have NO CLUE as to why the staff is unhappy-PUUHHH-LEEESSSEE-give me a break!!!!!

[Youda]

One place I worked, they put all these ads in the paper, Help Wanted! They couldn't figure out WHY after 3 weeks of daily ads that no one had applied for a job! LOL! WHAT? Do they think the nurses never talk to each other?

Nurse one: Hey, I'm thinking about working at W-X Hospital, what do ya think?

Nurse two: That place is a hell-hole, terrible patient to staff ratios, they treat ya like pond scum. Don't go THERE!

Or, how about when things get bad and people start handing in their resignations and the line is, "If all the good nurses leave, then it will never get better!" Like trying to make you feel guilty for leaving. HELLO? HELLO?

Begin with the idea that management has all had lobectomies, then nothing they do will surprise you.

[whipping girl in 07, RN]

The "W-X" hospital in my town finally got some people through the door when they offered $5000 sign-on bonuses. I had worked there for a summer when I was in nursing school and I swore I'd go back to waiting tables before I'd work there as an RN.

From what I understand, many of the nurses who jumped ship for the bonus did not hang in there long enough to get it and are back at the hospitals they came from. I've heard that things are changing there, they are getting better, but the people I know who work there on the floors (or who have worked there) said it's not changed a bit; still understaffed, no thought given to acuity when assignments are made, management still nowhere to be seen. And they just fired their DON (I don't know if that's good or bad, she seemed nice, but...)

[renerian, BSN, RN]

Boy do I agree with you 100%!! I presented a time study done over 30 days to the boss of the home health company I worked for. I worked there almost two years. Being paid only per visit in home health and not for drive or office time spent coordinating care, when I tracked my total hours worked to what I was paid my hourly wage was between $9.00 to 11.00 per hour. I would work between 15 to 25 hours per week coordinating the care for over 30 clients. WE were reimbursed mileage and I was putting between 500 to 800 miles per week for patient care and another 350 to 800 miles depending on which office I was booked from, getting to and from each office. NO mileage pay to and from the office which I did not expect. No cell phone call reimbursement when we had to call patients, call DRs or case managers of insurance companies. It just was not worth my time. My boss said sorry this is what home care is. I told her I could go work for a store or burger joint and make more than that. She said to bad. The last 5 nurses left for the same reason I did. I was the only one to offer proof of the wage vs. total hours suffered to work for the company. She did not care as she was making $80,000 per year to my 30,000 and she only workes 40 hours whereas I was working 60 to 70 hours per week.

Sad commentary,

renerian

[adrienurse, LPN]

I kind of spent a bit of this week being sucked into the world of nursing management. In their world, you do not advance far if you fight against the tightly established ways of doing things. Managers are rewarded by propagating the system, no matter how dysfunctional it might be. A hard thing for most to stomach, I would think -- I know I couldn't.

It is all about looking good on paper. Many managers do not concern themselves with making sure that the policies they develop can work or do not have negative consequences. Shortsightedness is rampant. After all, the people that they answer to have very short mandates in power (eg. politicians, chairman of the board etc.). Much of the work is done in order to satisfy audits and accreditations.

Nurses (general duty nurses) do not have a strong voice on comittees to appose such management-driven ideals. The shift-work does not lend itself well to attending meetings scheduled during the day. Most nurses are not trained to speak the language of management which further complicates the problem.

[fedupnurse]

Vicky, this is exactly why I have the screen name I do. I have been a nurse 10 years now and have spent those years begging, pleading and finally threatening the suits so that our patients could receive quality patient care. Bottom line: The only thing they care about is the bottom line. Penny wise and pound foolish. They have no clue how critical experienced staff nurses are. They say they are flexible yet only offer 2 shifts, bith 12 hours each. You need to change your status to per diem, better get that letter from the US Congress cause in my institution you will need just that. But yet we have Magnet status, are JCAHO certified, blah, blah, blah. None of those designations mean squat to staff nurses, but mean the world to the suits. Vicky, I have been living with your frustration for 10 long years. I am almost half hoping we do go out on strike this fall. I will take a break from this profession and go work at a check out counter for awhile. At least in retail I will be allowed to use sick days and vacatio time I have accrued!!

As has been said so many times: There is not a shortage of nurse, just a shortage of nurses willing to work in hospitals. Can anyone blame us with how we are treated? Here's a 4% raise, by the way we are increasing your health benefits contribution by 12% this year, 18% next year and 25% the following year. Doesn't this equal a pay cut??????????

[nell]

Originally posted by Youda

Begin with the idea that management has all had lobectomies, then nothing they do will surprise you.

Our CEO said there's no nursing shortage at our hospital; all management needs to do is make all of the nurses work full time.

[whipping girl in 07, RN]

I was just venting about this to my friend who works where I do (only she's in ER). In ICU, you WERE considered full-time if you worked 3-12 hr shifts a week. You had the OPTION of picking up an extra 4 or 8 every week, or an extra 12 every other week. Now, management has come down and said that everyone has to work 40 hrs a week. So the optional shifts have essentially become mandatory. They softened it a bit by saying the extra time could be "on-call," except without the "on-call" pay (time and a half). However, if you want to pick up additional voluntary "on-call" time, you can do it and get "on-call" pay. Now I'm so sure they are going to do an excellent job of keeping up with which shifts are mandatory on-call (no extra pay) and voluntary on-call (with extra pay), so that those of us who don't schedule the extra time as on-call but as our regularly scheduled time won't get paid less than our counterparts who are writing themselves in on the on-call list. (Did that make any sense at all?) I guess what I'm getting at is that I forsee on-call time and a half going the way of the dodo bird at our facility.

This was justified by the suits saying that the regular nursing floors do it, by scheduling both 8s and 12s. Yes, but we staff for 12 hr shifts. I'd gladly do 2-8s and 2-12s but they won't let me; you have to work 3-12s. The only people who get to work 8s are day shift PRNs. Night shift must work 12s whether they are full-time, part-time or PRN.

We floated along all summer running short (two nurses out on maternity leave, two travelers assignments expired and they chose to move on, two nurses quit and started traveling, and three new grads in orientation). I'd been told to get ready, during the summer I'd get pulled or cancelled a lot. I got pulled 5 times and cancelled once. We stayed full for most of the summer, and my phone rang nearly every day off asking me to work extra. Well, we've hired four new agency nurses, the new grads are out of orientation, one of the girls on maternity leave is back and the other will be back soon, three nurses from the hospital float pool have agreed to schedule all their hours in ICU and now they decide that everyone needs to work 40 hrs a week. This is so we can avoid using agency nurses. Hello, why wasn't this done before they hired the agency nurses? Now, on the next schedule, there are 8 or 9 nurses scheduled for every night (plus some nights have a person on call) when 6 or 7 is the norm. Occasionally 8 on Tues/Wed/Thurs because of fresh hearts. So who do you think is going to be cancelled all the time? Not the agency nurses, because the hospital has to pay them anyway even if they are cancelled. No, it will be back to how it was before; pull from ICU to staff the hospital. Except now we are not mandated to take a pull. We can take the cancel instead. But if we are so overstaffed that we're getting cancelled every other week, those of us who can't afford to do without the $$ will have to take the pull to get the hours, or give up our valuable vacation time to make up part of the difference on our paychecks.

The agency nurses are the only ones who are smart; the rest of us are just putting up with BS for less $$.

I love where I work. I love my job. I love the people I work with. But I do not like the way things are going right now, and they don't listen when we try to get things changed for the better.

[Youda]

Uh, Konni? Have they come out with a 1200 page tomb yet explaining the pay and staffing procedures? LOL! Just wait, it's coming! They'll pay some jerk 60-70 thou/year to write it!

Nell, they are goona "make" the part-timers work fulltime? DUH! Hasn't it occurred to these Einsteins that the part-timers will quit and then they'll be more short-staffed? Whoops! I forgot for a second there that they don't care about being short.

[recnurse1]

Guess what, folks... the suits in management aren't the only ones who just don't get it...... Last week I responded to our local newspaper{?} about an article regarding the shortage. It was an average length letter, very polite, but to the point. No longer than an average post here on our BB. They sent me a reply that the letter was too long! Said I should resubmit it and to keep it under 200 words! I could not do that and get the point across, so I guess that's their way to ignore the problem! :angryfire If the press doesn't want to hear it... what next???