gypsyd8, MSN 12,616 Views
Joined: Nov 28, '07;
Posts: 282 (62% Liked)
; Likes: 625
I saw this while on break last night and did not have the time to articulate a fair response. I do not want to come off as disrespectful, but something about this really rubbed me the wrong way. The first issue I had was this:
"Any seasoned pro will be able to tell you about the numerous times in which they were on their feet all day and not once stopped to consider a break."
This statement is not only untrue, it is actually wrong due to the implication (by the previous sentence) that this is somehow desirable. A "seasoned pro" will not be on their feet all day, and seasoned nurses take their legally mandated and justified breaks. There is nothing wrong with this. This is actually the desired state of affairs. Perhaps the author did not intend it to be interpreted this way, but as a read further it appears that the author has internalized some form of corporate sycophany.
My second quibble was with the repeated use of the word "task" to describe the activities we perform in the course of our professional duties. I suppose technically the things we do could be called "tasks" but honestly I never heard them described this way. In nursing school we learned the nursing process, and were repeatedly admonished to avoid becoming "task oriented." The theme of a problem solving process that uses critical thinking has permeated my work as a nurse for more than ten years. It was reinforced when I went back to school for by baccalaureate, and again when I returned for my masters, where nurses were repeatedly described as "knowledge workers." I have never hear the work I do be relegated to a "task list" until I learned Cerner, so maybe that is why I notice it now.
Finally, some of these seem like simplified versions of reality. "Avoid taking shortcuts."
Why? If something can be done more efficiently without sacrificing safety why not take a shortcut? Is it because it would allow the nurse to take their legally mandated and justified breaks? Please understand I am not talking about (for example) scanning a patient label and all the meds outside the room in the hall somewhere and then administering the medication. This is something that is routine practice at a facility I used to work at and students were actually being taught this practice by the staff nurses they were following. This defeats the whole purpose of barcoding and scanning patient wristbands and medications, it is the modern equivalent of signing off the MAR before med administration and is a dangerous practice. I bring up this example because there is actually a fairly nuanced conversation that could be had about positive deviance in nursing (Clancy) and the old adage to "work smarter, not harder." I have also had experiences where any deviation from protocol is harshly punished, even if there is a positive outcome. I think there is a place in between following policies, procedures, and protocols for the sake of following them and flagrant violation of standards designed to ensure safe practice. It is our job as nurses to find that happy medium.
"Don't rush tasks." Well this I can agree with, to an extent. I have felt for some time that it is better to be late (administering medications, for example) and correct than on time and in error. Time and time again I have been leisurely preparing my patient's meds when I find one that should not be administered for one reason or another. When I have been rushed and given everything early the physician invariably discontinues a medication after I have administered it. I still hate being late, though, and sometimes rushing is necessary. Again, nuance. there is no right or wrong answer here. It depends on the situation.
Right after "don't rush" is "manage your time effectively" with the suggestion to "break each day into different periods of time, in order of importance." That is not how nursing works. We do not prioritize our days by periods of time. We prioritize our patients, from most acute to least acute and go from there. Then, they change. The quiet one who never calls is septic and the one on the call light every five minutes is a drug seeker. Or, the one you think is a drug seeker actually has a dissecting aortic aneurysm and the quiet one needs to be transferred to a lower level of care. It is an ongoing process of assessment, diagnosis, outcome identification and planning, implementation, and evaluation. It is literally impossible to break each day into different periods of time in order of importance. Each day is different.
"Don't be afraid to ask for help." Okay. Don't be afraid to offer it, either.
"Set your own targets." I seriously need help on this one. I wake up, shower, get into scrubs, go to work, clock in, and do my job for twelve hours. Those are the only targets I need. The admonition not to "wait for someone in management to allocate you certain goals" makes no sense to me. Management does not do my job, and I am happy when I do not see them.
I suggest my patients for transfer when they no longer belong in the unit. This is not because I want an admit, but because throughput is important so people do not die waiting for a bed. I transfer my patients when a bed is available for the same reason. I call the ER or OR or cath lab for report when I am ready for the same reason. It is not because I am itching for that trainwreck of an admit. If I am having an easy shift I will allow myself that. I will take care of my patients and leave on time contentedly knowing my patients were cared for, they got the appropriate medications, physicians were made aware of important issues, my charting is done and I didn't forget anything. Anything extra I do only when I am told, it is required and/or there is additional pay involved.
There is nothing wrong with that.
The student applied for and was awarded the grant to attend the Professional Organization conference. Due to the intransigence of an administrative assistant, the student was forced to pay the $200 required for the conference, as well as the cost of the hotel. At the new member/first-time attendee breakfast, it was made clear that we were not going to be teamed with a current Professional Organization member as our mentor due to the large volume of students in attendance, therefore, there was no-one to interview. Instead, the student interviewed several people about the various affiliations between the Professional Organization and other organizations, as well as the vendors in the exhibit hall. The following is a summation of the conference sessions and the student's own impression of the role of the organization in the profession, health care and in policy.
Report of Conference Attendance
The conference schedule began at 0715 with the new member/first-time attendee welcome, which consisted of activities designed to get the attendees interested in each other. At 0830, we were directed to the Sapphire ballroom to attend the "Opening/Welcome/President's address" as well as the Keynote Presentation. This presentation consisted of a mutual admiration society that the student dubbed "Reflections on why I no longer attend Catholic Mass" due the amount of stationary aerobics necessary to complete the appropriate veneration of whomever was speaking. The attendees were presented with "Mary's story," which basically elucidated that medical professionals could be incompetent as long as the patient and/or their families were happy.
Thereafter, a "Concert Violinist, Recording Artist, and Certified Therapist" entertained the masses with his humorous take on life inspired by his experiences. He spoke about the importance of goals, visualization, meditation, objectivity, and confidence. The point of his presentation was essentially "fake it till you make it." There was then a break from 1000 -1100 in which attendees were invited to view the exhibits, which were basically sales pitches by various organizations. During the break the student ran into a nursing professor from her Associate Degree program, which highlights the value of conferences for networking.
Morning General Session
At 1100, the attendees were again directed to the Ballroom to view Profiles in Courage: Nurse Leaders Making a Difference. The speakers were MC, Vice President, National Patient Care Services, Large Hospital Chain; LBB, Vice President and Chief Nursing Officer, Large Urban Hospital; and DV, Dean and Professor, Large Public University, School of Nursing. The session was moderated by MF, PhD, RN, Director of the Center for Research and Innovation, Large Public University, School of Nursing.
MC gave a speech that had nuggets of good advice, but the gist of her presentation seemed to be that she is successful because she has always done what she was told. Another piece of advice, "never forward & linear- welcome detours," is the exact opposite of what the concert violinist advised. She opined that attendees should "be willing to take risks," in reference to her work for the Large State Nurses Union. She also advised that leaders "be willing to test the core understanding of who you are and who you can be." She also advised that attendees "don't take too long to make a transition," and "know when to quit." She encouraged those in attendance to incorporate her motto, "be true to yourself," which was again the exact opposite of what the concert violinist related in his performance. In a continuation of her "know when to quit" philosophy, she opined that "how you exit is as important as how you begin." Other advice included "don't dwell on negatives, be open to new possibilities."
LB emphasized the importance of a network of colleagues in overcoming various obstacles. Her inspirational statements included "say it plan it do it" and "nursing is the business of human caring," and "QTIP." DV emphasized the importance of mentoring and balance. The moderator, MF, ended the segment by reiterating advice she had heard years before, "know the top three leaders, know three things they do differently, and speak to them three times a year," this from LK, who makes a great deal of money as a "motivational speaker."
Right before lunch, at 1230, a gentleman came to the podium and mentioned the close relationship the Professional Organization has with the State Hospital Association (SHA). Due to the Professional Organization being a 501(c)(3) organization they cannot lobby. He then specifically requested donations to the State Hospital Association Political Action Committee , the lobbying arm of the SHA, citing their important work on behalf of the Professional Organization, including successfully lobbying for the Governor's veto of a Senate Bill which would have resulted in fines to facilities that do not follow legal requirements for safe staffing ratios. According to a union (with which the student is not affiliated) the Senate Bill "would have strengthened the existing nurse-to-patient staffing ratios in...Hospitals by requiring the Department of Public Health (DPH) to check for compliance during regular, periodic inspections and by putting into effect existing statutory fine authority for DPH by removing the requirement that DPH issue regulations" (United Nurses Associations of [State] Union of Healthcare Professionals, 2013, para. 3).
Afternoon General Session
After lunch, at 1330, retired Army Colonel JP, who earned her PhD while stationed in Afghanistan, gave an inspiring presentation, Leadership Under Fire: Directing Medical Operations in a War Zone, describing her experiences. Her presentation highlighted the differences between command and leadership. She explained the concepts of rank and chain of command that exist in the military and contrasted these concepts with leadership, authority, and encouragement. She noted that, despite the military hierarchy, politics and a circle of influence are still important.
Dr P's advice was drawn from her experience; she described a sense of teamwork among the soldiers she worked with. None of them said "it's not my job" in response to doing what was necessary, whether it was shoveling snow or assisting wounded soldiers. She spoke of the importance of mentorship, and allowing others to help, as well as the importance of compassion, consistency, and composure in the face of challenges. She also advised to "whine up, never down," meaning take complaints up the chain of command, and to remain vigilant.
After this speech there was another break, until the final presentation at 1515 in the Ballroom entitled "Hot Topics today!" which again consisted of a panel discussion. The panel consisted of LB, Executive Officer of the Board of Registered Nursing (BRN), BJB, from the SHA, SC and JB, both from a collaborative of the Professional Organization, BRN, State Institute for Nursing and Health Care (SINHC) and State Nursing Students Association (SNSA), and MF, from the State Action Coalition (SAC). PM, the Chief Executive of the Professional Organization, moderated the panel.
LB, in response to a question an attendee asked about "their" nurses refusing to go out of ratio because they will lose their license, advised participants that the BRN had never revoked the license of a nurse for being out of ratio and that this was not an excuse to refuse an assignment. The crowd responded with thunderous applause. BJB, Vice President of SHA (whose representative had earlier asked for money to lobby against legislation strengthening staffing ratios) then presented the 2013 legislative update.
SC, from the Large Public University School of Nursing, and JB, Executive Director of the SINHC "a statewide non-profit organization developing solutions to State's nurse shortage" (Hospital Association, 2011), presented a New Graduate survey showing that forty-six percent of new graduate nurses surveyed were not working registered nurses. One would think that a nursing shortage would facilitate employment in the profession.
The survey randomly sampled 5,147 out of 10,294 registered nurses licensed between September 2011 and August 2012. There were some limitations of the survey, including a low response rate of twenty-four percent, representing 1,219 respondents. It was also noted by the student that three were grouped together, which does not seem like sound methodology considering that one of the three counties represent vastly different demographic and socioeconomic levels, not to mention the lack of acute care facilities in two of the counties, which would probably result in a lack of available positions.
MF, who had moderated the morning General Session, spoke about the SAC, which seeks to "guide implementation of the recommendations of the Institute of Medicine's (IOM) landmark report, Future of Nursing: Leading Change, Advancing Health," (State Action Coalition, 2012). Finally, PM concluded with a presentation of a mentoring consulting firm. This firm has no registered nurses in its leadership team, and appears to have nothing to do with nursing in general.
MC's speech reminded the student of her experiences in the final semester of the Bachelor of Science in Nursing (BSN) program at State University, when she was paired with a preceptor at Large Hospital Chain for her Leadership clinical rotation. This preceptor in turn paired the student with an employee who responded to any query with "I don't know; I just do what I'm told."
For an entire semester, the student dutifully did what she was told, mostly data entry that could have been done by any volunteer from the local middle school. The student learned nothing about leadership, or management for that matter, from this experience. "Just do as you are told" is good advice, as long as one is listening to the right people, but it does not facilitate leadership or vision, in the student's opinion. MC's advice that attendees "don't take too long to make a transition," and "know when to quit" was understandable from an employment perspective, but would she say the same about education? Her advice, "don't dwell on negatives, be open to new possibilities," may be inspirational to someone who has possibilities, but seems to hold an air upper-class privilege. She noted that an interim position can do more than regular position because there is nothing to lose. This was an interesting concept, as it may be true for those who are not among the majority of the population that has to worry about paying their bills.
One of the most interesting bits of information from the panel was the statement by one of the presenters who was seeking a job that she had no experience performing. The interviewer told her "we haven't had much luck with people who have had experience." That the panel member was even considered for a position that she had no experience performing again illustrates the importance of networking, which was ostensibly one of the purposes of the conference.
LB's allusion to "QTIP" intrigued the student, who has only heard this in reference to a cotton swab or a rap artist. The student could not divine the meaning of "QTIP" from an extensive internet search. This illustrates the importance of privilege, and knowing the language spoken by those in power.
This reminded the student of a story her sociology professor related about tests to determine intelligence, and therefore students' placement in one of the tracks in the public school they attended. Those with lower test scores were placed on a vocational track, while those with higher scores were placed on the collegiate track. The question asked was: "a teacher is to a class as a conductor is to a what?" The students that answered "train" were placed in the vocational track, while those that answered "orchestra" were placed on the collegiate track. Nursing has been a vocation for many, including the student. It is also a profession, requiring diligent study and research to advance. This liminal state predisposes those who advance to leave their proletariat colleagues behind, as they seek more prestige and power.
JP's presentation provided an interesting contrast to the other agenda driven presentations, in that she spoke to what is at the heart of our profession: compassion, consistency, composure, leadership, teamwork. The student found it interesting that an organization that claims to speak for nurses would associate with an organization lobbying against nurses, specifically, the SHA. Further research into this affiliation revealed the nurse-to-patient ratios that the SHA and the Professional Organization supported back in 2000, before the law mandating safe staffing ratios in the State was passed. These included one nurse to six patients on an intermediate care unit (currently it is 1:4), one nurse to ten patients on a medical surgical unit (currently it is 1:5), and one nurse to six patients in the emergency department (1:4 under current law) (Costello, 2000).
The student worked on a telemetry unit prior to passage of the law. The student saw how "acuity based' staffing worked. Back then, a Licensed Vocational Nurse (LVN) on a telemetry unit that routinely used vasoactive drips, as well as anticoagulant drips, could be (and routinely was) assigned up to seven patients. The Registered Nurses could cover an unlimited number of LVN's. That is seven patients on cardizem and heparin (for example) to one LVN, with up to thirty drips for one RN to monitor. Patients died on that unit, and this student has personal knowledge that these deaths were directly attributable to unsafe staffing.
No RN the student knows is so stupid as to think that the BRN will divine when they go out of ratio and take their license. Rather, we know that when an adverse event occurs, and an investigator from the Department of Consumer Affairs comes to take our license, being overwhelmed by an unsafe workload will not be an excuse because staffing ratios are the law. We also know that the BRN is not an advocacy organization, but a division of the Department of Consumer Affairs. We know that the hospital industry is not an advocating for nurses or for patients, but for profits. Some of us know the unions are no better, and also advocate for their own agenda. The student discovered that years ago, during a strike, in which she crossed a picket line to work as scheduled. The student was considering membership with the Professional Organization but decided after this experience that her hard earned money could be better spent with a professional organization, and renewed her membership in the American Association of Critical Care Nurses (AACN).
This person has 2 years of experience. Nurses need ratios, not a reduction in hours worked. If I was forced to work 5 days a week without overtime I wouldn't be at the bedside.
Advertise With Us