Dozens of nurses at Northern California hospital balk at wearing locators - page 7

About two dozen nurses at Eden Medical Center near San Jose, Calif., have turned in the personal locator devices the hospital had required them to wear. The hospital contends the devices help provide... Read More

  1. by   rstewart
    Quote from ZASHAGALKA
    bored so bumping an old thread

    Don't y'all think it's unprofessional to require nurses to wear dog collars?

    I quite my last job over these tracking systems. They are so anti-nurse.

    They are the reason I sought out this site.

    What do you think,

    ~faith,
    Timothy.

    What do I think?..........Well, I think it's congruent with a comprehensivel plan to turn bedside nurses into something akin to stepford wives.

    The plan begins with scripting, that is, requiring a particular phrase recited word for word in response to a given scenario. The scenerios and their associated phrasealogies increase incrementally. Verbal behavior must be tightly controlled lest a human, emotional or individual thought escape non administration lips.

    Likewise, nonverbal behavior must be addressed. In the same facilities where continuing professional education beyond initial orientation has slowed to a trickle due to cost constraints, abundent dollars exist to have training programs where the floor is marked at 5 foot intervals with the nurse conditioned to make eye contact at 2 marked intervals and smile at one. You are reminded to answer the phone with a smile as well. Conditioning periods end with required signatures acknowledging understanding that these and other "'clever human tricks" are now job requirements. Anticipating countercontrol, the statement specifies that the behaviors must be performed with the proper attitude. The implied threat to those resistent to conditioning is clear, however to many if not most participants it's just another paper to sign.

    Now some pesky federal laws limit the ability to make all the nurses look exactly like. So administrative mandates as to how the body is covered or adorned must be specified in great detail. No part of the body shall escape notice or specification literally from the tips of the toes to the ends of the hair. And naturally everyone should wear the same color uniform under the guise of professionalism. That all other professions (physicians, accountants. engineers, attorneys etc) typically do not endure uniforms of the same color in their workplaces and in fact such requirements are associated with the trades and pink collar jobs is of no consequence. Professionalism in nursing has always been uniquely/selectively recognized by hospital administrations and others. While autonomy, respect and necessary continuuing education are given little more than lip service, in nursing, professionalism has been transformed into a club used to beat its members----as in if you don't conform or acquiece, you are not behaving "professionally".

    Now tracking devices are just more of the same. If you read articles about the practice, you will find members of our "profession" extolling the potential benefits. For example the devices can show that call lights have in fact been answered promptly despite patient's complaints to the contrary. Now I must ask..... Does anyone out there recall hospital management ever spending tens of thousands od dollars to prove that nurses are extremely productive, often have no time for breaks, lunches, provide unique value to the organization etc. When health care consultants were all the rage doing time-motion studies did they ever say "Wow, these nurses are amazing; how they are able to accomplish what they do is remarkable----but to do everything asked of them, there needs to be more of them?"

    In the real world of health care reality does not matter anyway; customer perception controls. Attention to a patient's needs is not an issue; rather, convincing the patient that their needs have been met (whether or not that was in fact the case) is the goal today. (Thus the appeal of scripting). Tracking devices may prove a nurse was physically present and for how long but the nurse will still remain "on the hook" for failing to convince the customer that everything that could have been done with the available resources has been done.

    On the other hand the tracking devices have an obvious potential dark side. And what other professionals are actively tracked and their movements scrutinized?

    The underlying problem here is that nurses can not bill for the services which they provide as other providers of professional services do. Since we have no means of demonstrating billable productivity, other means are necessary to insure management is "getting its money's worth." Tracking devices offer a partial solution albeit an dehumanizing, inaccurate one.

    I think we are creating an extremely toxic environment for the bedside nurse, one which is better suited both physically and mentally to machines.
  2. by   ZASHAGALKA
    Quote from rstewart
    Anticipating countercontrol, the statement specifies that the behaviors must be performed with the proper attitude. The implied threat to those resistent to conditioning is clear, however to many if not most participants it's just another paper to sign.
    I was actually told there would be 100% POSITIVE buy-in.

    I was written up for complaining about the system to my co-workers. I was told that it would be a minor infraction if I shut up about it; a major infraction if I kept bad-mouthing the tracking system.

    Oh, and I wasn't allowed to call it a tracking system anymore because that wasn't the way administration wanted to present it to staff.

    Did I mention that I work someplace else, now?

    ~faith,
    Timothy.
  3. by   ZASHAGALKA
    Long post: this was my official reply to management's implementation of a tracking system:

    I preface my comments by quoting the AACN's position paper for Establishing and Sustaining Healthy Work Environments: "It is ethical to request, encourage, and deliver feedback on all facets of individual and organizational performance. It is unethical to ignore, discourage or fail to give feedback." I have an ethical imperative to provide honest, if passionate, feedback on the adoption of a tracking system for professional nurses:

    I believe that it is unethical to require RNs to wear tracking devices for the purposes of administrative monitoring of care. These devices cannot measure the quality of work being provided by the professional nurse and cannot record the professional processes that dictate prioritization of care.

    These devices can only measure the quantity of work. When the results of data generated by these devices are ultimately used, in evaluation and/or disciplinary action, the end result is to supplant quality of work for quantity of work. This goal, increased efficiency over increased quality, is contrary to patient advocacy and has the extreme potential to create high levels of moral distress among professional nurses who view bedside care as an art rather than a statistic.

    Another result of this system is that it serves as an interruption to care. Nursing care is simply not a function of answering every call light as quickly as possible. Without a buffer system (charge nurse/CNA/secretary) to manage routine requests, the bedside nurse will simply be inundated with every call at the bedside, interrupting procedures such as IVs and Foley insertion, and more important, interrupting the undivided attention that bonds a nurse w/ a patient and leads to higher levels of care, understanding, and ultimately, satisfaction. Many nurses at hospitals that use this system report that the constant, routine interruptions created by this system served to de-personalize care. In addition, constant interruptions create the need to sort and reprioritize workloads, slowing down the nursing process. Simply put, the tracking and timing part of this system doesn't ensure efficiency, it just ensures swiftness. Instead of being able to group tasks in a timely fashion and by priority, the bedside nurse under this system feels compelled to answer requests in sequential order.

    The professional nurse is a strategic member of the healthcare team. An essential quality of that professionalism is autonomy and accountability for care. This system undermines that autonomy by allowing undo managerial control of bedside accountability. At the moment the bedside nurse becomes accountable to management for room to room intershift activity, the ability to effectively provide priority care in priority order becomes subject to review by members of the healthcare team that cannot be privy to that decision making process by remote monitoring. The end result is that the use of this system deprives the professional nurse of the very professionalism that makes that nurse a strategic member of the team.

    The ANA's position paper on 'Restructuring, Work Design, and the Job and Career Security of Registered Nurses' states, "When work redesign decisions affecting RN practice are being made, ANA insists that RNs from the affected workplace be at the table as a full partner so that the decisions will be justified in terms of both cost and effect on important patient outcomes, including mortality, LOS, patient satisfaction, and adverse outcomes." The ANA insists that the bedside nurse be intimately involved in change on this scale from inception to implementation. That has not been done. The AACN's 'Standards for Establishing and Sustaining Healthy Work Environments' lists as an essential standard that "Nurses must be valued and committed partners in making policy, directing and evaluating clinical care, and leading organizational change."

    I have heard the key phrase - 100% buy-in. Because the opportunity for input in the design of this system was not offered, 100% buy-in seems like a far-fetched concept.

    What will happen is that you will get a sharp increase in moral distress in nurses that view their jobs as a profession and a grudging acceptance with minimal compliance (within the means of testing the limits of undermining the system) by nurses that consider their job to be just that - a job.

    THIS SYSTEM WILL ALIENATE THE PROFESSIONAL NURSE WHILE AT THE SAME TIME BE JUST ANOTHER JOB REQUIREMENT TO NURSES THAT DON'T CARE ABOUT THE QUALITY THAT GOES INTO THEIR WORK. I have heard this administration complain about 'nurses that are just in it for the money'. This system, which compromises professionalism, will entrench just those workers while alienating the very nurse the hospital professes to want to recruit and retain.

    The components of the system that allow for easier bedside care are far outweighed by the negative aspects of the system. Those negative aspects will result from using data generated by these trackers to reduce nursing to nothing more than a timed skill.

    I understand that this system has been touted to administration as a magical efficiency tool. Everything has its price. The cost of purchase and installation of this product will only be a fraction of the eventual cost of this system if the result is a systematic alienation of nursing staff.

    I urge hospital administration to adopt a memorandum of understanding with its employees acknowledging that use of the system by professional nurses will not and cannot, under hospital policy, be used as a factor in evaluation and/or disciplinary action. Otherwise, I am alerting administration to be mindful of the potential costs of forced buy-in to a system that will only increase the moral distress of an already demoralized strategic resource. AACN - position paper - 'Moral Distress': "Moral distress is a key issue affecting the workplace environment. Research demonstrates that moral distress is a significant cause of emotional suffering among nurses and contributes to loss of nurses from the workforce. Further, it threatens the quality of patient care."

    Very Respectfully Submitted.



    ~faith,
    Timothy.
  4. by   BamaBound2bRN
    I will probably get blasted and flamed for this, but.............why the paranoia, if you are a good employee (RN, MD, CNA, or whatever) then who cares if someone else knows when and where you are. A similar device came out many years ago when I was a Law Enforcement Officer in Florida, the PBA and FOP went balistic, but now the GPS units are a normal and accepted tool in Law Enforcement. If ya ain't got nothing to hide, then who cares.
  5. by   Katnip
    Quote from BamaBound2bRN
    I will probably get blasted and flamed for this, but.............why the paranoia, if you are a good employee (RN, MD, CNA, or whatever) then who cares if someone else knows when and where you are. A similar device came out many years ago when I was a Law Enforcement Officer in Florida, the PBA and FOP went balistic, but now the GPS units are a normal and accepted tool in Law Enforcement. If ya ain't got nothing to hide, then who cares.
    This isn't about paranoia. Timothy made some very, very good points, as did others.

    This is a tool to try to push nurses into quantitative care while ignoring quality. If it hasn't already, it will be used to punish nurses for not being in someone's room within a certain number of minutes of the call bell ringing. Nevermind that the nurse may be with a patient who really needs more care at the time.

    This is an expensive system that really does nothing to help further patient care. It may give some patients the feeling that they're calls are being answered faster, thus possibly increasing patient satisfaction scores by a few points, but it's not really helping the patient directly. The money spent on these systems would be far better spent on staff and updated equipment than on tracking nurses around the hospital.

    And yes, it's about privacy. It's not about hiding anything, but some hospitals have these things tracking nurses to the bathroom. Is it really right to be timing how long you're using the toilet? How many other professions put up with this? Not many.
  6. by   BamaBound2bRN
    I have read many posts by nurses who are angry about being "Stereotyped" and having their positions "assumed" by politicians and administrators, but isn't that what is happening here. Are we not assuming the worst out of the Administration, or has the "Official Policy" been released to state that "You will only have 30 seconds to pee." And besides, there is no expectation of privacy in the workplace, employers have been given the ok by the courts to put up CCTV systems and monitor employees activities for decades.
  7. by   rstewart
    Quote from bamabound2brn
    i will probably get blasted and flamed for this, but.............why the paranoia, if you are a good employee (rn, md, cna, or whatever) then who cares if someone else knows when and where you are. a similar device came out many years ago when i was a law enforcement officer in florida, the pba and fop went balistic, but now the gps units are a normal and accepted tool in law enforcement. if ya ain't got nothing to hide, then who cares.


    well if that is your argument i would suppose that you would have no problem with law enforcement randomly entering and searching your residence and those of your neighbors tonight. in fact what good reason is there for the fourth amendment since "if ya ain't got nothin" to hide......?"

    more germaine to the subject at hand, however, i believe these devices are dehumanizing and insulting. it's purely a value judgement to be sure.

    but consider this if you will: what sort of individual would choose nursing as a profession if they knew their verbal and nonverbal behavior would be scripted, that their every action including trips to the bathroom would be monitored and timed, that every aspect of their appearance is up for review and control, that their full name and in some cases addresses are readily available to a not so sane public......that in addition to the inconveniences which are the nature of the beast (working weekends, holidays, call, being exposed to every kind of disease known to man and a few unknown, exposure to lawsuits etc. etc.)

    there is no reason to blast or flame you. if you are in possession of a nursing licence and wish to work under these conditions more power to you. regretfully there are probably plenty of individuals who either share your view or whose current life circumstances require that they endure their working conditions no matter how onerous. enough in fact that people like me must leave the bedside in order to save our own sanity.

    when i do, i have no illusions that i will be missed by the powers that be beyond an extra few blanks to be filled in which of course will be attributed to the nursing shortage.
  8. by   Jo Dirt
    Oh he** no! I can see where these things are going. Let them hire some help, that will take care of the "effeciency" part.

    I liken these things to an electric collar put on a dog to train it.

    Work harder work faster work harder work faster....

    This is a quasi solution, reinforcing the stupid public's ideas that nurses, if not constantly monitored, are irresponsible, lazy, and spend most of their time standing out in the hall talking and drinking coffee.
    Last edit by Jo Dirt on Sep 26, '05
  9. by   BamaBound2bRN
    [QUOTE=rstewart]Well if that is your argument I would suppose that you would have no problem with law enforcement randomly entering and searching your residence and those of your neighbors tonight. In fact what good reason is there for the Fourth Amendment since "if ya ain't got nothin" to hide......?"

    Well, since you brought up the Fourth Am. lets put it into perspective. The Fourth Am. does not guarantee NO SEARCH, just unreasonable. If you are going through an airport security screening for example, or a search of your immediate surroundings during a traffic stop. These are different than coming into your home. Most retailers require some sort of package check or clear plastic purses for their employers. But as a matter of fact, I don't have anything to hide and if the local police, sheriff, or even the FBI wanted to search my home, go for it! It sounds to me like there are some unhappy workers who really believe it is an "Us against Them" mentality with management, and if your situation is that bad, why not quit?
  10. by   lee1
    Tell me just who is looking at the data, how often, did they have to hire a whole new category of help to read them??? How are the locators read??? Who has the time to read them???? Then, how is it documented??? So and so nurse spent so and so time----written somewhere??? HOW???
  11. by   imenid37
    We have the wonderfil locators too. I often forget to wear mine. Personally, I think they are ridiculous. We also have pocket phones. If you need, call me. You won't find me sleeping somewhere. I don't do that. Hospitals have always had this kindergarten mentality that the employyes won't behave unless made to. Sorry, I am a professional and I know my job and do it. That doesn't mean I am some humourless automaton. I have a laugh and know the limits of what is okay. Honestly I don't need to be located or tracked and neither do 90% of my co-workers. There's a few that do. Management needs to "grow some gonads" and go to these people who have a problem functioning not inflict mass punishmenton the rest of us.
  12. by   ZASHAGALKA
    Quote from BamaBound2bRN
    Well, since you brought up the Fourth Am. lets put it into perspective. The Fourth Am. does not guarantee NO SEARCH, just unreasonable. If you are going through an airport security screening for example, or a search of your immediate surroundings during a traffic stop. These are different than coming into your home. Most retailers require some sort of package check or clear plastic purses for their employers. But as a matter of fact, I don't have anything to hide and if the local police, sheriff, or even the FBI wanted to search my home, go for it! It sounds to me like there are some unhappy workers who really believe it is an "Us against Them" mentality with management, and if your situation is that bad, why not quit?

    If it were simply a matter of 'I've got nothing to hide' then I would still have a problem with the idea of being leashed like a dog. But it's more than that. Hospitals don't spend a quarter million dollars just to make sure that you are doing your job.

    This is sold as an efficiency tool. Buy our system and we can show you how to make your nurses more productive, requiring you to hire less.

    How this is done is by generating data about employee work habits and 'tweaking' those habits over time. (and "data" is hard to dispute. - The data shows you can handle 8 patients. How do you dispute that?)

    I'll give you an example that I believe was buried in this thread or a similar one. You wear the trackers and nothing is said for 6 months while you merrily go about your way. You're doing nothing wrong so you have nothing to be afraid about the system. In 6 months you have a unit meeting. "The data shows it takes on average 2min 42 sec to answer a call bell. That is now the standard. If it takes longer, that is an occurrence. 3 occurrences equal a verbal warning, 3 more a written warning. Ok, that's doable. But what do you think happens in 6 more months when everybody is busting their hump to beat 2min 42 seconds? That's right, in 6 months, the time to beat becomes 2min 15 sec.

    If that doesn't scare you, try this: I know of a hospital that hired Filipino nurses for 1/3rd of their med surg staff and adopted the tracking system at the same time. Not even 2 months later, they upped the ratios from 5:1 to 7:1 (plus admits for sometime totals of 8-9:1). Why? Because "The Data" showed that the room/nurses station average time for nurses proved that this was consistent with safe care. Now the Filipino nurses are here at the grace of the hospital AND they are in many times unfamiliar with our culture and don't realize this is a completely unreasonable expectation. So they are aboard (especially when the 1 that complained was promptly fired). Now administration has leverage with all the others (They can do this, are you telling me that you can't? The data shows that you can. You just aren't being a team player.)

    Finally, as you might know, data can be manipulated. If I don't like you and I want to get rid of you, I can make 'the Data' paint you in a bad light, whether you have 'nothing to hide' or not. We live in a data driven, research driven society. It's very difficult to refute data. (I'm sorry, but the data shows that you are taking too long in some rooms and not enough time in others. The data shows that you spend hours at the nurse's station every day. The data shows . . . The data shows . . .) This has happened. Read the initial article - the nurses only started refusing to wear the trackers when 'the Data' started to be used to terminate people.

    To the extent that it's about US v. Them - these trackers are, in my opinion, definitely an attack from which I'm responding, not an offensive on my own part. It's not that I'm paranoid about collecting data on nurses to manipulate them: IT'S THAT THIS IS PRECISELY THE SELLING POINT OF THE SYSTEM.

    I have nothing to hide. But I'll be danged if I'm going to wear a dog leash. In fact, I quit over it.

    ~faith,
    Timothy.
    Last edit by ZASHAGALKA on Sep 26, '05
  13. by   ZASHAGALKA
    And even if your administration is very passive about using the data, you cannot tell me that big brother watching you doesn't change your behavior.

    In the meetings for the tracking system, an L&D nurse expressed the concern that the infrareds might not be in the delivery room: "Do we get credit for being in there?" THIS IS EXACTLY MY POINT. SINCE WHEN DO I NEED CREDIT FOR DOING MY JOB?!?

    Professionals don't need credit for doing their jobs.

    This is different from gps trackers in police cars. That truly is a safety issue. And it's impossible to evaluate from a gps beacon if an officer is doing his/her job. Unlike nursing, it's not unreasonable for officers to sit in a stationary position for extended periods of time.

    ~faith,
    Timothy.
    Last edit by ZASHAGALKA on Sep 26, '05

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