Radical Management Strategy

[oldenurselady]

It is called the TRUTH!!!

• Yes we are busy.
  
• Yes. You may need to wait if your death or grievous injury is not imminent.
  
• Yes. We are doing our best. (and..ha ha management knows it and supports us!)
  

I am tired of being told by managers that we need to mislead patients, not tell them that we are busy and pretend we can do it all. I decided I would like to see some mangers responses. We can't do it all. You guys sure don't. Managers do not have silver wings or teflon shoes. People have to wait at WalMart, the grocery store, and by golly in their PCP and other physician offices. They know it is busy and they deal with it. Why is the inpatient setting some other planet. I try my very best to do my very best EVERY day. I am only one person and can only do so much. The HCHAPS and Picker scoring makes me cringe. The documentation you expect (I know govt. regs, da, da, da). The expectations are insane and managers know it. When will managers and administrators accept reality? Is the truth really so bad? Is it better to lie and fail every time to meet the unreachable?

This Cupcake can't Eat that cookie anymore. I think there is cyanide in the recipe because they are surely trying to kill us with all of this customer service which would play way better in some upscale day spa! Thought???

[oldenurselady]

I worked at a facility where the CEO was removed for corruption. Don't worry about him. Not only did he pretty much totally get off. He now owns a healthcare consulting company and proudly asserts on the website that he was CEO of XYZ Hospital. Maybe he could teach a course called "Lessons from a Crook." Healthcare is totally messed up in so many ways. I hate to even go into to work.

What happens in countries like the UK and Canada? Patients have to wait a long time for many procedures. They just deal with it, correct? It should look very bad for management who let situations get dangerous when they are spending their $ on teambuilding activities at 5 star hotels while the 18 year old CNA has 12 people to left, bathe, and a nurse is supposed to do 12 assessments, give meds, and fluff pillows with a smile. Maybe patients need to demand more of management. Hmmm, when I finally go legally insane, perhaps I will put business cards in each patient room with the CEO's home phone number for patients to call 24/7 with their issues. These people are the ones who do all of the promising, so they definitely should hold the accountability for patient dissatisfaction.

[chevyv, BSN, RN]

That is hilarious!!!! When we all go insane lets do that! I work psych and my pts love to call the same people numerous times per hour! Giving them the higher ups personal phone number would be way too funny!

[catlover314]

As a manager, I will admit my first reaction to this topic was defensiveness. All the hatin' directed at managers and upward! Sorry to be the bearer of bad tidings, but the focus on satisfaction that has been building is a fact of life. Hospitals knew a while back that satisfaction would be driving reimbursement and yes, that is where we are now. That reimbursement keeps the doors open and pays all of our salaries. So there is that.

The next thing to remember is that being courteous to patients and families is not just what we are 'required by management' to do....it is the right thing to do as a compassionate caregiver. You can be honest and courteous at the same time, but the days of "you'll get it when you get it" attitude are history. And when its you laying in a hospital bed you will be glad that those days are over. Its what they taught us in grade school...be nice to other people.

And finally, like another manager said earlier, FTE's are not set by the manager, they are set by finance. To vent your anger at the manager is a waste of your energy.

[kcmylorn]

Then finance better get off there butts and come down and take care of these patients!!!

[mommy2boysaz]

I have been a staff nurse for 15 years and now a nurse manager for 6 months. This thread is interesting to me from both angles. First, as a floor nurse, I understand the frustrations and exhaustion that can come from working hard and long hours with not enough staff. However, if that is the standard, rather than the exception where you work, maybe you should look elsewhere for employment. It is not like that everywhere. I've worked in several places and our staffing has, for the most part, been adequate except on unusually busy times.

More concerning to me as I read this thread, is the unbelievably negative, resentful, nasty attitude toward nursing in general! Do any of you even remember why you went into nursing in the first place? Was it to take care of people who needed you? To make a difference in someone else's day? Or to punch in, punch out, and take home a decent paycheck, preferably without having to do too much in between? Nursing is NOT an easy profession. It requires self sacrifice and very often putting your needs second to those of your patients. I agree with catlover314 above that we all need to treat others the way we would want to be treated, or the way we would want our loved ones treated if they were in the hospital bed. I agree that lying to patients is not necessarily the way to go. If you are busy with an emergency, most people would be understanding of that and would not mind waiting for a drink/blanket, etc., knowing that that is the reason. I think many times the patients or their family members become understandably frustrated by long waits when there has been no explanation for the wait, nor any apology by anyone. Some empathy and kindness goes a long way in patient satisfaction.

[oldenurselady]

Well mommy. I think your attitude toward nurses is pretty poor. ...."take home a decent paycheck, preferably without having to do too much in between." I think NOT. Things like patient and family education and assessment are vital components of nursing. Responding quickly to requests for snacks or to open the doors more quickly for visitors when we are super busy or have an emergency are what gets to me. Perhaps you wok in shan-gri-la or need to get out of your office more BUT these are real issues for many nurses. I am appalled by the freedom which visitors and patients feel they have to be downright RUDE and management's willingness to reinforce that they are just totally entitled to service with a smile no matter what the behaviour or request. I suppose you think we should smile, smile, smile AS WE dispense snacks, get blankets and climb over snotty visitors when we try to take vitals or receive a hairy eyeball when we go into a room to do our JOB (YA know assessment, VS, give report at change of shift).

I wouldn't and don't treat patients with disrespect and do have great respect my co-workers BUT I am tired of some six sigma certified snot telling me I need to spend all day serving snacks, getting all of this documentation garbage done, and that I am so lucky to have a job BUT need to do it faster and more efficiently. Especially aggravating to me is that the "managers" rarely help on the unit and their own interpersonal skills in dealing with the nursing staff SUCK. There was a time when managers would confront patients and family who were disrespectful to the nursing staff! Imagine that!!!

"More concerning to me as I read this thread, is the unbelievably negative, resentful, nasty attitude toward nursing in general!" Nurses do not mind being nurses. They just want to be nurses and not PR apologists for dysfunctional organizations and brown nosing mid level managers. Many go into nursing thinking it is about empathy and helping people. It was and in some ways it still should be. The problem is the connotation of empathy has been changed to mean that we accept and encourage almost any unreasonable attitude or action on the patients' parts as a patient's right. We have become enablers or personal irresponsibility not healthcare experts or people who empower our patients but just another customer service driven industry catering to many selfish and irresponsible people. We are so bogged down and stretched so thin because we spend so much of our precious time and resources meeting unreasonable demands of government, management, and selfish, dysfunctional patients who have never been expected to do anything but think of their own instant gratification.

If a person makes it through nursing school, it is unlikely that they believe nursing is easy. Mangers need to face up to the idea that it is rarely easy and start working on solutions that include the premise that the staff are not always complainers, whiners, or lazy. Most of all managers and administrators need to stop scolding and finger pointing and LISTEN. It isn't all about a smile, sunny attitude, or staff sucking it up. Did you ever think that if the staff were more satisfied that patient care would be safer and more efficient? If you want a snack hostess or pillow fluffer, maybe that person doesn't need to have RN behind their name. Maybe the patients need to know that we are there to meet their healthcare needs not for "pamering."

If these surveys are being used to influence payment for care look at their healthcare not all of this other complete crap. Please do not give 'gifts" for griping. Just emphasize that meeting healthcare needs is the main focus of their stay and that "waiting" is part of the deal because we have to prioritize. Don't set your staff up for failure. Nurture and empower them for success by not setting unreasonable expectations or slamming them when they don't smile broadly enough in response to rude patients and families.

Take off the cowardly lion costume and have the courage to d the right thing. Good luck mommy. You're gonna need it.

[kcmylorn]

Oldnurselady- You Go Girl!!!!! You Rock!!!! I wish I could like your post 100 times. Yous said it all and I 100% agree.Well done and well said!!!

These mid level managers are playing up the angle of what nursing should be and ignoring the fact that nursing is no where resembling what it should be or once was. They are actually abusing us with their catawalling philosopy of admosnishment- "You are nurse, you went into this profession for the empathy and good of the patient, It makes me want to puke every time one of these lame ducks get on this site an start expounding how bad we staff nurses are and we should be ashamed of our selves. We are not their children, they need to go theH*** home and talk to their family like that and clean up their disgusting act before they come to work!!!

You said it well- they are now puppets for the business tycoons, It's not nursing, a science based profession. It's Donald Trump's school of resaurant and Hotel managment and we are the front desk clerks an treated as such No, I actually think the Donald treats his front desk clerks better.

MOMMY- you should go hide your head in shame. I didn't go into nursing to be brow beaten or emotionally assulted by nursing managment. If you want waitresses, and front desk clerks- go hire them!! and stop hiring licensed professional nurses they are 2 different job descriptions. Oh and if your want to do hotel management- go work in hotel

[Orca, ADN, ASN, RN]

I have been a staff nurse for 15 years and now a nurse manager for 6 months. This thread is interesting to me from both angles. First, as a floor nurse, I understand the frustrations and exhaustion that can come from working hard and long hours with not enough staff. However, if that is the standard, rather than the exception where you work, maybe you should look elsewhere for employment. It is not like that everywhere. I've worked in several places and our staffing has, for the most part, been adequate except on unusually busy times.

I have been in the profession about the same length of time as you have, maybe a couple of years longer. I have worked in hospital settings, a free-standing mental health facility, long term care, a rehabilitation hospital and corrections. I have been in upper management for the past six years. I have yet to work anywhere where the staffing could even remotely be called "adequate". You are either incredibly fortunate, or you have a very skewed definition of "adequate".

[northernbreeze]

This is the reason why it is so important for nurse managers to involve nurses in all aspects of how the unit or department works. All nurses have to be encouraged to actively contribute to the day to day functioning of their environment, they need to help with some of the decisions. I am not a manager but I understand the politics of business. I understand how patients and payers of health care are now demanding quality care and satisfaction. We can't just dump frustrations on the patients, telling them how short staffed we are does not ease their minds nor does it satisfy them. It just invites them into our frustration and low morale making matters worse. If nurse managers would take their staff and show them the budget, explain the S&^% involved in obtaining extra staff and resources they might find that the educated group of nurses working underneath them might direct their anger and energy somewhere else. Perhaps sparing the patient the details.

I was once a patient at a hospital where the staff was "overwhelmed" I just had a baby and when I called for help after fainting I was told by the nurse that they were working short and she could not come when I called (I was holding my baby when I went down). I really did not care about the "short staff" problem at that point nor did I feel better being told that, I found it inconsiderate (I was a nurse at the time of the incident). I had 2 other children after that and I never returned to that hospital, I also told everyone that I knew never to go there (even though I thought the L&D staff was wonderful and I loved my OB physician). I never forgot to this day the reason that the nurse gave me for not coming when I called. I would have preferred, genuine concern, an apology followed by a promise to check on me more often or a promise to find anyone to look in on me when I called even the cleaning staff would have sufficed.

My point is...If patients stop choosing your organization for care, and payers stop making contracts you are out of a job! The business goes under! Then you will have bigger problems than the ones that I read about in this post. Patients DON'T CARE if you are short staffed, why should they?