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Confessions of a Hospital Administrator: The Good, the Bad and the Ugly

Nurses Article   (14,061 Views 41 Replies 911 Words)
by ServantLeader ServantLeader (Member)

ServantLeader has 25 years experience and specializes in Administrator inspired by nurses.

6 Articles; 7,636 Visitors; 42 Posts

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A look at recent data that explains the impact of uninspiring workplace culture. You are reading page 3 of Confessions of a Hospital Administrator: The Good, the Bad and the Ugly. If you want to start from the beginning Go to First Page.

ServantLeader has 25 years experience and specializes in Administrator inspired by nurses.

6 Articles; 7,636 Visitors; 42 Posts

Or unionization. I worked with unions in two hospitals, including a nurses union, and we got along fine. Staff turn to union and lawsuits when they feel they have no other options. It's a shame for both sides, because when leadership creates a great workplace culture, performance metrics become top tier and everyone is happier at work.

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rearviewmirror is a BSN, RN and specializes in ER.

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Servant leader, you seem like a person with integrity from what I read, unlike all the administrators I have seen in hospital systems I worked at. The main reason I and other nurses do not trust administration is not because there is an incongruent process that causes mistakes or because we don't get a special parking spot like the physicians do. It's the STAFFING. When administrators have their faces placarded with big grin and tell everyone how much they care and love the community and is all about compassion and what not, I once as staff nurse, did not see congruency or genuineness in that statement because in real life, we were short and short and short and getting shafted from every corner by management and administration. So everyone pretty much had impression of administrators getting big bonuses by cutting staff and budget and freezing raises all the while they kept harpening on the fake facade of we-care-for-you. Now for your defense, I would never want to work as a manager or administrator at an hospital, but if administrators turned their attention to low staffing primarily instead of putting blame on intangible abstracts like "hourly rounding increases patient safety", things could be a lot better.

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BeenThere2012 is a ASN, RN and specializes in PICU, Pediatrics, Trauma.

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When I started as a hospital administrator in 2000, an older guy explained to me about how hospitals were becoming more complex to management: "You know, it used to be in the old days you counted the money in the morning, played golf with the doctors in the afternoon and underpaid all the nurses all the time." He was serious. While I know some good administrators who really care about their staffs, not allowing nurses time to take lunch or bathroom breaks or staffing so charting can be done properly makes me think we're not so far removed from those days in some hospitals.

All you mention is important, but especially the charting properly. When you get so busy you have no time but to run around putting out fires and then have to chart at the end of your shift, you risk forgetting details or time lines being in order. And likely, when you are this busy, something happened that is significant and important to have accurate charting on.

Since staffing ratios and breaks became mandatory in my state, hospitals have had to provide "break relief" nurses. You would think that could solve that problem....but no. There is one person to provide 2, 15 min. And 1, 30 minute break for 8 nurses. Do the math. More often than not, it became a situation of "take your break now or don't get one.". Or, "if you don't take your break now, then are you refusing a break?". It didn't matter what you were in the middle of...Blood transfusion, complex dressing change...and then you are to give only the briefest report before leaving. I didn't feel comfortable with this. Safety for patients was not assured.

GIVE US FEWER PATIENTS and we could accomplish our work safely and with continuity. When I was the break relief nurse, there were times I couldnt complete all the things required/due for the patients during the time frame the nurse was on break. And, I was not at all familiar enough with some to just jump in and start giving meds or whatever. These were very sick patients. All were high-acuity as hospitals discharge now-a-days 5 mins after being stable. (Exaggeration, but you know what I mean). We don't have CNAs/techs to do VS or help with bathing etc...The nurse does it all. So for those of you from other states, please don't say we have it easy. These things are time consuming. It's all the same in the end.

R/T charting in a timely fashion. More than once, I had a patient who unexpectedly had discharge orders, before I even charted what I already did, now had to go into the discharge teaching and all the other discharge charting, and by the way, your new admission just rolled in the door...from the ER with STAT orders. Or...We decided to float you for the last 4 hours and they are waiting to give you report on the next unit. So, hurry up and finish your charting.

Edited by BeenThere2012
Adding more..

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ServantLeader has 25 years experience and specializes in Administrator inspired by nurses.

6 Articles; 7,636 Visitors; 42 Posts

Well said - it's the staffing, stupid. From my own experience, I have found that balance between what administrators want to control labor costs (the biggest expense in hospitals) and what nurses feel they need to work safely and sanely, is possible. It's difficult for administrators to achieve the other metrics they care about (quality, patient satisfaction, outcome) when the nursing staff is angry every day. I read a lot of anger in the responses to my posts. There's no way of getting around the truth: such workplace emotion is a failure of leadership.

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Didn't you ever feel like simplifying our healthcare system? Starting with the patient and working from there. What does the patient actually need, not want, but need? Of course one would require magical powers to clean up so much of what we do that is not necessary. So much of what we all in health care do is about preventing lawsuits. The financing of course is major issue and the insurane companies now have one of the most important voices in patient care. It boggles the mind how we have gotten to where to where are. I am now a patient and dread every encounter with health care because I go expecting the worse. It isn't that the professionals are bad, it is that I can feel their anxiety as they try to rush to complete all the tasks. From this side I feel exasperated, I feel sick and then I have to deal with a very non-patient friendly system. I just spent 3 days trying to find a doctor in my town. There are at least 20 close by, but my insurance will not allow me to go to any of those. By the grace of God, I went to one of the approved doctors and was amazed at how he had simplified the process so well. I was in and out in one hour with blood work done in the office. The nurse sat with me before my appointment and took an excellent health history, focused, compassionate, efficient. There were no checklist, only a short half page of information, the doctor came in and understood me better than anyone has in 5 years. I left with clear instructions and an excellent treatment plan. In addition he sees walk in. I almost felt as if he was snubbing the system. No endless paperwork, not overly preoccupied with the checklist of preventives, just solved the problem. There is something to be said for simplifying, I did not feel stressed and he seemed to be fine, Also there were like 40 signs that said no cell phones and there was a quiet atmosphere.

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ServantLeader has 25 years experience and specializes in Administrator inspired by nurses.

6 Articles; 7,636 Visitors; 42 Posts

And administrators wonder why when charts get pulled during a regulatory inspection (JC, state) or a there is noncompliance. Or they wonder why medical errors (meds, testing, etc). Inadequate floor staffing is stepping over dollars to save dimes.

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In the opening paragraph of the OP, the OP referenced the John Hopkin's study about medical mistakes, and then asked a Chief Medical Officer about medical mistakes. The OP said that the CMO replied: In medicine, we rely on the heroic efforts of doctors and nurses not to make mistakes.” But people can make mistakes. It's not a matter of fault, but a bad process.”

Mistake: An error, fault, misunderstanding, a misguided or wrong action.

Not all health care practitioners efforts are heroic. And heroic effort combined with poor judgement or providing care that is below the Standard of Care has the potential to cause actual harm to patients just the same as poor effort by health care practitioners does.

Medical mistakes can indeed be a matter of fault.

It appears to me that the OP is trying on this thread to establish that medical mistakes are due to bad processes, and deflect attention away from personal accountability/responsibiity for medical errors. Yet, a practitioner who practices below the Standard of Care, who is negligent in the care they provide, has made a choice to practice in this way, although possibly they could argue that their choice is the result of "administrative processes." In Court an individual practitioner is held individually accountable for their practice and for the quality of the care they provided; their failure to provide quality care that resulted in harm to a patient is not excused on the grounds of a "bad process."

Edited by Susie2310

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ServantLeader has 25 years experience and specializes in Administrator inspired by nurses.

6 Articles; 7,636 Visitors; 42 Posts

I have occasionally come across clinicians who provided lousy or even negligent care and this is truly shocking. The main character in my novel "Medical Necessity" is such a person. However, most medical errors I investigated as an administrator were, in my experience, based on a bad process. I agree this is still often considered to be negligent, which is why hospitals settle so many lawsuits out of court (it becomes a business decision for the company covering with malpractice insurance). But a medical error, in good organizations, is an opportunity to improve patient care.

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NursesRmofun is a ASN, RN and specializes in Registered Nurse.

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Not to mention, violating labor laws by charging people for breaks they don't get. That would not work with me.

It is expected in a lot of places. Also- to get off the clock before you finish charting. So many do it. I have been rebelling. lol

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BeenThere2012 is a ASN, RN and specializes in PICU, Pediatrics, Trauma.

1 Article; 6,864 Visitors; 775 Posts

Well said - it's the staffing, stupid. From my own experience, I have found that balance between what administrators want to control labor costs (the biggest expense in hospitals) and what nurses feel they need to work safely and sanely, is possible. It's difficult for administrators to achieve the other metrics they care about (quality, patient satisfaction, outcome) when the nursing staff is angry every day. I read a lot of anger in the responses to my posts. There's no way of getting around the truth: such workplace emotion is a failure of leadership.

The minute you are able to clone yourself, please do!

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They wanted to CUT our staffing once. We asked a board member to follow us for one day to see what we did. The board member made it for 4 hours, and left the floor saying "CUT your staff?!? I don't see how you do what you do with the staff you HAVE!!!!!"

The hospital was only posting part-time positions for awhile (anyone remember when UPS was doing that about 12 or so years ago?) Our hospital thought it was a Great idea. I had been there long enough to know who to drop information to that it would get "carried" back to the powers that be efficiently, so I "dropped" that we were talking union. Suddenly, full time positions were being posted again. Imagine that?!?!

Edited by LadysSolo
punctuation

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ServantLeader has 25 years experience and specializes in Administrator inspired by nurses.

6 Articles; 7,636 Visitors; 42 Posts

Ha - very smart counter strategy - well done.

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