Dozens of nurses at Northern California hospital balk at wearing locators

NMAguiar · Oct 4, 2002

Thanks Rebelwaclause! I really appreciate it ... really!:roll

Now, back to your regularly scheduled thread:

teeituptom, BSN, RN · Oct 4, 2002

Howdy yall

from deep in the heart of texas

Kind of reminiscent of big brother and sister watching

but keep up the good overseering

doo wah ditty

booboo · Oct 12, 2002

I wear a tracker at my hospital. I like it in the sense that I am where I am supposed to be when I am at work. I have had it work in my defense when a patient complained that I was "never" in their room - I knew I had numerous trackings to prove otherwise.

It's easy to locate co-workers and I can prove how much I literally "run" from one room to the next!

The beepers work great also. I don't get bogged down with answering CNA calls for Kleenex, bathroom, etc.

However, if I was one of the nurses who sit at the desk all night, I wouldn't like the trackers. We don't have a sensor in the bathroom or breakroom. I'm not sure what you're talking about with the listening aspect of such a system.

Overall, I think the trackers were put in place for the benefit of the hospital for disciplinary action. Just one more "benefit" of being a healthcare worker!!

ZASHAGALKA, RN · Sep 26, 2005

bored so bumping an old thread

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

I quit 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.

VickyRN, MSN, DNP, RN · Sep 26, 2005

In one of the last units in which I worked, all nursing personnel wore the devices. I did not think twice about wearing it. The locator was very small and clipped easily to the front of my scrub top. These devices helped fellow nurses or patient-care team members locate a nurse in a hurry and prevented use of the overhead pager system at night.

ZASHAGALKA, RN · Sep 26, 2005

In one of the last units in which I worked, all nursing personnel wore the devices. I did not think twice about wearing it. The locator was very small and clipped easily to the front of my scrub top. These devices helped fellow nurses or patient-care team members locate a nurse in a hurry and prevented use of the overhead pager system at night.

These devices are sold to management as efficiency tools. They are designed to supplant critical thinking w/ sequential thinking.

If I can time my nurses, I can reduce their skills to a function of time and I can penalize for not conforming with those standards.

It's a dog leash. It's insulting.

If you want to know why we aren't treated as professionals - this is why: we allow ourselves to be reduced to drive through help at McDonald's. If you don't move the line along in 60 seconds, why, we'll be able to track you and force you to account for your actions. . .

But, it only works if EVERYBODY wears their leash. Because you can't just penalize your compliant worker bees.

~faith,

Timothy.

rstewart · Sep 26, 2005

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.

ZASHAGALKA, RN · Sep 26, 2005

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.

ZASHAGALKA, RN · Sep 26, 2005

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.

BamaBound2bRN · Sep 26, 2005

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.

Katnip, RN · Sep 26, 2005

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.

BamaBound2bRN · Sep 26, 2005

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.