Does Your Unit Director Do This? - page 2
I work nights on a very, very busy and very understaffed med-surg floor. Lately, the unit dir. has started coming onto the floor in the mornings, with a detailed list of the patients' complaints (if... Read More
Aug 15, '01Tough situation. But like I said Isn't it amazing.....I've had some horrible nurse managers in my time ie...the nurse manager who didn't know what my job was but still did my evaluation, the nurse manager that allowed the incompetent LPN continue to work until she killed someone..etc.. this person (and I use the term loosely) sounds like a real jerk and WILL get her due in the end. If your nurse manager will not stick up for you, stick up for yourself. Have you gone any higher in your institution about this? Quite honestly it sounds like she's got too much time on her hands, and too much time on her backside. Good luck, If you need a sounding board, E-mail me.
Aug 15, '01Oh yeah!!!!
Our director actuall held a workshop and told us that we were to behave as if this were "HOTEL RICH****" we had valet parking, a doorman, gourmet meals and wine available. Each floor also had at least one "suite." Too bad if we had a complaint. The customer was always right. And THIS was a county hospital at the time.
The occurrence report sounds familiar, except our manager never turned in the ones she disagreed with. We did request and get a time study. Of course they did it over a holiday so we were neither full census nor very busy that time.
Oh well, I guess I could have gone to work at the Marriot or McDonalds....would you like fries with your supersized shot sir?
Aug 16, '01Hi there, you can fill out the form assignment despite objection and I do not believe that legally they can fire you for doing so. You have to do something to cover your a$$. What if one of your patients died and that family member decided to sue you? At least you would have some defense--the assignment despite objection form. Let your house supervisor or your unit director know also and keep documentation of your actions because if there is a lawsuit filed against you then you have documentation that you tried to get more staff. Management/Nursing Supervisors are ultimately responsible for safe staffing. So if it shows that you attemtped to get more help but was denied then you have PROOF!
Our unit is SUPPOSED to staff according to acuity level but never does. See my post under the thread "how do you deal with Lazy co-workers". I had such a bad night last night it wasn't even funny.
Aug 16, '01Originally posted by prmenrs
I think you should fight fire with fire. I'm assuming you want some ways to make your situation better, and get her off your back? If not, don't read the rest of this!
Whenever you can't get to a call light quickly because you're passing meds, whenever you are late passing meds because of an admission, in other words, whenever you are in a situation that she might get a complaint about (actually it sounds like she's out there looking for them), where the institutions goals of customer service are being compromised because there are not enough staff to do the job, keep track--you could use a little notebook you can keep in your pocket, write just enough down to jog your memory, you may then have to transfer the info to an expanded format after shift. Then, when she comes back to you, you are prepared-- you may even have more than she does if I'm reading the situation right. Then approach it in a constructive manner, i.e., "You are so right, Ms A*s*o*e, how do YOU think we can resolve these problems? The entire night shift is very anxious to have the patients get the best care possible, but we need management's help to acheive these goals."
You might even invite her to join you one night @ what should be a relatively quiet time in order to have a "brainstorming" session.
With ANY luck, if you come back to her with info that might turn into justification for more staffing, you might just get it!!
Don't forget, she has a supervisor, too. Try to find out how they set up the staffing ratios for days, pms, and nights. Do they have a genuine rubrick to compute staffing, or ??? How many hours per pat day are alloted to your unit? These factors influence who they decide to staff you?
Is there any sort of acuity system? If not, look into some--try searching on the web, also the journal called Nursing Management (hmm...they may have changed their name.) Anyway, if you can, do some sort of lit search for acuity systems. The reason I'm suggesting this? It may be that no one has looked at the acuity on your unit.
If she just wants to be a pain and make life miserable, she won't work with you on this; If she TRULY wants "customer satisfaction", aka good patient care, she will go out of her way to foster teamwork and problem-solving.
If something comes back to haunt you @ eval time, your handy dandy documentation notebook will be of immense help. On the other hand, showing this kind of leadership and effort may also pay off.
Aug 16, '01I've seen this before. "Management" uses "customer satisfaction" as a tool to browbeat their nurses. Nurses tend to be very caring people, and hearing how unhappy your patients are is a good way (generally) to keep your nurses thinking they have to "do more, better" because a nurse is SUPPOSED to be taking care of these patients needs, despite acuity/staffing. That's the mentality that has held us back for so long, and it unfortunately still works very well in keeping us in line, as a group.
Also, your manager needs a clue. Coming in every morning talking about reported problems without a very different attitude from the one you have portrayed here isn't helping anything. I personally (as a VERY outspoken person) would be unwilling to discuss these with her unless she is truly willing to listen when told what the problem is, AND TAKE ACTION. Anything less is counterproductive and very poor management. To call her a "manager" is a misnomer, she obviously knows nothing about managing people.
I worked for one institution that used "Customer Satisfaction" in a more positive way. The first step in developing a customer satisfaction program is answering the questions "For any given position within the hospital, who are the customers?"
For a nurse, nursing assistant, doctor, respiratory therapist, etc., that person is the patient.
For a nurse manager, it is the people he/she is managing, NOT the patients.
For a maintenance person, it is the person who reported the problem (very often the nurse), NOT the patient.
For the supply department of a hospital, every other employee in the hospital is a customer, NOT the patients.
You get the drift? If your institution REALLY wants to focus on "Customer Satisfaction," shouldn't your manager's customers (you and coworkers) be filling out satisfaction surveys on him/her?
Aug 16, '01SLS, I have been wondering how things have been going for you. I am sorry to see that your facility is still chewing you up and spitting you nurses out.
I have to be honest here. This manager is doing this because she can get away with it. If it would be hard for you to get another job because this is the only hospital in this county, it would also make sense that there are only so many RN's to pull from in this county and wonce they go through them, they won't have much to pull from in the community. It seems with the staffing the way it is, this is already happening. By treating her nurses as is they are hotel maids is nsot only disrespectful, but she seems to putting all her eggs in one basket here and is about to drop the basket on a concrete driveway. Let her know this.
Just as this is the only place for you to work in the county, you are the only RN's that she has and it doesn't sound as if she has people knocking down the door to work there (can't imagine why). Take advantage of this situation and tell it like it is. When staffing is poor, verbally tell the charge or manager. When they come back to you that there is nothing they can do, let them know that you are just informing them of your fears in order put it is writing and that way you are not the only one liable if something should happen. Keep a journal about these things and the fact that the unsafe staffing was brought to the propper people and nothing was done. I don't know how much this will protect you, but it will help to spread the blame al little. It is about time that managers be held accountable for purosely understaffing to save money.
You all need to unite and do this as a group, it will work better. I doubt you are as replacable as they would like you to think. Your facility probably already has a bad reputation when it comes to staffing and this is surely not going to draw people to work there.
I hope you will find the strength to change things here. Good luck.Last edit by JillR on Aug 16, '01
Aug 16, '01Sirens: Even in your hospital (heehee) there must be a job description for RNs. I'll bet it doesn't have anything in it about providing maid service. I would also wager you're going above and beyond the call of duty. Make a copy and carry it around so you can point out you're doing your job. I worked with a supervisor last week who told a demanding patient that she wasn't at the Hilton; we made one bed change at her request and the SUPERVISOR told her that would be the last one. A good argument for cloning. Good luck, dear.
Aug 16, '01We have a new customer satisfaction thing that just came out...get a load of this:
1. All phones will be answered on the 3rd ring ...BAHAHAHAHAHA
Then get us a secretary on each shift so that we don't have to
forward the phone into the unit somewhere.
2. In the clinics, there should only be a 15 minute wait time. If
the person complains, you should find out how much longer
they will be waiting, offer to reschedule (like in 6 months ),
and then offer them refreshments and something to read....
I figure we will not ever get another raise as all the money
will be tied up in refreshments.
3. Each UM has to interview 3 clients/families a day. If there are
complaints she has 4 hours to resolve it. Isn't that a scream!
Aug 16, '01I have to agree with wildtime on this one. I was speaking with my (computer work) husband about this. It seems now that on a really good day, you may actually have time to watch someone swallow the medicine you give them, but God help you if they don't already have a glass of water and you have to get it for them. I've seen many days that were just that bad.
Michelle, working in CC must give you more available staff. If you work a floor with 3 warm bodies and 25-30 patients, exactly who is supposed to be "freed up" to take care of those needs? It's not a question of these being minor needs. When you're uncomfortable, an extra pillow can make all the difference in the world. But it takes a very low priority for the staff who are chasing dry IVs, puking patients, incontinent patients, acute pain, shortness of breath, etc. When you prioritize what you have to do (usually in your head as you run down the hall), a pillow ALWAYS comes in last to patients in acute distress.
Aug 16, '01Michele,
Sorry I mispelled your name.
When I say chasing dry IVs, have you never followed a shift where all the IVs seem to be beeping "EMPTY" as soon as you come out of report?
I'm glad you do your job well and care for your patients as you do. I'm glad the shift you follow wasn't so busy to the point that IVs are full and patients aren't screaming cause they didn't have their needs met last shift. I'm a burnout case who has left nursing after 10 years because of issues like this.
I wish I could say that while still working, I was always able to check my IVs every hour, I wish I HAD an LPN to give pain meds for at my last job. Unfortunately, the floor was split so that LPNs had a full patient load same as RNs (not together), but the RN had to do her own work for her patients plus cover the LPNs IVs on another group of patients entirely.
And you haven't lived until you've asked a Charge Nurse at a facility you are new at to go sit with a patient while you call the doctor cause there's major problem and you don't want to leave her alone (and this is at the beginning of your shift, you were called to the room by family as soon as you came out of report, haven't seen ANYONE yet). She does so, then comes back to the desk and tells you the patient isn't breathing and she's fresh out of school never done a code and wants you to go to the room and lead....
Needless to say, by 10am (this was day shift) I still hadn't seen ANY other patients, given any other meds, done ANY assessments on other patients (except the am admit for surgery)
and that's the day I quit that facility.
It wasn't worth it.
No every facility/job isn't that bad. But there are also worse places.
Aug 16, '01Staffing by acuity would REALLY be helpful in the instances mentioned here. Everybodies happier when you have appropriate staffing--and nobody is w/o it, IMHO
If a staff nurses researches this option, presents it in a professional and persuasive manner to people in management who care (there must be some one!!), and/or have the political power to influence change, it might just have a chance.