Knaves, Fools, and the Pitfalls of Micromanagement - page 4

In his brilliant little poem, "The Right Kind of People," Edwin Markham beautifully portrays the power of expectations. A traveler approaches a prophet sitting at a city gate and asks what kind of... Read More

  1. by   SherPCCN
    You really got to the core of what is driving the madness of modern medicine! I feel guilty for valuing my patients' outcomes over the clicking clocks and unchecked boxes, but I do it every time that I can't do it all, and I can sleep at night. Add to the increased acuity of hospital patients, we also must make sure we never have a "never event" such as a fall, HAPI, CAUTI,CLABSI, etc. And we must recheck by 3 people logging in separately every 8 hours certain medication drip rates and double check a wide variety of meds and changes. We are not to stay overtime and are to certify 3 times on our timeclock and once on our time sheet that we did not miss our dinner breaks, which most of us never take. Continuing ed is posted in bathrooms, the nurse lounge, the report room, the kitchen, the nurses' station, in folders on our report room table, on our emails, our healthstream, and required classes and courses. The speed only speeds up, as do the ticking clocks and boxes to check! Thank you, Robbi, for being a voice of reason!
  2. by   Daisy4RN
    Quote from RobbiRN
    If we let them take us out too, it will be a cold, dark, dangerous system.
    I am afraid it is already happening!!
  3. by   Daisy4RN
    Quote from SherPCCN
    You really got to the core of what is driving the madness of modern medicine! I feel guilty for valuing my patients' outcomes over the clicking clocks and unchecked boxes, but I do it every time that I can't do it all, and I can sleep at night. Add to the increased acuity of hospital patients, we also must make sure we never have a "never event" such as a fall, HAPI, CAUTI,CLABSI, etc. And we must recheck by 3 people logging in separately every 8 hours certain medication drip rates and double check a wide variety of meds and changes. We are not to stay overtime and are to certify 3 times on our timeclock and once on our time sheet that we did not miss our dinner breaks, which most of us never take. Continuing ed is posted in bathrooms, the nurse lounge, the report room, the kitchen, the nurses' station, in folders on our report room table, on our emails, our healthstream, and required classes and courses. The speed only speeds up, as do the ticking clocks and boxes to check! Thank you, Robbi, for being a voice of reason!
    Seriously...3 people checks, this is ridiculous!! When will admin get it, all these extra/useless checks take so much time it only hurts patients in the long run and makes for even more/greater errors, add to that increased stress levels from not being able to take a break without being inundated with required reading everywhere. Stop the madness!!
  4. by   SherPCCN
    Seriously, about IV drip checks, for example, it has been decided it is safer to have every off going RN and oncoming RN check the drip together and then individually log into EPIC and verify the rate of our Milrinone drips. Within an hour, the charge RN must also log in and verify the rate.
    In all my double checking and being double and tripled checked on any meds or procedures, we have never caught an error or found out later we missed an error. The computer scan also verifies all needed identifiers.
  5. by   FineAgain
    Awesome article, well written and thought out. I work in ICU and we have been subject to "creative" staffing and outrageous chart scrutiny for quite awhile now, it has caused burnout as well as interdisciplinary feuding and undermining. I am consistently receiving phone calls from "Quality" during my shift about things like ‘ your fall assessment for this shift hasn't been documented'. Never mind that it's 1130am and we walked into a code, then a bedside trach was scheduled for my patient, Oh and my patient assessments, my med pass and patient care needs to be done. Not to mention diagnostics, acute interventions doctors rounding, oh and last but not least communication with ‘helpful" family members. We are constantly receiving emails, calls and and annoying little mandatory "in services" given by a educator who has barely worked the floor for less than 2 years as a Med/ Surg nurse and has no critical care background. In addition we are made to go back and enter "addendums" in patients charts. Our actual assessments are no longer relevant, we are made to chart what "admin" wants. Also patient ratios and staffing are modified according to what administration wants not what's best for the patients. Administration has also put charting guidelines and protocols before true patient care, resulting in robotic staff who have lost their common sense and critical thinking to just blindly following the EMAR. That in itself has caused patients to have adverse consequences during their hospitalization, prolonging their stay, as well as many more patients not receiving the bedside care, as well as the much needed education that nurses provide. This leaves a vast majority of nurses feeling that they weren't able to provide quality patient care, this then leads to lower job satisfaction, and a greater mistrust towards administration and the facility or company they represent. It has become a vicious cycle within health organizations everywhere.
    This post needs to be printed off or copied and emailed to everyone, or posted to every wall in every hospital.

    BRAVA!!
  6. by   she244
    Spot on! What amazes me is the people who are auditing me at my place of employment do not know the job I
    perform or even how to perform some of my duties. Yet in my review I get to set there and listen to
    them say either yes! I perform my job well or a problem has been noted. Like most organizations,
    the administrator is a non medical person who makes charts and walks around watching people and then will
    decide to make a change without even talking with the people who perform the jobs.

    Will be so glad when I can retire which hopefully will be soon.
  7. by   JKL33
    Quote from she244
    What amazes me is the people who are auditing me at my place of employment do not know the job I
    perform or even how to perform some of my duties.
    I am convinced that this goes way, way beyond just bringing in a "fresh perspective" and a "different area of expertise that we could benefit from in our work."

    The "fresh perspective" is not knowing what is supposed to be happening from an actual healthcare or ethics stand-point. That is the attraction of this kind of arrangement.

    I realized it was all very calculated the very first time someone looked at a large group of us with straight face and kindly told us that our work needed to be studied and examined carefully because otherwise he wouldn't know how to help us since, "I don't know what it is that you do."

    Well I can tell you this: We aren't manufacturing car parts, Mr. Sensei.
  8. by   RobbiRN
    Quote from JKL33
    I am convinced that this goes way, way beyond just bringing in a "fresh perspective" and a "different area of expertise that we could benefit from in our work."

    The "fresh perspective" is not knowing what is supposed to be happening from an actual healthcare or ethics stand-point. That is the attraction of this kind of arrangement.

    I realized it was all very calculated the very first time someone looked at a large group of us with straight face and kindly told us that our work needed to be studied and examined carefully because otherwise he wouldn't know how to help us since, "I don't know what it is that you do."

    Well I can tell you this: We aren't manufacturing car parts, Mr. Sensei.
    I just have to love any post that incorporates the word "Sensei." I also love the perfect irony of it in this setting. It means "teacher" in Japanese, but the literal translation is "one who has gone before in life" (and therefore qualified to teach because he has learned by experience).
  9. by   Katillac
    Thank you, thank you for this insightful and important piece. I found especially troubling the push to point of failure phenomenon. Anybody who works under these conditions goes home every morning, afternoon or night with the knowledge that they failed to meet expectations that day; it's only a question of how badly they failed. I mean, they sometimes give even cadaver dogs live finds to train with once in a while because they get depressed and quit working if they only ever find dead bodies. In these totally timed situations, where is the motivation for the good nurses, who care about meeting expectations, to continue?

    Serious question here. All those timing programs and audits cost money. Administration doesn't do what costs them money unless they either see advantage (as in return on investment) in spending or disadvantage (as in regulatory penalty) in not spending. What's in it for the suits to develop, implement and maintain these numbers. What good to them is the collected data?
  10. by   RobbiRN
    Quote from Katillac
    Thank you, thank you for this insightful and important piece. I found especially troubling the push to point of failure phenomenon. Anybody who works under these conditions goes home every morning, afternoon or night with the knowledge that they failed to meet expectations that day; it's only a question of how badly they failed. I mean, they sometimes give even cadaver dogs live finds to train with once in a while because they get depressed and quit working if they only ever find dead bodies. In these totally timed situations, where is the motivation for the good nurses, who care about meeting expectations, to continue?

    Serious question here. All those timing programs and audits cost money. Administration doesn't do what costs them money unless they either see advantage (as in return on investment) in spending or disadvantage (as in regulatory penalty) in not spending. What's in it for the suits to develop, implement and maintain these numbers. What good to them is the collected data?
    Excellent question. I wish a suit would answer it. My suspicion is that it is part of a bigger push to idiot proof the job so idiots can be hired to do it. There is a method to the madness. If you can eliminate the need for critical thinking, you can get get much cheaper labor.
  11. by   withasmilelpn
    If in every day situations most nurses are failing to meet what the hospital has established as their goals, then the breakdown is on the organization not the staff. The hospital is failing in some way, not enough staff, inadequate equipment, inefficient protocols, inadequate training or unrealistic goals. It goes both ways when it comes to quality checks that not only the staff should be examined but the hospital's policies as well. Your best defense is to band together and challenge the data then eliminate one by one each possibility. Organizations often take the first step, looking at staff performance then education but often don't go further than that.
  12. by   HKBrandon
    Very well said! I work in a very different area but have many if the same problems with micromanagement. It is an across-the-board issue. Thank you!!

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