What about having 'Undercover Nurses'?

[FireStarterRN, BSN, RN]

As I've mentioned, I'm doing a travel contract in a nearby city. The facility is currently scrambling to prepare for a joint commission inspection. Basically, this means sprucing up the veneer of regulatory compliance. Meanwhile, I, as an outsider actually working in the trenches, see many inadequecies in the system and workings of this hospital that are directly affecting patient care.

I was thinking that it would be a very useful evaluation of a facility to have an 'Undercover Nurse'. This nurse could travel from hospital to hospital, working 3 months at a time as an actual frontline nurse, evaluating hospitals from the inside.

[nrsang97, BSN, RN]

If it would help with retention, better staffing, better relations with MD's, better relations between nurses I am all for it.

And they should have to go back and see if their suggestions are helping. No one should know who the "secret nurse" is.

There should be a nurse for ICU, ER, M/S, and OB. That way the policies can be evaluated by someone who has experience working in those areas. I would have no idea what to change to help the OB nurses, as they would have no idea what to do to help change the ICU for the better.

This makes me think of working at Kroger and the secret shoppers that would evaluate us.

[General E. Speaking, RN, RN]

Interesting. If it would help us, I'd be for it too. Unfortunately many times Administration's answer seems to add 'just one more thing' for the already busy overburdened floor nurse to do.

[llg, PhD, RN]

If it would help with retention, better staffing, better relations with MD's, better relations between nurses I am all for it.

QUOTE]

Somehow, I don't think having spies "tattling" to administration about nurses who may not be following every rule to the letter would help with morale and retention.

Remember, the person would be reporting the administration -- an administration who was resorting to the use of spies to find fault with the bedside nurses. The spy would not be working for the staff nurses.

[CHATSDALE]

i have heard of secret patients but i have never heard of secret nurses

in most hospitals patients are given a check off sheet to determine how satisfied they were witht their stay in hospital, if one floor or shift gets too many negatives they will send in a patient [usually a nurse] to determine what the problem is or if there is in fact a problem

[FireStarterRN, BSN, RN]

Somehow, I don't think having spied "tattling" to administration about nurses who may not be following every rule to the letter would help with morale and retention.

Remember, the person would be reporting the administration -- and administration who was resorting to the use of spies to find fault with the bedside nurses. The spy would not be working for the staff nurses.

I'm talking about an independent review of systems of a hospital, from a nursing standpoint, to see how actual systems in place are impacting patient care. This would be an objective review of systems that administrations have implemented from the perspective of a bedside nurse. This would be a way of truly evaluating a hospital.

This should be done to examine the flow of work, the impact of charting systems, flowsheets, careplans, etc. Also, availablity of equipment, staffing levels, and so forth. How does it drive care, or is it an impediment to it?

[Nursebarebari]

I don't like the idea, it sucks. If the facilities find this out, they they wiil stop using travel/agenecy nurses all together.

[ThatPoshGirl]

Am I the only one who thinks "Undercover Nurses" sounds like a Media flick? Just me? Okay.

[llg, PhD, RN]

I'm talking about an independent review of systems of a hospital, from a nursing standpoint, to see how actual systems in place are impacting patient care. This would be an objective review of systems that administrations have implemented from the perspective of a bedside nurse. This would be a way of truly evaluating a hospital.

This should be done to examine the flow of work, the impact of charting systems, flowsheets, careplans, etc. Also, availablity of equipment, staffing levels, and so forth. How does it drive care, or is it an impediment to it?

If they are not going to spy on the nurses and are only there to evaluate the systems ... why not simply evaluate the systems using nurses who already work there? Why not ask for and believe the input of the current nursing staff? There is no need for "undercover work" by outside undercover nurses.

Also, there already are "outsiders" who come in and evaluate hospitals and recommend changes. They are called "consultants" and they are very expensive. It's part of the "big business" of hospitals.

[Morettia2, BSN, RN]

It's like Nursing IAB.

My fiance's a police officer with the NYPD and he can spot an IAB or "rat squad" planted officer from a mile away. But some of the officers in the IAB don't choose to become IAB, they are just assigned and have no choice, the only other choice would be to quit and if you have major time on that's really not an option and my fiance always feels bad for the ones forced in to IAB b/c they loose respect but not by choice but because friendship and trust has been lost b/c they are now a part of the 'rat squad'. And there are those that choose to be IAB and those are the ones that the boys in blue hate, b/c they are there to break bawls. But then agian that's police politics.

I don;t know if it would be a good thing or a bad thing for nursing. I know I am super outgoing, and people trust me easily and I can spot things most Nurses don't pick up, so I would be a perfect fit for 'undercover nursing'. But insted of reporting the nurses to administration, I would like a program to 'help' nurses in a objective/subjective way with out admin. being able to find out what my findings were, and to keep the findings confidential. Only I, as the nurse evaluating or 'being undercover nurse', would know what other nurses were saying or thinking or doing, and would not use what I saw or heard to turn that agianst the staff nurses, but I would use what I heard or saw and try to think of ways to help the staff nurses and staff to improve working relationships, standards, conditions, stress management, patient ratio's, staff being passive aggressive toward each other, unfair assignments, did I say stress management, and unit encouragement, ect...

No negative outcomes at all, no verbal warnings, no write ups unless it's the admin. or TPTB that's being warned or written up, and not the staff Nurses, yea that would be the day that admin. gets written up!! Only positive reinforcement, and that is lacking in nursing. Rarely are we nurses ever told by administration or TPTB, "YOu did a really great job during your shift" or "great job working as a team during that code/mega code." OR this would be the PINNACLE, "Thank's for comming in on your day off to work OT, we really appreciate it"

But then agian it's hearing the kind words from the pt.'s that makes all the difference Because the pt. is experiencing your care as a nurse. But it would be nice for TPTB to recognize how we bust our butts.

And if I was undercover nurse, and when it came time to reveal my self at the end of my undercover nursing assignment, I would set up a private meeting w/o admin. people present and in a face to face individual staff nurse eval. but relaxed atmosphere. Preferably NOT in the hosp. setting, b/c some or most people tend to relax or feel less stress if they are out side of the work setting, and they know ADMIN. is not around to accidently overhear what they or I say about work. Another reason to have a outside work meeting is that the nurses know there are no lurking collegues to create gossip b/c you are speaking to a nurse behind a closed door, which would probably happen in a hosp. setting. BUT at the same time it would be difficult to meet if the nurses schedule did not allow for a meeting, so that's why the telephone was created. I know I work nights, and if some one wants to meet with me it has to be right after my shift at 8 AM or on my day off, which I HATE doing work related activities on my day off, but a phone call with a detailed message works. I know when I get calls from work, or #'s I don't know on my days off I either have the ringer off or I scan my caller ID, and you better leave a message, and not a vague message, but a detailed message. I know I would leave a detailed message, and a phone # that you can call any time, and my e-mail address b/c some people feel more comfortable e-mailing a few times before they talk on the phone PLUS when you write e-mail's you can edit what you want to say as much as you want, but no matter what I would want to tell every staff nurse what I evaluated...

I would say, "You did a great job, and this is what I found were your strong points, and here are the points that need improvement. How can we work on the points of improvement? Give me some feed back and write it down, and feel free to let it out, tell me if you were just having a bad shift, or week, tell me if you were over tired, or you felt your pt. assignment was overloaded, or on some shifts you work amazing with a certian crew of nurses and the last few shifts you were not with the right crew of nurses so you had a few bad shifts, tell me if your schedule for that week/month is something that conflicts with your home life(i.e. family, shifts that were scheduled for you and that you have an event that you need to be at but you were scheduled to work, and you need to switch with another nurse or take PTO). Tell me if you didn't get to have a break to eat, drink, pee, take a breath, tell me if you feel like you are recieving unfair pt. assignments,tell me about malfunctioning equiptment (i.e glucometers, VS machines, monitors, PYXIS, ect..) tell me about communication b/t departments (i.e. pharmacy, RT, house keeping,lab, other floors ect...), tell me how the MD's are treating you, tell me if you feel that your pt.'s safety is at risk b/c of ratio's, staffing,ect.., tell me about all the unecessary paper work that cuts into performing your duties as a nurse, tell me about all the non-sense you have to deal with every shift, and tell me anything that is on your mind, AND please tell me how I can help YOU, what you tell me will STAY between you and I. ANY and ALL suggestions, ideas or opinions are the best things that, we as nurses, can say or do if we want change."

It may just be something simple or it may be something that needs a major re-adjustment.

In the long run I would have a published report to hand to the ADMIN. or TPTB on the findings. I would also make sure that there were at least 5-6 other undercover nurses on different units at the same hosp. so we could collect the findings and have eval. for various departments. Med-surg, tele, ER, Critical care, OB/Mother Baby/peds, OR..

Ok I have been thinkig about this all day and it took me 3 hours to write/re-write. Tell me what you think about this kind of undercover nursing.

Sorry so long:bugeyes:

[patoyia]

i think undercover nursing would be a great idea!!! of course not conducted by the hospital itself but by and independent evaluating agency, that will publish its report for both admin and staff to read. i think that would be the only way to get right down to what the probs are.

when staff knows that an eval is occurring then everyone is on guard and the evel is not being conducted in the "real working atmosphere" and thus results are of little use. i think it would also be great for the admin to be evaluated also, so they can see first hand how they affect the staff. and if current nurses do the eval then of course there will be biases, fear of retribution etc., and it is easy for the admin to dismiss the findings, but not if an independent contractor does it. also, if an independent nurse does the eval, then it would be an eval of the entire program/hospital (from nurse perspective) as a whole; no one person/nurse would be targeted (unless something really really bad was going on), it would be a general perspective.

[Morettia2, BSN, RN]

I tried to edit my original post by saying I would NOT show my findings to ADMIN. BUT to the nurses at an outside of work, only if you want to attend, share more suggestions, no dry discussion, no ADMIN. in a 50 mile raduis, open bar, free food, confidential or anonyus (Ican't spell), meeting at 8-9pm. If I had an endless supply of money and resources I WOULD DO THIS. I love being an RN and I if I had the money and support I would HELP my fellow RN's. This would be a perfect meeting but I am pipe dreaming.

I hope one day Nurses are revered, respected, and appreciated (have better pay for being the well rounded RN's that we are) for everything that we do in the human healing process by all healthcare ADMIN., pt.'s, families of pt's, and anyone else involved in the healing process. I DO have patients and their families that have said to me, "You were the only person that I/we could trust and you were the only person who listened to me/we even when the MD ignored I/us, and I/we thank you for all of your hard work, persistance, positive attitude, compassion and care."

I am an RN for a reason when pt's say things like this it makes my job have meaning, and makes me as a person having meaning and purpose.

Ok I know when I edited the original post I had a great ending tag line but I forget it...thanks for listening