You are part of the problem with healthcare today if...

cherrybreeze, ADN, RN · Mar 16, 2010

i find it telling that everybody that has jumped on me about my satire automatically assumes i'm only talking about nurses or the nursing heirarchy.
i, and others, surely realize you're not only speaking of nurses. but nurses would be included, and that's the part people take offense to. coming back with "it's satire" and "it's a joke" doesn't make the original post any less inflammatory or insulting, and not only to those who are "business casual" nurses. i'm a floor nurse and have been all my career, and i found your original post too over the top.
why does the hospital support an army of billing people, dutifully filling out forms, locked in mortal combat with another army of clerks at the insurance companies, dutifully denying claims or procrastinating on payment, negotiating reimbursement rates, preapprovals and god knows what else, until 270 days after the service is rendered, the provider (maybe) gets a check for 30% what was billed?
how does all this busy work contribute anything to the end product?
why, in the digital age, is it getting more complicated rather than less to get paid?
how many assistant nurse managers does the manager of a unit need? if all 3 are on duty, is it unreasonable to ask for relief for a real lunch when short staffed?
does an education department that simply leaves a video tape at the desk with a sign off sheet need 6 full time staffers? (how about one of them come take over so i can go put on my "business casual" clothes to sit in the conference room to watch a 45 minute manufacturer's video on how to prime an iv pump?)
if the nurse manager has a fruit bowl, jelly beans and a coffee maker in her office, why is it such a big deal if i have a (covered) drink tucked out of sight at the nurse's desk? (especially when i frequently miss meal breaks due to short staffing?)
if my nurse manager has so much empathy for me, why can't she look the other way and ignore the drink and save the intimidation game for something that means something?
why do i have to carry a voip phone with me every minute of my shift? can i pee in peace rather than be told "room 6 wants a warm blanket" at that private moment?
the above statements are so much more relevant than how you started this thread. this makes sense, and can spurn a useful discussion. should have opened with this instead.
you folks that "did what you do for 20 years", did it 20 years ago. come out here now and be flogged for 12 hours and see how dark your "education-phobic, nitwit" mood becomes.
then you'll have some "street cred" with the unwashed masses and every right to tell us "whiners" to suck it up.
chances are, you'll see just how petty silliness impacts my ability to render safe, efficient care. oh, and maybe enjoy my job (like 15 years ago) rather than cringe everytime i see yet another memo posted telling me i'm not working hard enough.
prove me wrong and we can transform the nursing part of healthcare together. continue in the status quo and watch the attrition rates continue to surge.

while many facets of healthcare, including nursing, need overhauling, your op implies that every person not in a position of floor nursing is a problem in healthcare. you then find it "humorous" that it upset people. seems pretty straightforward and obvious why from my angle, and like i said, i'm a floor nurse.

Woodenpug, BSN · Mar 16, 2010

It would be nice, if, as stated in hospital policy....when we're short staffed....managers, assistant managers and clinical nurse "specialists" filled an actual nursing assignment. I imagine that we would be short staffed less often.

If practice council had an actual voice, rather than the usual...."let's do it my way and pretend it came from rank and file." Some improvement may be seen.

If "education" actually researched current practices and had valid citations, it's just possible we would attend mandatory training with enthusiasm.

No satire, no joke and this happens in most circumstances in most hospitals. Seldom do you find a manager who is able to preform as a floor nurse. "Been there, did that," is not the same as can do it today.

360joules · Mar 16, 2010

my apologies to the school nurse... the post refers to hospital-based healthcare, as that is my forte. public health, md office nurses, and the like can all disregard.

the bottom line of the post is this:

the ratio of "chiefs" to "indians" is way out of whack. it does not imply we don't need "chiefs", just not so many of them. the value they add to the process should be marketed better to the rank and file because it often looks like their only real interests are self-serving.

from my perspective most "chiefs" complicate my life rather than simplify it, often with petty, draconian and short-sighted policies. i'm willing to comply with anything that makes sense, but not to prostrate my will so someone can make a nice powerpoint presentation to show to upper management. a lot of it looks like good old-fashioned featherbedding to me.

i hope i live to see the day where someone in charge asks "does adding x,y, or z to the nurse's daily workload provide any real benefit to the patient" and "if function y proves to be valuable enough that our system should require it, which nurse function a-x should be reassigned, renovated, or removed entirely, as there are only so many hours in the day."

this would be "evidence-based" nursing, not "slavery-based" nursing.

i am not a machine that you can just turn up the production speed faster and faster. when my "belts fly off", someone (e.g. the patient, me, or too often my innocent family) pays a horrible price.

the folks in the chain of command that have the power to fix this seem to have deliberately turned a blind eye to the realities, or worse, seem to be colluding with the forces of darkness to oppress the staff and squeeze the last little bit of work from of our battered souls, all while telling us how much they "understand".

thanks for the crocodile tears. can i have a lollipop too?

controversy inspires passion. if this started out as a "i hate my job" post, no one would have read it.

i would hope everyone would agree that the current system is unsustainable and needs reform. when "consensus" is the only voice that will be heard, the waters of change freeze solid.

the "new blood" that enters this profession and quickly flees a few years later speaks for itself. the band is still playing, but the beer has run out -- expect trouble!

i now render up my firstborn for pagan sacrifice, shave my head, and will walk with my eyes downcast for a lifetime to atone for for this sin. (the "office casual" folks can look on ebay for my formally glorious locks when they get to work tomorrow.)

i'm out of this thread.

[asbestos suit: off]

allnurses Guide · Mar 16, 2010

I see (I think) what you were getting at 360joules, but I think you may have insulted a sub-category of people, because the mental image I have of the "problem with healthcare today" person isn't necessarily the nurse with alphabet soup after their name. Or more likely, "the problem with healthcare today" people have different alphabet soup after their name. I think most of the nurses here on allnurses are quite aware of what it's like in the trenches. In fact, you might be able to say that a nurse in an administrative position who takes the time to read about the reality of a nurse's work life has already self selected as one of the better ones. :)

I have to say, because I know, sometimes the person who was your co-worker 15 years ago and followed a management track loses something along the way. You meet them for lunch, and wonder if there's a pod nearby because this is not the same person!! They now see the wisdom in things like hanging a sign in the nurse's station saying, "Remember, customer service begins with a smile", banning nurses being able to sit and chart in public view because of the "appearance" problem, and many others (I'm keeping a running tally of these things). Their eyes get just a little too shiny when giving Dr. Muckymuck a tour, and a little too bored by nurses complaining that they can't take a lunch break because they cannot be paid overtime to finish charting if they are slammed with a crazy shift.

It's not usually the educator, the QA nurse, or the specialty liaison nurses such as Oncology or Organ Transplant teams.

The pharmaceuticals sales reps- hey they are just working schlubs like the rest of us (usually) They just make them dress nicer and give them a car. And really? Total different topic, but I think it's pretty pathetic that they ban the post-it notes and pens that usually ended up in the nurses hands while doing nothing about the real bucks paid by these companies for trips, lobbyists, advertising etc. What a joke.

Ed: no, joules, come baackk! We don't all hate you!

inshallamiami · Mar 16, 2010

Joules, don't let the management types chase you away! Ok maybe you made a few too many broad generalizations, but a lot of it was right on target. You have MY vote.

allnurses Guide · Mar 16, 2010

OK I'm going to call time out on this thread

Closed for staff review and cooling off

allnurses Guide · Mar 16, 2010

Right then ladies and gentlemen, this thread has obviously touched a few nerves, it's also sparked some excellent discussions and debates. You may not agree with each others point of view but that does not excuse personal attacks.

I am going to reopen for further discussion, please be respectful to each other. Please disagree, debate and discuss to your hearts content but leave the personal insults out of it

Thanks all

GitanoRN, BSN, MSN, RN · Mar 16, 2010

360joules, an answer to your question, I work with the V.A. system in a management capacity. Moreover, the V.A. has Zero Tolerance for any abuse against our staff, also many of my colleagues believe in getting their hands dirty and working along with the rest of staff when it's needed, therefore I can't take full credit for your compliments. In addition, don't get me wrong there's always a bad apple in any bunch. However, I don't allow anyone during my shift slacking on their duties, everyone has a task to perform. Lastly, we must understand that in order to provide an excellent care to our patients there must be a leader to foresee that everyone is completing their assignment, although this leader is aware that if the need arises he/she must comply and work side by side with their staff... after all this is nursing :cool:

luvRNs, BSN, MSN, RN · Mar 16, 2010

STILL this this is a good dialogue, but I think the most telling thing that you said (360 joules) was that health care NEEDS REFORM. That is the epitome of the problem here.

Many of the 'suits' you refer to are people trying to prevent unreasonable losses from third party payors due to documentation. This despite that fact that over the last year these same payors posted RECORD profits and raised rates by the double digits:eek:

Documentation? No one, bedside or above likes the ongoing and increasingly intrusive requirements to document. Without regulators ( JC) and lawyers we would most likely need less. It's well-documented ( no pun intended) that 30% or more of a nurses time is spent on documenting and it IS too much.

Whose problem is this ? bedside or boardroom ?? It's all of ours!! For too long as a country we have sat back and let legislators fail to address the fundamental problems with healthcare. We're poised to do that yet again. Apathy, not in my backyard, no my problem.......

I believe this is our problem in health care and not each other:banghead:

360joules · Mar 17, 2010

Lastly, we must understand that in order to provide an excellent care to our patients there must be a leader to foresee that everyone is completing their assignment, although this leader is aware that if the need arises he/she must comply and work side by side with their staff... after all this is nursing

If the "leadership" at *my* facility was to be abducted by aliens, it could possibly go unnoticed for several weeks.

The only time we see them is during mandatory meetings, or when we get scolded because "the Press-Gainey scores are down last month, so let's be sure we stay right on top of those call bells girls." The "banker lady" clothes and high heels also gives the implied communication that they will never get within arms-length of a patient, unless it's to do a spot check customer satisfaction survey.

I worked as a traveler for a few years before planting here, and found this middle management attitude all too common.

I have the back of any manager that can come out a take off a few orders or something when we're slammed. I know they have their own repsonsibilities, but a little bit of appreciation and kind words (vs. complaining about "drinks at the desk") would completely invert the atmosphere of my workplace.

Currently while I have my nose to the grindstone, the managers seen to only have their noses to upper management's backside - which makes it hard to "wake up and smell the coffee. They have the uncanny ability to ignore the apparent, be deaf to complaints, and still find tedious fault with the best we can offer.

My pension vests end of May, and I'm hanging it up (at 43) to join my spouse in our small business we started a few years ago. I have that option, but I know many RNs don't. If I was working for someone like you, I might reconsider...

I'm sure I'm not the only one with these thoughts. MOST of the nurses I work with are older than I am, and are nearing retirement age. The ones that are younger often bolt after a few years.

If the powers-that-be continue to avoid the very serious issue of workplace satisfaction for nurses, a perfect storm of attrition will rise up and decimate this industry in a decade or less.

Then the Press-Gainey memos won't mean much, as no one will be left to read them.

makes needs known · Mar 17, 2010

"We may not be direct patient care anymore. I may not get down and dirty every day but, I am doing my damndest to make sure this department runs safely efficiently and doesn't pile on more stupid paperwork and forms that take my surgeons/residents/nurses away from the patients."

We are receiving more and more stupid paperwork everyday. We have been told that by doing all that extra paperwork we would get raises, and now it is expected that we do lots of extra paperwork with less staff to perform the real nursing. And the very small raise we got is not worth it.

makes needs known · Mar 17, 2010

And why is everyone upset with joules?, I thought that Jeff Foxworthy wrote this:)