Going "Above and Beyond" UGH

[SubSippi]

At my hospital, there has recently been a push for nurses to "go above and beyond" when providing patient care. They send out emails, put up little signs and posters, and will occasionally show up in the unit and ask people how we have gone above and beyond today. It has really rubbed me the wrong way. First, because it's ridiculous to set such an ambiguous standard. But mainly, it's because I think it is probably impossible for a nurse to actually do something that would be considered "above and beyond." Let me explain.

As nurses, we have an incredible amount of responsibility for our patients. We are responsible for providing infinite aspects of bedside care. We are responsible for providing emotional support for both patients and their families. We are responsible for providing education to each patient about his or her medical condition, medications, any necessary procedures, and instructions for after discharge. We are responsible for keeping them both safe and comfortable simultaneously. And, we are responsible for communicating with each patient's specialists, surgeon, nutritionist, respiratory therapist, PT/OT and whoever else, and coordinating care between all of these people. And of course there's more.

These responsibilities are all part of a standard nurse's job description. We are expected to do each and every one of these things for all of our patient's every shift, and if we leave just one of them out, we have fallen short, and can even get written up. This isn't me complaining about being too busy or having too much responsibility. I love my job, and enjoy the patient population I get to work with. But with all the different hats nurses wear, it seems to me like anything I do for my patients, no matter how difficult it is to accomplish, or how much time it takes, is just me doing my job.

Nurses can't go above and beyond when caring for their patients...it's like trying to travel at the speed of light!

Anyway, it's been grating on my nerves. Partly because it's coming from administrators who have either never taken care of patients, or haven't done it in decades. And partly because I'm being asked to meet an unattainable goal. Any thoughts?

If y'all have any "going above and beyond" examples, please share.

[87RN]

I went through a whole cart of dirty linen bags to find my patients dentures because he wrapped it in a pillowcase (why???) then had a huge lactulose induced explosion all over the bed and it was my fault because i didn't check with him before I cleaned him up and took out the dirty linens. Yeah it was one of those today, I wish management would have walked in on that and I would have yelled "above and beyond!"

[wooh, BSN, RN]

I feel every shift that doesn't end in me strangling a random administrator is a day I've gone above and beyond.

[Esme12, ASN, BSN, RN]

I feel every shift that doesn't end in me strangling a random administrator is a day I've gone above and beyond.

[LouBean]

What is that Red Queen quote? About running and running just to stay in the same place?

Not a nurse yet, but I'm getting the feeling that's what the job is like...

[RNperdiem, RN]

Going above and beyond is an ambiguous concept when the nurses scope of practice and responsibilities are not clearly defined.

There are some wonderful threads here that deal with the "it is not my job" concept. Nurses might find themselves expected to be TV repairmen, substitute housekeepers, chaplains and chart auditors. Add in computer charting. Now we are being told that it is not enough to have your charting complete. It must be completed in real time. Especially codes. There goes any time flexibility for above and beyond.

It is hard to go above and beyond when what is considered standard or extra is a moving target.

[scottaprn]

Ask the administration to "help you understand" how this goal is attainable and measurable. Tell them you want to be able to clearly define how you have met this objective for your next performance evaluation.

Step back three steps and watch their head explode.

[Mr. Murse]

I agree to a certain degree, but I see what they're talking about at the same time. I know nurses who do the minimum of what they have to do to get through a shift. Go assess patients, pass meds, chart, then sit until you absolutely have to get up to do something again, whining about how tired they are. If a call light goes off, they answer it then dish it off to someone else even though they may have plenty of time to take care of it themselves. They dodge having to help anyone else out basically, anything that doesn't fall directly in their required set of responsibilities to their own group of patients.

With that in mind, "above and beyond" is doing things that help the team and the patients as a whole even though they may not be your designated responsibility. If you hear an IV pump beeping that needs a new bag, go change it even if it's not your patient. If someone outside your assigned group needs assistance to the bathroom and your group needs nothing immediately, take 2 minutes to do it. If a patient that's not yours asks for pain meds and you have a free minute but their nurse is tied up, go take care of it. etc. etc. etc. Basically, doing more than you are required to do in order to help the whole. I have to admit, when I work with motivated, helpful people who do more than they're required to do, then everything just goes so much more smoothly. On the other hand, people that do the minimum they have to make for a much more stressed, exhausting, frustrating shift.

I do agree though that it's frustrating when it's coming from an administration that has no idea what actually goes on on the floor, and basically they're saying "help us milk you for all you're worth".

[RNsRWe, ASN, RN]

My take on this is to be a bit insulted. Posters, placards, email messages.....all telling you to "go above and beyond" intimates that all you do every day is the minimum. And instead of saying "thank you, Staff, for all you do", they are asking you to do more, because you aren't doing enough?!

Plus requesting completion of an unmeasurable goal such as they're promoting is....well.....unrealistic.

Perhaps management would like to give an example of what "above and beyond" is to an assemblage of staff? At that time, naturally, each and every person can then offer what they ALREADY DO that meets the request of "above and beyond".

Then take down the signs

[imintrouble, BSN, RN]

My take on this is to be a bit insulted. Posters, placards, email messages.....all telling you to "go above and beyond" intimates that all you do every day is the minimum. And instead of saying "thank you, Staff, for all you do", they are asking you to do more, because you aren't doing enough?!

Plus requesting completion of an unmeasurable goal such as they're promoting is....well.....unrealistic.

Perhaps management would like to give an example of what "above and beyond" is to an assemblage of staff? At that time, naturally, each and every person can then offer what they ALREADY DO that meets the request of "above and beyond".

Then take down the signs

I also find the A and B concept insulting.

What happens when we've accomplished every single thing imaginable for our patient? Eventually that happens, because available options to answer wants and needs are finite.

Why doesn't the hospital provide free pay per view?

Or rounding nail techs to give free manicures?

Or singing telegrams with ballons and toy poodles?

DQ day?

Why doesn't the hospital PAY to make the patient happier, instead of loading that on our backs for free?

[RNsRWe, ASN, RN]

I'd want to be there for DQ Day

Of COURSE you know that any time a patient is less than thrilled with something in the hospital, it will be the nurse's fault who had to break the news.....yes?

Trying to picture a law firm with a motivational poster slapped on their kitchenette wall, telling them to go A&B. Somehow.....don't see it. But we're professionals, right?

[tarotale]

thanks for reminding me why this career choice was my decision.