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.

[wooh, BSN, RN]

My hospital used to give 'bucks' out for things. We had coins worth a buck to use in the cafeteria and buck ones that you could cash in for $20 gift cards once you got 5. But times got tight... Now each patient gets a letter from the hospital foundation that states if an employee did an exceptional job for them, they may donate money to the foundation in that person's name.

It's a bit better than the hospital constantly hitting the staff up for donations. But not much. :)

[BrandonLPN, LPN]

My hospital used to give 'bucks' out for things. We had coins worth a buck to use in the cafeteria and buck ones that you could cash in for $20 gift cards once you got 5. But times got tight... Now each patient gets a letter from the hospital foundation that states if an employee did an exceptional job for them, they may donate money to the foundation in that person's name.

Wow. you have to kind of admire the pure evilness of the person wh came up with this one.

This would make Catbert, the Evil Director of Human Resources, purr like crazy.

[BrandonLPN, LPN]

[laKrugRN]

We have the silliest things to add to our patient encounters. I work in Peds. I have to put down "never served in military" If they are 2 and above I ask about caffeine. Ten and up get the alcohol and tobacco questions. PArents look at me like I;m evil when I ask if their little angel has ever smoked a cigarette. I feel terrible. Also, we are big on AIDET. I have to introduce myself and say "We want you to have very good care." I've gotten several "you are stupid" looks. Then at the end we say "Thank you for choosing (Hospital name) we hope you had very good care.' PSH. I hate how we have to worry about so many details and it ultimately takes away from my time with the patient and their care. HATE IT

[Ethicsrn4life]

Hospitals and pharm companies don't go through tough times the same as other industries.

Have you ever worked at a facility that started cutting out things (essential things i might add) and nursing incentives or education and then they have a nursing poor mouth meeting to let you know wages will be frozen bc of the economy not faring well. But they are builiding some new building or wing or center.

Also Docs are still being paid without disruption to their lives. These are smoke screens, they are selling us a bill of goods.

I worked for the 3rd largest pharm co. in the world located in Texas or the clinical part, which is new. Bonuses were given out like candy on halloween during the worst part of the country's economy problems(quarterly) . Those managers lived like kings, huge benefit packages, overinflated salaries, company cars when their jags and Porsches needed a breather. We hve relation rooms, a breastfeeding room on every other floor. A large lounge area for every floor with free beverage dispensers(soda, coffee, tea etc breakfast qyick snacks, lrge screen LED TVs in each of the lounges

We had catered lunches for every meeting and nice quarterly picnics.

The largest group that worked there were not nurses, they well male project managers, nurses were supporting cast.

Nurses week in May were an extraordinary. And the gift were not from the dollar store or well wishes.

You had to compete by just emailing your name in for different events, which they could have given to eveyone because they were so loaded. Basketvall tickets, NBA,baseball tickets, concerts anything imagining happening in a huge city they had access to and has us compete for them. If it were activities for kids and families, a lot of us single nurses would put our hats in and just give them to ou coworkers that had kids. It was a very supportive environment for nurses to look out for each other because we were not vying for scraps, so thete was no need to be mean to one another.

It has been the most profesional nonstressful environment i have ever worked in. I observed the dynamics of why this was working and took very careful notes. It was not Utopia but it was an expeience evey nurse should have.

The whole time i was there i thought of nurses doing the hard physical labor things, as well as nurses dealing with life and death issues every day. I felt guilty bc i felt every nurse is deserving of these things and more when you look at if we dont exist you the facility does not exist.

People for the most part dont think they are going into nursing to get rich, but in that same vein we dont see ourselves as the hired help, but we act like hired hands.

The culture of nursing will not change until we force change.

A lot of hospitals/ facilities have cut out education days, funding for seminars when that was a natural part of the job. Now they have us convinced that to expect anything is not wanting to keep up with your professional goals...which is bs.

We have the power to change things that we define as essential to our practice, as well as to be compensated as well as other professions bc we deal with lives.

It does not heip the cause to grin and bear it.

If things effect the community at large where wages have to be frozen, benefits cut then it should effect everyone at every level except the least amongst us like housekeeping, nursing assistants, and staff already affected by the worst wages.

If the president is not frezzing his wages which will not hurt him/her anyway then dont ask me to be a good team player and understand because I WILL NOT.

Unions did not come out of people being treated fairly, and they are not a perfect machine, but hey are a bargaining voice for groups not being treated fairly. In a lot of places we have been indoctrinated to believe that unions are evil beasts and we parrot this language like it is the voice of God at the same time our needs are not being met, nurses are afraid to go to work bc of chronic understaffing when pts are much sicker, and we pray to get through a shift.

I can not nor will i work under constant stress, so i am constntly going to greener pastures, but it does not mean i have forgotten my peers and their struggles.

If administations were fair, appropriate, and had the best interests of patients and staff we would pull together during tough times but that is not going on.

We take our livelihoods and pts lives in our kands every time we step on a unit in a facility that disregards the profession and count on us to pull off miracles. Working chronically short, long hours, benefits being bare bones.

This is a sidebar but why do healthcate workers have the worst benefits of most professions? Should it not be the opposite? Can't blame the ACA for that bc it has ben going on for the almost 30yeas i have been a nurse.

This is the truth working for non direct healt companies i have ben compensated better, benefits were a lot better and i managed to get paid to finish a mastets degree outside of nursing and they picked up the full tab, no conditions attached BECAUSE IT WOULD BE A BENEFIT FOR THEM. Imagine that investing in higher education for your employee. I finished my masters in 2010, so yes Viginia there is a Santa Claus.

If you act like hired hands ou will be treated that way.

Men are a different culture and they have high expectations in their professional lives and they are treated a lot better because they dont except less.

This job that suppored me getting my 2nd degree, the largest population there are men, and many were working on 2nd degrees or dvanced professional training and it was strongly encouraged. You see they could market this to clients about pesonnel having a f vanced degrees or training.

Hospitals or direct care facilities use to encourage growth, then decided this was a way to save money.

Where have all the internships gone?

We have the power to change the dynamics in nursing and the climate in healthcare by our shear numbers. It would be a longterm fight.

My question is what is happening that we dont see the need to focus this power in changing things? Is it too hard? It is not harder than what you do and the conditions you work under. Is it because we are afraid?

The unknown is always frightening and the people at the helm will not embrace any changes that will challenge the status quo, and many facilities will gibe you that contrite ultimatum, if you dont like it here you can leave because they know that we are not wired for knowing how to harness our on power, so they will find an agency nurse or someone to take your place. But that is the reason that organizing as a group can be powerful. Have any nurses done it and been successful?

ABSOLUTELY. ...things are not perfect, but they are better when nurses are a collective group. Ratios are important, staffing is important, compensation, advancement benefits,and many other things.

Nuses by their very natures are not greedy. We go in the other direction and have to retrain ourselves into understanding our value, and being ok with having expectations. Again if we don't see or treat ourselves like hired hands then no one will. We can no longer aford to let others define our identities, or our worth.

Teachers and other helping professions are having the same struggles, yet people that work for APPLE would laugh at their employers if they underwent some of the things these ESSENTIAL professions put up with.

I say this, practice like Florence Nightingale but have expectations like people from APPLE.

Good luck to us all on our journeys.

[duskyjewel]

Holy wall of text, Batman!

[sissiesmama, ASN, RN]

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

No doubt!!

Anne, RNC

[Delicate Flower]

Have been perusing the job openings at my facility, and have taken note that 3 positions have STARTING salaries that are $5,000+ more than what I currently make:

-Occupational Therapist

-Chaplain

-Radiation Tech

The way these postings work, is the starting salary would be entry level, little to no experience. It just goes up from there. So I can conclude that these individuals would be either relatively inexperienced and making more than me, or experienced and making LOTS more than me.

Now, not to knock either of these fields, but I have been a nurse for 8 years, have extensive education, and am certified in my specialty. As an ICU nurse, recognizing subtle changes in condition, knowing how to intervene, and responding in an emergency is a daily occurrence and can make or break the patient's outcome. I think it says something about the VALUE placed on nurses at the bedside that this is how we stack up against other departments in the hospital.

Just sayin'

Have been perusing the job openings at my facility, and have taken note that 3 positions have STARTING salaries that are $5,000+ more than what I currently make:

-Occupational Therapist

-Chaplain

-Radiation Tech

The way these postings work, is the starting salary would be entry level, little to no experience. It just goes up from there. So I can conclude that these individuals would be either relatively inexperienced and making more than me, or experienced and making LOTS more than me.

Now, not to knock either of these fields, but I have been a nurse for 8 years, have extensive education, and am certified in my specialty. As an ICU nurse, recognizing subtle changes in condition, knowing how to intervene, and responding in an emergency is a daily occurrence and can make or break the patient's outcome. I think it says something about the VALUE placed on nurses at the bedside that this is how we stack up against other departments in the hospital.

Just sayin'

There's something we've got going for us.. We out earn the PT, RT, and radiology techs.

[Ethicsrn4life]

I trally wish i could be more concise and laugh about things,but i can not

[Ethicsrn4life]

And then what......

[Ethicsrn4life]

Have been perusing the job openings at my facility, and have taken note that 3 positions have STARTING salaries that are $5,000+ more than what I currently make:

-Occupational Therapist

-Chaplain

-Radiation Tech

The way these postings work, is the starting salary would be entry level, little to no experience. It just goes up from there. So I can conclude that these individuals would be either relatively inexperienced and making more than me, or experienced and making LOTS more than me.

Now, not to knock either of these fields, but I have been a nurse for 8 years, have extensive education, and am certified in my specialty. As an ICU nurse, recognizing subtle changes in condition, knowing how to intervene, and responding in an emergency is a daily occurrence and can make or break the patient's outcome. I think it says something about the VALUE placed on nurses at the bedside that this is how we stack up against other departments in the hospital.

Just sayin'

I know these professions evolved out of nursing and i don't know who are what entity determined their value, but i know that doctors and facilities determined our identities and value, that my friend is very dangerou when others determine your worth. They will always aim low in the compensation dept.,but aim very high when it comes to responsibility.

You are an xperienced ICU nurse working with pts teetering on life and death. You are invaluable, but your salary does not commensurate with this. if this is what you are saying you are right.

MDs are very happy with their salaries, they even think they deserve more bc of their special skills and no one blinks twice bout their OVERINFLATED salaries, but they identified their own value not facilit or others and we must do the same.

Join your local and natioal professional orgs and keep bringing the issue up and hold each other accountable.....it really is VERY important about organizing and fighting for a true identity with salary and benefits that commesurate your experience, skills. It is a fight that can be won if we as nurses see our own value.

The only group of docs that i have seen complain about their compensation are inexperienced psychiatrists and believe me they have cut out a lot of services they use to perform, once established they are going to self pay(controlling clientele. ...seeing only does in a certain tax bracket). Their premise is that they are valuable and if it means catering only to those that can pay they are doing it. No one pulls at their heart strings to do more with less pay.

Nurses can't and should not do that bc it is not our orientation, but we have a right to be compensated for our skills and experience.

Who are the best advocates for nurses to say what our value is? NURSES

If those other groups are being compensated appropriately i say Great, but our fight is not with them , our fight is with the people running hospitals and facilities. .....they are quite aware of the bargains they get with the nursing industry and it is not okay.....so let us start organizing and having a place at the adult table.