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.

[Ethicsrn4life]

Sounds like you are having a bad day. I'm sorry to hear that. Is there anything I can do to help you today?

.

I am not having a bad day.

[Ethicsrn4life]

I don't even know what to say. I think the assumptions you are making about nurses and the care they give based on a vent post are very wrong. Oh well, fight on I guess.

Yes that is my job to fight for the inherent worth and dignity of any pt perhaps i will be fighting for you one day.

Venting and vomiting are different things

[Ethicsrn4life]

Oh my gosh, ethics, I work hospice inpatient, and my sector is usually regarded as one of the more compassionate in health care. Let me just say if you're this upset over a message board post, stay away from our nurse's station once we finally get the chance to sit down and talk about the PITA boomer drug addict in room 8 or the crazy families that want feeding tubes and IV fluids on patients with pitting edema in all four limbs, but no pain meds.

We're human. We vent. We release the unhealthy stuff with each other so we can give the best to our patients. Get over yourself.

Even humans can exist without humanity and nurses are not exempte.

Very sorry you do not understand the difference between venting vs vominting on others bc you can.

[llg, PhD, RN]

Hey ... let's keep this discussion at least semi-friendly ... and stay away from personal attacks.

OK?

[duskyjewel]

Wow....did you just say I have no humanity? You really are a piece of work.

[canoehead, BSN, RN]

This is a pathetic way to justify your personal limitations as a human being and a nurse.

You sound like someone poorly trained, that you are unable to separate your personal self from your professional self and admitting that you give people you refer to as orifices the minimum treatnent.

Acknowledging silently that the person in front of you is lacking coping skills and common manners does not make anyone a bad nurse or a burnout. You can give good care and treat people respectfully even if they are jerks, but no one says you have to enjoy it.

[Esme12, ASN, BSN, RN]

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[macawake, MSN]

Yes it is a message board and i understood that it was not being said to pts faces, but this is a profesdional board and i will defend pts even when we use inflammatorty name calling.

Words are powerful and i understand that if we feel the need to call pts ******* bc we are frustrated and admit giving them miniimun care it should be addressed very strenuously.

It is interesting that other nurses have not addressed this as something quite negative and displaced anger calling pts names and one post admitting to giviing them minimum care.

I do not see any humor in that.

It does make me wonder about the care they receive when nurses have that attitude and can't separate their frustrations from the needs of the pts.

I take nusring care very seriously and my first job is to be an advocate for the pt and i will defend it with vigor.

I make no pologies about it because its was quite inflammatory and charateristic of nursing taking the frustrations out on pts...this is a sytemic problem in nusring that should be address on all levels.....,so yes WOW.....i was appalled that it was posted like that.

Pts should not be referred to as ******* even in the intimate circles of nursing.

Whatever happened to the art of spelling out a frustration and dealing with it, rather than reducing pts to nasty name calling.

And in the other post saying with pride they will get minimum care

I am fine with venting but this crossed a line.

I haven't read all the posts in this thread but this one about patients only receiving minimum care caught my attention.

I honestly don’t think it’s surprising that a patient will receive different care depending on how they behave. I would actually be much more surprised if nurses, who are human, managed to give the exact same type of care to every patient regardless of how they are treated. It’s true everywhere, not just in a healthcare setting. Wherever we go or whatever we do, people around us respond to our behavior. A nice behavior will most of the time generate a more favorable response.

Don’t get me wrong. Every patient deserves to receive the medical treatment necessary for their condition. Every patient deserves a nurse who is knowledgeable and diligent in order to prevent or catch errors, and every patient deserves a nurse who advocates for them. All my patients have in the past and still do receive that.

Most my patients are perfectly nice, however some aren’t. Of those who aren’t, some are probably usually agreeable people but pain, anxiety, stress or depression is affecting their behavior. The other group is those who are never nice, even when they aren’t dealing with the stressors of illness or injury.

The nice patients and those affected by stress will get more from me than the ones who are genuinely unpleasant 24/7. The nice ones won’t get better care in any way that can be objectively measured, they’ll all receive quality healthcare. What the unpleasant ones don’t get from me is any heartfelt warmth or the willingness to really go the extra mile.

So yes, in that sense they only get the minimum. They still receive the healthcare they are entitled to though.

Respect is a two-way street, even in a nurse-patient relationship. When I worked in the ER I’d sometimes care for the genuinely unpleasant ones. Today being a PACU and anesthesia nurse I just sedate them if they get too rude (I’m joking, it’s probably best that I clarify that).

One memorable patient in the ER yelled at me as he was being transported from the ambulance bay, give me the *profanity* medication right this minute, or I’ll *violent threat* your *rude word for genitalia* and *profanity* hurt your *more profanity* kids, so that they’ll never walk again, you hear me you *you guessed it, more profanity* skinny *female selling her body*. (This one was actually a man with an advanced academic degree, prestigious job but also a rather advanced nasal issue, whiff, whiff, snort, snort).

This individual did NOT get to meet the warm and fuzzy me. I didn’t pop out to the florists shop and buy him flowers with my own money. Would any reasonable person actually expect me to warm up to this patient and go the extra mile? I have compassion but there is a limit. It’s got nothing to do with me being unable to handle my frustrations. Ugly behavior just doesn’t inspire generosity and kindness in me, and I’m fine with that. In my opinion I can still funtion in a professional capacity. I’ll give patients like this one a stern talking to about how civilized people behave in company. Being in a hospital doesn't provide one with an automatic get-out-of-jail-free card in the behavior department.

If that makes me unprofessional in anyone’s opinion, so be it.

If you work in a large urban ED, we know what groups of people you are referring to as orifices.

Exactly... the ones who act like complete orifices. (which euphemism I use per TOS, not out of reluctance to use the term.)

Here's the problem with your assumption: It's not any particular socioculturoeconomic group... it's the orifices from all walks of life... the ones that are self-centered and demanding, the ones whose sense of entitlement and priority manifests in every sentence they form, the ones who place the physical health of myself and my colleagues at risk by their behavior in our interactions, the ones whose behavior would get them banned or arrested in any other environment...

It's not the junkies, not the gangbangers, not the hookers, not the psychs, not the ___... or it is... it's a behavior and attitude that's manifested by some people irrespective of intellect, class, wealth, mental state, education, ethnicity, age, gender... and even by some docs... and nurses.

If they're orifices outside of the hospital then that same behavior or attitude earns them the same label inside of the hospital.

And the truly ironic thing about your assumptions about me is that they're belied by the opinions expressed by the vast majority of my patients and their families as well as my colleagues in medicine, surgery, nursing, law enforcement, and ancillary services.

I am an old fashion nurse who believes that people should be able to identify me as a nurse regardless of the pt i am caring for.

Bully for you. A department full of "you" would be lacking some balance offered by having some "me"... just as would the converse be also true.

To the title of this thread, I have oft gone "above and beyond" for my patients in all kinds of ways... and I've been formally recognized for it. That doesn't mean, though, that I don't also call a spade a spade... or an orifice an orifice.

What job is perfect?

I don't know, maybe LeBron James's gig?

Perfect? Perfection falls in the category of perpetual motion or 100% efficiency... physical impossibilities.

I'm not clear when this thread morphed into something about perfection... except perhaps in your perception of nursing perfection and judgment that I and others somehow fall short of your standard.

You can think and feel whatever you like

Your indulgence is appreciated. I was having a crisis of self due to the restrictions to which I'd been bound. Thank you for freeing me from same. This should help me in my shift tonight.

Because you clean the words up does not justify just the lack of knowledge you have about human behavior under stress but i think this is a pervasive trait in your character by posting calling pts orifices and giving them minimum care.

I hope you've read a number of my more 'real' threads before choosing to attack my character.

To some patients I provide only the care that I am required to... to others, I provide anything and everything that I can think of... that is, above and beyond... not because my employer requires it (or it wouldn't be "above and beyond" but rather the minimum care that you find an indicator of my flawed character) but rather because I am a being who is interconnected to the beings around me and I choose to alleviate and comfort where I can...

We all have frustrations that we have to deal with

Wow, that's a revelation...

and i can not defend your behavior one bit.

Nor do I seek nor need your defense... I'm quite capable of defending myself and my behavior adequately.

There are so many of us who are trying to change the dynamics of the culture of nursing

Yes, I am one of them...

where we are seen as advocates

Oh yeah, preach it... I've gone toe-to-toe with senior trauma surgeons, ED attendings, parents, families, senior management... whomever is necessary... in order to advocate for specific patients, for our department, for customer-service initiatives and other issues.

, and a respectable profession and for you to come along an undermine the relentless efforts that we are trying to make it simply makes me ill.

You see me as undermining, I see me as undergirding and empowering... and I've received a sufficient number of accolades from various places to be confident that I'm doing at least some things right.

But I see no need to pretend that the orifices out there need not be identified as same... though I'm likewise always willing to wipe the slate clean and begin anew.

we can reduce people to orifices

I don't reduce them to that, they do it to themselves...

and provide the most minimal of care

Minimal required care is still sufficient care... if you can excelling care to each and every patient and family, I'm envious... though of the belief that you're deluding yourself because that would contradict the very notion of excelling or 'above and beyond' or whatever you choose to call it... it's like saying that you're always performing above your average...

because of a lack of profesional boundaries

I actually think the willingness to identify attitudes and behaviors in the way that I do is part of the boundary... I am not required to tolerate abusive behavior.

I said it to the first post that referred to pts as ******* abd i will say it again just walk away if this is how you feel. People leave their jobs everyday for different reasons.

Never. I am in exactly the right job and the right circumstance. The attrition at my workplace is significant because so many people just can't handle it... I can... and part of how I'm able to offer myself to some people is by blocking out others... choose whatever moniker you wish to describe them but the one that some of us use is apt and universally understood... and as I originally stated, thankfully, there aren't too many of them.

And tht kind of venom towards pts

See, this is where you're wrong... it's *not* directed toward them... it is an adjective to describe them... which adjective can be replaced with others of which you'd be more approving simply by changes in their behavior.

you give them th minimum care.

Not "minimum care" but "minimum required care" which can be extensive

I don't see the pt as the problem it is you.

Well, as my Drill Instructor used to say, "Opinions are like (orifices), everybody has one... and they all stink."

I CAN NOT CONDONE NURSES CHOOSING A PROFESSION DEALING WITH PEOPLE'S LIVES AND NOT DEALING WITH THEIR FRUSTRATIONS IN AN APPROPRIATE MANNER. SORRY THERE IS NOTHING YOU CAN SAY THAT WOULD MAKE THIS MORE PALATABLE.

I don't think anyone is asking you to condone anything... for myself, anyway, I'm simply providing an explanation of what is... in the thought that you at least choose to understand the viewpoints of some others around you regardless of whether you condone said viewpoints or agree with them.

That about which I continue to chuckle is that I suspect that if you were one of my team members, you'd be quite pleased to have me as part of your group... and I'm nearly certain that you'd be delighted with the care that I provided to your mom or your kid.

I don't seek your approval... I get plenty of it from the people who count: My colleagues, my management, and my patients.

Cheers.

From me, some patients get required care... and others get sacrificial care... but nearly all get standard-of-care

(and anybody who thinks themselves worthy of removing the terminal adjective is, in my stinky opinion, deluding themselves)

[Natkat, BSN, MSN, RN]

My opinion of my patient doesn't affect the quality of the care I give or how I do my job. That's because I am a professional. And that's what professionals do.

[klone, MSN, RN]

Poor Esme was very busy in this thread.