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.

[JenERally]

This thread's given me great ideas. My hospital uses an annual peer review performance evaluation that coworkers, one physician, and myself evaluate my performance over the preceding year. I'm going to write down every instance of my going above and beyond for patients, their families, and my coworkers and reference that list on my next year's evaluation!

[TriciaJ, RN]

This thread makes me kind of sad. While I agree with many of your sentiments, it just seems like administrators are universally hated and disdained. My ultimate career goal is to be an administrator. But I read threads like this and think " Yikes, is this what I'm in for?"

Well, at least you'll know what kind of administrator NOT to be. Just remember to be real and never think your butt is a good place for your head.

[TriciaJ, RN]

If employee motivational slogans were honest:

"The squeaky wheel gets the sack"

"Calling in sick makes Baby Jesus cry"

"Teamwork: Ensuring that your hard work can always be ruined by someone else's incompetence"

"Remeber: Just because you're necessary doesn't mean you're important"

"It could be worse"

Love these!

[TriciaJ, RN]

I work in home care case management and the "above and beyond" ones are the ones doing things for patients OFF THE CLOCK. Sorry but I work my butt off all day, most of the time working far more hours than I am paid for. I barely see my family as it is, so my off time is spent with them!

I actually had a job interview a while back where that was actually a question they asked!!! "Give an example of when you went above and beyond in your job". Uggggggghhhhhhhhh

"One day I wore 37 pieces of flair."

[TriciaJ, RN]

This campaign is what I call "happy horses###t" My hospital system spends a lot of money on publicity campaigns, one of which has a surgery patient saying "The service was excellent". That makes my skin crawl- I'm not a f###### servant! We have morning meetings where we are supposed to say that we are here to serve and we are world class! I refuse to say that, and I've noticed that fewer and fewer people say it. You can't fool all the employees all the time.

Do you have to do the Walmart dance?

[klone, MSN, RN]

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 know this is an old thread, but I'm coming back to it. Your quote above is spot-on, and I can give you a great example. In my role as clinic RN, one of my jobs is checking the messages on the triage line and returning people's phone calls. As with any clinic I'm sure, we get some regulars that I've become very familiar with. There is one particular person who is VERY unpleasant, verbally abusive, and just an overall unhappy person. Guess whose call I return LAST? Not because I'm punishing her, but because I dislike being spoken rudely to and verbally abused. So I have to steel myself and psych myself up for that phone call. Yeah, it sucks that she doesn't get the best nursing care from me (I try to return patient phone calls within 2 hours, but her call I save to the end of the day). But I'm human too.

[calivianya, BSN, RN]

Last year my dad lost his battle with stage IV gastric carcinoma (liver, brain, lung mets). His last admission was to the ICU. He stated to his nurse that the bed was too small. She kindly remarked that he seemed to fit in it well. He added that his wife couldn't fit in there with him and he really just needed her. (He was on comfort care at this point). That nurse, and I'm tearing up as I relay this, found a bariatric bed and moved it into his room so daddy could find comfort in the arms of the woman he loved.

That's amazing.

I wish I worked somewhere that these sorts of things were possible - patients have to meet criteria for a bariatric bed at my hospital, no exceptions. I've had patients so fat they pressed into the side rails on both sides and couldn't be turned without nearly flipping them out of the bed that couldn't get bariatric beds because they weren't quite fat enough. Usually because they were short, so although they were tremendously wide, they weren't quite heavy enough. When we can't even get bariatric beds for legit bariatric patients, you bet there's no way to get them for a circumstance like this.

I particularly like it when the families are pointing out the sores on their loved ones' arms from the siderails because they keep sliding their arms off the pillows. I really love the facial expression they give me when they ask, "Aren't there bigger beds available?" and I say, "Yes, but he/she doesn't meet criteria for one."

I think more of us would go above and beyond if our hands weren't tied quite so tight.

[NurseDiane]

[NurseDiane]

Oh please. This is a result of those stupid Press-Ganey surveys & Magnet certification. The whole thing is stupid. What has the hospital done to go "above and beyond"? Have they given the nurses a raise? Have they handed out gift cards to each nurse so they can have a massage at a spa paid for by the hospital? Have they given the nurses some extra vacation time?

It's hard to go "above & beyond" when you're overloaded with patients, have a crap-ton of paperwork to do so the hospital is covered if they ever get sued, make sure you get a patient a hot cup of coffee in 30 seconds so they won't give a bad survey, etc.

And that is the exact answer I'd give to any manager who showed up on my unit when they asked me what I did to go "above and beyond"----I'd ask them what the hospital has done that day to go "above and beyond" for the nurses that they are asking to do the same. Give me a break. Tell the manager that shows up & asks you that stupid question if he/she can go "above & beyond" by answering a few call bells/lights.

I'd have to reply to a manager asking me how I'd gone "above and beyond" like this: "I smiled at a pain in the ass patient when I wanted to say a 4 letter word", or "I finished my charting in time so I can go home when my shift is over", or "I got to take my lunch break today".

If health care hadn't turned into a for-profit business, moving patients in & out so fast that they should run a conveyor belt through the hospital so patients wouldn't even have to stop when they're going from the ER through radiology or the lab, cutting staffing to dangerous levels so nurses are overloaded with work, threatening nurses & scaring them of being turned into the Board of Nursing, and piling a crap-ton of paperwork on them to do, maybe nurses could go "above & beyond". Nurses are squeaking by, managing to just get done what they have to get done in the shift without patronizing the management.

[NurseDiane]

Or, some P.R. push by the hospital to show the public that "Our nurses go above and beyond!!!". Maybe there has been some bad publicity about the hospital lately, who knows. All hospitals are coming up with these stupid gimmicks to promote themselves. Healthcare should be taking care of patients, not advertising for business. Notice how no hospital will advertise "Free xrays!" or "Free echocardiograms!!" or "Free parking!!!" It's all about money, and when that happened, health care went down the toilet.

[NurseDiane]

At your morning meetings, you should ask if being "world class" means all the nurses are being gifted around the world trips courtesy of the hospital administrators.

[NurseDiane]

Yep, that's what you're in for as an administrator. As long as healthcare is being run as a for-profit business and not what it was supposed to be----taking care of people & healing them---that's what you'll be. Thinking up stupid slogans to "sell" your facility, seeking photo-ops when your facility brags about its valet parking instead of its huge nursing staff, schmoozing with big wigs that give a lot of money to the facility, and fighting the nurses when their contract is over & they want a raise. That's pretty much it.