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.
From a patient’s point of view, it depends on how you define “Above and Beyond.”
I was vomiting a lot after one of my operations, the nurse cleaned me up and changed my liens each time, after the 2ed time offered me some meds, after she gave them I asked if she could sit with me for a few minutes if she had that time because I did not want to be alone if I got sick again, she sat with me for a good 10mins at least. Although all she did was sit and chat with me, it provided great comfort to me knowing I just had someone there for me.
I once had a family member come and visit me in the hospital and they were NOT being supportive at all, they even made me get sick, my nurse that night told them, I need to provide some care to my patient which will take a while, since it is late would you mind leaving for the night and they did. She offered me a hug and told me to not let others get me down and that I am doing the best I can. I later went to sleep and woke up with a card on my tray table signed by all of nurses on shift, each wrote very positive, encouraging things, which really lifted my spirit. I remember her saying I know it’s not much but we wanted to give you a little boost, I replied “You did, Nurses are my favorite profession ever, I’m getting a kick out of this.”
Another time I had med ordered that wasn’t the easiest for me to take and I preferred another type which was easier for me to take, I told my nurse this, who I knew was very busy, rather than her say It’s going to do the same thing as the other just take it, she looked at me and said ok I’ll call your doctor and see if its ok if I give you that med, awhile later she returned with med I preferred.
To me in all of these situations my nurse did go “Above and Beyond” She gave up something very valuable to a nurse her TIME. Time to sit with me, time to write and sign a card, time to call the doctor to have med change while she was very busy. My nurses might not have looked at it as “Going above and beyond” But I sure did. Time is valuable to a nurse and they gave me some when I need it.
It’s all in how define it. Remember sometimes no matter what you do, you can’t please everyone.
Thanks, Wheels, for a post that goes "above and beyond!"
We get a newsletter that has stories of employees going above and beyond doing things such as
-arranging a party for a frequently hospitalized child that is spending an important birthday or occasion in the hospital
-arranging a mini wedding ceremony in the hospital so a cancer ridden/ill patient can witness their child's wedding
-raising money for a pt family to stay at local hotel, or staff buying clothing for a long term hospital patient
Employees do those things because they want to. It loses the value when its forced. Then it becomes a contest of who can out "above and beyond" the other.
I agree its also part of ones personality to do things you listed above, being forced to do so would build up resentment, also you can tell when someone is forced to do something, they might not say anything but their body language and demeanor do the talking.
Specializes in psych, addictions, hospice, education.
I think it makes more sense to have other people say what someone has done that's "Above and Beyond" than to have to come up with it yourself. I also think there should be some tangible reward, even if it's just a cookie!
In this case ,management doesn't care what you do for your coworkers. This is all about schmoozing the patients.
Try telling them you hung an IV for somebody, see how far that goes.
Well, I feel for all of you who just have incompetent, crappy management. That's a whole other issue. I guess I'm fortunate to say I actually like my manager, and although I don't agree with all the decisions that come down from "on high", I don't feel like we, as the staff, are just trampled on and disregarded.
The IV bag example was not something I was suggesting trying to get brownie points for, I was just giving an example of the attitude of going beyond what you're required to do.
Gosh, I really really REALLY want to be one of those "above and beyond" nurses but I am too busy being a "barely get through my shift" nurse. LOL. There are so many freaking tasks and they keep taking away resources so I don't really see how this situation is going to end in the favor for the patients or me. :/ ???
Isn't it the WORST when you are busting your butt all shift and here comes some chickie or dude (management somebody) to stop by and ask the patient "how has your stay been so far" "how is the care you've been receiving". I always hold my breath although every day I am doing my best and giving 200%. I'm always like, "OMG what is this patient going to say about me". It is so odd! Reminds me of the restaurant when the stupid manager comes by and asks your opinion! Ugh.
Wanna make a difference to your patients? Become a volunteer. Otherwise you suck because they don't have any crushed ice.
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.
I wouldn't dignify it with even a response! It is just these ridiculous press ganey scores then admin wants us to be cheerleaders and stand on our heads and do cartwheels down the halls to please patients and families to get the coveted good score! My response is people are impossible to please and no matter what you do there are people that will complain and find fault no matter what! This madness must stop!
Doctors and Nurses Fight Back; Proposal to Link Hospital CEO Salaries to Employee Satisfaction Passes Senate - Medical Satire - GomerBlog
Ohhhhh, if only...
"I think the plan is a brilliant balance of power to keep CEOs in check," alleged Quissers. "This way they have to balance the well-being of their patients with the well-being of their staff."
A good employer would already balance the well-being of their staff. Sadly, I believe those days are long behind us. It used to be you could work for the same company your entire working life and be rewarded for it with a pension and post-retirement health benefits among others. While there have been improvements to how we live over the many years, there have been equal steps back in other areas.
Maybe I'll start diagnosing patients and prescribing medications. That would be above and beyond, right?
I just had a patient demanding I fix her problem and wasn't happy when I told her I was not the Dr and could not prescribe the meds to fix her problem. She wanted me to get the Dr on the phone for her to talk to. It was a routine issue not an emergency and I wasn't able to get the dr, but did leave a note re the issue. She was unreasonable and demanding a fix right then! So I guess she is going to complain about me because I couldn't fix her problem right then and there. I'm not God, give me a break!
+ I went to the car of an admitted patient to fetch his briefcase when he found out he was being admitted.
+ I once gave a very long ride back to the city to a discharged patient - a traveler from Russia who crashed his rented motorbike while on a weekend break from the tech conference he was attending.
+ I carry with me phone chargers for every make and model of cell phone of which I'm aware because people often end up in the ED without their chargers and, while we provide phone access, who remembers phone numbers these days?
+ I once gave a patient the shirt I had worn to work before I changed into my scrubs because his had been cut off and he had nothing to wear.
~~~
The stupidity of the system encouraging nurses to go above-and-beyond is that, if it's a routine thing then it's not above-and-beyond. It's like expecting everyone to be above average... it's a logical absurdity.
It is logically, factually, and temporally impossible to go 'above-and-beyond' on a regular basis.
All wonderful examples and I'm sure we all have instances where we have done something special for a patient, but let's be careful and not become codependent. Boundaries are a good thing to have! We have donated clothes and shoes for homeless patients so we don't have to give the shirt off our back! That just seems a little extreme!
I think it makes more sense to have other people say what someone has done that's "Above and Beyond" than to have to come up with it yourself. I also think there should be some tangible reward, even if it's just a cookie!
We have a bud program where you can nominate someone for doing something special with a small gift. It is a nice touch, not the heavy handed above and beyond campaigns that sadly are being brought out simply because of pressure to raise press ganey scores. The fact is some people are very grateful for every little thing you do and others are impossible to please no matter how many hoops you jump thru! We get emails and occasional posters with ideas to improve patient satisfaction look in their eyes, why because you are too busy looking at the computer since now we have to pass meds in the computer! Even scripting ideas, although thankfully these are suggestions not mandations. These ideas really border on the desperate because the press ganey scores are not good!
RNsRwe's response is so much classier and helpful than my knee-jerk "stupid ass admins!!!" What an excellent way to produce burn-out, cynicism and lack-of-job-satisfaction.
In contrast, one of the "neighborhood coordinators" where I work doesn't ask, he observes and tells. A few days ago, he brought Hagen Daas ice cream bars to shift change meeting after a particularly hard day. He expressed admiration for all we do, including specific examples of patience and customized care for two very demanding, negative residents. He said he doubted he or many people could do our jobs adequately, let alone exceptionally as we do and that we are doing "God's work."
That little bit of noticing our excellence and affirming it made another tough day a lot less tough.
What if no administrator could get his/her job until they'd worked in the positions they supervised?
Bottom line: I'd be soooo tempted to graffiti artist those posters!
We
You could use my above and beyond approach to graffiti ! I would tape emesis basins on the offending propaganda.
SeattleJess
843 Posts
Thanks, Wheels, for a post that goes "above and beyond!"
:hug: