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.
Specializes in Nurse Leader specializing in Labor & Delivery.
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?"
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?"
I'm so sorry, Klone.
Yes, someday, you too will find yourself being the Grand Prize for the lucky nurse that gets to have pancakes with you!
Yesssssss... someday, they will print your face on hospital funny money... "Oh, looky looky! I got a Klone dollar! Now I can get that Diet Coke I've always wanted!"
... no lie, my hospital did this.
It was embarrassingly arrogant and stupid!
I know administrators have a job to do... whether I like what they do or not.
However, for me, it's the smarmy condensation and arrogance I cannot respect.
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".
I see what you are saying, but I consider teamwork a part of the job. That's why I'm finding it hard to qualify "above and beyond."
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.
Thank you for this. I don't know you, I wasn't your nurse, but your appreciation for my sisterhood lifted MY spirits. Just thank you.
I remember one day after I had just finished discharging two, very busy patients home; from out of a room where I had just performed lengthy, complex procedures on them simultaneously.
I went to the bathroom (I did not have CNA's or relief nurses) and came back to prepare for the next set of patients, only to find a Suit in my room picking up bits of paper off the floor. He literally glowered at me, and proceeded to chide me on the importance of keeping the rooms clean. I had no idea who he was. It was the COO. He was going up and down the hallways checking rooms because they were expecting some sort of media day.
Recently, I got my 90 day review. I've been there 2 years. The reason was "I'm finally getting caught up." WTH.
Then I was asked, "how was it being a new grad in the ER?" Now I'm P'd.
So, I told the truth. I didn't sugar coat it. I told her, "I was thrown to the wolves. I had no guidance from management. I was not assigned a preceptor. The disdain from the other nurses was palpable. I was left to figure it out on my own. It sucked. But I'm still here."
Her response...."oh. You should have told me."
*blink* "You should have given me my 90 days review a year and 9 months ago."
Does that qualify for Above and Beyond? Do I get a trophy for "1st Place in not being eaten alive"?
At my last job, we had a program where people (pts or staff) could submit us for recognition and we'd get a free breakfast with administration and a thank you. It was a nice thought, but I hated our administration and it felt very artificial.
At my current job, we have a program where every single patient writes 5 grievances about every nurse every day. It's a lot of fun.
You could've used that as an opportunity to guilt trip them for the duration of the breakfast about policies that affect care quality.
Yesssssss... someday, they will print your face on hospital funny money... "Oh, looky looky! I got a Klone dollar! Now I can get that Diet Coke I've always wanted!"
klone, MSN, RN
14,857 Posts
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?"