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.
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I would've given him a hospital scrub top!
As would have I had such been available... Which they're not at any of my 3 hospitals.
I also wouldn't drive any pt in my car anywhere. My luck, I'd be in a fender-bender, and the pt would ******* sue me! I would consider giving them cab fare, though.
This was a trip of over 200 miles. At some point, the impetus to do the decent thing outweighs the fear of unlikely negative consequences.
I don't blame management necessarily because I find a lot of managers and directors have served their time in the trenches and are pretty reasonable. They're also getting this stuff shoved down their throat by the people above them. The worst part is it's always the patient's and family members that insist on you going above and beyond who don't say thank you. Like "oh you can't wipe him with the cold wipes, get the ones from the warmer" I'm thinking well the warmer on my unit's empty but I guess I'll drop everything I'm doing walk to the other side of the hospital to find a warmer with wipes mostly so you don't tell the charge nurse or the next nurse that I'm terrible. And of course they don't say thank you it's more like "yea he needs those not those other ones you had"
Trust and believe, the posters didn't last long, at least not on my unit.
I am of the opinion that campaigns of that nature are the result of an extraneous administrator attempting to validate the necessity of their position.
"I shouldn't be the one who gets laid off. I'm the one who implemented the 'Nursing Staff Going Above and Beyond' project!"
OR the more likely...
"I deserve another raise and/or promotion. Not only am I responsible for improving the health of our employees by putting up fliers near the elevators encouraging them to take the stairs and sending out mass emails with healthy living tips such as 'Try eating fruit for dessert,' it was ME who was in charge of the 'Nursing Staff Going Above and Beyond' project!
...."and I shall take my bonus now, for instituting 2 projects in the last 6 months, thank you!!"
or
"See, cause if all of the nurses on my unit go above and beyond, I do not have to hire any more of them!!"
I am of the opinion that campaigns of that nature are the result of an extraneous administrator attempting to validate the necessity of their position.
Perfectly put.
I think the very existence of jobs like this play a huge role in the high cost of health care. And serve as proof that the free market isn't as efficient as we are led to believe. Its full of useless people creating the illusion that their useless position is somehow necessary. Just as much as any government bureaucracy.
Fire all the extraneous dead-weight and use the money to hire more nurses and aides. Not saying upper management is uneeded. But all the administrators buzzing around thinking up slogans and going to meetings and making little power points?.... off with their heads.
To me, being required to go 'above and beyond' pretty much negates the whole concept, which is doing something you don't have to do but are willing to put yourself out for to help the patient or the team. When a person is pushed into it, well..it's no longer above and beyond, but a job requirement. Same thing when our hospital changed to a new corporate model and we had to attend an orientation meeting and sign a statement saying we would exhibit the coporate values of compassion, dignity, respect, etc etc. Our meeting turned into a riot with lots of shouting and waving of arms. We told the facilitator that since we were being told we had to show those values 'or else', how was the hospital system showing the employees those values by forcing them to sign something or lose their job? Well, there was no good answer to that.
I treat my patients how I would like to be treated. I listen to them and respect their preferences whenever it's possible. My patients like me. Nobody cares.
I used to work for a hospital that gave out little gold keys whenever a patient complimented you or you did something else 'above an beyond.' I never got a one. The same few nurses had dozens. Their secret? If a patient said, "hey thanks you've been a great nurse tonight," they handed them a card and said "would you mind filling this out for me?" Gross...it's like kindergarten. You get a feather in your Indian Chief hat by coloring in the lines and not hitting anyone at recess. Two feathers for being a hall monitor.
I don't understand why administration would encourage staff to transport patients in their own private vehicles. I'm not talking about MIMH specifically, I have heard this a few times over the years cited as "Wow! Look what so and so did. So above and beyond!" It's so risky, and in my opinion takes the nurse/pt relationship over the border of what's appropriate. Pretty much out of the question for a female nurse/male patient or vice versa.
I do nice things for patients. One LOL was reciting an old poem but she couldn't remember the end verse. I googled it, printed it out, and made her day. She was thrilled, I was happy to help. I don't need a plaque.
Another place I worked had a big above and beyond campaign where you would get your glamour shot taken and posted on giant screens in the lobby with a description of what you did. A whole team of nurses from the ICU was selected once, and on picture day they were transported from the hospital where they worked to another hospital where the picture taking was to occur. A few of them were assigned to patients on the unit that day and had other nurses "watch" their patients for them while they were gone. They were off the unit for over 3 hours. You can guess how the nurses who were left behind felt about that situation.
For school, I just printed out two articles. One is on patients' perception of safety--what makes them feel safe in nursing. The other is oncology patients' perception of a good nurse. Here are the APA citations, if anyone is interested.
Lasiter, S., & Duffy, J. (2013). Older adults' perceptions of feeling safe in urban and rural acute care. The Journal Of Nursing Administration, 43(1), 30-36. doi:10.1097/NNA.0b013e3182786013
Rchaidia, L., de Casterlé, B., De Blaeser, L., & Gastmans, C. (2009). Cancer patients’ perceptions of the good nurse: A literature review. Nursing Ethics, 16(5), 528-542.
To me, the patients' expectations were realistic and expected of a nurse. However, delivering this expected care that patients deem "exceptional" can be difficult for even the best nurses at times, given the acuity of the patient group that day, the enormous amount of duplicative charting we have to do, and, of course, catering to the whims of the diva on our assignment that day.
As one poster said, going "above and beyond" every shift is temporally impossible, even for the best of the best. Maybe administration just needs to have the cajones to address the nurses who continually barely do their jobs that leave plenty of time for Facebook and texting.
Whew! That's a relief!
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