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.

All the "above and beyond" stuff from up the food chain is crap because the real "above and beyond" is a spontaneous manifestation of one's humanity and connection with another.

I ran into one of our peds nurses in the cafeteria where she was buying an expensive pre-packaged piece of cake. She told me that one of her patients was having her birthday that night and she was trying to brighten her day (night).

You can't script or force this stuff... it either happens or it doesn't...

And I wish management would just leave it the the eff alone. Somehow, their presence in this just sullies it... it goes from genuine compassion and caring to a Blue Light Special...

[Ethicsrn4life]

The initial thread is a testimony to trying to bring a light to the multide of issues that nurses are asking to do.

All the posts are accurate ie nurses with so much responsiblities and asked to do more that is unrealistic, unobtainable.

You also have nurses that are lazy and would rather delegate in the sense of relinguishing responsiblities vs delegating and making sure those duties are done.

Caught between administrators who understand what is going on and still cracking the whip, and patient needs.

Now that the isues are being identified what are we going to do about it?

Administation will not be moved by conscience they have used manipulation, coercion and other adverse tactics to get the job done, and we get in done in most cases.

We dont have advocates or anyone interested in understanding the culture of nursing.

Nursing responsibilities NEVER end we lack authority to be able to say what is safe and realistic. There is no other profession like this one.

If we ask to be paid appropriately , it is frowned upon if we ask to work in safe facilities we are admonished for it and asked to pull together as a team and get it done.

Physcians dont have these issues in their profession. Why? People think they deserve whatever they ask for Why?

Because they have a culture of respect as professionals who do not see themselves as well trained volunteers. They have an identity separated from other identities. They are a male dominated culture who would never allow themselves to fall prey to manipulation, coercion.

This profession needs to have an identity and be able to set limits and evolve from a culture of volunteerism to a culture of trained professionals who warrant major changes in order to do y their jobs safely, opportunities to grow, limits.

One thingthat has always concerned me was why are nurses demanding UNIONS. They are not perfect but nurses should decide what that you union should represent. Patient quotas, safety practices enforcement of delineation from other groups ie NURSES are professionally trained people with a liscense(they are not MAs CNAs, are other groups that are allowed to be called nurses.

The culture of nursing has to change within nursing because we are our on saviors

Our salaries should be commensurate with our expertise an experience. What profession that is not female oriented allows for the same salaries for an inexperienced nurse vs one with 20 yrs , the anser is none.

Please understand i am not blaming nurses for the mess that we find we are in, but we are not fighting we are settling.

There are too many talented nurses out there who understand the is d ues very well and also know how we can tackle the problems.

We need to be involv r d in legislation to promote the growth of nursing to enter into the 21st century.

We have the numbers but e e first have to start with changing how we see ourselves. Are we wortwhile in our training, expertise, education to be treated and respected in the level of responsibilities we are given?

We care for people's lives and their families/support systems ii is the highest of responsibilities and honors, but we allow others to tell us what we are worth, what our limits are, and we allow coercive techniques to be utilized to get us motivated. Ridiculous huh? Think about how ridiculous it is that it has not evolved.

We motivate ourselves by entering the profession, we go into specialty areas of interest then what.

Education for nurses have become extinct, salaries are not consistent with responsibilities, unsafe practices like working chronically understaffed.supplies unavailable and numerous other problems that are not being appropriately addressed.

Can we afford not to be moving forward because if we are affected our work is affected.....patients.

Thank you for the initial thread s nd you are not complaining. You just have the courage to say out loud tht those in the profession see every single day and the lack of support their is with hospital/nusing administration.

We are not living in the times of Florence Nightingale and we can no longer afford the status quo.

[divegguy1]

It's ludicrous! It's always from the Administration, of course, and WE are their lifeline. It's also from RN'S that sold out and/or have forgotten what scrubs look like. I have no no respect for a company that makes me A. Work through lunch or B. Makes me acknowledge my patients as "clients". Mamas don't let your children grow up to be ' nurses' .( It'll never change! ). Overworked, underpaid but still happy somehow-- thanks for the post! Katie-- in Marietta Ga.

[divegguy1]

Pinkturtle56.. Who sits where you work?

[wooh, BSN, RN]

There's a sign on my unit that says something like, "We're the best unit because we give the best customer service." Ergh.

Here I thought we were the best unit because we give the best nursing care. Stupid me.

[duskyjewel]

Spitball it. I dare you.

[joanna73, BSN, RN]

Perhaps they might hire more staff so we could go "above and beyond." Instead, the few minutes we do have need to make an impact.

[dec2007]

I'm sad to say that it is impossible to "go above and beyond" at my institution as nothing nursing does, no matter how great, is ever enough.

[armyicurn]

The lazy bastards that I have in my ICU claim that they qualify for the "Above & Beyond" just for coming in for their scheduled shift! They already know that their annual evals will not be what has been for their past 25 years, a pencil whipped "Excellent" rating.

Sometimes those oxygen deprived management geniuses get my MAP >100!

[Melfldrn]

"I feel every shift that doesn't end in me strangling a random administrator is a day I've gone above and beyond."

I'm dying! Lol!! I always say, it's a good thing I'm on night shift because I would be fired if I had to deal with our 26 yr old Barbie doll administrator every day! Ugh!!

[javmrn]

Upper level management is all about the money and press ganey scores and edcaps and hcaps. In other words all about the money. But America has become a demanding society. Nurses are no longer permitted to just do their jobs and take care of patients. Now we have to please everyone all the time. If the ER is full and the doctor is taking care of a cardiac arrest. The patients in the waiting room feel that it is oK to treat the triage nurse like a second class citizen ; it is ok to be rude and ignorant. And if the toothaches and back aches don't get their dilaudid or oxycontin for their "terrible" "10" pain while they play on their cell phones. They feel it is within their rights to complain and get an apology from ER/hospital staff!!

[Lazydaisy]

That last bit is part of our scripting. Yay, scripting.

"I have the time." is part of our scripting too. Along with "I want to provide EXCELLENT care to you" and "Thank you for allowing me to provide EXCELLENT care to you." Love those Press Ganey scores.

My hospital used to give 'bucks' out for things. We had coins worth a buck to use in the cafeteria and buck ones that you could cash in for $20 gift cards once you got 5. But times got tight... Now each patient gets a letter from the hospital foundation that states if an employee did an exceptional job for them, they may donate money to the foundation in that person's name.