Whenever I experienced problems in my life, my father used to say, "To solve this problem, start by looking in the mirror."
Nursing is a great profession and we should all be very proud of what we do. Nursing is the backbone of healthcare, try running a hospital without them--doesn't happen. Nursing is the largest, single profession in healthcare and has more power than we realize, like a "sleeping giant."
When I reflect on my experiences as a staff nurse and in hospital administration, there are some things that stand out. The old phrase "nurses eat their young" is very true in many ways. How many of us have worked on oppressive, negative nursing floors or units? The gossip, character assassination, complaining, whining, refusing to help each other out, lack of teamwork, more patients than you can handle, nurses writing each other up, etc., etc. What new nurse would want to work under such conditions?
As I have said before in many posts, the culture and atmosphere of a nursing unit and department starts with the nursing leadership. I can tell you that hospital administration depends on the nursing leadership to tell them what is needed. If the nursing leadership lacks the skill, knowledge, or general where-with-all to EFFECTIVELY communicate nursing needs then we will get what we have now. The old "bleeding heart" soap box just does not work. Hospital administration looks at numbers, you have to communicate your needs in numbers and show how nursing contributes to making the numbers. Nursing does in fact contribute to making the numbers but "nursing" has failed miserably to portray itself as a generator of revenue and not a mere consumer of resources.
It all starts with the nursing leadership. Staff nurses are generally just too busy and exhausted to jump into doing things of substance, on the job, to advance the profession. This responsibility rests on the nursing leadership--that is the nurse managers and DONs. Improving nursing and advancing the profession has to start at a grass roots level, one hospital at a time, right in your own backyard. The ANA is not doing it for us, no one will do it for us--we must do it ourselves.
If you are a burned out, tired, walk around with a cup of coffee, complaining about management and complaining about the new nurses who just don't want to work kind of manager--please do us all a favor and resign. Likewise, if you are the kind of nurse manager that insists on everyone knowing that you are in charge and create an oppressive, intimidating, negative culture--please do us all a favor and resign. If you are a nurse manager that really cares and is passionate about what you do then help your staff succeed and create an atmosphere that is positive, energetic, professional, and will ATTRACT people, not run them off!!
DONs--please learn how to communicate effectively with administration--know the overall numbers and your numbers, know what drives those numbers, know how to make operational changes that will change the numbers, know how to engage in effective financial management. Demonstrate your nursing department's financial contribution to the hospital. Administrators know numbers not clinical issues. Stand up for your staff effectively. Help your nurse managers learn how to make their staff nurses successful, your success depends on their success.
We should all be more positive and proud of what we do. Our attitudes speak volumes to new nurses and people that are considering nursing. If we are negative and come across as a down-trodden, powerless, victimized bunch of people--who in their right mind would want to go into nursing?!?!
Greedy administrators run over nursing because nursing allows them too. Same with arrogant doctors. Think about what usually happens when there are not enough nurses in a hospital, they either bring in very expensive agency or close beds. Neither option is appealing and an administrator will be in very hot water with their board or corporate boss if they don't straighten it out. Creating an adversarial "us versus them" situation with your administration is counterproductive and will not help nursing, it only perpetuates the negativity that is so common in nursing departments today.
So has nursing created the nursing shortage?? I think nurses have been the MAJOR contributor to the shortage. Let's be positive and help each other succeed so we can attract people, not run them off.
This is LOUIE! That's my name, I live in Michigan, I am married, have raised 4 kids (2 adopted and met a lady with two) I mean that is who I am NOW who are you? Are you the Lvnac or whatever and entering nursing school. Congratulations
I am an old man with many nursing experiences, however I also have lifes experiences along with them and see nursing as a calling, rather than a profession or 'job.' If it indeed is a calling there would never be any debates, gossip, trying to be better than's. Trust me I KNOW! You look into the eyes of those you work with. You may not be coming on a calling, you may be one of the gossipers or want to be better than's and this is alright too.
I also have EARNED one thing if nothing else and that is RESPECT!
You are fortunate to have had a father that said words like that to you. All I wanted was to one time hear my father call me 'SON.'
But, I was taught something similar to your saying except the man that said it to me said "It is the man that says the most with the least amount of words to listen to." Know many words it took him? NONE
Now as your journey begins and I have to tell the Doctor what I need, he listens. You listen too, to the eyes you recognize at work. (hope we're on the same side little brother for it's ruthless I am)
I'm Louie
Anyone in this for money alone is in the wrong place.
I think this tread was a very good idea. Nurses do eat their young. I am two plus year into nursing and I see this all the time. It's like even the old NA's come down on the newRN's I mean what it that all about? There is plenty of stress for a new RN. Negativity from other staff does not need to be put on top of that.
I guess I am looking to go into a work environment that is positive and giving. I guess nursing is not that field. I however give to others. I help the newer RN's. I help other staff memeber. I can only change me. I have stopped hoping to change others
Of course my post is quite simplistic. There are many other players that have contributed, and continue to contribute, to the nursing shortage. Perhaps I should mention a few. Let's start with someone who has money to invest in the stock market, it could be anyone. Part of their portfolio will probably include some healthcare stocks. This investor expects a return on their investment, they expect the stock to increase in value. In the for-profit hospitals, the corporate CEO must answer to the Wall Street analysts who ask some difficult questions and point out things that are troublesome. These comments, questions, and how the CEO addresses them makes the stock price per share fluctuate. If it goes up then the stock holder and the CEO are happy, if it goes down they are not happy and expect more. Even if it goes up the happiness is only for a short period and then they want more, and more, and more, and more.
Then the word comes down from the corporate CEO and the corporate Board of Trustees--make more money, increase our strength, make the analysts comfortable, reduce our risk rating, increase the stock price, attract more investors, more growth, less operating costs, and on and on and on.
The corporate CEO then pressures the hospital CEO to reduce costs and increase profits. The hospital CEO is a businessman who is paid and expected to make business decisions and is judged on his/her performance based on the numbers. Make money and you have done a good job, lose money or stay flat and you are a failure. The hospital CEO will then look at how to cut costs and increase volume of business in the form of more admissions, surgeries, ER visits, outpatient visits, and other revenue generating procedures etc. They bring in more doctors who bring in more patients. They buy more and better equipment to broaden capabilities and reduce time spent per procedure. They renovate and build on to increase capacity and make the place look better. They initiate new programs to attract more business--thus the beloved customer service program. Then they look at expenses and what sticks out like a sore thumb--NURSING SALARY EXPENSE. They fiercely attack it spending hours trying to figure out how to reduce that expense. So they make cuts and do all kinds of things to try to reduce that expense while at the same time trying to initiate the latest nurse retention and recruitment programs and employee satisfaction programs and so on. They "allow" focus groups and employee work groups and committees to get together to solve problems and make the hospital a better place to work. They pay lip service and do not believe that educated, intelligent, clinicians will see through it very quickly.
The so called "not-for-profit" hospital does not make a profit, it only has revenue that exceeds expenses. That revenue is also invested in the stock market and other places. This CEO also has a board of trustees to answer to and he/her is also expected to increase revenue and decrease operating expenses, same scenario.
Then there is the federal government trying to reduce spending on healthcare by reducing medicare reimbursement and tightening control of all kinds of little ways to "maximize your reimbursement" thus making it harder for the hospital CEO to increase revenue. Even if the CEO can increase business volume, if it pays less then it takes more. Same with state Medicaid programs, money must be allocated annually, if the budget is in trouble then they start cutting programs, Medicaid is no exception. Then the commercial insurers follow suit and renegotiate their contracts with various hospitals and networks to pay less. Again, the CEO is faced with more challenge on how to increase profit/revenue and reduce expenses.
These are just a few of the other contributors to the nursing shortage. So how do we change this, where do we begin? We certainly can't do it all at once, can we?
My suggestion is we start by looking in the mirror. What can each and every nurse do every day to advance the profession and improve working conditions? They can have a positive attitude and be supportive of one another and work to attract people into the profession instead of crucifying new grads or new nurses or CNAs or whoever else they are lashing out at for whatever reason.
The nursing leadership is the spokeperson for the nursing service. They interface with, and are a part of, administration. The CNO or DON is supposed to be a nursing expert and have the skill and knowledge to effectively communicate with administration and make sure the nursing department has the resources it needs to do a quality job and meet their objectives, and not at the expense of the nurses doing direct patient care!!
The unit nurse manager is a key person by being in position to set the tone on the unit, to reward and recognize nurses who do good work and display professionalism. They are also in best position to identify and deal with negative, nonproductive nurses in whatever way is appropriate to stop it--including termination. Nurses that are negative, complaining, and slacking in their work are pure poison to the unit. Nurse are notorious for tearing each other down in many ways, some of them quite creative.
So one place to start that ALL NURSES can do immediately is to be positive and helpful and supportive toward each other. It is very simple, costs nothing, takes very little time, but will make a tremendous difference. If we can do this, then we can unite in sufficient numbers to tackle these other issues and other people.
You are hitting on a crucial aspect of the discord running throughout nursing. Admins really are not even looking at the "human" aspect of the "business" they are in when they make decisons. Nurses are. Thus the neverending discord. Instead of pointing the finger "as usual" at peon staff nurses maybe require ethics and humanity courses for admins. I think that might help.
Nursing is short-staffed again and although you "know" there are nurses out there looking for work somehow management just can't seem to hire anyone (after months of shortage). Morale is getting low, OF COURSE!!!
So what does management do? Do they hire new help? Do they give out raises. Nope.
Nurse management (ie corporate big guns voice box) calls a MANDATORY staff meeting. So people have to put their lives on hold and pay an extra hour of daycare when all they want to do is go home.
What is this oh so necessary meeting about? The NM is going to tell everyone that she "just needs staff to pull together and get through this hard time" and then everyone gets a little cookie with a bow on it and a pat on the back.
Meanwhile back at work 3 months later, nothing is changed and nurses are REALLY stressed and sick of the overwork and underpay. And guess what? There's another MANDATORY meeting!!
Yes, if only those nurses would just be nice and stand up straight with all the BS loaded onto their backs then nursing would be a great profession.
I believe most graduate programs that prepare administrators do require an ethics and some sort of humanities courses.
Administration is not going to take a look at itself and try to understand the nurses point of view, not at this point. The concept of "pay-tied-to-performance" is more motivating. If the CEO hits the numbers then they get a nice bonus at the end of the year. Everyone is working to get that bonus. That desire sort of cancels out much ethical and humanistic consideration.
You are absolutely correct, that discord runs strong. Unfortunately administration is in the decision-making position and usually has the power. Therefore, it is nursing that will have to adjust and learn how to effectively communicate with administration. There are many ways to do this but it takes time, effort, unity, and nurses seem to be generally unwilling to do this.
So what are you saying ainz? That nurses need to just swallow the bitter pill and act nice like little stepford nurses so admin can get their bonus?
Until the system changes the health care environment will not change. You can only push people so far before they break, and nurses are breaking from being pushed. As you said NURSING doesn't have control over what admin does. Yet you are also then saying that we should just play nice with the bullies who are money grubbing at everyone elses expense. Thats what it sounds like to me and I beg to differ.
Nursing is taking the natural course based strictly on one thing.
"LIABILITY"
Therefore, the traveling nurse or temp is the nurse of tomorrow.
Then the CEO will save millions in insurance. You will soon see the same thing happening with Docs, but there will be no room for philosophers or the weak. They will all be on ODIGO.
I believe nurses can be our own worst enemies sometimes, but I also agree with Bluenurse that there are many players in this and the solution is not simple.
We work in largely oppressive environments based on generations of accepted practice. It ain't gonna change overnight. Personally, I have been as outspoken as I can be in my career and still BE a nurse, due to the troublemaker label.
It is real and it is used against us effectively in controlling our collective voices.
IMO, if we can't effectively organize and speak 'in one united voice' about ANYTHING we will never be able to make things better.
Until then I do the best I can in my unit, on my shift, with my coworkers and patients...to be the best I can be in very imperfect situations that are NOT under my control. I'm OK with that and refuse to assume some mass guilt about the dire straits this profession is in.
One problem with nurse managers is that most of them are not educated as managers, that is to say most nurse managers come up through the ranks, are strong clinically but do not have formal training in business. They cannot talk the talk of administration and do not really know modern business practices on how to manage employees. Trying to learn the business of health care management on the job just won't cut it any longer.
If nursing leadership want to do something for nursing it could be insisting that managers get this type of training by offering it, financing it, making it mandatory for managers to have credentials in health care administration before becoming managers.
Interesting post, we_rn. I've been watching this thread but not joining in because I haven't been sure of what to say. Sure, I know that there are some bad managers out there, but I also know that there are many good ones -- nurses who have stepped up to the plate to try to lead their units or hospitals and do the best they can. Most are given very little support from their upper level administrators and given even LESS support from their staffs.
In many cases, the middle-manages are in the most stressful positions in the hospitals because they get dumped on and squeezed ffrom both sides. As a profession, we are not going to get anywhere until we (at all levels in the hierarchy) HELP those people in the middle do their jobs instead of just bashing them.
Your idea about insisting (and supporting) them to get the best educational preparation for the job raises a whole lot of interesting questions.
There are many valid points here, and I find it difficult to pick which direction in which to respond.
I agree that the middle manager, highly stressed and squeezed from all ends can make or break the culture of a department.....but it's tough to offer rewards when there is no money budgeted to do so. Our salaries are not so great that we can afford to spend from our own pockets too often either, although we do.
The manager should have the educational preparation for the job, before taking it....there is not much time for that vast body of knowledge called management when you are just running to stay afloat. If you don't have it up front, even reimbursed education is difficult because we are exhausted at the end of the day too and frequently just want to go home.
We in nursing management really try to do our best to motivate, reward, educate, discipline,set standards, assist with system issues, pitch in with patient care, support staff with a variety of issues, staff the unit, meet budget, get to meetings to get information to share, hold meetings, write minutes, prepare for site visits by regulatory agencies ....while trying to maintain our sanity.
Many nurses get advanced into management because of clinical expertise and a desire to improve things, and they get those jobs because there are not many qualified applicants who already have the educational background, and they have to learn as they go. To borrow from business: we are victims of the Peter principle-advanced into a level of our own incompetence.
The problem is, that it takes so long to get a fully qualified manager that there is no real orientation for many. The position has been vacant before you get it, and there is no one to really teach it to you. As a middle manager, I try to share information and knowledge with new managers, but don't have much time to do so and find that frustrating.
The unit staff suffers because the new manager has no idea how to help fix things, and the promoted staff nurse frequently does not want to rock the boat with previous peers who are friends in the unit when it comes to behavioral issues.
The causes are many and multifaceted. I dream of a day when each manager is assigned a "buddy" when hired, and just because they are hired into a position it does not mean they are ready to fill it. The person who has been covering the department administratively should continue to do so for at least 3 months. The new manager should have a structured training progam. The staff in the units should be aware that this new person, although nominally their "boss", is not yet responsible for the unit issues but is in training. If new managers had this level of support-in the long run they would be better able to deal with issues and the unit would be happier.
It's really hard to be a motivator when you feel like the life is being sucked right out of you. We all feel it, regardless of expertise. The newer managers feel it worse. I am an experienced nurse manager, and took today off. Why? Because I was feeling more negative than my staff and needed to recharge my batteries, otherwise I would have infected my staff. One problem with that? It doesn't seem right that I should have to waste a vaction day when I already worked >50 hours this week before Friday......ah the life of a salaried individual.
Louie18
176 Posts
This is LOUIE! That's my name, I live in Michigan, I am married, have raised 4 kids (2 adopted and met a lady with two) I mean that is who I am NOW who are you? Are you the Lvnac or whatever and entering nursing school. Congratulations
I am an old man with many nursing experiences, however I also have lifes experiences along with them and see nursing as a calling, rather than a profession or 'job.' If it indeed is a calling there would never be any debates, gossip, trying to be better than's. Trust me I KNOW! You look into the eyes of those you work with. You may not be coming on a calling, you may be one of the gossipers or want to be better than's and this is alright too.
I also have EARNED one thing if nothing else and that is RESPECT!
You are fortunate to have had a father that said words like that to you. All I wanted was to one time hear my father call me 'SON.'
But, I was taught something similar to your saying except the man that said it to me said "It is the man that says the most with the least amount of words to listen to." Know many words it took him? NONE
Now as your journey begins and I have to tell the Doctor what I need, he listens. You listen too, to the eyes you recognize at work. (hope we're on the same side little brother for it's ruthless I am)
I'm Louie
Anyone in this for money alone is in the wrong place.