How much for your soul? (This is very long.)

[workingforskies]

This is an open ended, rhetorical question for anyone who is in management that used to be a regular staff/floor nurse. This is for those nurses who used to be one of the girls and who would get their butts beat down in the trenches on a regular basis alongside his or her coworkers and who then accepted positions of leadership such as charge nurse, nurse manager, dept. head, administrator etc..

I have to ask collectively, what happened to you? Why did you sell out? Was it really worth the few extra bucks thrown your way? Or is it that you are so insecure about yourself that the crumbs of power thrown your way along with your meaningless title somehow make you feel better about yourself?

I keep hearing about how the costs of healthcare have risen 20% every year for the last five years now. But relative to inflation, my overall compensation has actually dropped a bit when you factor in increased deductions for my benefits. Therefore, I think I am quite right in saying that the rising costs of medical care are not my fault. Yet somehow, I am the one who is being asked to make up for those rising costs in the form of increased patient loads, having to do more work with less resources and being basically told to shut up and be a "team player" lest someone else need to be found who will do the same work with a smile.

Whose idea was it to shift the burden for data entry to the nursing staff under the guise of "computerized charting"? When you tell me it is computerized charting, what that means to me is that I chart my assessments, interventions and outcomes on a computer as opposed to on paper. Instead, what I am finding, both from my own experience and from those of my peers is that we now have to do both because there is no way I can explain to a jury what I saw, what I did and what happened as a result of my observations/actions using the computer programs you are forcing me to use. Although, I am sure there are more than a few coding and data entry specialists off your payroll now. When you were a floor nurse, would you have been dancing around, bubbling with excitement about having to essentially do double charting? Then why are you so surprised that I am not?

Have you not realized that as medicine has become more advanced and specialized, so too has nursing? When you were working on the floor, were you comfortable with having a co-worker who only works in an ER setting and had never even been orientated to your unit? Were you comfortable being floated to a critical care setting when you had no critical care experience? This attitude and mentality that an RN is an RN and can do anything required of an RN is just insane. Having an ER nurse float to a dialysis floor with no experience is akin to having an ENT doctor working in the Cardiac Cath. Lab for the day. It is unheard of. It would not happen. Yet it is just fine and dandy for your RN's to be shafted like this. Don't you remember when that would happen and you would roll your eyes, shake your head and complain to the brick walls above you wearing the suits? Now you are in the unique position of having a say about things like this, you're the one wearing the suit and yet you do nothing! Is there a part of you that still cares?

When your boss tells you that in order to save money, support staff will be cut and your nurses will have to pick up the slack, why do you roll over and say nothing? Remember how annoying it was when a housekeeper would call out sick on your shift and you would either have to hide the messes or simply clean it up on top of your regular patient care responsibilities? Then why is it that you are OK with the wholesale cutting of support staff to save money and shifting that burden to the nurses. I know that you have responsibilities to your bosses and to your budget and I actually do respect that. But, just as you work FOR the people above you, remember that you also work FOR the people below you as well.

Nursing is consistently ranked as the top most trusted profession, not only in this country, but in the world. And for good reason. For most people, the word "Nurse" implies a trust and a sacred bond. Peoples lives and wellbeing are quite literally in our hands. From my own personal perspective, I feel that I have a duty to uphold that perception of trust for the sake of my chosen profession. I find it abhorrent to have to do anything that may lessen that perception in the eyes of the people I serve. I have very serious concerns when I am told that I need to do things like collect billing, contact and insurance information or I need to escort the patient to a co-payment collection desk, even if it is at the end of their visit. I see the possibility of people then wondering where my true loyalties lie. Is it to the patients wellbeing or to the account's receivable department? Can you, as a boss, at least see where I am coming from on this? Or is that twenty bucks really more important than the trust that has been painstakingly earned over the last century? I still remember back to my nursing 1 class when I learned that even up to the mid 1800's, whores and hookers who were convicted in the courts were still given the option of 6 months in jail or 6 months labor in a hospital as a nurse.

When did public relations and marketing become a larger part of nursing responsibilities? At my soon to be former hospital, the nurses are required to make follow up calls within 24 hours of a patient being discharged. I was told we have to do this because it has been proven to raise scores on patient satisfaction surveys. So in essence, you are not interested in the patient's opinion of their stay here, your are interested in their overall perception of our facility in general. Basically, you are just peachy in "queering up" the numbers as long as they look better in the end. Looking at this from a broader sense, to what end does that accomplish? Say you do eventually get the high score, say you actually find yourself ahead of Mr. and Mrs. Jones, what do you win that justifies whoring out your nurses for cheap and tawdry marketing gimmicks? Getting back to the point of this rant, would this have been acceptable when you were working on the floor? Would you have rolled out of bed and celebrated the fact that on top of patient care, you also got to call back all the patients you discharged yesterday? I didn't think so.

Along with that pay raise and your added responsibilities, you were also given a title when you moved up the ladder. Remember when one of your co-workers was promoted and then morphed into a complete jerk who could not be approached or questioned lest you be accused of being disrespectful? Is that you? Because if it is, I will remind you that while I do have to give at least a token amount of respect to your title, I do not have to give you, personally, any respect what so ever. If you want respect, you have to earn it. Don't worry, it really is not all that hard to do. I would suggest starting by respecting the professionals you are charged to provide leadership for. You have no idea how far basic human respect and courtesy go.

Do you recall how hard it was to get your license? Remember how precious it was when you got it in your hands? Remember your more seasoned co-workers telling you to be careful in what you do so that it may not be suspended or revoked and wondering and even being a little anxious about that? I certainly do. Now that you are above that, why is it OK now, for you to put those licensed professionals below you in precarious licensure situations by winking at dangerous staffing levels, decreasing support and eliminating resources to save money? Before you think to yourself that you are not that type of manager, I will ask you if you are willing to personally take responsibility for those cost saving measures? If you are, good for you! But until I see, in writing, a policy stating that those in charge are fully and solely responsible for situations that arise from those cost saving measures, then you are little more than a blowhard hypocrite in my eyes. I know that, should push come to shove, you will be the one signing the letter that details my incompetence to my nursing board. You will write how I neglected my patient to their detriment and conveniently omit the fact that you were the one gave me a 10 patient, high acuity assignment with little or no help. And to hearken back, yet again, to the point of this, were you cool with situations like this when you were faced with them on the floor?

From my overall perspective, the problems now in nursing can be traced to two main things. The great redesign debacle of the 80's and 90's where experienced and seasoned nurses were forced out in favor of younger and cheaper nurses and their wholly inadequate support staff. This caused 2 ill turns of fortune in our profession. It embittered a lot of experienced nurses who were forced out of their good paying jobs and in which they were expert in doing. Even to the point where, by word of mouth, they discouraged many younger people to avoid this honored profession. It also led to early burnout and embittered those left behind who were expected to take a huge responsibility with ridiculously inadequate support. We are paying for that not only now but will pay for it for a for a long time to come. The other thing currently conspiring against nursing is the influence of HMO's. To that end, don't blame me because you, the hospital administrator except below cost compensation for the care that is provided for their paying customers. In my opinion, the 20% annual increase in health care costs, in large part, are going mostly towards Wall Street in the form of profits, dividends and excessive compensation. I would like to avoid terms like pillage, profiteering and exploitation but no better ones come to mind.

Do you see the common denominator in my perception? They way I see it, more and more, patient care is being dictated by accountants who have never touched a patient in their lives save for reaching around them and grabbing hold of their wallet. Why is it that way? Why do you let that happen? Why do you go along with everything they say? You, my former comrades in arms, are increasingly acting like little more than the impotent, minion mouthpiece you have collectively become. Increasingly, selling out your own.

If, dear boss, this is you, may you choke on those 30 pieces of silver you sold your passion, loyalty and very soul for. I may be overworked, unappreciated and underpaid, but at least I can still look in a mirror and see a person of integrity staring back.

[workingforskies]

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[ShayRN]

Wow, I actually feel sorry for you. There is a whole lot of anger in that post. Glad you have your integrity.

[jellybean_1]

You know what some people will certainly say....Be happy , you have a job.

Not what you want to hear....Once you get into management, you become someone else, you follow what is in the "Book of Managements".IT explains every steps to follow and gives you answers on how to deal with staff.

They are "Yes Man", I prefer being me.Ok sarcastic...After all the tears I am still working full-time and do not worry about management...do not care...

[LeahJet, ASN, RN]

That was a powerful post. I do not think it is angry, only truthful and sad. I honestly believe the reader's take on this post will be directly related to the experience and/or number of years as an RN.

I consider myself to be very positive and I do love my chosen field of practice..... however, the OP is right on target.

[UM Review RN, ASN, RN]

From what I've seen, the manager actually has very little power. Our manager can shout to the skies that we need more staff, but what will happen? Nothing. Or, if she consistently defies TPTB and goes overbudget enough times, she will be terminated.

Great choices, hunh?

Until the REAL powers-that-be are convinced that their agenda of "good customer service" necessitates a generous staffing grid, we nurses will continue to deal with these dangerous practices.

FWIW, I refused to go to a local hospital for a procedure precisely because the nursing care was not up to where it should be. How did I know that? By word-of-mouth and by checking their postop infection rates.

I went to the other hospital and had a good outcome. Patients at the hospital I rejected did die having the same common procedure.

Maybe hospital administration needs to hear a few stories like mine. Maybe the general public needs to be made more aware of how to choose a good hospital.

It's obvious that nurses are not being heard on these issues--up to now. But this is a new day. There is a more informed consumer out there. There is better media coverage of nursing issues. We just need to keep these issues in the forefront of the public mind.

[workingforskies]

I am really not angry. Just frustrated. But so you know, there is no place I would rather earn a living than at the side of a bed. I still have way to much fun doing what I am doing. It's all the other crap piled on top.

As far as management, I applied at one point earlier in my career. I was told that I was going to have to toe the party line and sell to the staff what ever flavor of the day BS that was rolling down the hill. My reply was thanks, but I was sure there were other, more suitable candidates. I have not looked back since.

The bottom rung managers can make a difference if they stick together. But they don't. To much ego and ambition. Whatever.

Anyway, I am grateful for this forum where I can spout off, rant, vent, etc.. It's nice to get the proverbial group hug from a bunch of kindred spirits.

[99_99africa]

Hope you feel better after the rant? My unit manager is faced with the same problems and her job is always on the line. We face yet another problem as to teaching whoever comes through the door. Big mistake! People who did not even think of nursing are recuited in certain areas, and told 'the state will pay for them'! The nursing council will not drop their standard so we have a high failure rate. We need to take people who are inadequately skilled (perception of right or wrong), have no motor skill or cognitive skills and turn them into nurses, so smile please and know someone is worse off than you are.

[ShayRN]

I like to think in my one year as a nurse coordinator (assit. manager) I have made some postive changes on my unit. We weren't staffed for 32 beds, so the manager, dayturn coordinator and I balked until we got 8 of them closed, now we are down to 23 beds. The absolute WORST part of my job was being part of the deciding factor that made 5 people displaced from their positions because we shut down those beds. I lost a lot of sleep over it. In the mean time, TPTB were calling my manager to the board meetings because of the over time to staff those beds that they made us open. Did I mention the PERSONALITIES that I have to deal with on a day to day basis? The RN's who think they are better than everyone and literally drive the aides to tears with their constant demands? The aide who thinks she is a "nonliceansed" nurse. The nurses who scream at each other in the nurses station? How about the patients and family members who are rude and obnoxious that I must do/say whatever necessary to protect my staff. Try being on the other side for about a week and you will see why we get so irritated. The petty crap that goes on affects us as well, but we get it from up top and below. Why do I do it? Because I like feeling I am making a difference for the NURSES on my unit. I try to make an atmosphere that is professional, while being enjoyable to work every day. Maybe if your manager is that bad, it is time to move on.

But to answer your original question, my soul isn't for sale. At any price.

[Sheri257]

I keep hearing about how the costs of healthcare have risen 20% every year for the last five years now. But relative to inflation, my overall compensation has actually dropped a bit when you factor in increased deductions for my benefits. Therefore, I think I am quite right in saying that the rising costs of medical care are not my fault. Yet somehow, I am the one who is being asked to make up for those rising costs in the form of increased patient loads, having to do more work with less resources and being basically told to shut up and be a “team player” lest someone else need to be found who will do the same work with a smile.

This is so true. After you adjust for inflation, nursing pay has only increased by $360 per year in the last 20 years. So ... that's only an extra $30 a month which is easily wiped out by increased benefit deductions.

Yet, every time nurses ask for a pay raise, they're told they're going to bust the healthcare system. That 20 percent annual increase in healthcare costs is not going to nursing salaries. It's going to hospital profits.

The hospital with the lowest nursing pay in my area charges double what other hospitals charge for patient stays ... $10,000 a day versus $5,000 at other facilities. Yet, they claim there's no money for nurse pay raises and that they will go out of business if nurses get a raise.

It's just wrong.

[Messink]

Those are exactly the reasons why I plan on never going into management and I'm only a first year nursing student.

[Bipley]

I have to ask collectively, what happened to you? Why did you sell out? Was it really worth the few extra bucks thrown your way? Or is it that you are so insecure about yourself that the crumbs of power thrown your way along with your meaningless title somehow make you feel better about yourself?

Don't paint us all with such a wide paintbrush, not all are like that.

I went into management because I was foolish enough to actually believe I could make a difference. I *did* make a difference in a LTC setting but to try to be positive, do the RIGHT thing, actually do my job in a hospital setting, I don't think it can be done in many hospitals.

I was also foolish enough to believe that part of my job as a manager was to defend the nurses when they screwed up too. Yeah, try that once for yourself. Defend a nurse that just made a stupid, yet human error. We all know it happens to all of us, when the nurse feels like a piece of pooh is it appropriate to stand there and scold her like a little child? No, it isn't. The way she feels about her own human error is punishment enough, that error will likely keep her from making a similar mistake. But when you refuse to fire someone for a human error that we have ALL done it suddenly becomes an issue of... well, you didn't do the same for me! You play favorites, Bipley!

There is a world of difference between a med error vs. coming into work so hungover you can't perform your job well. One is an honest mistake and the other is a total disrespect for your profession, patients, and coworkers.

You know, there are two sides to this coin. It's easy to point fingers at the manager/DON, it's quite a different story when the blame is put where it should be place. That would be all of us. Being a manager is like having a severe case of food poisoning, you are attacked at both ends. In a hospital setting you are attacked by nursing and attacked by those above you. Either way it is a no-win situation and I think most who go into management do so believing they can actually make a difference. When you experience your 10th to 12th episode of management food poisoning you finally give in and say enough. Then survival kicks in. You put your foot down, you tell them how it is going to be, and if they don't like it they can move on.

I used to be soooo angry, I would keep my nurses up to date on what I was trying to do. My long term goals, how I was trying to do it. It was never fast enough for them or good enough. *I* was blamed for every bloody decision by hospital Admin. If they didn't get enough of a cost of living raise (merit raises aside) *I* was personally to blame. WTF? What say-so do I have in cost of living raises? Hospital costs? And speaking of hospital costs be honest here... how many have slipped something in your pockets and taken it home? A course of PO abx's? TEDS? Saline? Read these very threads. There was a nurse on another thread (regarding support stockings) that admits she just takes hers from the supply room. Any clue how much this happens? Used to be that we couldn't keep Augmentin in the Pyxis. I'd go to give it and the Pyxis would say there were 40 and there were actually none. Not even enough for ONE dose for the patient who is actually paying for it. We finally had to increase our narc spaces in the Pyxis and put the drugs that were stolen in narc spaces to keep a closer eye on them. What about wasting supplies? We ALL have a hand in hospital cost, some have more of a hand than others. That's all.

Then there is the good buddy system. When I was a staff nurse "X" was my friend. But she took advantage of our friendship and thought she could get by with calling in sick every Monday or Friday. Just how much of a merit increase should she get? You tell me, how much of a merit increase should she get?

You are short staffed? Yeah, so am I! I have a full time job doing what I do but when my "friends" call in sick, who is there to replace them? Yeah, that would be me. Don't talk to me about being short staffed, I'm busting my tail to try and help and then I stay another 4+ hours daily to try to make a dent in my own work.

Then while I am covering for my "friends" while they are calling out for the 10th time of the year all I hear is whining and complaining. The hospital is terrible, I need a raise, I have too much work, too many patients.

Yeah, so do I.

I've asked for help, I've asked for more staff, I've asked, demanded, and insisted on more staff for better patient care. Let me tell you what goes on in the meetings for managers, we are told this is how it is and it isn't likely to change. Tell your nurses this is all the budget will accomodate.

I keep hearing about how the costs of healthcare have risen 20% every year for the last five years now. But relative to inflation, my overall compensation has actually dropped a bit when you factor in increased deductions for my benefits. Therefore, I think I am quite right in saying that the rising costs of medical care are not my fault. Yet somehow, I am the one who is being asked to make up for those rising costs in the form of increased patient loads, having to do more work with less resources and being basically told to shut up and be a "team player" lest someone else need to be found who will do the same work with a smile.

Ohhhh, so you are a manager too! Do you think I am getting $20K annual raises merely for being a manager? I likely make about a dollar or two an hour more than you for 50% more work and hours.

I want to know what your manager has to do with this. How is this his/her fault? That IS who you are blaming so you tell me how this is your managers fault. I don't think you realize it, but you just proved my point beautifully.

Whose idea was it to shift the burden for data entry to the nursing staff under the guise of "computerized charting"? When you tell me it is computerized charting, what that means to me is that I chart my assessments, interventions and outcomes on a computer as opposed to on paper.

Yes, that is correct. That is the idea behind computerized charting. Again, may I assume you are blaming your manager for computerized charting? We are told what to do, our job is to pass on the information to you in a way that doesn't seem like the end of the world. We can get into a screaming match and I can tell you to suck it up because this is how we will ALL be doing it or I can try to present it in the most positive way I can. Do you really think I am any happier about these issues than you are? Com'on, you are not being fair here.

Have you not realized that as medicine has become more advanced and specialized, so too has nursing? When you were working on the floor, were you comfortable with having a co-worker who only works in an ER setting and had never even been orientated to your unit? Were you comfortable being floated to a critical care setting when you had no critical care experience?

I never did that as a manager, perhaps that is why I worked such long hours. If your hospital is putting people in your critical care units that are not qualified, why are YOU still working for THAT hospital? It's a two way street.