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.
