Magnet/Primary Nursing Vent

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Hello!

The hospital I work at has been implementing the new care model Relationship Based Care with Primary Nursing being the center. The hospital is also reaching for Magnet Status. We recently had the surveyors come to the hospital, and our document has passed with flying colors.

Personally, I loathe both processes. I am a fairly new RN, only about two years out of school, naive in the idea that I would be caring for patients instead of working on committees and completing paperwork and being a "foot-licker" to outside surveyors and administration.

I think Magnet is a complete parody. I believe the true issues in nursing involve not having the time needed to do our jobs, low staffing, sometimes inadequate pay, and little to no respect from other healthcare professionals/administration and often disrespect and dislike from the public and our own patients. I am so disappointed that so much money and effort goes into a process that I believe to be a fallacy. It, so far, has not improved anything within my work. Instead, it has made me feel like a toy utilized to gain the "company" of the hospital a status that will bring them more revenue and allow administrators to boast to others. I work more hours on committees while maintaining my regular 40hr work week on the floor, and am expected to be the perfect, non-complaining employee to individuals who come and inspect our hospital to decide if we deserve this so-called Magnet Status. The process has gained nothing for me personally, the floor RN, the person whom it is supposed to make the most benefit for.

I also find RBC or primary nursing to be irrelevant to my practice. It was presented to our Unit Practice Council not as a choice, but rather as a requirement. I'll never forget our Patient Services director stating "No one has a choice in this, you all have to do this, it's going hospital wide. There is no choice." When the hired outside company came to address us personally, I was so surprised when they stated to the RN's "This is what you wanted." I was surprised because no one actually asked us what we wanted to do for our caring model. It was decided by the higher-up's that this is what was going to happen for the hospital. The entire process is lengthy, with meeting conducted with this outside company and participating in embarrassing processes that I personally felt were ridiculous and demeaned my so-called "healthcare professional" status as a registered nurse. However, I do think that the behind principles are important - creating a relationship with your patient, continuity of care, and working more towards your patient's individual requests and needs. But, I believe that my floor was already doing these things. We worked hard on continuity and all took our relationships with our patients seriously. With the RBC process all I find is that we're doing more paperwork, no increase (for me, at least) for my satisfaction, and finding myself almost having to lie in order to maintain my job status. I have addressed my issues to my nurse manager as well as the hired outside company, and all I have received back is "You're not being positive enough" or " You're a new nurse, you'll see how this will help" which all make me feel once again, not appreciated nor involved in the decision-making process for my care, which becomes linked into the Magnet process. How am I supposed to feel excited for processes that supposedly help with my "satisfaction" when things are just becoming harder and harder for me to actually care and apply my expertise in health promotion to my patients whom I am there for in the first place?

I'm sorry I wrote a book. I could probably go on forever on these topics. Thanks for anyone who actually read all of this. I would love any feedback.

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Oh, hello, we must work in the same facility.

We, too, felt we were doing the primary nursing and RBC *before* our facility spent a load of time and money implementing it. If we ask "How is this different than what we were doing before?" we get the response "You don't understand how primary nursing works. It is an entire philosophy, an attitude of taking charge of the care for the pt." Huh?

The the unit based councils are a joke. Now, if there is something we don't like, instead of management addressing it, they say "Take it back to your council." But honestly the council doesn't have nearly the authority that our management says it does. So taking it back to the council really just means forgetting about it.

I agree there are some great points to the entire RBC; it irks me, though, that they act as though this is something new. At my hospital nothing much has changed in how we care for the pts. We were already doing this; we just hadn't paid some Healthcare Management Company thousands of dollars to put a name to it

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Specializes in Critical Care, Education.

You have my sympathy - sounds like you feel not only disconnected from decisions that directly affect your practice, but are also experiencing more difficulty delivering quality care as a result of all the "improvements".

I wish I could say this is unusual. But to those of us who managed to survive the "patient focused care" mania of the 90's or the "primary care" craze of the 80's - it feels like just another healthcare 'pet rock'. This too shall pass. But in the meantime, caregivers are caught up in another flavor of the month. BTW, what kind of crazy hoopla is Relationship Based Care??? I'll bet someone trademarked that name and is making money off it.

Like you, I also believe in the principles and aims of Magnet, but I really don't think that they can be artificially injected into an organization - certainly not by hired guns (consultants). The only way clinical environments can really change is from the inside out. It takes talented and dedicated nursing leaders working alongside their staffs . . . and sometimes it takes years.

Be careful if you plan on staying with your current job. Anyone who is courageous enough to attempt to bring others back in touch with reality will usually be seen as an obstruction. Right now, the favored ones will be those nurses who willingly drink the Kool-Aid. Just be aware of the consequences and keep your options open.

In the meantime, rest assured that this too shall pass - you will be recalling it 10 years from now when the next fad is sweeping over healthcare.

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so much fun being patronized, NOT!

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Specializes in ED, ICU, Heme/Onc.

Primary Nursing is a term bandied about that is basically an excuse to eliminate assistive personnel without lowering the ratio. Instead of a CNA or MST helping you with a patient who is a two or more person assist and full care, you are running around looking for another RN to help you, and he/she is in the same position with their heavy "primary care" assigment.

I'd try to fight the disbandment of your union (if you had one in the first place) - staff nurse councils are lovely in theory, but you serve at the "pleasure of managment".

Blee

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Specializes in Critical care.

The the unit based councils are a joke. Now, if there is something we don't like, instead of management addressing it, they say "Take it back to your council." But honestly the council doesn't have nearly the authority that our management says it does. So taking it back to the council really just means forgetting about it.

The problem with unit councils is when they turn into a popularity contest or a clique. If you are an "outsider" or a new person, your opinions are blown off. It gets worse when the unit council leaders are buddies with the NM.

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Our unit councils all have a management rep there and I don't remember ever being asked about my thoughts on unit needs... and most of our council members don't work even part time, and every new idea they get gives us more paper to deal with, less time with our patients, and more crap to remember. We are seeking magnet status also, but to me, it's just a selling point for the hospital. I wish that I could just go to work, take care of my patients, and forget politics, and scripting, and the eternal patient satisfaction stuff...

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Specializes in Community Health, Med-Surg, Home Health.

I loathe Magnet, because as far as I am concerned, they do not advocate for ALL nurses; just RNs and BSNs in particular. I want to say that I am not starting the infamous LPN and RN war, so, please don't take any of this to offense, RNs, just hear me out. What I am saying is that we are all licensed nurses who made a commitment to patient care and we are ALL in this together. In addition, many non-unionized hospitals have laid off LPNs or reduced their titles as well as pay to being techs in order to appease the egos of the Magnet surveyors. I have not seen improvements in other facilities that have received magnet, so, I don't expect them to come our way if they are insane enough to grant the title to my facility. Facilities that are more nurse-friendly are that way because of a strong and supportive leadership, not due to Magnet recognition.

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Specializes in ED, ICU, Heme/Onc.
I loathe Magnet, because as far as I am concerned, they do not advocate for ALL nurses; just RNs and BSNs in particular. I want to say that I am not starting the infamous LPN and RN war, so, please don't take any of this to offense, RNs, just hear me out. What I am saying is that we are all licensed nurses who made a commitment to patient care and we are ALL in this together. In addition, many non-unionized hospitals have laid off LPNs or reduced their titles as well as pay to being techs in order to appease the egos of the Magnet surveyors. I have not seen improvements in other facilities that have received magnet, so, I don't expect them to come our way if they are insane enough to grant the title to my facility. Facilities that are more nurse-friendly are that way because of a strong and supportive leadership, not due to Magnet recognition.

Pagan -

I think the Magnet push demeans all of us. Which is ironic considering the whole point is to have nurses be a recognized profession in its own right. But it comes at too high of a price. I have a diploma (RN) but since I wasn't enrolled in a BSN program and didn't belong to enough professional organizations, I was not thought well of at my last hospital which was going through the polarization process.

Blee

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Specializes in Public Health, TB.
I'd try to fight the disbandment of your union (if you had one in the first place) - staff nurse councils are lovely in theory, but you serve at the "pleasure of managment".

Blee

In defense of unions, our local has been resistant to the formation of a nurse council as we see it as a shifting of blame instead of empowerment. We especially protested the requirement that council members needed to be deemed worthy to serve by management and to have not received any discipline.:nono: This in effect would eliminate nearly all union local officers. Heck, that's why we are officers. We've been disciplined on groundless charges, grieved them, and won.:nuke:

I agree with a different PP about primary care being an excuse to do away with ancillary help. At my facility primary care=paying someone $30/hr to empty the garbage.:rolleyes:

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Specializes in tele, oncology.

We're getting ready to roll out "relationship based care" at our facility...meanwhile, our unit can't even afford to buy pens for the nurses to use or paper with the holes in it already for the printer. How about you give me the tools and the time to adequately care for my patients, and I'll decide how much of a relationship to have with them?

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Specializes in Community Health, Med-Surg, Home Health.
Pagan -

I think the Magnet push demeans all of us. Which is ironic considering the whole point is to have nurses be a recognized profession in its own right. But it comes at too high of a price. I have a diploma (RN) but since I wasn't enrolled in a BSN program and didn't belong to enough professional organizations, I was not thought well of at my last hospital which was going through the polarization process.

Blee

This is what I mean...in my opinion, each nurse on each level can have intrinsic value, and meanwhile, they'll dismiss a diploma RN? Comparing programs between diploma and college, I always felt that the diploma nurses came out more prepared to deal with real world nursing, and their experience is nothing to sneeze at. I do believe that it is a dehumanizing experience to go through Magnet, because I don't see where ANY nurse is paid their worth. I just had a friend graduate with her Master's Degree, and the job offered paid much less than a staff nurse. She felt that was a slap in her face. So, what interest does she (and others) really have with Magnet? I am tired of the nursing flavor of the month..let's get down on some REAL nursing in action.

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