Nurses, Doctors, and Admins: Nightmare Becomes Reality

[Joe V]

Nurses, Physicians, and hospital Administration all strive, in their respective roles, to ensure high quality, safe, and efficient patient care. But as we all work to get to the end result, our collective efforts may fall short of that goal. Communication difficulties, egos, tunnel vision - all play a role in the dissolution of any primary objective. If we are not all on the same page this nightmare becomes reality. In the end, who profits? No one. It's a lose-lose situation. What can we as Nurses do?

[Scottishtape]

I've been an LPN for 10 years now, so I've got quite a few years of the nursing mindset under my belt. I have also been working on a bachelors in healthcare administration (only 2 more semesters left!). I have to say what I've learned in this program so far has really opened my eyes to the aspects of healthcare that as a staff nurse I never considered. I can easily see why there's a breakdown between the levels based on the vast difference in education and then actual responsibilities in the real world.

I think to help close this gap, cross education and training is necessary to ensure that no matter which area you function, you can see the hospital as a whole, instead of just you and your department.

[LadysSolo]

I think that often administration treats nurses like they have no clue. We DO realize that facilities need to make a profit (if they are for profit) or at least come close to breaking even (if they are a non-profit) and are okay with that. We only object to the methods used if it negatively impacts patient/resident care. Administration COULD ask our opinions on occasion, or at least act like we have a brain......

[TheCommuter, BSN, RN]

Nursing is a so-called 'caring' profession. The interests of a caring profession, IMHO, will never fully align with administration's interests to contain costs and generate profits by all means necessary.

If administration could pay nurses a princely salary of $1 yearly, they would...

[Bat Lady]

Those who are studying for a degree in Healthcare Administration should be REQUIRED, as part of their degree, to spend a year doing clinicals under the guidance of CNAs and nurses. Only then will they fully understand what it is that we do. They would, in my vision, have to shadow and, as we did as students, actually work alongside the nurses, the CNAs, the dietary staff, the radiology techs, and even housekeeping, to see what makes the hospital run. THEN they will know that it takes people to make it go, and that the hospital can't make a profit without us.

[Joe V]

Have you felt like this in the past year? Share your story...

[LadysSolo]

The "shadowing nurses" idea was done at one hospital where I worked. The hospital board wanted to cut staff, and we asked if one of the board members would follow one of us for a day before they made the decision. The board member made it for 4 hours, and said "there will be no cuts - I don't see how you do it with the staff you have!" A success in my opinion!

[Katillac, RN]

I'm not sure how meaningful the answers can be; your premise is seriously flawed.

Joe V said:

Nurses, Physicians, and hospital Administration all strive, in their respective roles, to ensure high quality, safe, and efficient patient care.

While all concerned possibly should have the same objective and may want to create the appearance of providing that great care, the reality is often much different. Painting them all with the same brush is not helpful in my opinion and may in fact be the root of the problem.

Not everyone entered or remains in healthcare for the same reasons. For many, the priority may be simply to maintain an income, or leave a legacy, or build a career, or stay in a certain geographic region. And while most want to see good care given, when that competes with their actual primary objective the resulting decisions don't necessarily support good care.

I'll give some examples.

1) A CEO gets brought in to turn a failing hospital around. She feels strongly her career hinges on doing so. The board makes it clear they believe the problem isn't lack of budget, but ineffective leadership, so the new CEO is hamstrung in hiring staff to ease chronic shortages, or making conditions more attractive financially.

2) A nurse manager recognizes his unit has problems with productivity and caring. But the bad apples are connected socially with the DON who makes it clear she won't support any discipline against her friends. To go against the DON means the nurse risks his job, and there are few opportunities in this small community where he's finishing an NP program.

3) An HR President is aware of morale problems organization wide that are causing mass defections of valuable staff. The agency is in the middle of a buyout, and to present anything other than a glowing picture could cause a loss in value to executive stock options, so the morale and staff defections are ignored.

4) A nurse is aware of chronic and dangerous regulatory noncompliance. Escalating the concerns through every avenue available results in nothing other than subtle retaliation. The nurse's mental health begins to suffer as a result, so efforts at advocating for good care and treatment of her patients and colleagues are abandoned.

None of the above examples involve bad people per se or anyone who didn't enter their role seeking to see good care delivered, but their priorities resulted in less than desired outcomes. I'm not suggesting nurses can and should do nothing. But to lay the problems at the feet of "communication difficulties, egos, and tunnel vision" is short sighted. Quite often the decisions made which then inform the actions of the people involved are - or feel like - a matter of survival. In the end, the only thing we can do as individuals is interact with others with as much kindness and compassion as possible on every occasion. That doesn't require the cooperation of or mutual goal setting with anyone else.

[Joe V]

This is not an emergency. 😡

[Davey Do]

This is a verbatim conversation that I had with high-maintenance somatic patient at the nurses station just last weekend:

[Daisy4RN]

Joe V said:

Nurses, Physicians, and hospital Administration all strive, in their respective roles, to ensure high quality, safe, and efficient patient care. But, as we all work to get to the end result, our collective efforts may fall short of that goal. Communication difficulties, egos, tunnel vision - all play a role in the dissolution of any primary objective. If we are all not on the same page this nightmare becomes reality. In the end, who profits? No one. It's a lose-lose situation. What can we as Nurses do?

While I agree with you in principle that all should strive for quality, safe and effective care I am not sure that some admins really do care about this, hence the nightmare that some hospitals have become.

One a different note re: DaveyDo's above cartoon, we have pts calling the sheriff's and 911 from their rooms.