Okay, so I have to wonder, I hear nurses on my unit complain about working conditions and new (ridiculous) patient satisfaction directives. However, when they are brought up in a group setting with the manager everyone stays silent. Example: we had an staff energizer on our unit to bring up our "pain scores." Two new directives: if a patient calls for pain medication, the unit secretary will call the patient's room after 5 minutes to ensure that the nurse has made it to the room. Then, they will pull reports and if a patient's charted pain level is more than 2 levels above their pain goal, charge or an ANM will meet with the nurse to see if he/she has a plan to control pain.
Frankly, the first directive is insulting. A nurse needs to be "checked up" on? The second directive is bogus because I KNOW that patients will continuously rate their pain as high so the physician does not take their medications away. Of course there are exceptions to that, but in my experience, I have seen many more incidents which I described.
The nurses grumble, complain and gossip (I won't lie, me too) but say NOTHING to make it better or speak up with suggestions to the manager. I did and I felt all alone and left out to dry. I don't know if it is because Florida is a non-union state? Maybe nurses are scared of losing their jobs. Because in NY, this never would have happened.
Why don't nurses speak up? There's supposed to be power in numbers. But yet, it doesn't seem that anyone wants to challenge the status quo. Thoughts?
I smile and nod. Speaking up never changes anything except to make the meeting even longer. I have better things to do than hang around work after my shift is done.
It's so sad that I have to agree with most of you all. Speaking up is brave, but it all too often has repercussions. There are lazy managers, unethical leaders, inexperienced leaders..... Nurses are often promoted to these positions without the necessary qualities of a Manager. True too, that the quiet people will be left alone. The change agents are viewed as trouble many times. Throw in a bunch of estrogen (hate to say that) and good luck with making positive change. If any Managers are reading this, listen to your employees. Sit them down, one by one, and ask them, "How are we doing as a unit? Do you have any suggestions? Here's what I appreciate about you..." Loyalty to employees gives it back in volumes to the organization and patients.
Specializes in Psych, Corrections, Med-Surg, Ambulatory.
It's so sad that I have to agree with most of you all. Speaking up is brave, but it all too often has repercussions. There are lazy managers, unethical leaders, inexperienced leaders..... Nurses are often promoted to these positions without the necessary qualities of a Manager. True too, that the quiet people will be left alone. The change agents are viewed as trouble many times. Throw in a bunch of estrogen (hate to say that) and good luck with making positive change. If any Managers are reading this, listen to your employees. Sit them down, one by one, and ask them, "How are we doing as a unit? Do you have any suggestions? Here's what I appreciate about you..." Loyalty to employees gives it back in volumes to the organization and patients.
Just because managers ask the questions doesn't mean they want the answers. I worked on a floor with a manager who was a snake. The staff satisfaction scores were always in the toilet because of her. Then she would call meetings to ask how "we" could improve morale. Of course no one said anything to her about her behaviour being the problem. She had a million ways to retaliate.
I email, with copies to people higher up in the food chain. I've been lucky so far. The manager knows I won't hesitate to call "retaliation."
I have been guilty of egging on the person who I think will say something while staying quiet, but I back them up in meetings.
We have a unit meeting coming up in a couple of weeks and I CAN'T WAIT to see what people are saying. Half the staff left since I started on the unit 6 months ago, including a bunch of the assistant managers. They had to shift the remaining managers to 4 10's to get enough coverage.
I also have precepted two orientees in the last few weeks who are already threatening to leave. I think they've both extended their orientations.
If the unit keeps hemorrhaging staff, they're going to have to close off beds. I hear that they're even having people refuse to float to our unit!
I understand that to an extent, but it has not led to bad policies not sticking around, it has lead to MORE bad policies. Maybe at your facility that is the case. Yes, people continue with their usual habits, but now managers are coming up to patients, checking charting and harassing nurses to make several phone calls a shift to a physician, despite the physician being aware and already made decisions regarding care. These policies are not going anywhere at my facility. And if they don't see the scores they like, it will continue mount. And this has lead to gross entitlement by patients who will have deplorable behavior until they get their pain medication of choice! Condition be damned.
To start, we can probably all agree this is a stupid plan. And there are many hospitals where people WOULD speak up about it. I work at a hospital with a very strong union, so nurses have a lot more say in how things go on. Plus most of the nurse managers are reasonable people. The more I'm on AN, the more I realize many hospitals are not like this. Which brings me to my next point.
I think people don't say anything about this policy because it's SO ridiculous that it's going to fail spectacularly on its own. So why waste time and energy (and risk management's opinion of you) for a battle that doesn't need to be fought? If management is so out of touch with reality that they think this is a good policy, they're going to be too thickheaded to listen to any rational arguments you put in place.
So the nurses on your unit are just going to wait them out. It's only a matter of time before doctors start pushing back about the constant phone calls asking for more pain meds.
And really, if you think about it, what's going to happen if doctors and nurses really DO start giving patients more and more narcotics? Pretty soon you'll start having to pull out the Narcan. Nothing says good HCAHPS like a good dose of Narcan.
Specializes in med-surg, IMC, school nursing, NICU.
At my last hospital job, we had about one nonsense policy added a week. More charting, more work, more stress with none of the intended results. I spoke up. Several times. So did several of my colleagues. We were met with a response that basically went "This is the way it's going to be. No amount of complaining is going to stop _______ so we all need to get on board."
It was useless and insulting. That's why nobody speaks up.
Specializes in Allergy/ENT, Occ Health, LTC/Skilled.
In today's crowded market, it's best to keep your head down. It stinks this is where we are at right now but until our numbers start to decline, we have no way to have a voice that has to be heard -- the are 25 applications for your job that wont speak up in management's eyes.
Specializes in Allergy/ENT, Occ Health, LTC/Skilled.
One of my former managers LOVED the phrase "Everyone needs to get on the bus or those who choose not to will be left behind." I love how she felt it was ok to essentially say shut up or you will be fired because she used a bus analogy instead of coming right out and saying it.
I wish I could say that I did XYZ, led the charge up the hill, and ended irrational, time-consuming, prioritization-defying "pain management directives," (or whatever is the current upper management focus) forever, but I can't. When I was working med/surg several years ago, we had a very similar "Let's get this accomplished, team!" focus challenge on...wait for it...meal tray temperatures. The hot food had to stay hot (but not too hot) and the cold food had to stay cold (despite being right next to the hot food. Physics be damned!). The floor staff had to stop whatever they were doing, whether it was med pass, dressing changes, stat blood draws off a CVL, hanging and monitor PRBC's, toilet/change incontinent patients. Food trays!
The first day of the new policy, the Pumps and Pearls Brigade was on the floor, serving patients as if they were serving prime rib and stuffed lobster claws. Patients who felt that their eggs were a little too cold or toast wasn't crisp enough had entire trays replaced. Obviously, Dietary was completely overwhelmed, so trays were walked back to the kitchen (walked!) so that the life-threatening limp toast or scant secretory scrambled egg was replaced. Made from scratch!
The "super duper patient-friendly dining experience" program, lasted four days. Patient meal complaints went up, not down. The final nail in the culinary coffin? Pain meds were delayed! Gee, imagine that...turn Nurses into waitresses and the nursing tasks don't get done. Shocker! Maybe they should have delegated the med pass to the culinary aides?..
Love it the Pump and Pearls Brigade! Good one! lol
Pangea Reunited, ASN, RN
1,547 Posts
I smile and nod. Speaking up never changes anything except to make the meeting even longer. I have better things to do than hang around work after my shift is done.