KatyRN~ the staff definitely know that we offer a flexible scheduling. That part of the office culture has been present prior to my arrival and it's a huge perk. You may be on to something with my communication style. In this forum, I could see where it might come across as being cold, rigid, and formal. That's not my personality at all. Live and in person, I'm warm, fun, and open-minded but always fair and consistent. That's how I perceive myself. (Hopefully, I'm not looking in the funhouse mirror..haha) The nurses actually seem to be comfortable talking to me and their direct supervisor. A couple of the nurses who left actually were the ones who told me that they felt like I was questioning their nursing judgment when I offered to help them look for a reason to recert by doing a chart review. That's how I learned that bit of info. I respect them for telling me. It's not easy to give your boss that kind of feedback. They weren't being mean or catty when they said it. I believe they were being honest. We have a neutral party from another department conduct all of our exit interviews. We also do anonymous exit surveys to try to ascertain even more information.
More on that discharge issue.. Our exec admin really scrutizes our number of discharges so I do reviews to make sure they're goals are met and well documented, that they are truly homebound, etc. And I can totally understand how some nurses could view this as being micro- managed. So I go into great detail to explain that sometimes, a fresh set of eyes can pick out something that they might have overlooked. I had suggested letting them do peer reviews but that idea went over like a lead balloon. lol.
I am directly involved with the QI department so we are always conducting chart reviews on wound care patients, patients who were hospitalized, etc. Our approach is to provide QI feedback to the group as a whole without divulging the patient name or the nurses involved. Occasionally, we will have to meet with a nurse individually and coach her on what was missed, etc. I'll be honest, we've had a bit of a learning curve with some of our nurses both the new ones and the seasoned ones. As we have really revamped our QI department, our nurses are getting more feedback than ever. It's never derogatory or demeaning. I don't believe in that style of leadership. However, some nurses are receptive to feedback and some aren't.
My position as the Administrator is unique in that I'm actually middle management. I have an exec admin team above me and one clinical supervisor below me. I have to tell you~ middle management is tough. But I accepted the position so I accept all that goes along with it. I always make the exec team aware of the staff concerns. Both the clinical supervisor and I are solid advocates for our staff. But we also have to carry out the instructions of the exec admin team and try to meet the goals they establish for us. Sometimes, the goals are negotiable but often they are not. So we work diligently to come up with solutions that are win- win for both.
Perhaps it's the nature of a for-profit organization that is causing unhappiness. Our patients receive the services that they need. The staff members, clinical supervisor, and I are unwavering in that aspect. However, with all of these Medicare changes, we really have to plan ahead and really be smart how we spend their healthcare dollars. I'm not sure of any agency that can send a home health aide out 3 days a week anymore. One of the nurses told me that she didn't really think she should have to worry about any of the financial aspects of patient care. This made me really question if I had failed her in some way by not properly defining the role of a case manager when she was in her orientation phase.
I love the idea of improving the socialization aspect. I'm already thinking of things to do.
I'm not in any way trying to say that my company runs a perfect organization. We wouldn't have had the staff turnover of late. I definitely get that. But so far, I'm hearing the workload isn't completely unreasonable.. and that we seem to fair in what we expect of the nurses in the coordination of care aspect. A communication mishap? Perhaps. I'm doing some soul searching on that one. I've worked for employers who were cold, demeaning, and even derogatory. I sure hope I don't come across that way. It's definitely not my intention. I'm thinking my frustration with the situation is pretty evident. I'm working through that..... it's another reason I'm here....seeking info, suggestions, and tips.