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Radical Management Strategy

Posted

Specializes in ob. Has 25 years experience.

It is called the TRUTH!!!

  • Yes we are busy.
  • Yes. You may need to wait if your death or grievous injury is not imminent.
  • Yes. We are doing our best. (and..ha ha management knows it and supports us!)

I am tired of being told by managers that we need to mislead patients, not tell them that we are busy and pretend we can do it all. I decided I would like to see some mangers responses. We can't do it all. You guys sure don't. Managers do not have silver wings or teflon shoes. People have to wait at WalMart, the grocery store, and by golly in their PCP and other physician offices. They know it is busy and they deal with it. Why is the inpatient setting some other planet. I try my very best to do my very best EVERY day. I am only one person and can only do so much. The HCHAPS and Picker scoring makes me cringe. The documentation you expect (I know govt. regs, da, da, da). The expectations are insane and managers know it. When will managers and administrators accept reality? Is the truth really so bad? Is it better to lie and fail every time to meet the unreachable?

This Cupcake can't Eat that cookie anymore. I think there is cyanide in the recipe because they are surely trying to kill us with all of this customer service which would play way better in some upscale day spa! Thought???

chevyv, BSN, RN

Specializes in Gero Psych, Ortho Rebab, LTC, Psych. Has 20 years experience.

I have to agree and I tell my pts if I'm busy or there is a serious situation going on and occasionally I get someone who only thinks of themselves (and I work psych), but the majority understand and cut me a lot more slack than me lying and fumbling an excuse. I am a terrible liar!

Managment does it for the same reason they demand unemployed nurses go back for their BSN. Business people will never tell the truth, they sugar it up with something so 'fantastic" any reasonable person with an ounce of common sense has to get away from them or they will reach out an "touch them" they will lie and say they are checking with the boss, when they are not, and never had any intention on doing so; they will tell you your paycheck they shorted you is in the mail and it isn't, hoping you'll forget about it. They treat you like a child-" oh, if we don't remind them about it, they'll soon forget about it". How insulting is that mentality? It's called dumbing down a workforce!!!!!

oldenurselady

Specializes in ob. Has 25 years experience.

I am seriously burned out. It makes me sick, literally, to put up with some of this stuff. This is not nursing. It is some kind of twisted BS marketing strategy concocted by administrators and gobbled down like nectar by mid level managers. These mid level managers see these patients, the staffing, and know what the "real" and "really crazy" issues are. They need to grow some gonads and speak up for staff and patients. Last time I checked, being a true patient advocate was a role of the professional nurse. If patients do not like the food, it goes against our department or if the furniture for visitors is uncomfortable, they count it as negative. Dumbest of all, we have started to give a "gift" card for the hospital shop or cafe if they are unsatisfied. Really??? Guess what they are still gonna say that they did not get their meds when they asked or that they had to wait to long for a diagnostic test. We do see that they SOMETIMES appreciate the "gift", but many times see it as a meaningless token or even worse a buy-off. It doesn't improve the HCAHPS because they still complain. It also may encourage griping because some of our patients (not all, but a few) want their free card too and expect it for any concocted gripe. I wish I was younger and could do something else. I have never felt like this before, but I am totally toasted!

NutmeggeRN, BSN

Specializes in kids. Has 25 years experience.

Ya! During an extremely busy/understaffed time (ok that is ALWAYS but this was a particularly brutal time with an exit seeking man who would take a swing and run...) we were told to have this reply

"we are doing things a little differently today" in a nauseating sing song voice....

grrrrrr :banghead:

imintrouble, BSN, RN

Specializes in LTC Rehab Med/Surg. Has 16 years experience.

Pts aren't stupid. They know when we're short handed. What gets me is when they look at me and ask me "are you busy", when I'm sweating profusely, breathing heavily, and generally looking panicked. Denying the obvious makes me a liar on top of everything else.

"Sure I can get you that coffee, recliner, warm blanket, and WIFI code for your laptop". I guess that dying pt will just have to wait for their Morphine.

My biggest resentment against management has always been, expecting me to be able to do something they know is impossible.

Walmart gives out free gift cards to customers who are disgruntled.

Do we really want to model healthcare after retailers?

Maybe my hospital will start giving gift cards to staff who are overwhelmed.

Edited by imintrouble

tewdles, RN

Specializes in PICU, NICU, L&D, Public Health, Hospice. Has 31 years experience.

In hospice we are honest with our patients from the start. We let them know if they are at the distant edge of our service area because it will impact our ability to get there quickly...requiring everyone have a plan for care. We tell them that we may have to change appointments if we have other patients who require our presence on an urgent basis...that we will spend time with people who need our presence the most at a particular time.

In hospice care, we are partnering with patients and families so our honesty about what they should expect helps to improve their satisfaction with the service.

" People have to wait at WalMart, the grocery store, and by golly in their PCP and other physician offices. They know it is busy and they deal with it. Why is the inpatient setting some other planet."

I'm gonna try this quote on the next DPH surveyor who tags me for staff not answering the call lights "timely!" :yes:

oldenurselady

Specializes in ob. Has 25 years experience.

There is a BIG difference between answering a call light and immediately acting on a patient's complaint of chest pain and instantly fulfilling their request for Hawaiian punch and cookies.

dirtyhippiegirl, BSN, RN

Specializes in PDN; Burn; Phone triage. Has 8 years experience.

Weeeeeeird, I was just thinking about this the other day. When I went through orientation at my hospital, we had to take a customer service class -- where we were told to never, ever tell a patient that the unit was busy, short staffed, or to imply that there was someone sicker than them who needed to come first -- no matter how long the patient had been waiting or for what trivial reason, etc. Because that's not what the patient wants to hear. More like...it's probably not the impression that the hospital wants to give its patients -- your nurses are understaffed and overworked!

I think it does patients a disservice to assume that they are incapable of taking into account what is happening on the unit. Obviously, you're going to have that patient who would still be unhappy if you flew to the moon and brought them back a goose that craps golden eggs, y'know? But when you acknowledge that, yes, I am very busy right now or yes, there is someone very sick on the unit right now which is why everyone is in their room -- you're also acknowledging that you're not sitting on your butt at the nurse's station reading Facebook instead of fetching them a glass of water.

edit - sorry, I didn't realize that this was in the management subforum!

DSkelton711

Specializes in OB/GYN/Neonatal/Office/Geriatric. Has 25+ years experience.

I am so-called "management", but I don't get a say so in how my unit is staffed. That is a much higher-up decision. I can try to do my best to ask for more help, but it ain't gonna happen. Then if I complain too much, my job will be on the line. We are staffed according to regulations, but many times that is not enough. I also feel burnt to a crisp--trying to keep everyone satisfied enough to keep on coming back, which they do for various reasons, obviously. I am fortunate to have great people, but I know and realize they can't do it all forever. I just wish those above me realized it. I often feel like I am not made for "management" for these reasons.

Weeeeeeird, I was just thinking about this the other day. When I went through orientation at my hospital, we had to take a customer service class -- where we were told to never, ever tell a patient that the unit was busy, short staffed, or to imply that there was someone sicker than them who needed to come first -- no matter how long the patient had been waiting or for what trivial reason, etc. Because that's not what the patient wants to hear. More like...it's probably not the impression that the hospital wants to give its patients -- your nurses are understaffed and overworked!

I think it does patients a disservice to assume that they are incapable of taking into account what is happening on the unit. Obviously, you're going to have that patient who would still be unhappy if you flew to the moon and brought them back a goose that craps golden eggs, y'know? But when you acknowledge that, yes, I am very busy right now or yes, there is someone very sick on the unit right now which is why everyone is in their room -- you're also acknowledging that you're not sitting on your butt at the nurse's station reading Facebook instead of fetching them a glass of water.

edit - sorry, I didn't realize that this was in the management subforum!

Managment doesn't want the staff telling the truth to patnets because if a mistake is made- the patient has a legitimate leg to stand on that is the managment's fault. Managment staff the hospitals not the worker bees who are run ragged.

If the nurses are running around and too busy- it does look bad for management. As it should. It says they are not doing their job correctly. Which they aren't. If a patient asked me - or commented"your really busy today" I answered them honestly Yes we are down x number of nurese. I don't fluff anything up for managment. Mid levels are kissing but to keep the million dollar baby earning the million dollar paycheck so the million dollar family continues to live well, meantime, our lives are hell, burned out, fed up and shopping at Wal Mart to make ends meet, buying every kind of cheap- presevative pack crap food meal stretches just to pay our light bills or mortage company! Keeping the HTN and obesity states going.

Managment is the only ones who get to look forward to the holidays anymore-everyone else holiday is filled with not only work BS but wory of where the next bill money will come from, Do we pay bills or celebrate the holidays. We should be able to give managment a good hard back hand when they mutter Happy Thanksgiving or Merry Christmas-we all know they don't mean it, its a forced gesture. Personally what would make my holiday- knowing some Ceo was indited for embesslement or fraud and thrown in jail for the holidays at the big house!

Edited by kcmylorn

oldenurselady

Specializes in ob. Has 25 years experience.

I worked at a facility where the CEO was removed for corruption. Don't worry about him. Not only did he pretty much totally get off. He now owns a healthcare consulting company and proudly asserts on the website that he was CEO of XYZ Hospital. Maybe he could teach a course called "Lessons from a Crook." Healthcare is totally messed up in so many ways. I hate to even go into to work.

What happens in countries like the UK and Canada? Patients have to wait a long time for many procedures. They just deal with it, correct? It should look very bad for management who let situations get dangerous when they are spending their $ on teambuilding activities at 5 star hotels while the 18 year old CNA has 12 people to left, bathe, and a nurse is supposed to do 12 assessments, give meds, and fluff pillows with a smile. Maybe patients need to demand more of management. Hmmm, when I finally go legally insane, perhaps I will put business cards in each patient room with the CEO's home phone number for patients to call 24/7 with their issues. These people are the ones who do all of the promising, so they definitely should hold the accountability for patient dissatisfaction.

chevyv, BSN, RN

Specializes in Gero Psych, Ortho Rebab, LTC, Psych. Has 20 years experience.

That is hilarious!!!! When we all go insane lets do that! I work psych and my pts love to call the same people numerous times per hour! Giving them the higher ups personal phone number would be way too funny!

catlover314

Specializes in NICU, Educ, IC, CM, EOC.

As a manager, I will admit my first reaction to this topic was defensiveness. All the hatin' directed at managers and upward! Sorry to be the bearer of bad tidings, but the focus on satisfaction that has been building is a fact of life. Hospitals knew a while back that satisfaction would be driving reimbursement and yes, that is where we are now. That reimbursement keeps the doors open and pays all of our salaries. So there is that.

The next thing to remember is that being courteous to patients and families is not just what we are 'required by management' to do....it is the right thing to do as a compassionate caregiver. You can be honest and courteous at the same time, but the days of "you'll get it when you get it" attitude are history. And when its you laying in a hospital bed you will be glad that those days are over. Its what they taught us in grade school...be nice to other people.

And finally, like another manager said earlier, FTE's are not set by the manager, they are set by finance. To vent your anger at the manager is a waste of your energy.

Then finance better get off there butts and come down and take care of these patients!!!

mommy2boysaz

Specializes in OB. Has 10 years experience.

I have been a staff nurse for 15 years and now a nurse manager for 6 months. This thread is interesting to me from both angles. First, as a floor nurse, I understand the frustrations and exhaustion that can come from working hard and long hours with not enough staff. However, if that is the standard, rather than the exception where you work, maybe you should look elsewhere for employment. It is not like that everywhere. I've worked in several places and our staffing has, for the most part, been adequate except on unusually busy times.

More concerning to me as I read this thread, is the unbelievably negative, resentful, nasty attitude toward nursing in general! Do any of you even remember why you went into nursing in the first place? Was it to take care of people who needed you? To make a difference in someone else's day? Or to punch in, punch out, and take home a decent paycheck, preferably without having to do too much in between? Nursing is NOT an easy profession. It requires self sacrifice and very often putting your needs second to those of your patients. I agree with catlover314 above that we all need to treat others the way we would want to be treated, or the way we would want our loved ones treated if they were in the hospital bed. I agree that lying to patients is not necessarily the way to go. If you are busy with an emergency, most people would be understanding of that and would not mind waiting for a drink/blanket, etc., knowing that that is the reason. I think many times the patients or their family members become understandably frustrated by long waits when there has been no explanation for the wait, nor any apology by anyone. Some empathy and kindness goes a long way in patient satisfaction.

oldenurselady

Specializes in ob. Has 25 years experience.

Well mommy. I think your attitude toward nurses is pretty poor. ...."take home a decent paycheck, preferably without having to do too much in between." I think NOT. Things like patient and family education and assessment are vital components of nursing. Responding quickly to requests for snacks or to open the doors more quickly for visitors when we are super busy or have an emergency are what gets to me. Perhaps you wok in shan-gri-la or need to get out of your office more BUT these are real issues for many nurses. I am appalled by the freedom which visitors and patients feel they have to be downright RUDE and management's willingness to reinforce that they are just totally entitled to service with a smile no matter what the behaviour or request. I suppose you think we should smile, smile, smile AS WE dispense snacks, get blankets and climb over snotty visitors when we try to take vitals or receive a hairy eyeball when we go into a room to do our JOB (YA know assessment, VS, give report at change of shift).

I wouldn't and don't treat patients with disrespect and do have great respect my co-workers BUT I am tired of some six sigma certified snot telling me I need to spend all day serving snacks, getting all of this documentation garbage done, and that I am so lucky to have a job BUT need to do it faster and more efficiently. Especially aggravating to me is that the "managers" rarely help on the unit and their own interpersonal skills in dealing with the nursing staff SUCK. There was a time when managers would confront patients and family who were disrespectful to the nursing staff! Imagine that!!!

"More concerning to me as I read this thread, is the unbelievably negative, resentful, nasty attitude toward nursing in general!" Nurses do not mind being nurses. They just want to be nurses and not PR apologists for dysfunctional organizations and brown nosing mid level managers. Many go into nursing thinking it is about empathy and helping people. It was and in some ways it still should be. The problem is the connotation of empathy has been changed to mean that we accept and encourage almost any unreasonable attitude or action on the patients' parts as a patient's right. We have become enablers or personal irresponsibility not healthcare experts or people who empower our patients but just another customer service driven industry catering to many selfish and irresponsible people. We are so bogged down and stretched so thin because we spend so much of our precious time and resources meeting unreasonable demands of government, management, and selfish, dysfunctional patients who have never been expected to do anything but think of their own instant gratification.

If a person makes it through nursing school, it is unlikely that they believe nursing is easy. Mangers need to face up to the idea that it is rarely easy and start working on solutions that include the premise that the staff are not always complainers, whiners, or lazy. Most of all managers and administrators need to stop scolding and finger pointing and LISTEN. It isn't all about a smile, sunny attitude, or staff sucking it up. Did you ever think that if the staff were more satisfied that patient care would be safer and more efficient? If you want a snack hostess or pillow fluffer, maybe that person doesn't need to have RN behind their name. Maybe the patients need to know that we are there to meet their healthcare needs not for "pamering."

If these surveys are being used to influence payment for care look at their healthcare not all of this other complete crap. Please do not give 'gifts" for griping. Just emphasize that meeting healthcare needs is the main focus of their stay and that "waiting" is part of the deal because we have to prioritize. Don't set your staff up for failure. Nurture and empower them for success by not setting unreasonable expectations or slamming them when they don't smile broadly enough in response to rude patients and families.

Take off the cowardly lion costume and have the courage to d the right thing. Good luck mommy. You're gonna need it.