Should nurses strike?

[clint]

Should nurses strike? Would you cross the picket line?

[Milehighnurse]

Originally posted by ainz

PsykoRN,

Stereotyping is not exactly an open-minded approach. I am a RN who has become "administration" and I have to disagree. True though, I have seen this happen to people as well, the focus on how much money they can make. When you look at the big picture of who makes up "administration" in the healthcare system, most are business degrees, accountants, etc., and they think a little differently than RNs. As RNs begin to replace these people there will be a shift in the general thinking that is much more patient focused. A word about $$$, unfortunately it is the slime that greases the wheel that keeps it turning. That is reality and one that nurses need to learn about and understand so that we can more intelligently make our view known and our place in the system more fully understood, appreciated, recognized, and compensated for. We have to start somewhere and having nurses move into these positions is much more effective in bringing about change than sitting here typing about our complaints to ourselves on a nursing bulletin board.

Ainz,

Sorry you felt that I was stereotyping;I was speaking of a facility that I used to work at where the nurses are in "administration"/ management from the CEO/Pres on down to lower levels of managment. What I experienced was that $$$ take precendent over________. I believe that nurses do understand that money is the "slime that greases the wheel," but nurses give greater creedence to what they see versus what they are being told. Kinda hard to understand things like "we can't afford to hire more staff, increase the budget, buy capital equipment...etc" but you walk past a new wing being built on the way to work. Perhaps you could enlighten me as to how to understand the administration mind-set. Thanks in advance.

[angelbear]

Just adding my two cents. Yes I believe I would strike if the reasons warrented it. I personally feel it is immoral and unethical to knowingly and willingly tolerate a work environment that is not safely staffed. Working when you are tired has been proven to effect ones judgement as well as ability to think clearly that in my opinion is willful negligence yet that is what management is asking many of us to do on a regular basis. I am only one nurse and a human being to boot. If facilities would work with nurses and reps from all staff dept truely listening and problem solving with them they could save themselves millions of dollars. There arent many nurses that I work with that consider pay rates an important consideration. Yes they want to make a good wage but it is by far more important to them to have a safe, friendly and well staffed facility. Noone wants to strike after all you are loosing pay everyday it goes on but sometimes there is no other way. I also think that if nurses would all get together on the same page at the same time they could use the power in numbers to effect change. For example when management understaffs a shift consistently but then other nurses pick up to fill in management doesnt have to come in so they never actually experience the consequences of their lack of staffing. I think that there are alot of times when if nurses stuck together for a certain point we could effect change without union involvement. Ok that is my oppinion take it or leave it.

[ainz]

PsykoRN,

First, I like the username!!

Second, chatting on a board is an effective means of bringing about change, sharing information, learning, and so forth, that is why I do it!! :) Sorry if my moment of sarcasm offended.

OK. My humble attempt at "enlightenment to understand the administrative mind-set." Relatively simple (and a little sarcastic fun!!). OK, here goes: Money, power, prestige, and an intense need to preserve and defend it.

Most administrations, if not all, have very clear financial objectives their organizations must meet. Ultimately, in for-profit companies, they answer to the stockholders via Wall Street analysts' analysis of the strength of the company and what the short-term future looks like, usually quarter-to-quarter (every 3 months). Not-for-profit CEOs answer to their Board of Trustees. If the financial objectives are not met, the CEO is held personally responsible and their job is in jeapordy. You can compare this to nurses' work during their shift. Medications have to be given on time and correctly, charting has to be done, other treatments and interventions have to be done etc. If these goals are not met then the nurses' performance is not good and ultimately their job can be in jeapordy. It is the same principle. At the level of CEO, COO, etc., if you are not performing well, your boss will not counsel you or give you a bad evaluation or talk with you. No second chances. The CEO is expected to recognize when they are not performing well and take corrective action without having to be told this. At the level of CEO it usually takes 3 to 9 months to find another job.

Additionally, most CEOs and other members of administration have financial incentives tied to financial performance of the organization. This comes in the form of bonuses. This is a two-edged sword. It helps motivate the administration to see to it that their business runs good and they are growing which can do good things for a hospital and the community it serves. On the other hand, knowing their bonus is at stake can motivate the administration to do some not-so-good things when financial performance is not meeting goal and they see their bonus growing wings and beginning to fly away. In this case you usually see idiotic things like attempting to cut costs by reducing labor hours, sending staff home early and deflating their morale, cutting OT, cuts, cuts, and more cuts, lay offs, hiring freezes, and all of the other nasty morale-killing things that administrators do when they are really afraid and about to panic. A little defense for administration here please--when an administrator is worried and starting to do things like this, the last thing they want, need, or will tolerate is staff that begin to criticize, complain, gripe, threaten, and so forth. It is like throwing gas on an existing fire, it is inflammatory. Now defense for the staff--when things are tight, the last thing staff wants, needs, or will tolerate is administration that begins to erode their ability to make money, takes away benefits, asks them to work harder for the same or less money, cuts their help out by reducing staff, and generally makes their jobs harder and the working atmosphere more negative. It is like throwing gas on a fire. It is inflammatory.

Most administrators like the power and prestige and other perks that come with the job. They want to hold on to it. Many are not clinicians so they don't understand what motivates nurses and what turns off nurses. Different languages and motives are at work here though there are some similarities and some common ground. Both want success. Both need each other in order to succeed. Likewise, nurses don't know how to communicate effectively with administration in many cases.

Administrators focus on two things primarily. 1) how to build the volume of business, usually in the form of increased admissions, surgeries, ER visits, and lucrative diagnostic procedures like CT, MRI, heart caths, etc. This is primarily done through getting physicians to use your hospital and recruiting physicians to your market where they feel a sense of loyalty. So physician relations is paramount as they are the only ones authorized in our society to order things done to patients that will generate revenue. 2) Controlling expenses is the second thing. In order to meet the financial incentives, administrators must keep revenue high and costs low so they don't want to spend money on stuff that will not build volume and/or revenue. This explains why you walk past a new wing being built but they will not increase pay, hire more staff, buy more equipment etc. The new wing will allow more patients to be admitted. The new wing will attract more doctors to use the hospital, it will increase the hospital's capacity to have more business which brings more revenue, more profit, allows them to meet their financial goals. Increasing pay, hiring more staff, etc increases their operating costs which they are not interested in doing. Capital equipment will be purchased IF IT GENERATES REVENUE and the "return on their investment" is where it needs to be, usually above 20% and payback years less than 2. When you are presenting an idea, an initiative, requesting to buy something, wanting additional staff etc., you must demonstrate to administration how it will increase revenue and/or reduce or at least contain expenses. If you cannot do this for whatever reason, your words are falling on deaf ears. If you have a revenue generating idea, you must be able to demonstrate that using good financial data prepared in a professional way. Most nurses do not know how to do this and go only on "intuition" without a proforma (financial forecast) to back up what they are saying. If you get your CFO or assistant controller to help you put together a proforma and present your idea in a professional way you have a much better chance of getting it approved.

The problem is that many administrators don't see the relationship between employee satisfaction = customer satisfaction = higher profits, however, this is changing. It is true. When employees are satisfied with their jobs their productivity is higher and the quality of their work is better. Two basic things a business needs to survive, including hospitals--satisfied customers, satisfied employees. If either become disatisfied the business will fail.

In summary, the best way to get administration's attention and support on any initiative or idea is to show how it will increase revenue and/or decrease (or at least contain) expenses. This is the language they understand and want to be communicated with. Nurses going in with no quantitative data, no tie to the financials, and going purely on "patient care" and "improving quality" or anectdotal ideas about improving "morale" have a snowball's chance. However, if you do your homework and get the help of a finance person in your organization, you can usually tie patient care, quality improvement, and morale improvement ideas to the financials.

For example, you propose to allow each nursing unit to purchase a cake and associated plasticware etc to celebrate staff birthdays once per month with a unit party. You feel this will improve morale and help the unit. You would need to do a few thing to prepare. First, calculate the cost per month and per year of the party. Get that total dollar amount. Then find your employee satisfaction and patient satisfaction scores. Most organizations have done surveys and have this data laying around somewhere. Good surveys have a system to quantify their scores so you have numbers to use. Get your finance person to help you determine current revenue and correlate it with current employee satisfaction and patient satisfaction scores. Have your finance person help you estimate the value of each point on the satisfaction scores, they can probably extrapolate this. You can then say for each point we raise the satisfaction score we should see a corresponding increase in revenue and you can put a number on that. You would then need to estimate how much you think this event will raise the score on your unit. Then calculate the increase in revenue and compare it to the cost of the birthday party. If the revenue exceeds the cost of the party--you will get it approved!! This is just an example of the principles I am talking about, probably not a good one but you get the idea.

I know this is a lengthy post (I tend to ramble on, sorry guys) but I was a nurse for 14 years before I even began to get a clue about all of this. I walked around frustrated at the mysterious and idiotic ways administration was thinking. After finishing graduate school and working in administration I began to understand all of this. It truly makes a difference in trying to get things changed in your organization.

[Milehighnurse]

Originally posted by ainz

I know this is a lengthy post (I tend to ramble on, sorry guys) but I was a nurse for 14 years before I even began to get a clue about all of this. I walked around frustrated at the mysterious and idiotic ways administration was thinking. After finishing graduate school and working in administration I began to understand all of this. It truly makes a difference in trying to get things changed in your organization.

Ainz,

Thank you for the informative reply, very enlightning.