Take this job and shove it!

[TTK RN]

Have to vent just a bit: This marks my last week at an incredibly mismanaged and dysfunctional hospital. I'm feeling great about moving out of a toxic workplace with all the incivility and safety issues you could imagine. That said, I'm pretty sad about not getting to work with some of the wonderful colleagues I'm leaving behind. They know I'm leaving because of the safety and mismanagement issues that they all see and care about but are somehow going to tolerate.

My question to the allnurses world: in your experience, does change happen in hospital administrations when strong, experienced nurses leave in droves? Do healthcare administrators discuss the reasons why and the frequency with which people quit their hospital, even if it is in private meetings behind closed doors?

[meanmaryjean, DNP, RN]

One thing I read recently, it takes at least 3-5 years to effect a facility-wide culture change, and about 10 years for a company to shed a bad reputation in the community.

Would you have a source for that? I am writing up a proposal right now, and that would be a great addition to my lit review.

[NurseSpeedy, ADN, LPN, RN]

One thing I read recently, it takes at least 3-5 years to effect a facility-wide culture change, and about 10 years for a company to shed a bad reputation in the community.

There are a lot of LTC organizations where I live (practically one on every corner). What I've noticed (since I used to work in a hospital and learned there where I hope to never end up one day) is that the bad ones will change their names, hoping that people will start coming and not realize that it's that place that everyone heard about in the news a while back....yet they don't change the way they run their facility...so a could of years go by, more bad press....oh, yeah, another name change at the same location.

[imintrouble, BSN, RN]

Typically, no.

Generally, change only happens when you get personnel change in the highest levels of administration. Change is almost always going to be from the top down.

I agree in part. But sometimes you have to have an overhaul involving everybody. The top are the ones who've hire and promoted those in the middle and the bottom. If you fire the top, you still have middle managers who think like their mentors.

[Meriwhen, ASN, BSN, MSN, RN]

Typically, no.

Generally, change only happens when you get personnel change in the highest levels of administration. Change is almost always going to be from the top down.

Or in there's some sort of sentinel event that results in patient harm or death, a lawsuit, and/or bad publicity. Maybe if all three are present, you might​ get some change.

[klone, MSN, RN]

Would you have a source for that? I am writing up a proposal right now, and that would be a great addition to my lit review.

I *think* it was in this article that my manager gave me:

Kotter, John (shocker!) - "Leading Change: Why Transformation Efforts Fail" Harvard Business Review, January 2007.

[klone, MSN, RN]

The top are the ones who've hire and promoted those in the middle and the bottom. If you fire the top, you still have middle managers who think like their mentors.

And that's when you have a mandate from upper administration to those middle managers: either adopt the new way, or find a different job. If you have a REALLY good administration, that mandate will trickle all the way down to frontline staff.