"They" Who Are "They"?

At work we often talk about 'they' I have heard on a regular basis about this unknown faceless people who are referred to as 'they'. They are the rule makers of your company, they are the people who send down new policies and procedures, they are the people who in our minds really don't have any concept of the reality of what it is like to work short staffed and then be expected to follow policies and procedures. 'They' are many people and sometimes we can become a 'they'. Nurses Announcements Archive Article

"They" Who Are "They"?

When I came into nursing, which was a long time ago now, I was part of the old cliche, which was to help people, I know a shocking concept in the ever changing world of healthcare.

Never in my wildest dreams did I envision my self at the top of the ladder and that I became 'they'

I am sure you have all heard it said 'they' want us to do it, it came down from above and 'they' need us to behave in this way. Why are 'they' giving us more and more to do? With less time to do it.

So my question who is 'they'? In my company they are a variety of people all with the best intentions in the world. I work in dialysis and dialysis is one of the most heavily moderated specialties in this country. So lots of rules, regulations govern us and higher standards of care are expected from the dialysis community, what does this means to the direct care staff? Lots of new policies and procedures have to be initiated plus evaluated constantly.

A definition of they-'They' are old, young, clinical, non-clinical, very experienced nurses and nurses with no floor experience, they can be male or female, any race, culture or religion. 'They' can be you if you want to be 'they'.

'They' do have the best interest of the patients and staff when planning and implementing changes, new policies, new tools to assist changes and they are part of the company you have chosen to work at. This means they are you!! Confused yet?

I was one of those nurses who wondered who they were and how did they know what it was like to work on a floor, how tiring it is, how hard we worked, no breaks and how do they know how it is to care for a sick or dying patients and their relatives? I spent over 15 years giving direct care to patients, I have the knowledge and experience to represent nurses-I wanted to be part of the team of 'they' as a RN.

I worked hard to be a 'they' I took courses, I volunteer for projects, I was flexible and open to change-I love to be innovated to be part of new projects and pilots to see if it will improve the quality of care delivered to the patients. I love to audit to see how care is given, to educate where I see the need, and I am the advocate for Nurses, PCT's and other direct care staff in dialysis units.

Do I make a difference? I know I fight daily with a team of RN's to stand up for nurses and pcts. I love the concepts of some of the ideas but I also know the reality for many direct patient care staff. I am skeptical and always open to be proven wrong to some ideas and really enthusiastic for many other ideas.

I remember back in the day when changes would be implemented thinking to myself 'if it is not broken why mend it' of course today we have to have research to prove that something works, pilots with hundreds of steps carefully written for staff to follow.

Why? Because we have to make sure that we do not harm a patient or a member of staff, we can only guarantee anything if we follow the steps laid out-and be prepared to change quickly if something is identified during the pilot that has the potential to harm.

I love what I do, but I cant look back I am so far removed from the floor that I am dizzy. I often wondered how it happened and if I am as happy as I was when I was a RN working the floor in a busy bustling hospital.

My answer to this question is no I am not as happy as I was when I was a RN on the floor, nothing in the world can compare to looking after patients, working with a team of nurses and laughing/crying so hard with patients, staff and family members. Feeling proud when I helped to support patients and families through good and bad news.

However I do believe that I am up there, supporting the nurses by making sure I never forget my grass roots. I am 'They' and 'They' are us, whether we like it or not!!

RN with 26 years of experience many of those years spent in dialysis. I have worked in acute care, home, ICHD as a CN, FA, and currently a director.

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Buyer beware, BSN

1,139 Posts

Specializes in GENERAL.

When "they" give "us" large bonuses and generous stock options and golden parachutes and facilitated lateral movement from one company owned hospital to another, despite exibiting no managerial or people skills, only then will I buy into your thesis.

Until then I will continue to live with my, just to name a few, issues involving intractable back pain, stagnant wages, staffing shortages, crappy high deductable, ever more expensive health insurance, arbitration agreements upon condition of employment robbing me of my day in court, and BS ice cream social blow-smoke-up-my-derriere disingenuous attempts at kumbaya.

And still some wonder who let the devil unions through the front door.

Harveyslake

89 Posts

What he said! "They" are those who are not us. "They" have a different agenda. "They" have different loyalties and priorities. It is "They" whose job it is to do make "us" do more with less. "They" have to do it or be replaced with those who will. Make no mistake. Once you are "They" you become part of the problem and can no longer be part of the solution,....and keep your cushy, no poop on my hands, job. It is "They" who keep nurses, the real reason people stay in a hospital, at a disadvantage. It behoves "They" to keep nurses disorganized so no uniform improvements in patient care and working conditions ever come to fruition.

I bet if reimbursement is radically restructured in a way that nurses can bill for their services and finally become an asset to hospitals instead of a financial liability, conditions will dramatically change,......of course, I live in a delusional world where this might actually happen.

smartassmommy

324 Posts

'They' are the clueless managers who cut staffing to dangerously low levels and then continue to slam the floor with admissions. 'They' are the ones so far removed from direct care that they don't think adding one more thing to the to do list is a big deal. 'They'are the ones who turned healthcare from being about the best possible patient outcomes to being all about the customer service survey.

Trauma Columnist

traumaRUs, MSN, APRN

88 Articles; 21,249 Posts

Specializes in Nephrology, Cardiology, ER, ICU.

"They" often become "us" as we advance in our careers. As an APRN, in management, I'm sometimes considered "them". I'm not naive enough to think everyone loves traumaRUs and sometimes I have to make decisions that make some unhappy.

Its not something I apologize for but I do endeavor to bring people into the decisions I have to make if time allows. Its important that the lines between "us" and "them" be blurred for the benefit of the patient.

Libby1987

3,726 Posts

I'm a they in some aspects and like OP I'm still close enough to patient care that I both know the realities and how to execute the patient care position as well as get the regulatory and reimbursement issues and have the responsibility to juggle the budget.

What I am not is someone up in some ivory tower with stock options and any kind of a parachute.

What I am is someone who has a voice, uses it and does influence policy. I see both the struggles and the unrealistic denial/naivety of clinical staff who do their best while also staying a little stuck by unwillingness to embrace change and kick its ass. I learned that lesson from my experience in being cross trained in clinical, clerical, quality and administration and have been able to thrive understanding the whole picture, so far. I advocate for patient, employee and company and do my best to expose my staff to all of the aspects of our healthcare business as I believe understanding lifts some of the resentment. I can't satisfy everyone but I'm always trying.

Lev, MSN, RN, NP

4 Articles; 2,805 Posts

Specializes in Family Nurse Practitioner.

I am "they" in a way. I am a member of the nurse practice counsel and "they" are grateful to have a "real live" perspective.

AutumnApple

482 Posts

Specializes in M/S, Pulmonary, Travel, Homecare, Psych..

I am one who believes the detached approach administration ("they") uses is a double edged sword. It takes many skills, interpersonal and decision making alike, to weild this sword.

"They" to a degree must remain autonomous. They must make decisions that have a ripple effect throughout the facility they oversee. No matter how well they choose and implement new measures, someone dislikes it.

Nursing has an advantage over "they" in that our purpose is focused and we'll defined. We use pt outcomes as our guiding beacon when a difficult decision must be made. And we should. They do not have this luxury.

I've been in middle management and am acutely aware of how no matter what you do, legions of people are going to disagree. Some are so discontent, they will even go beyond disagreement. That is when sabotage rears it's ugly head.

With that said, I feel I need to say something after reading your article: "Never take your personal experiences as everyone else's reality."

The "they" you have become and work beside sound like they ride home on Puff the Magic Dragon and clean their houses by singing a song to bring the broom and dustpan to life.

This is not the reality in the majority of healthcare facilities.

Corporate America has made its objectives the priority in modern healthcare. To refuse to humor them is to accept closing your doors.

Yet agreeing to humor them means having to run with minimal staffing, arbitrary and misguided policy making and having to be content with a grade school definition of customer service.

That is the riddle they face. Forced to partner with other "they" who have an agenda that does not support ours. They are damned if they do, damned if they dont.

Sounds like the same riddle we as nurses say we are facing. Trickle down perhaps?

Most "they" solve this riddle by submitting to the Corporate America agenda. Then they try to achieve the original agenda of superior patient care by squeezing the life out of the nurses.

Less representation, lower wages, smoke and mirrors benefits, scarce supplies and support staff, being demeaned instead of recognized, higher standards with less support.

This is the solution most "they" find themselves implementing, regardless of what their original intentions were.

They burn out, just like nurses do. Of course they do. And when they do, the results are devastating to everyone who must endure their tenure.

Most (not a select few, not some........most) "they" are either struggling to solve the riddle I spoke of and on their way to being burnt out or are already there. See, that's something else we have in common with them.

This is the reality of "they".

Specializes in ER.

I don't buy it, and I don't mean it with disrespect to you personally, but the sole reason me leaving bedside was because of "them". It's easy to say things behind a desk, walking on high heels eating corporate served bagels and coffee while my ER colleagues struggled to even have proper staffing let alone be served a cup of kool-aid. Then I see "them" walking with a smile and making comments about "we care about patients and our staff", I laugh at this. No one becomes an administrator to "affect the community in bigger impactful way", you get out because life is less stressful and less demeaning at the desk in a suit compared to working with short staffed department all day long and get chastised because you didn't meet sepsis bolus time or patients complain because they didn't get their pain med or a retarded second pillow. It's easier to set goals and policies when you don't really have to abide by them physically. They are the reason I will never work at a bedside or hospital ever again unless I am "them." all I gotta do is act like a give a crap but just rake in my bonus and cut corners for all the other cronies to make more bonuses, if you can't beat them you gotta join them.

allnurses Guide

NurseCard, ADN

2,847 Posts

Specializes in Med/Surge, Psych, LTC, Home Health.

I get it. I understand what you are saying. "They" do have good

intentions, are not evil tyrants living solely to kick back in a leather

chair and line their own pockets every day. "They" have a job to do

just like the rest of us.

The Director of Nursing at my hospital has a job to do, and if her job

is not done effectively, she's fired. She's not all powerful, she has

people over her making sure her job is done effectively.

Many times when staff doesn't get what they, understandably want

such as better benefits, better hours, better nurse to patient ratios,

they blame "them". Sometimes "they" really are to blame, because

they are doing their jobs poorly. Other times, "they" are doing the

best they can to make things better for the floor nurses, though the

floor nurses may not realize that.

I've been a member of administration. I've been a case manager.

At this point I would rather be passing out medications, wiping butts

and charting, as opposed to having the responsibility of a manager,

case manager, or administrator.

madwife2002, BSN, RN

26 Articles; 4,777 Posts

Specializes in RN, BSN, CHDN.

Great comments thank you for reading and taking the time to comment-I can't argue with any of the issues you have raised because what you say are very real issues.

I am not part of the operations I am purely clinical leadership, so while I do agree with how hard we work our nurses, I know that I have to implement changes due to changes in health care, which are driven down from the government level

Chaya, ASN, RN

932 Posts

Specializes in Rehab, Med Surg, Home Care.

The other name I see used for "they" is "TPTB" or "The Powers That Be", meaning those who actually hold and wield the power to make those decision and take those actions that impact our policies and resources to care for our patients.

I am heartened to hear from so many nurses who have not forgotten what it's like on the clinical side and genuinely struggle to balance budgetary prioroties with excellent patient-and staff-care. There need to be more of you.Please keep on fighting for our patients AND those of us still in the trenches with them, Quixotic though it may seem at the present.