Here are some reasons to think twice.
First, let me just say that I know that many of the issues I am raising are epidemic in today's hospitals across the board. I know the grass is not always greener. But the thing than motivates me to vent like this is the fact that the institution I am about to leave, markets itself to nurses one way, but is essentially the same as everywhere else. If they say they are going to be special and different, if they say they want to be the best and want to stand out above every place else, then I would think that some type of real effort would go into that promise. Anything short of that effort is little more than hypocrisy and lies.
They, (VCH), do not make more than a feeble attempt to market themselves too, or recruit experienced Nurses. An occasional experienced pediatric RN may fall out of the sky and into their lap, but the vast majority of your new co-workers are going to be new grads. One bonus for the new grads was that they raised the pay by a dollar an hour for an entry level RN. But they did not adjust the rest of the pay scale accordingly. One way to look at it would be to think that everything was being done to get more nurses on the floor. Another way to look at it would be that an increase in value was being placed on those who never got paid to care for a patient as opposed to those that are already here. You, the reader may decide.
Their pay sucks. It is at the bottom of the market. (A base of $21.00 and change per hour for my years of pediatric experience.) The powers that be will tell you that it is in line with their market surveys. But speak to nurses at other hospitals and compare wages. You will find that VCH is at on near the bottom. Also missing from their pay consideration is the fact that services offered are specialized and one would think professionals would be paid for that specialty.
Vanderbilt is a very academic institution. The work that needs to be done by the floor nurses is not academic, it is procedure orientated on a day to day, hour to hour basis. However, the typical RN's performance is judged by some far off, academic standards that do not apply to what one does on a day to day basis.
When it comes time for your annual performance evaluation, it will be done by yourself and your peers only. Management will not write an evaluation on their own. They will tally up the numbers and summarize what has been said about you and your compensation will be based solely upon that. You will have no recourse on this matter, you will have no way to challenge a person on what they have said about you. A very cowardly and lazy approach from my perspective. Also, if you grade yourself or someone else too high, you will be essentially told to change it by being given an impossible set of criteria to meet in order to justify those high marks.
The performance evaluation criteria are exactly the same for everyone. From the PICU nurses to the ER nurses to the regular floor nurses. You get no extra points for being skilled with IV starts, chemo certification or running ECMO for example. It's a one size fits all, cookie cutter approach that totally disregards what ever subspecialty one might develop skills, expertise and a real passion for.
On the last round of performance evaluations, the manager of one unit knocked points off everyone's eval. because the unit scored poorly on an in-house inspection because there was equipment in the hallway. Never mind the fact that there was not, (and still not for that matter), any place to store it. It did not matter if you were off that night, were on vacation or had not even been hired when that inspection had taken place, points were deducted. Sort of flies against the face of an individual performance review in my opinion.
The managers manage numbers, not people. The "kudos"/"awe craps" are geared around things like patient satisfaction surveys and general statistics. A great day for a manager is when the FTE to patient ratio improves by a tenth of a point. Never mind that some poor nurse was overwhelmed by an exceptional high acuity patient load. That never sees to matter. If one complains about it or tries to ask for more help, the stock answer starts along the lines of, "Well, the numbers...."
I respect the fact that patient satisfaction surveys are important and a useful tool to measure quality of the service. But that is only one facet of measuring the quality of care given. It also has no way of disregarding the absolute unrealistic expectations some parents may have as well as the true mental cases that might complain as well. When the kitchen and cafeteria are closed at night, it is still the nurses fault that a patient could not get a hot meal at 2:00am when they were finally admitted. If an ortho. doc comes in to consult 3 hours late, it's the nurses fault. It's the nurses fault when little Bubba does not get his popsicle in a timely manner because the staff was preoccupied by working a code on Bubba's next door neighbor. (All of these have actually happened.)
VCH staffs by the numbers, not by the mission. VCH has a brand new, beautiful, state of the art hospital which they market to the hilt. They promise to be the first, last and best place for children anywhere in the country. But they don't staff it accordingly. There are almost always beds closed due to staffing issues which generally boil down to either lack of available staff or trying to save a few bucks. If your child suffers a traumatic brain injury which requires immediate surgery, it's best if he or she does it during daylight hours, during the week. At least then there is a surgical team in the house.
You have to pay to park there. Sorry, that is a minor issue that sticks in my craw every time I go there. One should NEVER have to pay to park where they work.
Like virtually everyplace else, they use "Enron" style accounting logic when giving out benefits. When one signs on there, one is told that they get 7 paid holiday off per year. And that is absolutely correct. IF you work a 9 - 5er, 5 days a week. If you are a nurse who works the typical 3, 12 hour shifts per week, you get paid 7.2 hours of those holidays. Ditto for the vacation days. (Apparently, the logic goes, number of hours in a work day are 8. Since a nurse works 36 hours in a week as opposed to 40, they work 90% of a work week. That would equal 7.2 hours of an 8 hour day.)
Charge Nurse candidates are not chosen for their potential leadership skills or their experience, they are selected on their likelihood of going along, unquestioningly, with every lamebrain idea that comes down the pike. It is astonishing to me sometimes to see a coworker get elevated to the level of charge nurse and in a few short months, they absolutely forget where they came from and what they did while they attempt justify some of the most idiotic ideas that are promulgated by upper management. (How much for the soul of a nurse? A mere $3.00/hour or there abouts at VCH.)
VCH is very big about paying lip service to the concerns of the staff. If enough people complain, the solution is to form a committee of nurses to study it, identify the problem and find solutions. Then it is kicked up to the administrators where, if it will cost a bloody cent, it will die a slow and agonizing death. (The number 1 activity for nurses week? "Blessing Of The Hands" by the Chaplin twice a day. PLEASE!!!) (Although, I am sure it sounds great from a marketing standpoint when they announce the schedule for the blessing of the hands every other hour over the hospital wide PA system. Can anyone say, "CRASS PANDERING?")
I went to VCH over 3 years ago. I watched with growing excitement as they new hospital was being built. I thought it was going to be a special place to work where things like experience, leadership, education, commitment to excellence would not only be cultivated, it would be valued. Instead, and it pains me to say this, it's just like any other place here in good ole corporate America. It is run by accountants with the eye always and only on the bottom line. The difference is that Vanderbilt operates on a pile of cash. They sit on a billion dollar plus endowment. It does not have to be like any other place. It could actually be special. But for whatever reason, it is not.
I will be leaving shortly. There are still some good, RN friendly, pediatric facilities out there. I have done my homework this time instead of just being awed by the "Vanderbilt" name and assuming that it will be a great place to work. To the people that work there, I say, "Take care!" You guys are great. To the people that manage that place, I say, "Good luck." Because, stay on this same path and it will be luck alone that will preserve the reputation of VCH, especially as word gets out and more and more people realize just the kind of operation you are running.
