Time for some introspective criticism perhaps?

steelydanfan · Feb 15, 2011

On board with Texas? Even if they're getting some union activity, they've still got the "background check" company (something or other "one"??) that will blacklist you in a heartbeat if you cause trouble, aka, sticking up for yourself and other nurses. Texas is where nurses face criminal charges if they report MDs for horrendous behavior.
Ratios are the answer. Legally mandated ratios. If Joint Commission wants to be relevant instead of just a pain in the petoot, they'd mandate ratios instead of stupid stuff like "Did you write to give the asthma inhaler by mouth on the asthma action plan? Because if not, someone might take the inhaler rectally when they're having trouble breathing!" Of course, even they probably know that ratios would be such a good fix that they'd put themselves out of work because everything else could be done well if we had the freaking time to do it!

Joint Commission is NOT where you want to look for "relevancy". They Are a PRIVATE company, that is HIRED by every hospital in this country to survey themselves. JCOHAA exists because it EXISTS. Every year, they HAVE to think up more rules and problems to solve, simply to stay in business. If no problems were happening in hospitals, there would be no need for them. Thus, there are ALWAYS problems.

Get my drift? They do some good work, but their regs are often ridiculously reactive, time consuming, and often to the detriment of the problems they are trying to solve.

One idiot nurse goofs, the rest get to suffer in perpetuity. Joint Comm. has NEVER taken a standard off the table, even when found to be redundant

Joint Commission basically takes the tack that nurse are idiots, and if it wasn;t for them, every pt. in the country would die.

Want ratios? Get NNU in there, and watch your hospital change. California nurses stuck it out and won, and so can you. You just have to have the guts and determination.

silverbat · Feb 15, 2011

ok, I gotta say this... I am considered administration as MDS coordinator. As far as time off, not earning my salary, I beg to differ. There ain't a week go by that i don't work anywhere from1-4 extra hours each day, and even work at home on the computer at night at times. I am on-call every 6th weekend and one week day a month, as well as fill in for weekend manager or Rn in the building. I eat my lunch typing on the computer with one hand and eating sandwich with the other. So much of my work has timelines that if other duties crowd in, i still have to meet the deadline no matter how late I work, or if, like today, I have pneumonia, but had to do some MDS per schedule and could not miss.

Not saying that some administration isn't guilty of what you say, but please don't lump us all together!

I really understand what you are saying as I worked the floor in both hospitals and nursing homes and nothing is more annoying than to be busting my butt and have the nurse manager smile as she leaves, or know that a fellow staff called in to go to the fair, or a movie, or what have you.

THe solution simply would be for everyone just to work when they are supposed to as often as humanly possible and call in very rarely, but we all know that won't happen......

eriksoln, BSN, RN · Feb 15, 2011

ok, I gotta say this... I am considered administration as MDS coordinator. As far as time off, not earning my salary, I beg to differ. There ain't a week go by that i don't work anywhere from1-4 extra hours each day, and even work at home on the computer at night at times. I am on-call every 6th weekend and one week day a month, as well as fill in for weekend manager or Rn in the building. I eat my lunch typing on the computer with one hand and eating sandwich with the other. So much of my work has timelines that if other duties crowd in, i still have to meet the deadline no matter how late I work, or if, like today, I have pneumonia, but had to do some MDS per schedule and could not miss.
Not saying that some administration isn't guilty of what you say, but please don't lump us all together!
I really understand what you are saying as I worked the floor in both hospitals and nursing homes and nothing is more annoying than to be busting my butt and have the nurse manager smile as she leaves, or know that a fellow staff called in to go to the fair, or a movie, or what have you.
THe solution simply would be for everyone just to work when they are supposed to as often as humanly possible and call in very rarely, but we all know that won't happen......

MDS Coordinator? IDK. I worked night shift last night, that may be why. What is that?

For me, when I use the term "admin." I'm talking specifically about the decision makers. Those who go to meetings and decide...........do we give raises or not ect ect.

Some administration? For me, "some" means, well, a good bit less than half. I'd say probably close to, eh, 70% of admin. could stop showing up and not much of anything would change (other than their salaries not being taken).

Well, 70% is harsh but you get my drift. I base this on the two separate "death march" incidents I saw back when the recession started. Two separate hospitals called in the "admin." (my definition) and told a great many of them not to report to work the next day. It was reported in WA when it happened, in the papers, and people balked at the salaries that were being paid out to people who apparently could be let go with no real consequence to the flow of the hospital.

silverbat · Feb 16, 2011

Erik.

MDS is MInimum Data Set. a compendium of information that CMS has decided is a minumum amount of information CMS wants compiled on nursing home residents(and others). This has gone from 17 pages to 39... yep typical government bs... wayyy tyoo much paperwork.

I agree with you that the upper admin hasn't got a clue. too far from floor nursing and too far from reality much of the time. I agree they could evaporate and the rest of us could get the job done way better.

I always have said that anyone above the level of nurse manager should HAVE to work the floor at least 6 shifts a year, one on each 7-3, 3-11, 11-7, etc. AND they should work at the less admin type level available, speccifically CNA or at least floor nurse. MAybe they would understand better, but I doubt it.

Night shift? I worked nighs to 15 years and LOVED it!!!! ENJOY! but don't work so much, Life does not have to equal work only!!!!! :)

eriksoln, BSN, RN · Feb 16, 2011

erik.
mds is minimum data set. a compendium of information that cms has decided is a minumum amount of information cms wants compiled on nursing home residents(and others). this has gone from 17 pages to 39... yep typical government bs... wayyy tyoo much paperwork.
i agree with you that the upper admin hasn't got a clue. too far from floor nursing and too far from reality much of the time. i agree they could evaporate and the rest of us could get the job done way better.
i always have said that anyone above the level of nurse manager should have to work the floor at least 6 shifts a year, one on each 7-3, 3-11, 11-7, etc. and they should work at the less admin type level available, speccifically cna or at least floor nurse. maybe they would understand better, but i doubt it.
night shift? i worked nighs to 15 years and loved it!!!! enjoy! but don't work so much, life does not have to equal work only!!!!! :)

that almost sounds like it'd fall in the nursing informatics side of things. i'm giving a lot of thought to advancing my degree and going in that direction.

yeah, you wouldn't fit under my very narrow definition of "admin.". hmmmmm.........wonder if there is a better term for the people i am talking about.

i don't like nights at all. i just..............can't do it. from time to time, i am ok with them. full time nights catches up to me and i change. i become chronically irate for no real reason and just plain critical of everything, again for no real reason. its unhealthy for me on a lot of levels.

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on that note, can't help but share what the last couple days have been like for me. completely ties into this thread.

talked to a girl who, like me, recently came to the unit from elsewhere. for me, it was to get off nights. for her, it was to get away from a toxic situation on her old unit. it was filled with total non-team players. everyone on her unit gets burnt out eventually.

we were talking about the little things people do "in the name of teamwork" that seem so trite, but make such a huge difference. things she pointed out: being polite and personable on the phone, not cold and dismissive, stocking supplies when you are having a good night and aren't busy and, well, just basic little things that you'd think no one would notice much.

me, well, of course you know exactly where i went with it. "i try to be flexible on the schedule, so people with needs for certain days off have a better opportunity to get them". no argument there. "i stay a late from time to time so the other nurses don't have to take outrageous raios". by now i'm caught up in it all, not really noticing her silence. "and i come on on off days to help out" there is a look of............idk..........."been there done that, it doesn't work" on her face" lol.

so, she proceeds to talk about how she used to be a lot like me. then she got married, has a kid and one of her parents died. it dawned on her, we are getting older and older and life can pass us completely by while we are in the hospital trying to take the weight of the world on our shoulders. for the past few years, she's practiced "balance". talked a lot about not being married to our jobs because our jobs, in the end, don't do much more than give us a paycheck. then she expanded on how the more she sticks to her ft schedule, the better of a nurse she is. too much ot drains any nurse of their compassion.

so, once again, it got me thinking "is this really what i want?". to be married to a job? and, the last part really stood out to me. i've been told i can be "mechanical" at times with people, that a small injection of compassion would take my nursing to the next level. is playing superman and, as she put it "taking the weight of the world on my shoulders" sapping my ability to practice with compassion. idk. its food for thought though. i know some of my fav. nurses are quick to point out "avoid doing too much ot, its not good for you or the hospital."

so, i hope that was the message people were trying to get across to me. at times i felt like a lot of people agreed with the nurse i was complaining about in my opening post "i never do ot, i don't care, i'll walk right out that door and leave you with ten patients each, its not my problem."

there is a difference, in my eyes, between doing ot selectively or just not being in a position to do it, and not doing it at all ever simply because of some resentment boiling inside you making you want to thumb your nose at the powers that be. i definitely though need to redefine what "selective ot" is.

NightOwl0624 · Feb 16, 2011

I really enjoyed reading this thread...I'm glad you started it!

anotherone, BSN, RN · Feb 26, 2011

My facility won't pay OT either. So it ends up being the few of us that are part-time that get guilted into coming in. Never mind, that if we want to take one of our weekend rotation days off, then that also has to be filled by a part-time person. I'm part-time for a reason. If I wanted to be full-time, I'd work full-time and get the full-time benefits.
If the facility refuses to budget for people to call in sick, then the facility will be short.
It's not up to to nursing staff to make the budget work, it's up to the bean counters. It's already the nurses' responsibility to:
1) Do all the nursing work.
2) Do all the aide work because if they're short, it's up to the nurses to pick up the slack.
3) Do the respiratory therapists' work because how dare we call them for something we can do ourselves.
4) Do the physical therapists' work because well, they can't put the patient back to bed, they're off in 15 minutes.
5) Do all of the cleaning that the housekeeping staff doesn't want to do, because it wouldn't be "teamwork" if the nurses didn't pitch in.
6) Go to pharmacy to pick up our medications because they're short-staffed.
7) Hunt for equipment because it would be just crazy to expect the equipment people to bring it, after all, they're at lunch.
8) Call the physician because well, isn't a rule that only nurses can call physicians to clear up whatever anyone else wants in the hospital.
9) Position the patients in radiology because you can't expect the radiology people to do everything in radiology.
10) Pass the meal trays, after all, it's an infection control risk for anyone other than a nurse to enter a patient room.
11) Pick up the meal trays, because well, see above.
12) Walk down to the cafeteria to fetch whatever the dietary department forgot to put on the meal trays.
13) Get coffee for a room full of visitors, after all, the coffee maker is in the visitor lounge so that it's convenient for the nurse to get to it.
14) Fix the television.
15) Fix the coffee maker.
16) Fix the monitor because you don't want the equipment fixing people to actually have to come to the room, that would be crazy.
17) Fix the computer, because the computer people aren't going to come to the floor.
18) Fix the printer, see above.
19) Fix the phone in the room.
20) Fix the phone at the desk.
21) Answer the phones, because the secretary is a bit busy on a personal call to answer the phone, besides, it's just going to be some other department wanting you to call the doctor anyway, so might as well answer it.
22) Unstop the toilet, after all, maintenance is busy, oh wait, no they're not.
23) Clean up the water spilled on the floor from the toilet, because housekeeping doesn't actually mop the floors if there's something on the floor, that's the nurse's job.
24) Reorder everything the way whatever department wants it ordered because of course the way the physician ordered it will never work.
25) Give directions to every single person that walks down the hall, because they didn't want to bother that nice lady at the information desk.
26) Other tasks as necessary for patient care. Remember, we're a TEAM!
Sorry erik, but at the end of the day, I'm not going to feel bad for delegating the staffing to the people who are refusing to pay for it. I've got too many other people's jobs to do during the day. At some point, I've got to let someone in the hospital actually do their own dang job.

OMG THANK YOU FOR SAYING EVERYTHING I FEEL AND WHAT WE ALL DEAL WITH. One of the most annoying aspects is playing middle man between the doctor and everyone else!!!!!! They call me to call the doctor! Even other doctors have done this...........................!!!!!

eriksoln, BSN, RN · Feb 26, 2011

ok, I gotta say this... I am considered administration as MDS coordinator. As far as time off, not earning my salary, I beg to differ. There ain't a week go by that i don't work anywhere from1-4 extra hours each day, and even work at home on the computer at night at times. I am on-call every 6th weekend and one week day a month, as well as fill in for weekend manager or Rn in the building. I eat my lunch typing on the computer with one hand and eating sandwich with the other. So much of my work has timelines that if other duties crowd in, i still have to meet the deadline no matter how late I work, or if, like today, I have pneumonia, but had to do some MDS per schedule and could not miss.
Not saying that some administration isn't guilty of what you say, but please don't lump us all together!
I really understand what you are saying as I worked the floor in both hospitals and nursing homes and nothing is more annoying than to be busting my butt and have the nurse manager smile as she leaves, or know that a fellow staff called in to go to the fair, or a movie, or what have you.
THe solution simply would be for everyone just to work when they are supposed to as often as humanly possible and call in very rarely, but we all know that won't happen......

I forgot to say too, I think the bolded part up above is the first step. Nevermind if you can play hero from time to time, a lot of stuff would be solved by eliminating unecessary call offs. Not everything would get better, but a lot would. I don't see it now so much as a staff nurse, but when I was a travel nurse, some nurses were so comfortable with calling off just for the sake of making it to some party or seeing a movie on "opening night".......they'd walk around the unit talking about how they were planning on doing it. Then, the day after doing it, they'd be telling everyone what a great day they had. Eh? :uhoh3: I remember the days when calling out for no good reason was frowned upon, and not because admin. told us it was bad.

I might be finding some of the balance I was talking about before though. The other day, it was snowing like mad in my area. Just before going in for a 4hr shift, my mother calls to inform me my father fell while salting/shoveling the sidewalk. He was complaining that his right ankle hurt a bit, and he never complains. So, at first I thought "I'm going out there, who cares about four hours?". I knew though that there were probably call outs galore because of the snow, and I didn't want to be part of the problem. So, I went to work and figured I goto my parents after, maybe spend the night if the snow was too bad.

Sure enough, just as I'm getting ready to leave work and head out to the folks place, the supervisor rings the floor and wants to know if any of us can stay. They told her about my situation with my dad falling and that I wouldn't be interested but she persisted in trying to talk me into it. "You won't make it all the way out to where they are anyway, safer here." Nice try. I didn't get talked into playing hero and checked on my dad. He was fine, hospital didn't collapse from low staffing.

TheChair1 · Feb 26, 2011

Eriksoln, I've treated you cordially and with respect, and I expect the same in return.
As we have all said, we agree with A, with pitching in to help in rare urgent situations - there's no issue with that. Maybe its your definition of rare that differs with the majority of posters on this thread?
Trading days off and preplanning is good and is a completely different situation than last minute frantic phone calls. If float pool, PRN, and on call nurses can't cover things on the unit enough to where these calls are being made many times per month, there are big issues. Obviously people pitching in is good, but we can do better than that by working for lasting change. Address the reason for the issue instead of merely reacting to it.
You have yet to tell me how staying silent and accepting any shift you are called in to do will result in any changes to the unit? How about attempting to work for permanent meaningful change with the persons who can make that happen - management, committe, or, people like NNOC/CNA? Being a voice for your unit will do more than just keeping the status quo. Have a couple of leaders on your unit meet with your manager and show their overtime numbers, and how costs would have been saved by hiring another staff member for float pool/more staff on call for example. Or maybe staff needs to start refusing to accept dangerous patient loads if your unit is having this situation happen repeatedly. Long term objective changes are what we should focus our time and energy on advocating for.

THANK YOU!!!

I'm not an RN yet (10 more months to go) but I worked on a telemetry unit as a tech for almost 2 years and saw firsthand how huge of an issue staffing can be. As a tech, I picked up OT when it was convenient for me and when I needed to make more money. I would never act as a martyr for my hospital because they do not want to implement adequate staffing ratios. Picking up shifts and complaining that everyone should be helping out because it is not a management problem is just maintaining the status quo like you mentioned. The original OP sounds like such a weak person to me. What I read/heard was, "we have no power and our needs mean nothing to management so instead of trying to fight a battle that is impossible to win let us all just accept how things are and continue to take their crap." This is part of the reason why nursing (the largest segment of the healthcare workforce) continues to be viewed as skilled labor instead of being a highly respected profession. We as nurses have so much untapped POWER collectively speaking! If only more of us would grow a spine and for once consider the interests of nurses and protect our profession like other PROFESSIONALS do.

eriksoln, BSN, RN · Feb 27, 2011

THANK YOU!!!
I'm not an RN yet (10 more months to go) but I worked on a telemetry unit as a tech for almost 2 years and saw firsthand how huge of an issue staffing can be. As a tech, I picked up OT when it was convenient for me and when I needed to make more money. I would never act as a martyr for my hospital because they do not want to implement adequate staffing ratios. Picking up shifts and complaining that everyone should be helping out because it is not a management problem is just maintaining the status quo like you mentioned. The original OP sounds like such a weak person to me. What I read/heard was, "we have no power and our needs mean nothing to management so instead of trying to fight a battle that is impossible to win let us all just accept how things are and continue to take their crap." This is part of the reason why nursing (the largest segment of the healthcare workforce) continues to be viewed as skilled labor instead of being a highly respected profession. We as nurses have so much untapped POWER collectively speaking! If only more of us would grow a spine and for once consider the interests of nurses and protect our profession like other PROFESSIONALS do.

Hmmm, odd interpretation. I actually talked about that before, but not in this thread.

In my eyes, us taking the staffing into our own hands takes the power from management. If nurses create their own schedules and everything else, thats one less thing the DON can use to control us. If we take over the staffing ourselves, no more of this back and forth rule making that never suits the nurses. One week 12s are allowed, the next they are not, one week holidays are fully staffed but the next week the weekend is short...........................

TBH, us taking over more of the staffing issues takes the power from them. We'd be more autonomous and have more say in how it gets done. Then we could "grow a spine" and "consider the interests of the nurses". Continuing to say "not my problem, I don't make the schedule" is........well, thats the mentality of a workforce, not of a profession.

Consider this. A profession is responsible for their distinct area of expertise. Often, need for their services wax and wane. Take lawyers for example. Lots of times, they probably take an extra 15 min. at lunch time, leave 5 min early because, well....the work is done and they can. But, when there are issues that need dealing with on the table, they deal with it. They "own" their section of responsibility and would refuse to let anyone else make their schedule for them if someone tried. So, if they have to stay four hours late every night for a week or two...........they do it. Its part of being autonomous and protecting your control over what it is you do. If you throw in the towel and say "its managements problem", they'll find their own solution to it and you won't like it.

Again, the whole "I don't help because it's managements fault and I'm teaching them to deal with it" argument is here-say. No administrators or managers ears are tuned in to that jazz. They are not getting the message. They never will. And again..........why won't they?..............because when things go wrong with staffing they are not the ones who take the heat, we are. The nurses and the patients suffer, not admin. or management.

Point is, I'm not saying "We can't do anything about it, let them have their way". I am saying "Staffing seems to be a bit above their capacity, lets take it from them." Helping out (selectively mind you) and getting things squared away for each other is a part of that process.

LPN2RN2B, LPN · Sep 30, 2011

Wooh, if you ever need extra money, you should seriously be a stand up comic! Your monologue was hilarious and so true! :rotfl:

You had me practically crying from laughter. I could hardly stop laughing to write this reply.

But, thanks for the laughs Wooh, I really needed it tonight!