Unit Practice Council Haters?

jadelpn, LPN, EMT-B · Feb 20, 2015

A UPC can only suggest best practice for the unit. Then it needs to be backed by a policy. Then the policy needs to be approved through administrative functions. It can go back and forth as far as changes to the policy. You can not (and should not) put into practice anything that doesn't have a specific policy to back it up. This takes time, and has many hands into making it a reality.

Personally, I think that UPC and other committees such as this give nurses the illusion of having control of their practice, when in reality, it is a tremendous amount of work that may or may not lead to changes. That is the job of your DON, who has the final say and can choose or not choose to accept any ideas from the UPC, more than likely will pass of the good ideas as his/her own, and has someone to "blame" if the ideas either don't become reality, or don't work for the unit.

I also find that with a theme of "governing ourselves" it erodes any union involvement and/or keeps unions out of facilities.

Ya'll aren't governing yourselves. You are doing part of the DON's job for them, making suggestions that you may find the most effective ones are squashed by management who has not a clue about the day to day of the unit, and/or a general frustration of what is not broke is attempting to be fixed, what is broke-let's play the blame game, and call it a day. So we can do the same thing tomorrow--and the next day...

Gooselady, BSN, RN · Feb 20, 2015

It is impossible, and inappropriate for the council member to themselves be responsible for enforcing anything. If my manager told me to enforce a rule with my uncooperative peers I would explain why that would be inappropriate to expect of me. These are your peers, not your subjects. I don't want to assume your manager deliberately set you up as the fall guys but dang . . . it's hard not to see it. Putting through changes is always tough, there's always lack of cooperation and resistance just to be stubborn. The managers know this. So they give the job to you?? Uh . . . and then tell you it's your responsibility to enforce it.

I think this council needs to self-advocate with management for management back up. It's like they've tied your shoelaces together lol. You may have the responsibility to 'enforce' your changes but you do not have the AUTHORITY to enforce changes. See the difference? This is a serious oversight (or whatever it is) on the part of your manager, and if they really want this council to succeed, they will have to give something, too. They need to back you, they need to attend the darn meetings and be the power of enforcement themselves. Good luck!

calivianya, BSN, RN · Feb 21, 2015

I am a self-confessed council hater. My job changes almost weekly because of stupid new things management and the nurse educators come up with. That's about all I can take. Having some unit based council also coming up with new rules, on top of everything else I have to do, is exhausting. Maybe if your unit council advocated for the nurses in the form of encouraging management to come up with a policy and STICK to it, instead of changing things all of the time, the other nurses would like you better.

MunoRN, RN · Feb 21, 2015

I'm a big proponent of shared governance when done right, but when it's done wrong it typically fails, just as it should when done wrong.

The basic premise of good shared governance is that it provides a mechanism for direct care nursing staff to have some control over their own practice, rather than it being controlled only by administrators. It follows the current model of any effective organization which is that the role of administrators should be to empower their staff to provide the best care possible, rather than working against staff. So where shared governance fails is when it just becomes a puppet government for administration and instead of working on it's own initiatives, the practice council just pushes the initiatives of administrators.

I've been on practice councils that have been very successful, but only because they had the support of administrators but were not in any way controlled by administrators, yet had the ability to implement and manage all aspects of direct patient care.

When done correctly staff will naturally support the council since it helping them do their job. When done wrong it helps administrators do their job and often works against nurses.

Gooselady, BSN, RN · Feb 21, 2015

I am a self-confessed council hater. My job changes almost weekly because of stupid new things management and the nurse educators come up with. That's about all I can take. Having some unit based council also coming up with new rules, on top of everything else I have to do, is exhausting. Maybe if your unit council advocated for the nurses in the form of encouraging management to come up with a policy and STICK to it, instead of changing things all of the time, the other nurses would like you better.

See, this is very important information for the council to have -- and to respect! It can't be ignored that the council often comes up with what appears to be 'more work' to already overworked nurses! Whether they ARE overworked or just FEEL like they are is not for us to decide, that's like telling someone what to think and how to think it.

If it's gotten to the point the staff is saying **&^ the council! Then the council needs to listen to the nurses and take their concerns seriously. Maybe THIS is more important than whatever improvement project is in the works? Ha. It IS more important :) Obviously, you need their interest and cooperation :) You can't DEMAND it, you have no authority to do so, not that you'd want to.

Instead of widening the gulf between the council and the nursing staff, COLLAPSE the gulf. No one likes the idea of a small group of people deciding what all the others are gonna do. It calls for a more creative way of defining what the council's purpose is.

jrall60 · Feb 21, 2015

Thank you for all of your responses they are very helpful! I would like to point out that the people who do not favor some of the council's ideals are the same people who do not accept any change. There are only 3 or 4 of them out of a staff of about 60 so it is difficult to gauge if they are being legitimately pissed or just refusing change as typical to them. They are the ones, though, who have the loudest voices. Because of this, it makes it seem a lot worse than it is. My concern is that it effects the morale of the entire floor. Since this has happened the president of the UPC met with our manager and told her that we need more support if we are to continue the UPC and that we can't do things if we don't have her support and authority. Our manager agreed to mention our current projects in the monthly unit meeting and she spoke individually to people about their personal issues regarding changes being made.

When coworkers complain about things under their breath I immediately think to myself that these processes may seem like more work but it's work we have been neglecting. This work is important to patients and doctors. It may not seem significant to some of the staff members I work with day-to-day, but that's not the whole care team and that's not who we are serving.

In terms of what we have implemented so far, a lot of it is UPC thought of and management approved. We have avoided being a "puppet government". We have completed new signs to go on patient rooms (npo, fluid restrictions, etc.), made a physician directory book, completed a prn q 2 hour turn schedule, etc. Sometimes management does ask us to help come up with solutions like a rotating holiday schedule. I do hear a very small amount of employees grumbling about it but I don't think it's personal, they just don't want a "schedule". Some people would prefer anarchy to order in that sense.

I've noticed that we have to move very slow and take our time with everything and ask for feedback from management and employees. I think this is fine that it takes so long, it can just be discouraging to people in the UPC and it makes some of them not want to continue our attempts. I hear a lot of "We've been trying to make this happen for months, what's the hold up?"

We are very new and I think that overtime we will make small but vital changes to our unit that will save us all time and make our daily lives easier rather than harder. The people who always complain will continue to complain and the people who want change will continue to strive for change (not for the sake of change, but for the sake of the patient).

Thanks for all your input!

OCNRN63, RN · Feb 22, 2015

Your UPC came up with a physician directory? I'm sorry, but that doesn't seem like something that should be the responsibility of UPC. Same thing with signs.

When I think of UPC, I think of developing policies specific to a department. Perhaps the pushback you're getting is because staff can't see specific benefits brought about by the UPC.

Does your UPC let the staff know what it's working on? A monthly newsletter might help to make your co-workers a little more understanding.

jrall60 · Feb 22, 2015

Well one of the UPC members is our secretary so if we notice things that could enhance our unit we mention it to her and she does what she can. We work on barriers to anything that can make our jobs more efficient. We did send a newsletter out for the first time last month, but as things happen so slowly I feel a monthly one would be a little repetitive and sporifice. Also, I'm thinking about creating a survey to get some feedback from the staff!

Gooselady, BSN, RN · Feb 22, 2015

There are always a few oppositional types, aren't there. I'm remembering a previous coworker who, when we RNs did 'primary care' (no CNAs) complained vociferously that we RNs need help, patients are waiting in their pee to be cleaned up, call bells not answered even remotely in a timely way. Then we got CNAs, and just before I resigned, this same coworker started up a discussion about how much 'worse' it is now with CNAs. I just chewed and said nothing. What would have come out of my mouth at that moment wouldn't have helped anyone.

Two fairly new RNs took over our unit counsel (they called it a different name) and did a great job IGNORING the nay-sayers who wanted to spend the meetings complaining. One had this knack of giving one complainer answers that shut her right up LOL , they were 'appropriate' answers, like 'Just do this instead, and your problem is solved' She had a gift, for sure.

The less you 'feed' the chronic complainers with attention, the less they'll be validated (they can get validation just by getting attention). Maybe a "thank you for sharing" and then move on to the agenda, not 'allow' them to side track when your council is presenting ideas, or just talking among yourselves at lunch. If your ideas are an effort to make things MORE efficient, that implies LESS 'busy work' or repetition of work, right? You'll have to find a way to demonstrate this so the nurses SEE it for themselves. Otherwise, I'm afraid most of us are pretty cynical. If you have a handful of oppositional types, and a handful of motivated types (you, the council) you have a majority in the 'middle' who just might need to be told HOW this new bit of paperwork replaces two others, or something like that. Or somehow gives the nurse 'credit' for what she does, when before, no credit was given.

It's always very, very easy to come up with 'new ideas'. What's hard is to take the 'old ideas', modify them, and then implement and IMPROVED version of them. That is the 'formula' for creativity, btw :)

NicuGal, MSN, RN · Mar 4, 2015

Our unit practice council has been in place for 20 years. I have been a part of it since it's creation. We deal with exactly what the title says, practice issues in the unit. We do not deal with any unit politics, etc.

We look at EBP, hospital/unit protocols. We have instituted and follow up on our VAP protocols, central line bundles, any other practice related things. We have branches off of our committee that split into Unit Education, parent/family education, hospital standards, skin committee, EPIC, bereavement, breastfeeding, customer service and a few others.

The people who make up base PC are UM, AUM, CNS, the heads of the sub-committees. You have to

keep it small to prevent total chaos! The secretary is on customer service since she is front line at the desk. During the meeting we discuss what we need to by committee. Our UM sends out an update note to the staff and then posts the minutes for all to read and sign. Anyone in the unit can give any member something to

bring up, even docs.

Good luck!! Once you get it settled and organized it will greatly benefit your unit. The sub-committees are like worker bees and help get things done! Our UPC has been instrumental in so many things!

calivianya, BSN, RN · Mar 10, 2015

If our UPC came up with helpful things, I would like them better. Directories? Heck yes!

Ours said recently that we need to write more notes about things that happen because the physicians don't look at our assessments. So. Let's take a blood sugar of 45 that comes up on AM labs, as an example.

1. Lab calls a critical. I have to fill out a "Critical Results" flowsheet, which includes the time the lab was called to me, what date and time the lab was drawn, what the lab was, who the lab tech was that called the lab to me, a checkbox that I read and verified it back with the name and birthdate, what I did with the result (i.e. notified provider), who the provider was that was notified, and what time I notified the provider. That leads me to:

2. The provider notified section of the assessment! The name copies over, but nothing else. So in this section, I put the reason for my call (critical lab value, BG 45), who I called (pre-populated from the above), what time I called, how the communication was performed (face-to-face, on the phone, emailed, etc) and the response (MD aware, MD in department, orders received).

3. When I'm giving D50, the MAR asks me for the current BG. I put 45 in that section.

And now... you're telling me I have to write a progress note, too? You're literally saying three sections of the chart is not enough places for me to record the info?

And that's why I hate my UPC.