What do you really think about your Quality department?

[QualityNurseRN]

Hi All,

I have recently started my first job in hospital quality as a Joint Commission coordinator. Please don't throw rotten tomatoes just yet! I paid my dues in med surg (nights no less!) and loved every minute of it- the crazy old ladies, being out straight with two patients crashing while one wants to get up on his new hip and the others have decided to just go in their beds, then staying late to document when you've finally handed them all off. It was an invigorating roller coaster ride that taught me a lot about myself & others. But I always knew I would leave the bedside at some point. My first career was in public health and I knew I needed to somehow find a position that utilized that side of me in order to be truly fulfilled in a career. Well I have finally found it, but I have to say I am incredibly discouraged by many of the comments I hear not just from the nurses at my hospital, but from the nurses on this forum. It is disappointing to hear so many educated, experienced, intelligent people question the value of those whose job it is to keep their eyes on the big picture. We nurses in the quality department work hard to improve patient outcomes on a hospital-wide scale. We keep up with the evidence, and identify trends that could signal problems. We work to improve safety for every patient who walks through our hospital's doors, as well as every employee. My goal is to keep my bedside nursing perspective as I move through my career as "a paper pusher", as I've seen us referred to on this site, so that I can continue to work towards a safer hospital by working WITH the frontline staff - to implement changes that fit INTO your workflow, or IMPROVE your workflow while ALSO improving outcomes for the patient. Anyway, what I would like to know is, deep down do you truly believe that the nurses in the quality department are so terrible? Or are you just venting after a tough 13 hours when you talk trash about us? I truly believe that we can achieve great strides for patients and the nursing profession if we can work together.

[wooh, BSN, RN]

I think a lot of the quality people are anything but. It starts as, "I really was one of you!" and then it's, "One more form for them to fill out won't be a problem, they've got more than enough time."

Sure we need someone looking at the big picture, but a lot of the "watching the big picture" quickly turns into throwing the floor nurses under the bus and giving us even more work to do.

We NEVER hear how we're improving outcomes. We only hear from quality about how we're costing the hospital money, killing little old ladies when we throw them on the floor (aka, they fall), and not meeting whatever goal has been come up with this week. And we're supposed to only talk fondly of the people that only come around to tell us what a crappy job we're doing?

[monkeybug]

I never had anything against most of these nurses personally, I just never saw how it benefitted me in any way, and I did see how their actions worked to my detriment on a daily basis. One fine example: On our unit, we had a small alcove of the nurses desk that had a sink, the med refrigerator, the transport tube system and a door. The door made an excellent short cut. It was great to save some steps every time you needed to access the upper hallway. If the halls were crowded with people, I knew I could use the door to save a few minutes to get to the rooms. The doctors loved the door, too, because every minute for them was money. And then the Quality team hit. The door gave access to the med refrigerator! (the refrigerator that had a lock on it, the refrigerator that was easily accessible from the open and unsecured nurses desk? Yeah, that refrigerator.) And so, the door was locked. Adding steps and minutes to all of our days. But I'm sure the Quality nurse was very proud of herself. She had solved a problem that didn't exist! Go her. I know, what's a few steps and a few minutes every day? Well, over the course of a year it's miles and hours. And the worst part, the part that made us all howl with rage was that a)there was no problem (refrigerator was locked, and refrigerator was also easily accessible by anyone who wanted to get to it because the desk was wide open) and (b) their solution wouldn't have fixed the problem if it really was a problem.

Another example: In our sterile suite, we had a couple of ORs and a sterile supply room off of an area that contained the scrub sinks and the drug cabinet. We would line delivery tables in the area when they were not in use. Quality comes in and demands we move them. Where? There is not another available inch in the unit. From the mouth of the Quality nurse: "I don't know where you are going to put them, that is not my problem. You find some place to put them!" So, we went from a tidy row of tables in an open area to shoving all the tables in the sterile supply room. So every time you had to run in there and find something, you had to move tables to get to the cabinets. I can't tell you how many bruises I ended up with after darting in their to find something and banging into a table. Sorry, doctor, I know you need that hysterectomy tray stat, but I just had to move 3 tables out of the way to get to the hysterectomy tray, and then I had to move them back where they were to start with so I could exit the room. I know that seconds are life when someone's bleeding out, but hey, doesn't it look nice and open out here without row of tables?

So, while I understand high ideals and wanting to move up in the world, too many times it seemed like this department did a lot of things just to justify their existence. And in the process, they made my life more difficult.

[lkulmann]

The issue I have with the behind the scenes nurses doing their research and whatever it is they do is the majority are completely disconnected from the bedside care nurses. What you did 5-10yrs ago at the bedside is ancient history.

[Morainey, BSN, RN]

Very removed from the realities of bedside nursing. Sure, maybe it's "just" one more form or "just" another intervention to fill out. But the message we get is, Administration doesn't care if you don't like this, or it takes up more time, or if it is redundant - the patients/families/administration likes it. You may have put your time in but it sure as hell doesn't seem like you're one of us anymore, particularly when staff nurses get asked for their input which is ALWAYS ignored.

[Nurse_]

I think nurses in the quality department lost perspective on how easily changes happen on the floor.

Can Joint commission really see the picture? Is it really for clients' safety? Maybe... even when you bury the nurse with pages after pages of work instead on taking care of the patient. Is that really patient centered? But I did the paperwork, right?

In the perfect world of joint commission:

- Nurses never rush

- Client's change conditions are spotted as soon as they arise

- Nurses take bathroom breaks as many as they want

- Nurses finishes Care Plan notes, Assessment notes, chartings, med orders, core measures... etc.

I do care what happens to nursing in the future, but what I don't understand is when you look at the big picture long enough, you miss the details. Joint Commission employs a one-size fits all policies. What a big urban hospital can do, a small rural hospital should be able to, what one unit can do, the other unit should be too and what one nurse can do, the other nurses should be able to. There's no gray area, and we know that in nursing... a lot of areas are never black and white.

[HouTx, BSN, MSN, EdD]

"Quality" is such a nebulous term that it has become meaningless. Maybe it would be a good idea to re-brand yourself with a name that reflects your actual purpose. The "Looking good for accreditation visits" department? The "fill out all the forms" department?

Hey, I'm an educator - can't resist the chance to lob a few at another department that no one really understands.

[krwrnbsn]

What I love is when they come into my OR to "observe" something they know nothing about and get too close to the sterile field! Sheesh! I do not care if they come and observe but when you are too close to the sterile field I'm telling you "you're entirely too close," you'd better move BACK. It doesn't matter who you are or what you are doing, if you are told you are too close, duh. Move it back, jack. **sorry but that's my pet peeve**

[tewdles, RN]

Too often the nurses in Quality take an adversarial tone with the staff nurses who are not meeting the expectations of the quality department.

It is not easy for an overworked RN to take criticism from someone who doesn't demonstrate that they have any knowledge about the processes of the job being done, or, in some instances that they even care.