Why Management is often not sticking up for Nurses

[MarcusKspn]

I know that we, myself included, often ***** and moan about Management taking the sides of doctors, when it comes to conflict between us and them. I know we often feel that we rank pretty low on the hiearchy when it comes to whom to please. I'm taking some management courses in school, one of them being in management of Health care institutions. It opened my eyes a little bit to the other points of views out there. Basically we were discussting who the most important customer for any health care institution is. Who do you think it is?

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

The Doctor! I know its hard to swallow, but without the Doctor there wouldn't be any other customers. The patient pays the bill, we take care of the patient, make sure they are happy, make sure they are taking care off. Make sure everything goes well. But it is the doctor who admitted the patient to the hospital in the first place. Most doctors in bigger areas have at least a couple of hospitals that they can admit to. If they know that a certain hospital staff will stand up to them and lasso them off the high horse they sit on, they will simply quit admitting to that hospital, and thereby cut of the funding. No patient, no money. At least thats whats being thought in my classes. I know that doesn't make the behaviors of a lot of doctos justified. They have no right to treat us the way some of them do. And it also doesn't mean we should take the abuse some of them dish out. But in the end the higher-ups gotta keep the doc's happy, or they'll quit aditting people there, or admitt less. I don't know if this theory is completely correct, or if I agree with most of it. It certainly doesn't give any justification to the way some of us are being treated by the doctors. But it does give an explanation about why upper management is often reluctant to take actions against docs.

Let me know what you think, I know there will be lots of negative responses to this. I hope they are not against me, I'm just presenting a viewpoint from another perspective. It just made me think for a little bit about why things are the way they are.

[llg, PhD, RN]

I think that what you are experiencing is a healthy eye-opening to the fact that there are perspectives of the world other than your own. No one perspective is the "be all, end of" of a situation.

Like you, I think that taking this view of the physician being the most important customer to the extreme is not right. In the end, we should be partners serving the patients -- and nurses (and other providers) should be able to "sell" their services to the physicians without having to degrade themselves, completely subjugate themselves, etc.

However, like you, I can acknowledge that there is some validity to the notion that the physicians are the ones who bring the patients into the hospital and a hospital that wants to stay in business has to please the docs in order to keep the patients coming in. This is particularly true in places where there is competition among hospitals.

The problem is that many people are not sophisticated enough to view a situation from mulitiple perspectives and they end up taking one perspective to the extreme. Here are some examples of this kind of simplistic, extremist thinking that I see regularly on this bulletin board:

1. The doctors are our #1 customers and we need to keep them happy at all costs

2. The staff nurses are the backbone of the hospital and their view (and their welfare) is the most important thing

3. The patients are our #1 customers -- so we give them whatever they want, regardless of what that means to the nursing staff

4. Mangers are only concerned about money and about keeping their cushy jobs. They have forgotten what it is like to be a staff nurse and they don't care.

5. Staff nurses just don't understand the big picture. They can't see beyond their own personal desires and convenience.

All of these examples of simplistic, extremist thinking. Whenever you start to think in terms of absolutes such as "always" and "never," then you know you are in trouble.

Yes, physicians are the ones who bring the patients into the hospitals -- and therefore hospitals must be sure to pay attention to the physicians' needs. Many nurses don't understand that. However, catering to unreasonable demands is just that -- unreasonable. Administration can and should maintain their integrity in their dealings with all of the "players" involved and attempt to treat everyone fairly. A good hospital with a strong staff should be able to "sell" their hospital to the physicians and to the community in general without having to abuse their staff in any way.

Good topic,

llg

[Geeg]

I realize that docs are the main focus for hospitals and that docs like to be catered to. By the same token, docs dislike hosptitals where their pts have poor outcomes. We all know what a large factor in poor outcomes boils down to: high nurse to pt ratio. Admin needs to be reminded of this fact constantly.

[oramar]

I hear the same stuff over and over again and I can tell they are parrotting it out of some book. What the book says is no excuse for the way managment treats nursing. Why is it that the book does not say, "treat your employees like they are assets. To the pateint and the physician the employee IS THE HOSPITAL". Read my signature line if you will, the trend is for business to consider it's employees CAPITAL not CHATtEL. Hospitals that kiss up to physicians at the expense of nursing are practicing 19th century business techniques in the 21st century. Time to rewrite the books.

[live4today, RN]

The patient is the most important customer to any healthcare institution. Why? Without patients we wouldn't need healthcare insititutions, doctors, nurses, or any other healthcare professional.

When human beings as a whole realize that we are not in this world alone, and that we need each other to scratch each others backs from time to time for survival, then we can begin to build off of this base with the cornerstone of that base being "caring for one another". :)

We need to all remember who the "patient population" is.......ALL of us at one time or another.

Patients become doctors, nurses, etc., etc., etc.. We will all take our turn as "the patient" at some time in our lives. When I take care of a patient, I remember this rule of life.......I, too, am a patient at times and desire the best healthcare possible just like everyone else. Doctors should keep this in mind, nurses should keep this in mind.....we all should keep this in mind so when issues arise where we work, this rule of thumb should bring us back to reality, to the basics, to the core of healthcare........human kind.

The reason we are all so unhappy in our jobs/careers is because some of us have lost sight of our human state and vulnerability as human beings.....we fall sick, we die, we need each other...always.

[bellehill, RN]

I can agree that the doctors are a big part of the hospital being successful; however, there is no point in the doctor admitting a patient if there are no nurses to take care of that patient. The whole hospital needs to work together to make patient care a top priority from dietary to doctors.

It is true that without the patient we wouldn't have jobs, I don't think that opinion should be carried too far. Making the patient happy should never compromise patient care.

Nurses hold patient outcomes in our hands, that needs to be considered by management. Yes, we need patients to have a job but they(administrators, managers and doctors) need up to keep their patients alive and healthy.

[Spidey's mom, ADN, BSN, RN]

Our physicians don't have another hospital to send their patients to except ours unless they want to lose the patient to another physician in a hospital 80 miles away. And our physicians treat us well, so no complaints there.

I think if there are any conflicts, it is the same stuff that goes on everywhere. Personality conflicts. Having a bad day conflicts. Feeling sick conflicts. Etc.

No one should have to kiss anyone's tush to make any business work. We all deserve respect and should also respect each other.

Unfortunately, we ain't perfect.

steph

[barefootlady, ADN, RN]

Sounds like a different version of the same lecture I had over 20 years ago. No big surprise, doctors bring the money into the hospital by admitting patients. Nurses are an expense because we do not generate business, our salaries decrease profit. Of course, if there are no nurses, or incompetent nurses, the doctors go elsewhere if they can. This is the cycle that has not changed in 200 years. We, as nurses, need to develop a good working relationship with our doctors, one of trust and respect, the same relationship needs to exist with the patients. Too bad we don't see how important each role is and too bad administrators don't see nurses as assets. The best job I ever had was at a small community owned facility where the doctors and nurses worked hand in hand for the best outcome for the patient. I was always treated with respect and felt like my opinion was of value. Too bad there are not many of this type of facility left.

I really try to treat my patients and the doctors I come into contact with respectfully and with kindness. I expect the same type of treatment. When I don't get it, I walk to another facility. Money is important to me, I have a sick hubby, his meds are very, very expensive, but the best paying job does not make up for ill treatment by doctors, HN, patients, or administrators.

This is not a new dilemna, just one that needs a new answer in the 21st century.

[MarcusKspn]

Thanks for all the responses, great feedback and opinions. Always love to hear what everybody has to say. Lots of stuff for me to think about and ask in class. Keep in comming.

[Agnus]

I think most of us who have been practicing for any length of time understand this thinking and where it comes from.

Now here is the other side. Allowing a customer to (in this case the MD) to abuse staff does not increase business. It increases contempt by the customer (MD)

Hospitals with this out look over look the fact that they have power. Power to deny a physician the right to admit to thier facility. If a physician repeatedly misbehaves and is therefore denied hospital privileges he has a problem. Limiting privileges limits his paractice and income.

They call it privileges for a reason but some hospitals have lost sight of this.

\

Sure he can take his business down the road to the next hosp. BUT the truth is with very rare exception physicians have privileges at multiple hospitals and without that today their practice suffers.

If hospitals clamped down and enforeced rules and regulations physicians would straighten up.

I own a business (not health care) if a "big spender" came in an began abusing my staff the way some physicians do I would be sued by my employees, the customer would likely be sued and I would be without a staff. Quite honestly from what I have seen of some physician behavior I would have to call law enforcement in my business. Without a staff I would loose my business.

Now think about this. I have seen docs be abusive at one hospital where they can get away with it. Then go across town to another hospital where they also have patients and treat the staff well because that hospital would not stand for thier nonsense. Docs do it because they can.

Management is short sighted in this type of thinking.

Kissing booty never got you to the top. Those who rise in business and remain there do so because they they are leaders and to be a leader you must have confidence.

You will not be on top if your face is under somone's back side. You can't lead if you are always 6 steps behind someone.

Because it is in a book does not make it fact. This author needs to study the greats like Carnage, and others captains of industry that not only rose to the top but stayed there. She/he would find they did so by lifting others not stepping on them and never ever permitting anyone to be stepped on.

[KMSRN]

Physicians bring in patients (and money) to the hospital however nursing is the function of the hospital. This is what some physicians and administrators don't seem to grasp. The function of nursing is the reason the hospital exists so it would be in everyone's best interest if there is excellence in nursing. We've all seen the studies about patient outcomes related to nurse/patient ratio and nursing education.

[hatzi]

Well, I agree that the patient is the most import consumer, but I do agree that we all work collaborativley to ensure they are happy with the service, thats what we all do isnt it?.......provide a service to consumers, just that our customers are in need of medical intervention in one way or another.

Where I work, we all work together, if we have concerns about a particular treatment or drug regime, we simply ask about it, our consultants and inturns are always oblidging. We work in a very large public (privatley run) hospital. We treat them with respect and we receive the same in return.

Obviously there are exceptions to this rule, there always will be, maybe thats why all new inturns get a pretty confronting lecture before they leave university, " remember, treat the nursing staff with respect, they are neither your slave or scapegoat, get on the wrong side of them and they can make your life a living hell".

I kinda like to believe that we all try to get along and hope and strive for the best outcome. Call me stupid, but I still believe that I treat others as I would have them treat me!!

I often find new inturns asking nursing staff "what do you think I should do now?". It doesnt mean they are stupid, it means they are extremely smart and not too "full of themsleves" to ask for assisstance. Isnt that what we are there for anyway??? To assist?

Very interesting topic I must say, gets the words flowing.

Cheers HB

"Life is what happens when your busy making other plans" John Lennon.