Saturday, November 20, 2004


Employee reviews were yesterday. Everyone on the floor was rated a 3 on a scale of 1 to 5, three being "meets expectations". Ones are apparently reserved for nurses who, you know, actually kill patients, while fives are reserved for the Holy Ghost Incarnate types who work immense amounts of overtime, spend hundreds of hours each year on clinical ladder work, and generally overachieve.

For what it's worth, I got two fives--one for "talks to her patients as though they're human beings" and "takes time to explain the niggly shit that nobody else does".

Still, there are things that bother me about this. Why, for instance, would a manager simply mark everybody at "meets expectations"? There are a couple of folks on the floor who most decidedly do *not* meet expectations. I was always under the impression that reviews were supposed to give you something to work on as well as kudos. And why would a manager who spends most days on a different unit bother to rate our practice at all? Why not leave that to the sub-managers, the people who actually see us practice? Why not give us something useful rather than simply playing it safe?

It's an interesting sidelight to this that the manager has specific goals for all of the nurses on the floor: Everybody Has To Do Everything. We have three "special" programs on the floor: clinical ladder, preceptoring, and COU.

The close observation unit is something I've written about before, so I won't go over that again. Preceptoring is, basically, taking on a new nurse or a new-to-us nurse and training them in the procedures and patients that they're likely to run into on a neuro floor.

Preceptoring takes a person with a lot of patience and a well-organized mind. I have a well-organized mind but a shitty memory and zero patience with students. Realizing that, I told Manager yesterday that I will not precept. Period. "But you're good with the nursing students" Manager protested. Yeah, for five minutes at a stretch. Give me the same person for six or eight weeks and I'll turn into a snappish martinet. There's no need to traumatize a new nurse in order to prove that I'm not good at teaching; I've done it before and know my limitations.

The other bugaboo is Clinical Ladder. This is a hospital-wide program designed to make nurses more competent in their specialty, as well as to introduce them to the wide world of volunteer work and training other nurses. We do get paid more if we complete the clinical ladder program, so there are compensations besides being a Champeen Form-Filler-Outer.

At the end of the day, all CL proves is that somebody is willing to copy articles, post them, and cram for a cert. exam once a year. There's no standard formula that tests whether a nurse on the ladder is actually becoming more competent. Those who invest the time in CL are generally those who 1. live in the city and don't have to commute, 2. work three-quarter time or only on weekends, or 3. are generally recognized as being such strange people that it's inconceivable that they'd have a life. Petty but true, that last one.

I'm pretty damned competent, as are most of my colleagues. We see no reason why, as a group, we should be expected to conform to a standard set apparently at random by someone who isn't competent in our field (Manager is a cardiac nurse, not a neuro nurse) and who doesn't live in our unit.

I guess what bothers me about this whole culture of standardization is this: We work with patients who have weird brain things going on. Every patient is different, as is every nurse. Yes, there are some similarities among people who have subarachnoid hemorrhages, as there are among people who specialize in neurology...but you can't expect total uniformity inside either group.

If you hired me because I'm unique, then let me *be* unique. Don't pressure me to do things that I'm just plain not good at, like preceptoring, or expect me to produce the outward flourishes that signify competence instead of demonstrating competence. If you want good nurses, let us be good nurses. Let us spend time with our patients rather than pressuring us to copy yet another article from JAMA.

I probably have more esoteric crap stuffed into my brain than almost anyone else in the unit. I read compulsively and widely. My talent is Translating Medicalese Into English For The Benefit of Civilians. I'm good at what I do. I'm as intelligent as almost anybody else and more so than a number of people...but the current standard, as it's been put into place by Manager, doesn't allow me to demonstrate that.

Nor does it allow other nurses with different talents to demonstrate those talents. It's the standardization that bugs me. We're a tight group of loose cannons. We demonstrate our strengths every day. Watch us instead of asking us to fill out yet more forms. You might learn something.


Anonymous said...

As a patient (fortunately, VERY infrequently) I just want to say, thank you!

As a daughter and niece to several nurses and cousin to doctors, I've heard similar complaints.

bobbie said...

I know I'm very late finding this post (almost 5 years!), but I just wanted to let you know ~ AMEN to all that you wrote about clinical ladders!! I would love to copy it and turn it in with every single perf. review!!
Thanks for putting into such eloquent words what I've always felt ~

PS ~ I think we MUST somehow be related!