Tuesday, February 01, 2005

Sometimes I wonder: A Rant.

So we have this new management team at work.

About a year and a half ago, there were massive layoffs at my facility. A consulting group was brought in, at huge expense and with great trepidation, to tell us how to fix our hospital. They came, they saw, they left reams of paperwork in their wake.

(All of this, by the way, was occasioned by something so silly I can't even blog about it lest my head explode again.)

So in comes the new management team, right? They're all nurses and doctors who've left active practice in favor of management. And they have great ideas about Improving Customer Service. Yes, that's how they put it.

I had to sign a form at my last employee review that said the following things about Good Customer Service:

1. The nurse will introduce herself at the beginning of the shift to each patient in her care. (Check.)

2. The nurse will perform a complete head-to-toe assessment of each patient at least once a shift and more often as circumstances dictate. (Assessment? Like I don't already do that?)

3. The nurse will outline, with the patient, goals for treatment for that shift. (Check.)

4. The nurse will answer questions to the best of his or her ability. (Duh.)

Point being, I already do all that. It's called basic nursing care, not good customer service.

I really believe that anybody who has a medical or nursing degree who's in management should be required to work, or at least follow a nurse, for an entire shift before making recommendations like these.

That way, they'd see that the layoffs of nuts-and-bolts staff like cleaning folks and transporters have occasioned such things as nurses cleaning rooms and running patients across the medical complex (thus leaving their other patients un-nursed). They'd understand that those Four Bullet Points are things that we do anyway. They'd see the difficulty of working a shift when you don't have enough urinals, or NG tubes, or wheelchairs, or Lortab, and are constantly having to steal said items from another unit.

Another fun case in point:

A Highly-Placed Member of the Management Team showed up unexpectedly on the floor the other week. She was exercised to see that there were five people in the breakroom eating lunch at once.

Here's the breakdown: Two were unit secretaries, one not from our unit. One was a transporter, also not from our unit. One was a nurse's aide, not from our unit. One was a nurse from our unit.

It was two o'clock in the afternoon. We had had an almost-complete turnover of patients that morning, with fifteen discharges and fifteen admissions before noon. The folks in the breakroom were the first to eat lunch that day; the other nurses were attending patients.

There was one nurse (the charge) at the desk, answering call bells and trying to chart on her own patients. (Note that we are a high-acuity unit, yet our charge nurse still gets stuck with one to three patients daily as a result of staffing changes recommended by management.) A patient called for help with a bedpan, and apparently the charge nurse didn't move fast enough away from the desk to help the patient.

The Highly-Placed Member of the Management Team Went Ballistic.

Without assessing the situation, without asking why there was only one person at the desk, without discovering what on earth could induce a nurse to eat at two pip emma, the HPMMT stormed off to the floor manager and hollered about our not caring for our patients.

At that point, the Credibility Meter in my head goes past zero and the Bullshit Meter is pegged on redline.

We already have five-liter capacity bladders. We already work sick, hungry, dehydrated, underslept, and injured. And we've got a good floor with almost enough staffing to handle the patients.

Here's a person who's been at the facility a matter of weeks, who walks on the unit and makes assumptions about the quality of care based on three minutes' observation. That's their right, I suppose, but it's equally our right to inform them that their assumptions aren't valid. Instead of then trying to find out why a nurse had to scare up help for a patient with a bedpan, the person then got very upset and made *further* assumptions about the quality of care on our unit.

(For what it's worth, the charge nurse estimates that it took her two minutes to wrap up a phone call, deal with two other call bells, and get into the room.)

I would love to invite that particular manager to come follow me for a day. If the manager's license is up-to-date, I'd even invite them to come work with me for a day. I think--no, I know, having been one myself--that managers tend to forget what it's like to work on the floor every day.

The trick is not to blow a gasket and theorize ahead of your data. If you do that, not only are your management skills suspect, but nobody will listen to you.

Our manager's solution to the Enormous Lack Of Concern For Patients On Our Unit, as seen by the HPMMT?

Close the breakroom door.

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