Let’s say you have been working for a company for 13 years.
You have six years in your current position. You are working a high acuity cardiothoracic stepdown unit. You are in charge every night with a full assignment, start 90% of the lines on the floor, and precept almost every new employee. You work short every single night, 5:1 ratio or worse, on patients who are post op day 1-2 CABG’s, valves, MAZE procedures, and other complicated chest surgeries. Sometimes when the ICU needs a bed, you get a post op day ZERO.
These people are SICK. They are on sternal precautions, and most are quite obese so you are deadlifting 200-350 lbs constantly. There is absolutely no lift equipment in this giant, state of the art teaching hospital that will help you. You do not have enough nurses to help each other, and support staff is simply not even budgeted for. At all.
Sounds dreamy so far.
Like most major teaching hospitals, you have a combination of charity care, normal middle-aged folks, elders, big money VIP’s, and …..people who do not ‘adapt to the hospital environment well’. 🙂 You have a relatively new manager who is trying to slog her way to the top of this leaning tower of unsafe staffing, low morale, and bad patient satisfaction scores. As a matter of fact, your floor has terrible scores.
You recently gave your thirty day notice because you got a new job in an outpatient, day shift environment. Even though you have loved your job, the changes are a little overwhelming….especially since the floor cannot keep a decent manager. The environment is no better for management, and they are constantly pressured to do more with less.
Does any of this sound familiar?
You took report from the day shift nurse, who told you to remember to give the ambien to a specific patient at bedtime. This patient’s family is slightly intense, but Mom has had a long, complicated hospital course. It is well known that they complain loudly about essentially every staff member they come in contact with. It happens.
When you go to give the patient’s meds at bedtime, you see that no ambien is ordered, despite the day nurse saying she took care of it. It happens. You bite back some pretty awful words and page the doc. You give the patient her other medications and apologize profusely about the oversight. You promise to get the ambien as soon as humanly possible.
Her daughter arrives at the desk and makes a giant scene. You explain what happened, again. You are completely honest about it, apologize, and stay classy. When she asks to speak to the charge nurse, you are forced to admit that you are in charge. She stomps back to the room.
Twenty-two minutes later (and still a few minutes before it was actually DUE) you get the order. You are in the middle of cleaning up a gigantic CODE BROWN and ask another nurse to quickly give the patient her medication. Naturally, you want the patient to get a good night’s rest. The medication is given promptly. The patient seems to like you now, and you navigate getting a new IV on her because it is expired, while getting her labs so she doesn’t have to endure several sticks. GREAT JOB!
You are told that the patient’s family had a problem with your ‘perceived attitude’. You have had exactly ZERO patient complaints in 13 years. It was the patient’s word against yours.The patient who complains about everything and everyone. And your current manager is trying to make a name for herself, because your unit is only a stepping stone for her. HR was really confused about what your manager was trying to accomplish with this meeting. She states that she wants you terminated, for a single patient complaint, about a missing medication the day shift assured you was ordered.
You cut her out of the conversation and speak to HR, offer to resign since you already have a job, and verify that you are eligible for rehire.
This is how completely insane nursing has become. You have received multiple commendations from every manager who has run this unit. You have won hospital awards. You have literally never had a patient complaint before. Ever.
The manager has been under pressure to raise your unit’s satisfaction scores.
So now she can say she ‘got rid of’ you, the troublemaker. And how your unit will be better with less bad attitudes.
And get a new, higher paying, high powered leadership position. Which is actually what happened.
This is the story of a good friend of mine. I have some advice for you:
- If your hospital organization takes a patient’s word over your word when your record speaks to the complete opposite, resign.
- If your boss is only interested in ‘just in time’ charting, and not whether you put your hands on a patient or not, resign.
- If your floor cannot keep a manager for longer than six months, resign
- If your staffing grid actually calls for unsafe, ridiculous staffing, resign
- If your boss seems to think it is ok to climb over the backs of her fellow nurses to get promoted, resign
And if you have any self respect left, please write your legislators about why reimbursement should not be based on patient satisfaction, and why it should be based on outcomes.
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