Friday, March 8, 2013

Dear Management

I hate to intrude upon your endless pursuit of JCAHO's infantile good graces, higher Press Ganey scores from the whining bastard drugseekers to whom you send surveys, and various other manifestations of professional career masturbation you indulge in, but some happy few of us are busy trying to save a few lives around here.

I wouldn't interrupt you playing with your org charts, fapping to your brilliant cost-saving moves, or the other various and sundry versions of Office Happy Time that must certainly fill your days in your office between surfing for web porn or planning your next vacation, or, please sweet Jesu! your pending retirement, unless this was something kind of important.

Now, I realize I'm only one of those lowly peasants who still works at the bedside, because somehow, when I enterred the profession of nursing, it was with some vague idea that actually caring for people in need would be involved. And I'm sorry I can't muster the enthusiasm for the Happy Gas they're sniffing in academia enough to want to put up with whatever artsy fartsy Theory Of How We're Really Really Important they're pushing, so that I could write you a scholarly article you might actually read, if not comprehend, but it seems I'm too busy doing what matters for the people who matter, and they're called PATIENTS.

In case you haven't bothered to, you know, come by the department and see what actually goes on (and judging by the fact that even after several years' employment here, most days you have trouble picking me out of a crowd, you don't) we're a little busier lately. A solid 10% busier, year over year, across the last decade, means we're now seeing double the volume with virtually the same number of staff. I haven't checked with personnel, but last I looked, I'm not getting paid twice as much as then. So in lieu of upping my salary, a few other suggestions come to mind.

1) You could, without requiring dynamite up your @$$ or a horrible headline in the local newspaper, come around at night, on weekends, and during holdays, and these not being your office hours, you could brush the cobwebs off a set of scrubs, put them on, and lend a hand. Not every night, weekend, or holiday - I'm not asking you to be chained to an oar. But once a month, just pull half a shift during the times and days you're not usually around. We get that all that Invisible Leadership you think you're providing must be important to someone in the hospital, even if we can't for the life of us figure out to whom, or what it is. But actually being around once in awhile would educate you about the place you're supposedly in charge of 100 times better than a stack of memos would, and some of your minions might actually get some idea that you give a damn for something, or even someone, like perhaps them. If the selfish motivation that it would better equip you to do your job is what you need to make the effort, I say whatever turns your crank. Just do it.

2) A secondary effect of this would be you'd get to actually see a lot of people who're overwhelmingly just names on a staffing matrix to you. (Of course, to be fair, the hellhole of employment your studied disinterest has created has also made the merry-go-round of getting hired and moving on as soon as possible a little tough for learning names before they're already out the door. So you might even slow down that revolving door too, but let's not go all crazy yet.) Which sudden notice on your part might lead to a view of who does what that's a little less inclined towards the relentless brown-nosers, once you see who's a doer, versus just a showboat.

3) These first two might even lead you to, once again, without dynamite shoved up your @$$, know who deserves a heartfelt "Thank You" for exceptional performance, and 5 seconds of recognition during shift change report, which won't cost you more than the 5 cents to spit an Attaboy/Attagirl out of your printer, and handing it to that person. The secondary and tertiary effects this would have on individual and group morale, as well as helping hone your subordinate managers' rather elastic idea of accurate performance reviews, without embarassing them, would be breathtaking. So for a few hours' time and a few cents a month, you could get better workers, better supervision, and better performance. Sorry to have to tell you what I learned in about 15 seconds, in a job where life and death was in the job description, at the tender age of 22, but it seems what they cover for Marine combat leaders for 240 years evidently hasn't filtered down to hospital management at your level.

4) Some other things you might notice are how constantly short-handed we are. Miraculously so on weekends and holidays. One hole in the schedule is a problem. Nine is a catastrophe. Don't yap about "nursing shortage" because there isn't one where we're concerned. What there is, is a shortage of hospitals willing to spend the time and effort to hire people, and do the commonsense things that every other business does to reward and retain the good ones, and discipline or weed out the bad ones. And when the holes in the schedule are techs, you have absolutely no excuse. I could put an ad in the paper today, and by morning there'd be 5000 ambulance company EMTs with skills, real-world experience, and a strong desire for regular shifts and the raise in pay that an ER job represents, lined up outside personnel to fill out an app. So not having droves of them in a ready pool for exactly the shortages we come up against nightly, shows that a little Surgilube up your hindquarters might help with the rectocranial impaction problem you seem to be suffering from regarding adequate recruiting, since forever, apparently. Just curious, but how much do you think it would improve satisfaction scores if we had enough people to take everyone to X-ray, ultrasound, CT, and upstairs when they're admitted, promptly, rather than 1/2 to 2 hours later, which increased flow-through times by cutting average ER stay-time in half? I'm just spitballing here, but it might actually save a life or two by not leaving sick people waiting outside unable to get in. Again, there seem to be some gaps in "How To Manage The ER 101" materials.

5) And speaking of materials, a little random visit now and then might make abundantly clear to you that as a 24//7/365 operation, it's a little beyond the pale to ask patients on a three day weekend to pee in their hands when we run out of urinals, because the waste of skin you hired to stock the supply room can't find his @$$ with both hands, a mirror, and an anatomical chart. We've also run out of, with regularity, things like bedpans, catheters, IV saline, IV needles, injection needles, blood culture tubes, IV tourniquets, and band-aids. But it's not like we need any of that stuff, right? And I'm not talking just once in a while, but this happens every frickin' week-end, since the Pope was in diapers. What would you ever do if there were an actual major disaster?? Given the annual operating budget, this situation is simply laziness, sloppiness, and slipshod stocking, not poverty. Does this guy have naked pictures of you with a donkey, or is he the CEO's nephew, or what??

So it's time for some tough love here. We know you like your job. We only ask that you actually do it. If you can fit it in your schedule.

Look at it like this: McDonald's sends their assistant managers, most of them younger than you by 20-30 years, to McDonald's University, and in mere days there they cover that the bulk of their job is two-fold:
Have enough staff to cook and serve the burgers, and
Have enough burgers for the staff to cook and serve.

Amazingly, an ER runs just about the same g**d****d simple way: just get us enough people to take care of the patients, and enough stuff to do the care, and we'll do everything else just fine. There's no worry about the customers coming in the door at Mickie Ds, and neither are we in any great worry about the 1 in 10 Trillion chance that tomorrow, no one will show up at the ER.

If you'd just take a chance, go out on a limb, and actually get the staff and equipment we need to do our jobs, and if, once in a blue moon, you'd actually say "thank you" to some of the people who're getting their butts kicked day in and day out to make your stats look good, and keep your travel agent in business, you'd be amazed at what a turnaround you'd see in the place you imagine you're the Kings and Queens of the Universe.

Sorry if that leaves a swollen purple bootprint on your ass, but sometimes it's the only way to break the suction and pop your head out of there.

Love and Kisses,
Everyone Who Works Here

1 comment:

  1. I just discovered your blog via an extremely circuitous route, starting, I think, with Ambulance Driver or maybe LawDog. Your writing is so vivid, and your snark level leads me to think you're right where I am in my career trajectory. Typically, I'm a selfish lurker, but I had to respond to this one. If I just changed a few titles/details, it could be my rant on the very sorry state of teaching at the university level. Thanks for putting into words for me. And the Baby Huey story was one of the funniest I've read anywhere. Right up with LD's Santa killer. Keep writing!