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Another year, another performance evaluation, more questions... - The Rancho Commons
Note to self: no whining, no slacking
Another year, another performance evaluation, more questions...
This is about work, and it is long and full of frustration.

Skip it!

I told my supervisor this morning over my yearly evaluation that I've never felt less appreciated in my 8 years as a nurse than I do now. I haven't written much about nursing of late because there is so much to cover that is not positive. I still enjoy doing my job most of the time, and my families and patients appreciate my efforts. I will attempt to summarize the "problems with healthcare" from one nurse's perspective.

Healthcare has become a lucrative "business" and thus, has drawn greedy people who are less interested in delivering quality healthcare to the people, and more interested in getting their piece of the funds. You are familiar with this because you've seen it before, in banking, in the courts, in insurance, and in government, just to name a few examples. The well used maxim, "Power tends to corrupt, and absolute power corrupts absolutely*" applies nowhere better than when people are in need of life-and-death healthcare, and are in a situation where they have no other choice but to pay whatever is asked for it. As such, the inevitable result is way too many people making complicated policies designed to justify and ensure their continued employment, even at the expense of the people who work for them, and their patients and families. This is what is happening, in a nutshell, in healthcare today.

Nurses bear the brunt of this assault, being between the hospital and the "clients," better known to nurses by the term patients. The nursing staff is the, and I don't consider this to be an exaggeration at all, backbone of any healthcare facility. They are the liason, the bridge, between the patients and families and the rest of the "healthcare team" which includes physicians, housekeepers, pharmacists, secretaries, social workers, therapists, etc. They facilitate contact with whichever member(s) of the team the family/patient has a need to interact with. The nurses "interpret" doctor speak into laymen's terms that the patients can understand. They clarify, teach, and reinforce all of the information conveyed to the family and patient. They also take the heat, negotiate, apologize, resolve, rectify, and perform countless other acts of customer service when the "client" is dissatisfied with the service they are receiving.

However, in spite of all these responsibilities that are borne by the staff nurses, they continue to go unrecognized as the major source of "customer satisfaction" providers that they are. Budgeting cuts in order to increase profits and reduce expenses are frequently targeted toward the nursing departments. Other departments, such as the pharmacy, housekeeping, and other "ancillary" staffs, cut their budgets and rely on the nursing staff to perform tasks that previously fell to them.

As one example, when I first came to the unit where I work now, 5 years ago, the pharmacy department would send a representative to the unit at the beginning of every shift (twice a day). That person would check all of the medications being given intravenously (running on the IV pumps), determine which ones would need to be reordered during the next 12 hours, and return to the pharmacy where they would be prepared and delivered by the pharmacy back to the unit. Now, the nurses must determine at the beginning of their shift what their medication needs are for their patients, use the computer to order the medications from the pharmacy, and go the pharmacy to pick them up when they are ready. What that means to you is that now, rather than remaining at Mom's bedside providing her with care, I'm on an elevator heading three floors down to pick up her morphine.

I can give you countless examples of how the nursing care of the patient has been compromised in just my eight short years of experience by things like excess paperwork, tortuous computer programming, the micromanaging of procedures by outside organizations, and above all, the incompetence of highly educated people who have nothing to do with whether you or your loved one lives or dies during their hospital stay!!

My frustration comes from the knowledge that this isn't going to change: that, in fact, it is going to get worse. And that nurses will be the victims of further abuses by "the healthcare system." To effect change, one would have to become one of the people having the power, and by doing so, one would be becoming part of the problem. As Pogo said so famously, "We have met the enemy... and he is us." I see two options for someone like me, apart from the third option of leaving the nursing profession: attempt to attain a position of influence where positive changes to "the system" can be made (read: upper management), or to minimize one's contact with the system. To date, I have made the latter my choice, which is why I work weekend nights, three nights one week, two nights the next. In this position, I surrender all my weekends, work 60 hours per two week pay period, and get paid for a full 80 hours. I also get reprimanded, and lower marks on my evaluation (resulting in a lower "raise") if I have more than 2 unscheduled absences per year! If they could do so without creating a major uproar from both the weekend workers and those who appreciate not having to work as many weekends because of those workers, they would label this pay practice as an inefficient use of funds and eliminate the weekend positions.

So far, they've been careful to avoid any major structural damages against "the bridge" as I called the nursing staff before, the staff that is the cement of the healthcare system. But, they are systematically removing the supports in the name of "reforming healthcare" and making it more "profitable" and "sustainable" as a "business." I tell all of you now, as an insider with a very limited view of what's happening, this is going to get a lot worse for all of us, and there's nothing any of us can do about it.

And in closing all of this, remember this last thing I tell you. More nurses are now choosing that third option, leaving the profession, and I predict even more will continue to do so. This will result in an ongoing nursing shortage (like we've been having for at least the last 10 years), even higher turnover, and overall less experienced nurses in the field taking care of you, me, and our loved ones. And don't even consider for a moment that getting the government more involved, or having them "take over healthcare" would improve the situation!! Government never improves anything it touches; never manages any business better than private companies could, and only fools believe otherwise.

This is my opinion, on the day of my evaluation, as I ponder how I'll spend my 3% salary increase. (Maybe on gas, which I'm sure has risen way more than 3% in the same period?)

* Quoted from Lord Acton

Crossposted to nurses_notes


4 aspirations -{}- aspire with me
tinamarie From: tinamarie Date: June 25th, 2007 01:37 am (UTC) (Link)

I have often wondered why there is such a nursing shortage and you've explained it so well.

Now, I even more admire what you do.

aspiring2live From: aspiring2live Date: July 2nd, 2007 05:23 am (UTC) (Link)
Sorry I failed to answer this in a timely manner! I appreciate your compliment. Unfortunately, the people up the chain mouth appreciation but fail to show us they appreciate us.
schmimi From: schmimi Date: June 26th, 2007 02:03 am (UTC) (Link)
I'm sure I've mentioned to you that my mom, sister, two aunts, an uncle, and grandmother are nurses (not counting the several doctors, paramedics and other sundry medical professionals in the family.. then there's me, who get woozy at the sight of blood, but anyway...)

I don't think any of them would disagree with anything in your post. And, like you, none of them see an alternative. It's very frustrating and depressing. Like a lot of what's going on in this country.
aspiring2live From: aspiring2live Date: July 2nd, 2007 05:27 am (UTC) (Link)
I'm sorry I didn't reply to this when I first read it. It almost slipped completely away, and I don't mean for that to happen!

Like a lot of what's going on in this country.

Ironically, my mom called and asked me if she could show her pastor what I wrote because she thought it illustrated what was "happening in the world today." I knew it wasn't just in nursing, but that was my current focus when I wrote it. But the truth is, these trends toward greed and away from providing quality and value are virtually universal. It IS frustrating and depressing.
4 aspirations -{}- aspire with me