Tackling bad nursing management effectively from below

Here's a post from Those Emergency Blues,
and two comments, on it, one of them mine.

Your comments would be welcome as well! This is an important issue!

Unbearably Unhappy

Any experienced nurse can walk in to any particular unit and tell almost immediately if it’s a happy place to work. There’s something about the body language, maybe, or the lack of laughter, or how the nurses present themselves. Like pornography or good art, you can’t exactly put you finger on defining it, but nevertheless, you know it when you see it. I like to think (for all of my moaning and biting) my own little corner of nursedom is a fairly happy place to work, or at least, it’s far, far better than most of the places I’ve worked.
My father has a chronic condition which requires fairly regular if infrequent visits to a particular Toronto-area hospital for consultation. So today I spent the day with him and his wife at this hospital while he was getting treatment. While my father was in the procedure room, I remarked to his wife (who incidentally is a retired nurse, and a pretty sharp observer, to boot) that the nurses working in the short stay unit seemed particularly unhappy.
“Oh yes,” she replied. “I’ve talked to a few of them and they’ve all said it isn’t a pleasant place to work.” She lowered he voice. “In fact, I’ve seen the manager come on the floor and ream out a few of them here in front of patients and families. Totally, totally inappropriate.”
At that moment the manager came out. She was short and pale, and looked like she ate nursing licences for breakfast. Hell, she scared even me. There was an immediate stiffening amongst the nurses, and a couple of them, I noticed, surreptitiously left the unit through a back exit. Definitely an authoritarian, then. I felt sorry for this gem’s staff.
If I were a manager, and my staff were avoiding me like the Ebola virus, I might think I may have a problem. She probably thinks she’s doing a good job, and has mastered the voo-doo arts of human resources management.
I emphatically would not work that particular unit, nor would I work in a hospital that supports that management style. It’s bad nursing and bad for nursing.
I wondered though: in choosing between a happy work place and an unhappy one, wouldn’t you choose the former and eschew the latter as being unfavourable for morale and a quality nursing work-life environment, and therefore poor inducement for retention and recruitment, and more importantly, an indicator for poor patient outcomes?

This entry was posted on 23/08/2010 at 1921 and is filed under Battered Nurse Syndrome, Health Care Policy That Matters to Nursing with tags Nurses, Nursing, nursing management, Nursing stupidity. You can follow any responses to this entry through the RSS 2.0 feed You can leave a response, or trackback from your own site.

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   Diana Says:
   23/08/2010 at 2057

   That unit sounds a lot like mine. I’ve only been there 2 1/2 years, and morale seems to be at an all time low. Weekends are the least stressful as our manager isn’t present to micromanage the trivial while ignoring the relevant. Something’s got to give. I’ve definitely been thinking of what I’ll do when my initial contract is up. For now I’m simply encouraging our unit nurses to utilize existing councils to exercise autonomy in the day-to-day running of our unit. We’re up for magnet re-certification next year. Now’s the time to force administration to take the councils seriously.

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   Wade Says:
   24/08/2010 at 0657

   I’d say it’s more than an “indicator of poor patient outcomes” … it’s a direct cause.
   It’s fascinating, in a morbid way, that a unit with a leak in the ceiling and wet floor would be cited by JCAHO as a patient risk, but a unit with a manager who clearly damages the psychological-safety and open feedback teamwork required to catch errors and deliver safe care is allowed to continue without comment.
   So stick a red flag and GPS-location-transmitter on that problem and let’s group think about how to do something more powerful than notice it, complain, and dismiss it. This is a clear and present danger to patient’s lives, and should be a clear duty to address, but in some more effective way than whistleblow-and-be-fired-for-life.
   Pondering. As W. Edwards Deming noted, management is generally not interested in hearing about the fact that management IS the problem. Retaliation for even THINKING such a think seems common. So, the direct approach of presenting credible peer-reviewed studies and evidence is off the table.
   Similarly, going over management’s head outside the chain of command has a pretty dismal track-record of success.
   So, for this effort, to fix a hazard to patient care, is going to need to come from higher, such as JCAHO or better CMS – now that Don Berwick is in charge, bringing IHI’s focus on quality. HE certainly understands the direct cause-effect relationships here.
   So, assembing the fragments of thought here, it would seem that (1) nurses (or anyone) could substantially improve patient care if they could take effective action that would remove rattlesnakes, wet floors, and dangerous managers from the system.
   (2) For anyone to try this alone, unaided, by pushing UPWARDS is a proven no-win approach.
   (3) Don Berwick is the right guy to lead an effort to put teeth in a move to deal with such managers, and CMS certainly has the clout to threaten to cut off all medicare funding for a hospital that refuses to listen. So that part is in place, finally.
   (4) So how can individual nurses contribute to this nascent action coming to fruition. Probably, that’s what professional organizations are about and for.
   Conclusion — it’s within nurse’s professional duty to lean on and assist their collective professional organizations to put pressure on Berwick to “do the right thing”, and to rally other nurses to join them in this move to improve patient care AND, as a side effect, to improve working conditions, retention, cost-effective care, hospital survival, etc.
   Is that logic solid?