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the progressive
mediate
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the onion
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last---past---next---now
�2006 Candor Communications


2006-09-03 - 8:41 a.m.

Dear Boss


Dear Boss,


This letter is an attempt to express what I believe to be some vital ideas for improvement of patient care at RTC and to give you a snapshot of how a conscientious employee perceives working at RTC. This letter is in four parts, the first being an introduction on this page.

The second page is an attempt to offer concrete ideas for improving patient care, strengthening accountability, increasing productivity, and retaining MHT staff.

The third page is an expression of the frustration I and other conscientious staff face every time we come to work. I believe it is important information you need to know in order to better understand some serious problems in the organization and why turnover is so high.

The fourth page is my personal request for items and incentives that would improve my productivity in the additional work I do for RTC beyond direct patient care.

Recently I applied for and was given a new position at RTC so page four might have been omitted from this letter, however I include it due to the recent posting for a Night Shift Lead Tech as I believe it represents the needs of any staff attempting to do what I did, especially a Lead Tech trying to turn around the current atmosphere and do additional work on the night shift.

I believe this letter contains important information and equipment necessary for a Night Shift Lead Tech to have in order to be able to do an effective job of turning around a long standing atmosphere of poor work ethic and staff with either lazy or entitled attitudes.


Since I started working at Residential Treatment Center, I have attempted to provide structure and organization to the medical and behavioral documentation while working the night shift. From the start my work ethic and efforts were met with resistance, ridicule, disregard, and at times, direct hostility and deliberate undermining from other staff and from supervisors.

In my opinion, this reaction came and continues to come from an atmosphere of laziness, entitlement, and an acceptance that little is expected of night staff beyond rounds (in some cases without actually paying attention to or providing a compassionate atmosphere for the patients) and clearing out the filing box as quickly as possible (sometimes without regard for filing properly or worse, discarding documents) so that socializing and breaks can remain the priority.

Attempts at solving this, at least on the night shift, have largely revolved around memos that restrict what staff can do. I do not believe the solution is to tell staff what they can not do. I believe the solution lies in supervision and accountability for what staff are paid to do.

One challenge on the night shift is that, most nights, the work can be done in a few hours. This creates down time in which staff get distracted with socializing or get sleepy and this can deflate moral. Over the years my techniques for keeping staff alert and keeping moral up have included group activities like playing cards or a board game during the down time. I've found solitary activities like TV or videos are much more likely to provide distraction and sleepiness.

For the first few years I did not sense managers were receptive to my ideas or initiatives. This may have been a mistaken impression or in part due to my presentation.

Recently my efforts are being recognized by managers and directors. I wish to especially thank you, AA, DON, HR, AT, MIS, HS, IF, and LTS, and all who've actively supported my efforts to help improve the work ethic, operations, and patient care.


Page 2


The following organizational changes have been the most effective I've seen in my 20 years of professional health care experience.


Incentive bonuses and higher annual pay increases for those who initiate ideas or systems that become policy and for staff who actually produce better work.


A two tier MHT advancement structure, MHT I and MHT II, that includes a requirement for an effective demonstration of additional skills and passing a test in order to advance to MHT II, with a fair salary rate increase, after two years of service. Staff who choose to do the minimum work required for an MHT I would not be eligible for advancement.


Additional pay for staff qualified with additional credentials (i.e.: PCM II staff should be paid more than PCM I and so on).


Training for supervisors, specifically in the RTC program, in evaluating staff, and in holding staff accountable for providing optimal patient care and services. This is essential in order to implement the first two ideas effectively.


Hiring supervisors who accept direct supervision and training as part of the supervisory position. I believe this is the primary weakness in the system here at RTC


In my observation, some, if not many direct supervisors do not accept their supervisory role, do not feel comfortable performing it, or do not have the necessary skills to do it effectively.

Perhaps this is most true on the night shift, but my observation is that many direct supervisors of MHTs do not know or show any interest in most of the tasks MHTs are expected to perform. I would not be surprised if many supervisors in this hospital do not know how to run a point exchange or know the procedures for how to do a room search, run groups, PCM, or the daily operations and behavioral programs that should guide interactions with youths on each unit.

I strongly suggest that we are not providing the necessary training or accountability for our supervisors. This leads to a poor supervision and a lack of accountability for MHTs. This further leads to frustration for the staff with strong work ethics who must pick up the slack and do the work for other staff acting as though they are entitled to do as they please on the job.

In some cases Nurse Supervisors simply do not want the responsibility of supervision of staff and openly state this when a problem is brought to their attention. In some cases supervisors have a habit of relatively constant complaining, gossiping, or speaking negatively about other staff, encouraging and even initiating a counterproductive and unprofessional milieu.

I think it is essential that the systems in place for monitoring staff are utilized to their full capabilities. It is not enough to track Q15 rounds of bedrooms. We need to use the electronic key system to track where individual staff are at night as compared to where they are assigned to be, to track how long each staff is off the unit, and to question why that is necessary.

An incentive based pay scale requires that supervisors know the jobs of those they supervise well enough to correct, train, and accurately evaluate their subordinates.

An organization runs more effectively when supervisors are the leaders and have a detailed knowledge of how to perform the job they are directly supervising.

Page 3


This page includes some of my personal frustration and expands upon issues mentioned on the previous page. These are reasons I had friction with supervisors in my first few years here.

It's taken years, but now, 99 nights out of 100, I accept these things as "the way it is."

To put it bluntly, I've learned to act as though I ignore a lot.

Another obstacle to improving patient care is simply laziness. There are staff and supervisors who, with no exaggeration, sit down the moment they get to their work station and you can count the number of times they get out of their chair with the fingers on one hand.

There are staff who routinely refuse to do work and/or follow directions from supervisors and get away with it. There are staff who have been trained repeatedly, some who've been here for years, who play dumb or passive aggressive and ignore the obvious work, including rounds. There are staff who disappear on breaks for much more than the time allotted.

There are supervisors who will sit next to a phone and ignore it, expecting an MHT to walk up from the hallway to answer it. There are supervisors who will act as though they not part of the staff ratio, rather than help out with the youths in the hallways and/or do rounds.

There are staff who do not know or simply ignore the behavioral system and rules of the programs in the facility, undermining treatment with inconsistent reinforcement and they ignore corrections arguing "not enough staff" nor "the behavior program doesn't work anyway."

There are supervisors who will accept outright insubordination and disrespect from staff as if they, the staff, are entitled to whatever they please. This is perhaps the most frustrating and demoralizing aspect of the job for staff who have to do the work the other staff avoid doing.

There are supervisors who act as though confronting a staff who is not doing his or her job is just not part of their job. Sometimes that is because they are too busy with other work. Sometimes it appears as though they simply do not want to get up and leave the comfort zone of their RN station. In the past, sometimes that was because they were asleep themselves.

All this leads good and potentially good staff to frustration, anger, burn out, apathy, and ultimately to seek employment elsewhere. This is the work environment I see as a tech at RTC.

Unfortunately, some new staff with potential to develop good work ethics are influenced by peer pressure and become some of the most problematic staff.

Most nights I challenge myself to find creative ways to motivate myself and others, including supervisors, to do their jobs better. Most nights it works.

Occasionally I get frustrated enough to feel I should stop initiating and providing the additional work I do each night, accept the prevailing lack of work ethic, and simply give into the peer pressure which demands little more than to sit in the hallway, make rounds, and stay awake.

Knowing myself, if I chose to give up, such a choice would eventually lead me to seek employment elsewhere as I prefer a work environment where avoiding work, complaining about work, open insubordination, negativity and even hostility are not the status quo.

On the other hand, I have stayed at RTC for more than five years because I do not believe in quitting, because I enjoy a challenge, because I believe in a commitment to improving care wherever I work, and because I continue to hope that others will step forward and find support in their attempts to resist negative peer pressure in order to change the status quo and provide better organization and documentation that leads to better patient care and services.

Page 4


For me, the following would help to provide additional organization and assistance to management that and to continue to initiate ideas for improvements. I welcome input and assistance from management in dealing with the obstacles and frustration I am experiencing.

A comfortable work chair.
A computer with Windows XP and Office XP software.
Staffing within compliance.
Exemption from rounds for doing other work when other staff are doing nothing.
A fair pay increase for the additional work and productivity.

A comfortable work chair. Studies demonstrate productivity increases and repetitive stress related injuries decrease when staff are provided with an ergonomically efficient workspace. Much of the extra work I do on the night shift is the same work performed in an office, at a desk and computer. I don't expect a desk or an office, I'll be happy and more productive with a decent ergonomic chair. The chairs currently on units are cast-off chairs that no one wanted to use in their offices or the cheapest chairs on the market.

A computer from this millennium. I believe DON and IT are working on this and I'd appreciate any help anyone could provide. Much of the additional work I do now is done with Windows 98 and Office 97 on an old computer I keep on a cart so I can wheel it into the hallway each night. The computer/software can not handle some of the work. I could do twice the work in half the time on a up-to-date computer. Also, secure place, perhaps in an office/storage area, to store the computer (and chair) and paperwork would be prudent.

Staffing within compliance. Obvious and challenging to do, but fill vacancies. When staffed within compliance, more work can get done and most importantly, the kids are safer. I believe Staffer is doing an outstanding job with the staff currently available. There has been respectable improvement in this area in recent weeks.

Exemption from rounds for doing other work when other staff are doing nothing. When any staff in the ratio is doing no other work and another staff is doing productive work for RTC, The staff doing nothing work-related should do rounds and the other staff continue doing the other work. This also helps keep the staff doing nothing else awake.

A fair pay compensation for the additional work and productivity. Most nights I self-initiate secretarial, auditing, supervisory, organizational, cleaning, and managerial work that no other night shift staff or supervisor does on any consistent basis. Most nights I do most of the tasks on the assignment sheet and others not listed, many more tasks than any staff I work with. Most mornings I am taking care of youths needs while others stand around or sit chatting with each other ignoring youths needs. Overall, most nights I am actively working for 6-8 hours while some do little or nothing for 7-8 hours.

Many of the ideas I initiated or paperwork I produced on the computer have been praised and implemented by management. My efforts help managers in most departments to ensure increased compliance, and improved quality and delivery of patient care.

I think initiative and work ethic should be tangibly rewarded.

As I've said, I believe anyone attempting to be a Lead Supervisor on the night shift needs to know and would benefit from this information. If they have the computer skills, then the equipment would be very helpful as well.

I hope this is accepted in the spirit in which it was written, not as a complaint, but as an attempt to help improve patient care by improving the work environment for conscientious staff.

Thank you for your time and attention.






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