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last---past---next---now
�2006 Candor Communications


2006-05-29 - 4:04 a.m.

heads examined: priceless


ah, back at work (where it seems much of my writing happens lately) and after giving four hours to the job, the next four hours (except for the job related interruptions) are for the babbler and you and for starters, it's time to take another look at the work place de candoor

I don't know how many of you work in rather ridiculous work settings, but this most recent career move (stepping back on to the work force ladder at the bottom rung) is presenting me with quite an astounding look at private medical care in this country, specifically from the psychiatric end now it could just be this place, but the research I've done tells me it's at least this Central Florida area, but it is amazing just how lazy and incompetent a workforce is hired at the direct care level (and all through the chain of care) in the psychiatric hospitals around here

routinely (several times a year) administration is pressured by a few staff or by stumbling across a mess they can not ignore into taking some action, which is almost always sending around a memo and repeating the hospital rules and consequences at a meeting

with little or no follow up, however, there is little change

and about once a year they consider the situation a crisis (usually when staffing turnover hits it's annual high and they must mandate overtime in addition to the regular overtime most staff do just to staff the hospital adequately) in the past week we've reached yet another annual crisis

it usually goes like this

someone with some clout, an auditor, a doctor, a parent, an outside agency, or occasionally a manager themselves who might be feeling more insecure than usual and actually looks closer at the operations or paperwork in the facility, discovers something that violates our hospital rules

in the past few month the issue of misfiled paperwork has come up several times and when it's brought to my attention I point out that the four people actually doing the paperwork on the night shift can not be there every night and can not be responsible for the other fifteen or so people (not to mention regular overtimers) who either do not do any work or do it wrong especially since none of the four of us who do the work are supervisors

the most notable deterioration has been on my unit since Berry left and I refuse to do her job when they supposedly hired a replacement who's been trained three times, but has fallen into line with the 15 or so other staff who get away without doing any work between Berry and I, the work on this unit far exceeded hospital standards because the systems I put in place worked with Berry and Elpien following up on them without Berry, the product deteriorates

the problem for management is that they can no longer ignore the sloppy paperwork because they no longer have this unit to show auditors and others when they need to prove they have systems in place that work (as long as the system works somewhere, then it's not a management or systemic problem, it's a staff performance problem and management will correct it through retraining or replacing the staff not following protocol

without our unit as the example of how well the information management systems work, management has to face the fact that their systems actually do not work and they've been relying on my systems, or subsystems, and pretending that's the hospital system

so management came to me for help and I explained their job to them and with a sincere smile said I'd be happy to do it for them if they paid me, knowing they won't pay me and since I put it that way (stated what was fair, professional, ethical, and respectful) in a pleasant manner, and they realized that they had to come up with a solution themselves

so they looked closer at the situation and discovered that aside from the four staff who actually do most of the work correctly with some measure of consistency, the rest of the staff generally sleep, take extended breaks, watch DVDs, play video games, talk on their cell phones, and socialize all night (all of which are prohibited activities in the hospital) and have no interest in paperwork work and minimal interest in patient care (which consists mostly of simply paying attention to the sleeping kids and not losing yourself in another activity)

faced with the fact that most of the staff are violating most hospital policies on the night shift, management called a meeting a mandatory meeting for the night staff (scheduled right at the end of the shift)

two of the four people who actually do the work on the night shift showed up at the meeting they were the only night staff at the meeting other than a couple of nurses

the subjects were brought up, the chief administrator emphasized the need for improvement and how serious the violations have been, threatening termination when he was done I pointed out that for the umpteenth meeting in a row, the staff who needed to hear what was being said are not present and the two staff who were present have not violated any rules

a bit red in the face, again, the chief said he'd check the sign in sheets and see who hasn't attended the last few meetings and they will enforce the policy that mandates staff to attend 10 out of the 12 mandatory meetings or forfeit any pay increase for the year I pointed out that would help management reduce their expenses because very few staff are entitled to raises for this year since all but a few have already missed five out of the twelve mandatory meetings

I encouraged management to follow through since meeting budget this year means I can get my five year bonus (which perked up the staff sitting next to me who missed her fifteen year bonus last year because the facility did not meet budget and when she said "and I'm not going to let you forget it" to the chief, that got a laugh out of most present)

but back to the issue of getting the work done properly and enforcing the hospital rules, which seemed to be management's primary concern, I pointed out that any organization is only as strong as the systems in place and the accountability it can achieve I stated the obvious (as I usually do at these meetings, which is why management and I maintain an active love-hate relationship), that the existing systems need overhauling and the accountability needs to be more effective (read: started)

the systems overhaul is progressing slowly as the performance improvement committee is reviewing and processing the information I'm providing them and will likely approve my systems for information management just as soon as they figure out how they can make it seem like they thought it up the accountability is where they will always break down as long as they manage with their heads in the sand and have a fear of confrontation and lack of actual supervision

the primary problem with accountability is the structure of staffing

unit nurses are expected, in addition to most nursing tasks, provide direct supervision and correction for all staff on their unit unit nurses are also expected to be part of the staffing ratio and try to be buddies to the direct care staff so they are not left hanging with direct care paperwork or direct patient involvement as a direct care staff

so even if the nurse had minimal personnel management skills (which is in no way a prerequisite for a nursing license), it is challenging for the unit nurse to step back from the daily side-by-side equal staffing ratio work situation and try to discipline direct care staff with whom they've already buddied up

I imagine this becomes especially challenging for the nurses who are doing the very same things they are told to discipline the direct care staff for doing

add to this situation the fact that none of the nurses or administrators have strong personalities and none have shown any personnel management skills (or any management skills, for that matter) in the five years I've been here and you might be able to imagine the problem with accountability in this hospital

moreover, particularly on the night shift,. the nurses (supervisors) have almost no knowledge of the information systems management or what the work night staff is actually supposed to be doing all night

so in the past few days management sent around memos reiterating the hospital rules and policies regarding patient care, staff activities on the job, and management of paperwork, supervisors had staff sign off acknowledging receipt and understanding of the memos, and the rules are now supposed to be enforced

and we come to tonight

in the first hour of the shift the charge nurse for the hospital walked around with yet another memo detailing the rules and expectations and consequences for night staff

and at this moment, one staff sits down the hallway fast asleep

another staff sits in front of her portable DVD player

another sits in the hall behind the medical record charts hoping no one notices him nod off

and the nurse supervisor sits behind the nurse's station completely ignoring any supervisory responsibilities (and some of her own nursing responsibilities), complaining to me about how she's doing more work than other nurses, asking me to help her decide how to do the paper part of her job, and thanking me for letting her vent

I nod occasionally and just keep typing, except for when she asks me to do her a favor and make some copies for her because "if I have to get up again I won't make it through the night" obesity is prevalent among night shift nurses in this hospital and from my perspective, laziness, but it may be a psychological issue as well

so this is a typical night

for the first few hours, after the basic night work is done (which takes less than an hour a night, even though much more is done on this unit than on the other units), I work on the forms and detailed instructions of the systems I've implemented on this unit for the performance improvement committee for the last few hours I type for myself that's the compromise they accept because they are not paying me to actually write the book they need to do their jobs better of course they still need to find backbones and an interest in actually doing their jobs better

and they wonder why nothing changes






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