After years of conflict with most of the physicians in my hospital, my boss is turning in her resignation. I really hate seeing her go, so much so that I wrote a letter to the CEO, the COO, the Vice President of Nursing, the Head of Human Resources, and the other charge nurses.
The letter sums up a lot of the frustrations I face as charge, and thought it made a good post. You can tell I'm angry because the more passionate I get, the longer my sentences get.
To set the mood, I'm replying to an email from my boss, Terri, who is asking me to reconsider my thoughts of giving up charge and returning to the floor as a staff nurse, a task for which I feel I am generally more suited anyway.
Let the drama begin...
Dear Terri,
These are terrible times, and I know, after a full day of emails and phone calls, that many of our staff are going through the throes of despair about what is going on with you. I think many of us are "reading between the lines" and have come to the conclusion that you are being forced to resign, if not directly, then at least in an indirect way by setting up a hopeless scenario. I think that is what is so upsetting to us, that someone who has so dependably and effectively served her staff so faithfully and fairly over the years is now subject to perceived unfairness and indeed cruelty. I know that you are making this decision based on your own needs, and on the best interests of our unit. I know this because you have always put the unit first, even at the expense of your pride and determination. We just don't want to sit on the sidelines and see one of our beloved champions get rail-roaded.
I know you have already made up your mind, but I hope you will consider taking back your resignation. Most of the day, I have spent reflecting on all of my own personal selfish reasons for keeping you as the Clinical Director. We have worked so well over the years, and I can honestly say without even a hint of hesitation or reservation that you are, by far, the most capable and gifted leader I have ever worked with, and I say that having worked every year of my life in a hospital setting, from the age of 17 until my present age of 47. I have worked with a lot of talented leaders. I have worked with a lot of incompetent leaders. You are the most gifted not only because of the mundane day-to-day challenges all managers face (the budget, staffing, recruiting and retention, blah blah blah) but you have an uncanny gift to allow your staff to not only enable their individual abilities, but indeed to amplify them. In the few years I have worked with you as charge, I have found new strengths previously unknown to me, and I have withstood personal and professional challenges that I simply would not have survived without your leadership. So, on a very personal and selfish level, your leaving represents a real blow.
We are all painfully aware of the ever-degrading relationship you have had with many of the physicians on our staff. I have seen firsthand how judgmental and unfair some of them (not all of them) have been, and I have witnessed you doing your best to not only give their concerns a voice among nurses, but also to give our version of the events to physicians who are angry. I have suffered verbal abuse and humiliation at the hands of physicians who, for whatever reason, do not fully appreciate the challenges we face on our Unit. They don't appreciate our level of turnover, with nurses at times handling four or five patients, along with admissions, discharges, and a system where physicians do not communicate with one another and thus leave gaps in the patients' care -- gaps which, when a nurse notifies a physician, subject too many nurses to anger for interrupted sleep, or too many phone calls, etc. The technical side of our profession increases ominously every year, and with it come challenges for nurses who must communicate with physicians. As our physicians yearn for a more "9 to 5" existence, this conflict is sure to become more violent and distasteful as the years go on.
I remember my first year as a new grad nurse, when we first started doing chemical cardioversion on the floor, rather than moving the patient to the Intensive Care Unit. My first cardioversion was attended by myself, my charge nurse, another nurse from the floor, the clinical educator for the unit, the charge nurse of ICU, two respiratory therapist, the attending physician, a resident, and the Cardiologist. In the span of a few short years, I now exercise the responsibility of literally stopping and restarting someone's heart, and do so with the assistance of another nurse and a respiratory therapist. Our skills over the years have grown, and I know with certainty that our skills have directly or indirectly saved the lives of many patients. However, on a daily basis, we are faced with the possibility of verbal abuse and belittlement from physicians who are not willing or able to communicate effectively with their own patients, who show no compassion for patients in horrific pain, or who show a heartless disdain for the families of the frail and elderly, who have the audacity to want to speak directly with their loved one's caregivers. We, on a regular basis, force air into lungs, shock hearts into beating again, and rescue the most vague sparks of life, and yet we have been accused of falsifying patient weights, practicing medicine without a license, and not knowing how to do I&Os because we can't force an alert patient to measure his/her urine as instructed. These abuses are a constant nightmare that has sadly become a part of our profession. You have endlessly proven your resolve to be fair to all parties involved, and we all know you have now paid for this resolve in the harshest way.
When we spoke on the phone yesterday, you mentioned some survey that the physicians filled out, which may have played a role in your demise. As I think about this, I must admit that my eyes found themselves rolling to the back of my head with such sarcastic and unbelievable disdain, I fear I may have actually sprained my eyeballs. To think that some physician survey may be at hand, with a group of physicians with such a low Press Ganey rate of approval, makes me sick. The last I looked, the physicians had satisfaction rates as low as 10%, 5%, even 3% in some areas. These are shockingly low values, considering how difficult it is to get away from the "mean" score of 50%. I find it laughable that they can say anything negative about our satisfaction scores, which are well above the mean, and which we consistently strive, under your direction, to get as high as 90%, 95%, even 98% in some areas. I find it interesting that, while you resolve to beat the mean so handily, the physicians are beaten by these statistics so grossly. Some would consider it believable that they would "gun down" anyone that makes them look bad (and, Terri that would be you, we all know).
I also find it very telling that, as I contemplate leaving the charge nurse position (I know a hopeless cause when I see one), your first response was one of concern for the needs of night shift staff. Telling, but not so surprising. You are well known to put our needs above your own. If your leadership can not see this, then we all are surely heading straight to hell in the proverbial hand basket.
God save our patients.
God save our nurses.
God save us all.
Yes I'm working on another Trek book, but this is the first one that deals with the crew of the very first crew of the enterprise, with Captain Jonathan Archer. It's been very well written.
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