Nurse Leaders are Stupid

At times, I question the intelligence of nursing administration. I question their validity as a profession. I question whether there is such a thing as any nurse administrator that possesses even a vague idea of what a bedside nurse does for a living.

We've just gone through more than a year of preparation for our bid for magnet status. Obtaining magnet status supposedly means that the practice of nursing is evidence-based, qualitative, quantitative, and governed by input of nurses.

We had a two day visit from two magnet evaluators (I can't say for sure but I am willing to bet the last time they saw the bedside they were sterilizing metal bedpans in dishwashers).

They had specific problems with the way our hospital conducts the shift report. So they suggested to management that we should give up taped report and that every nurse should give a verbal report.

I personally have no problem with this. Many hospitals use a verbal shift-to-shift report. What bothers me is that, per the magnet ideal, and utilizing our "Shared Leadership" structure, we opted for taped report because evidence was out there that stated patients were most dis-satisfied with their care when nurses seemed to "disappear" during change of shift (which happens because all nurses are in report, leaving no nursing presence on the unit.) We felt that utilizing a taped report would mean that there would be a nurse presence on the unit even during change of shift.

So instead of utilizing the magent model, our executive officers simply told all nursing leaders that, effective imimediately, we were to switch to verbal reports, and that we were to receive report in teams of two (so that every patient's report would be heard by two nurses, in an effort to glean more information).

I'll go into the obvious problems in a second. But what changes this discussion from one of criticism to one of utter disdain lack of respect is that it proves we are, by no means, ready for magnet status, because we are neither evidence-based nor self-governing.

• No gimmick can get around the fact that nurses are graduating from nursing schools with questionable skills, and limited ability to think critically.
• No gimmick can get around the fact that nursing care is better when nurses, by design, education, or force, spend a significant amount of time at the bedside observing and treating patients.
• No gimmick can get around the fact that nurses need to read the medical record of each of their patients, including all current physician orders, all lab/procedure results, and all progress notes (even discharge planning).

What disgusts me is that these truths to me are self-evident. When nurses do not spend enough time at the bedside, and if they do not familiarize themselves with the medical record, patient care simply doesn't happen. This is true regardless of how many times questionable leaders suggest meaningless change.

Regarding the ridiculous idea of teaming two registered nurses together:

• This is blatantly done because too many nurses are having trouble due to poor clinical skills, and this is a way to prop them up (which I don't consider to be my job). I believe nurses should help each other, and be available to render another opionion. But it is not my responsibility to keep my eye on bad nurses practicing badly.
• There has been no specified announcement of what this "team" relationship means. In other words, if a nurse makes a clinical error, how much responsibility will fall on the other nurse?
• Switching to a verbal report will not help nurses realize the value of maintaining a bedside presence and reading the entire medical record.
• The new team structure does not (yet) manage the ancillary team members (who seem to be totally unstructured and uninformed of their patient load for the first several hours of the shift -- an obvious recipe for disaster).

I don't know what we're doing, and leadership doesn't know either (but doesn't seem to know they don't know). What will probably happen (because nurses only listen when disaster, death and litigation are on the horizon) will be some type of "sentinel event." Someone will DIE or suffer obvious HARM. Only then will someone pull their head out of their voluminous and unimaginative asses.

Comments

[Jessica]

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[jajski]

the hospital I work at started 'walking rounds' to give report approx 2 years ago. It is wonderful ... there is no 'disappearing' of nurses during report time, you are right there. You get to see each patient first thing in the morning ... get to see condition of pt as previous nurse leaves, can look at IV sites, check correct IV solutions, look at wounds, incisions, edema etc. together - there is much more involved of course but ... I wouldn't go back to any other way of reporting off

[Eric]

I've never worked at a for-profit hospital in all the years I've worked in hospitals (more than 20 years total at this point). I've heard so much about how $$-driven for-profit hospitals can be. There aren't many not-for-profit hospitals in the Phoenix area.

I think my present employer has a real desire to work toward the best possible patient care, but is frankly hindered by the fact that most nurse leaders are not born leaders, but instead are floor nurses that can't handle bedside care anymore. I think, as do you apparently, that this is an industry-wide problem. They've all attended the same lecture on "The Art of Delegation" that every nurse manager attended in the 1980's and 90's, and now they don't know how to do anything themselves anymore. Sad.

You may rant whenever you wish, Maria :-)

[Maria]

Well said.

At the risk of sounding cheesy, the best healthcare teams are those that are composed of people who share the same mission.

It drives docs crazy when it seems like RNs are trying to do as little work as possible. It drives nurses crazy when MDs are trying to get out of the hospital as early as possible. It isn't about the patient anymore; it becomes a self-centered endeavor. And the person who suffers the most is the patient.

I think the primary reason why I am so enamored with the county hospital (vs. the private hospital I am currently at) is because of that sense of mission, that sense of service. It IS about the patient and everyone works together towards that end. When healthcare becomes an exercise of litigation avoidance or trying new medications or practicing procedures, the whole system falls apart.

Sorry for my ranting on your blog.