Turning the Tide

Two months ago, I became more serious about making a change.  It has become more difficult to make this decision come to life as the surgery department is awash in crisis.  We had some staff turnover, including my partner-in-crime, another assistant nurse manager.  Her departure is a HUGE loss for our O.R. and for me.  Every day is painful as I struggle to get another assistant nurse manager up to speed on the care and maintenance of our department.  The new gal just doesn't pick up quickly in this high speed environment.

Despite what is going on at work, I am really trying to put myself FIRST.

I'm taking myself out of O.R. nursing and heading in the direction of informatics.  This is something that I already do in my current position; I'm just looking at making this my only focus.

Will I miss the O.R.?  Sure, but I am ready for a change.  While I love taking care of patients, I do not like managing staff.  It has taken the joy out of work for me.  When that happens, it is time to LEAVE.

I have already applied for other jobs within my hospital and at our sister hospitals.  Maybe I will start applying at the various software companies that have medical software.

In the meantime, it is nose to the grindstone.  Survival, if you will.  Using that word in reference to my work is downright sad.

Time to get happy!

And here we go...  Keep your fingers crossed.

Roller Coaster

Life in the OR is like a roller coaster.  One moment you're climbing so high you feel like you can conquer the world and all its challenges.  Other times it goes fast, hard, and makes you cry for your mama.

I started the year feeling like I had perspective.  And over the last two and a half months that euphoria has come and gone over and over.  I don't know how to sustain the perspective.  If anyone has any tips on how I can do this, I am open to hear it.

Accountability seems to be the theme of 2013 as the higher ups push those of us in the front lines of management to drill this into our staff.  My counterpart and I, of course, started with ourselves and have been killing ourselves to be an example.  That's all fine and well, but it doesn't seem like we are making an impact.  Many staff members think themselves exempt from everything.  They continue to point fingers at everyone around them who is doing wrong, yet somehow can't seem to find a mirror to do some self-reflection.

The attitude and behaviors that I see in the many of the staff members make me really, really dislike people.  It is so crazy how people just expect you to be there, to know everything, to handle everything without even trying to tackle the problem themselves.  What happened to critical thinking?  What happened to teamwork?  What happened to a little gratitude?

I feel myself slowly pulling away from what I had hoped would be my home for at least two more years.  No thanks.  I think I've learned all the lessons I need to learn from this experience.

The Universe is pointing me in another direction and is offering me all kinds of opportunities.

So what am I waiting for???

Nothing now!

In the past I was unsure of my direction, but now I know that there are other areas of nursing that I have left to explore.  I don't want to jinx anything, so I am just going to work on my CV and put it in the right hands.

Stay tuned...

Refresh

It is the first full week of January and I can already feel the tide turning in at Little Trauma Center.  My counterpart at work has gone into "No More Miss Nice Guy" mode and is on a mission to change the culture in the OR.  Unprofessional outbursts are dealt with almost immediately by coaching the employee and explaining the consequences of their behavior.  I am on board with this mission, although I tend to be more nurturing and not as stern.  Maybe our Good Cop/Bad Cop duo will make a positive impact on our work environment and culture.  I'm keeping my fingers crossed!

My secondary mission is more personal.  I am very serious about maintaining perspective about this job, reminding myself that it is only PART of my Life and not my WHOLE Life.  It is so easy to get caught up in my management role that I forget that it's OK to play the part of Human Being too.  Who says that I have to be stoic, cold, and distant?  Just the thought of having to be something I'm not stresses me out.

I have started thinking about the next step I want to make in my career.  I have no desire to move upwards to be a manager or director.  CNO?  HELL NO!!!  It might be time for me to find something slightly less stressful, if that is even possible in nursing.  To put a different spin on it, if I can figure out where my passion lies, then that is the direction I need to take.  We'll see what I can come up with.

In the meantime, I'm giving my best at work and trying not to lose myself in the process.

Is It Just Me or Is Everyone Crazy?

I'm beginning to think that I work in an insane asylum.  Seriously.  On an almost daily basis, there is at least one random outburst by a staff member or a physician.

CYRUS THE SCRUB TECH

Normally, Cyrus, a surgical technician with 25 years experience, is assigned to a room.  On occasion, when we are fully staffed and have "extra people" (on standby for traumas), we give people projects to complete.  One day, Cyrus was told that he would be helping us clean and organize an equipment room in preparation for a joint commission visit.  He happily complied with the request.

Approximately an hour later, the charge nurse paged him overhead to come to the Charge Desk.  One case was delaying another case, so she decided to take an "open" (i.e. unused) room and have someone set up for the case that was being delayed.  This would help increase patient and surgeon satisfaction because, at this point, they had both been waiting for an hour and were very upset.

When Cyrus appeared in front of the Charge Desk, he was visibly annoyed.  The Charge Nurse gave him new assignment.  His face flushed and his voice erupted.

"I HAVE A PROJECT TO DO AND YOU'RE MAKING ME DO SOMETHING ELSE AND IF SOMETHING HAPPENS TO ME IT'S GOING TO BE ALL YOUR FAULT!!!"

Huh?  It didn't make any sense.  This was a simple request.  The Charge Nurse required his assistance.  She asked him nicely.  We were all confused on why he made a scene.

Does he need a course in anger management?  Could it be the beginning of Alzheimer's or some kind of dementia?  I don't know, but it seems that his meltdowns like this are becoming more frequent.

TERESA THE TEAM LEADER

Teresa [Yelling down the hallway as she walked toward her assigned room]:  I AM ALWAYS PUT ANYWHERE THEY WANT ME AND NEVER IN MY OWN SPECIALTY!!!  THIS IS SOOOOO UNFAIR!!!

LTC is a small hospital.  We do not have 40 rooms like the big university hospitals, yet we do complex cases similar to those teaching institutions.  In fact, we ARE a teaching hospital.  When you are a small hospital, there are no specialty teams like Ortho, Neuro, General Surgery.  There are people who have a primary and secondary specialty.  Some even have a third and fourth.  In other words, people are CROSS-TRAINED.  I'm even cross-trained!

Teresa is one of those nurses who has many years of experience at a Level I Trauma Center.  She can scrub and circulate in almost every specialty.  However, she lacks the professionalism and flexibility to handle the demands of this small but complicated operating room.

I have tried to provide moral support and even show gratitude for her "flexibility."  We have even gone as far as telling her that she is one of our "go to" people.  This is the truth because they are not many RNs who can do what she does.  But accolades and reasoning fall on deaf ears with Teresa.  She is the type of person who wants what she wants.  If she doesn't get it, then holy hell!  Everyone will feel her wrath.

What the heck do we do with that???  The manager has brought her in many times, but I think the "Come To Jesus" talk is in her future.

DR. A. LITTLEMAN, SURGEON OF THE YEAR
Every time Dr. Littleman operates at LTC, NOTHING goes right.  At least in his eyes.  According to this surgeon, no one knows what he wants, management is good for nothing, and nothing ever gets better even if someone says they are going to take action.

If a manager is paged to his room, you can already predict what you will find when you enter those doors:  a stressed out circulating nurse, a terrified scrub, and an anesthesiologist rolling his eyes at the debacle ensuing.  And it's not about patient safety.  Everything can be fine in his room as far as case preparation goes, however, if he doesn't see his favorite people he starts throwing a tantrum.

There are certain behaviors that every associate of the hospital is expected to follow - professionalism, respect, etc.  We have been told that this applies to surgeons, but someone has yet to follow up and make them accountable for their actions.

Nothing is going to change unless the head of medical staffing and the chief of surgery step up to the plate.  Will that happen? Who knows!

* * * * * * *

Sooooooo...  Every day is interesting.  My goal is to remain steady amid the craziness that surrounds me.  If it starts rubbing off on me, then it's time for me to hang up my green scrubs and running shoes and find saner pastures.

Behind The Scenes

In the OR, it is easy to think that management is doing nothing.  The staff members are each assigned to an operating room, which they are basically confined for a long period of time.  They don't really leave the Surgery Department because it is a locked unit, unless of course, they are on their lunch break.

If the managers doesn't make rounds, checking in on the nurses and techs, then it is basically "out of sight, out of mind."  Their guess is that we are sitting around having coffee somewhere laughing at how hard the staff has to work.  Having been a staff nurse not that long ago, I remember thinking that leadership had no idea what was going on in the rooms.  Back then, it was true because our managers hardly made rounds, never gave a lunch relief (scrubbing or circulating), and were tough to find when surgeons were angry.

Our staff can't say that about us.  Even our OR manager knows how to scrub a total joint.  How's that for rolling up your selves and pitching in?  I wish I could have a camera mounted on my head (just like we have headlights for surgeons), so that the staff can see what we go through.

Ultimately, I know that no matter what I tell them, they won't care about what management endures.  The load they carry is big because they are there in the rooms giving direct patient care.  I get that.  This desire is selfish on my part.  It would be nice for people to appreciate the things that we go through just to get them the tools they need to do their jobs, keep their overtime, have a nice newly constructed lounge with brand spanking new furniture, or whatever the case may be.

If I was a bit more selfish, I probably wouldn't worry about this at all.  I would go and have that cup of coffee.  Unfortunately, that's not how I'm built.  As the demands increase from levels above and below me, I tell myself that I have an expiration date.  Just like our medications...

My manager told me this morning, "As leaders, we have to give up a lot."  Blah, blah, blah.  Sure we do.  But where do we draw the line?

A couple of weeks ago, I had a terrible headache so I ran to the holding area to ask a friend Tracy to take my blood pressure if she wasn't busy.  She took one look at me and her smile turned into a worried frown.  Tracy grabbed my hand to lead me to the sphygmomanometer.  Pointing at the number on the screen,  139/91, she exclaimed, "This is why you have a headache!"

My blood pressure has NEVER been that high before.

It was then that I realized that I have to stop putting myself last.  I have to stop taking to heart every little thing that happens during my work day.  At some point, I need to stop sacrificing myself.  I HAVE TO PUT ME FIRST BEFORE IT KILLS ME.

So I'm done venting (for now, ha ha).  I'm coming up with a plan.  The New Year is right around the corner and it's time for a change!

From The Archives: " The Path to Leadership"

This is a post that I wrote back in October 2009 for my old blog, "Livin' Large."  Back then I wanted to be in leadership.  Fast forward to present time and I'm thinking about stepping out of this role into something that is not hospital based.  Oh, how our needs change over time!


The Path to Leadership

I've been thinking about this a lot. Perhaps it stems from me trying to figure out my next move. I want to grow as a nurse leader, but the path isn't clear. Good examples of a nursing leadership track I have yet to discover.

* * * * *

SCENARIO #1 - The Corporate World:

In the corporate world, Camille gets a job - low chick on the totem pole - and she pays her dues. She types memos, create spreadsheets, collates and copies, and formats presentations for her boss. She might even organize team outings. By luck or because of company culture, someone recognizes her hard work and gumption. The next thing she knows she is asked to do more, take on small but key roles on committees, and maybe even take the lead on part of a project.

Evaluation time comes around and, not only does Camille get a 5 star rating, she's been given a raise and promotion. The next step is not only more money, but more responsibility, more visibility, and a chance to continue developing her leadership skills. The company starts sending her to seminars on public speaking and how to facilitate meetings.

The growth process continues and before she realizes it, years pass and she has accumlated layers of skills that equal credibility and proven leadership. Camille is ready to play with the Big Dogs.


SCENARIO #2 - Surgical Nursing World
(may possibly apply to other nursing units - I'm not sure):

Carina gets a job out of nursing school in a busy surgical unit. In orientation, for the next six to seven months, she learns how to scrub and circulate in a variety of specialties (General Surgery, Neurosurgery, Orthopedics, etc.). When she finishes her intro to surgical nursing, Carina is assigned to the General Surgery team.

She works hard and becomes more efficient as time goes on. A couple of years pass and Carina wants to grow as a leader. Unfortunately, the OR is way too busy and her manager cannot set aside time to talk about career development. Who can do that when there are high case volumes and only a limited amount of nurses to staff the rooms?

Carina thinks that maybe she can be active on unit committees, only to find out that those groups have little or no activity. The nurses involved have trouble getting out of rooms because there isn't enough staff to relieve them and run the OR schedule. Sorry! The patients come first. Don't forget that's how they pay your salary. Oh well...

A nurse educator position opens up and Carina applies for the job despite her lack of experience. How else is she supposed to get her experience aside from getting it on the job? Somehow Carina gets the nurse educator job --- good interview, the right people on her side, the promise of signing up for grad school, or whatever the case may be.

Now what? She has no idea where to start. The pressure is on and lots of things start falling through the cracks. For example, new nurses are starting, no one knows where the certifications records are from the last nurse educator, and who knows if the RNs are keeping up with their CEUs. Oh and don't forget all those meetings she has to attend. It's big load to carry... Can Carina do it and do it well?

* * * * * *

Perhaps I'm oversimplifying things, but these are two scenarios that I have personally witnessed. Unfortunately, I have yet to see how nurses, who want to develop into nurse leaders, get their actual leadership experience especially if they are strictly in a room being clinical.

Is there such a thing as a hospital that has a leadership track for nurses? If more hospitals had one, maybe there wouldn't be so many Director and Manager positions posted on the job boards!

Is the only way to get a leadership job to go back to school to get a Masters in Nursing? I personally don't think that having an MSN qualifies a person as a leader. There's more to being a leader than having another degree behind your name. You have to know how to talk with people, be able to conduct conflict resolution, understand how to interpret various reports, and be brave enough to stand up - professionally, of course - to other leaders for your staff or for what's right. Let's face it, there are some things that a Masters program just doesn't cover.

How can nurses participate in unit committees when there is short staffing in the OR? It's a difficult task to figure out staffing for lunch relief and change of shift in a busy surgical unit. What more if we added professional development to the list? Yikes! I think our charge nurse would have a coronary.

I've been talking to a very reputable institution in the heart of Big City. They don't have a leadership track in place, however, they do support their surgical RNs in advanced learning. Whether I would pursue a masters degree in nursing, an advanced nursing certification (like RNFA), or take a computer skills class, this facility tells me that they would do their best to work with me. Sounds like the opportunity I've been waiting for...

(Note:  I was offered a job at that hospital, but then ended up in a leadership role at another institution without having to get an advanced degree).

It's Crunch Time

Once again, work has taken me away from writing.  I'm back and motivated now, more than ever, to bring to light the changes that are felt on the ground level from a nursing point of view.

The Finance Department and Executive Leadership at Little Trauma Center have put their noggins together and decided that it's time to become LEAN.  OK, I understand that there's a recession and the current state of healthcare is forcing us in this direction.  But it is really hard to explain this initiative to our staff (who by the way are killing themselves to deliver quality patient care) amidst the large spending going on --- making improvements to the existing hospital and planning the construction of a new building.

The Powers That Be at LTC wanted to make a quick hit with cost savings.  Unfortunately, this resulted in floor nurses, who have been frequently sent home due to low census, either losing a job or being "redistributed" to another hospital in the Big Hospital System.

Despite being the "money maker" of the hospital, we have felt the impact of this unwelcome earthquake of belt-tightening.  The Powers tell OR Leadership to look at overtime hours - including mine!  It's funny because there is so much we need to accomplish and they want me to do it within the constraints of an 8 hour day, 5 days a week.  Ummm...  Right.

We are also terribly short-staffed due to normal attrition, vacations, and FMLA.  Nurses and techs can't help it but work an excessive amount of overtime.  Would it be completely unreasonable to request that our executive leadership walk through the halls of our OR so that they can see that there is no such thing as a unproductive moment in surgery?


What happens when administration imposes limitations on staffing, overtime, supplies, etc., dances dangerously close to negatively impacting the quality of care we provide our patients.  The thought scares this nurse enough that I am trying to stay as healthy as possible so that I don't have to be a patient!  Now that's something to think about...