No one really wants to hear this, but Healthcare has become more business-like than we care to think. It is no longer the warm and fuzzy oh-I'm-gonna-save-humanity-one-sick-person-at-a-time. It's time to wake up and smell the proverbial coffee.
I turned to nursing as a disenchanted business person looking to do something more with my life. Here I am facing, once again, the realities of a large corporation whose concerns sometimes feel less like quality patient care and more like the financial bottom line. Having lived in both worlds, I understand, only too well, we have to strike a balance between the two.
Yes, I get that - LOUD AND CLEAR!!!
As an assistant manager in surgery, I can see both sides - but yet I feel in my heart that the driving force for decisions that I make ALWAYS go back to the patient.
Is there anyone else in nursing leadership that feels this way?
3.22.2012
Managers Are People Too
There was one day last week that it finally happened. Yes, I had a breakdown. The pressures of my job squeezed me until there was nothing I could do but POP!
At the start of my day, I knew it was going to be challenging. My manager, who is in a constant whirlwind of meetings, was unavailable most of the day. Unfortunately, my partner-in-crime - the other assistant manager - also had the day off. I set my expectations for a possibly difficult day.
It was more than I anticipated.
Most of the morning was spent running around, helping the nurses look for supplies and instrumentation. No matter how organized we try to make our department, somehow things are reverted to the old stuff-it-in-a-cabinet or hide-it-somewhere methodology. We have committees who work so hard on this department initiative, but the tough part is getting the entire staff to buy-in to the new ideas. There are old habits to curb.
I've heard it takes twenty-one (21) days for something to become a habit.
Am I supposed to remind people or nag for 21 days??? Good grief!
While I was running around, whenever someone could stop me, they did. Forming a human speed bump, the nurses would step in front of me, blurt out their problem and expect a solution. It did not seem to occur to them that I was en route to the Sterile Processing Department to urgently find an instrument that was missing from a tray in another operating room with a surgery in progress.
Helloooooo... Move out of my way!!!
Even though the temptation was there, I never said that. Instead, I had to explain that I would be with them as soon as I could put out the fire in the other room. I asked them to call the charge nurse who should be able to assist while I was busy.
In many cases, the questions were simple and almost ridiculous. Answers could be discerned through utilization of critical thinking skills, something that I remember using as a staff nurse before escalating anything to leadership. But I guess that was me. And that's how I ended up in this position.
Ahhhh... Leadership.
I know that I don't have all the answers, but when I took on the role of assistant manager suddenly, in the eyes of the staff, I was like the Dalai Lama. Seriously, I don't know EVERYTHING about every specialty in the OR. Like any good nurse, I know my resources --- people, websites, books, etc. Sometimes it is as simple as a phone call or a search on Google.
And the day continued... The running, the troubleshooting, the questions... And there was the service recovery.
Angry Surgeon? My pager went off and I ran to see what I could do to make things better. Most of the time, when I address a surgeon, I become a therapist who listens to them vent. And boy do they vent!!!
There was nothing that I could have possibly said to make this particular surgeon feel better.
"Management never does anything..."
"Management doesn't care..."
"There are certain surgeons that get everything they want, but when it comes to me, no one cares."
"Management is a bunch of people who don't think..."
"Management is all talk... They want to make changes and nothing ever happens."
"Management is completely useless..."
The insults went on and on. And on...
I was supposed to take this without batting an eyelash... Seriously???
My response was that I would look into the issues and then I headed out of the door. I had to leave that crazy man. No wonder no one wants to work with him.
After listening to his complaints, I had to debrief. No one was around, so I just did a "mirror check." I stepped outside of the department to catch my breath and remind myself of who I am.
First and foremost, I am a patient advocate. No matter what the surgeons or staff say to me, I know WHY I am there. There is no confusion on my part. Insult me if it makes you feel better, but at the end of the day that's who I am. I am a nurse and a leader.
To make myself feel better after such abuse, I have to remind myself who I am and from where I've been: a bachelors degree in business, many years under my belt in the Corporate World, a bachelors in nursing, and experience at a large university hospital and large, busy trauma center.
Healthcare has been, so far, the most unprofessional environment I have ever worked in. When I was in consulting, I had never seen anyone act like a raging lunatic in the office. That would have warranted an immediate call to security for an escort out of the building.
Here in surgery, behavior like this is tolerated. We are trying to change this, but Doctors are allowed to do things considered unacceptable in civilized cultures. I'm sure I could have done something different, but under the circumstances, I could not since a case was about to start.
As if that wasn't bad enough, there was yet another incident where I had to deal with an unhappy surgeon. You might as well hit the 'Repeat' button on this one. To make matters worse, there was a staff nurse who was only happy to throw me under the bus. She is notorious for this. I swear, she is spawn from The Devil himself. No one, not even regular staff, enjoys working with her.
On top of all this, I had the pressure of administrative deadlines that I missed or that I was straining to meet.
I wanted to wave the white flag, thrown in the towel, surrender to the enemy.
You got me, you big piece of crap...
I don't know when it hit me, but the tears started coming. There was nothing I could do to stop it. I ran for cover.
Get it together, MB, I urged myself over and over.
Um, yeah. That didn't work.
I gave up on trying to finish anything else on my To Do list, rushed to the locker room before the crowd got there, changed out of my scrubs, punched out, thus ending My Day From Hell.
I'm sure there are lessons that could be learned from this experience.
If you asked me that evening, my big takeaways were:
Today I see things differently.
It has taken almost all of this week for me to get over the trauma of that day. Sad, but true. This is what happens when you care about what you do.
Nursing is really more than a job. It's a vocation, no matter what your role - staff or leadership. You need to have a heart for it, otherwise you shouldn't be in it.
I'm not sure how much my little heart can take, but I'm pressing forward until it's time to do something else.
At the start of my day, I knew it was going to be challenging. My manager, who is in a constant whirlwind of meetings, was unavailable most of the day. Unfortunately, my partner-in-crime - the other assistant manager - also had the day off. I set my expectations for a possibly difficult day.
It was more than I anticipated.
Most of the morning was spent running around, helping the nurses look for supplies and instrumentation. No matter how organized we try to make our department, somehow things are reverted to the old stuff-it-in-a-cabinet or hide-it-somewhere methodology. We have committees who work so hard on this department initiative, but the tough part is getting the entire staff to buy-in to the new ideas. There are old habits to curb.
I've heard it takes twenty-one (21) days for something to become a habit.
Am I supposed to remind people or nag for 21 days??? Good grief!
While I was running around, whenever someone could stop me, they did. Forming a human speed bump, the nurses would step in front of me, blurt out their problem and expect a solution. It did not seem to occur to them that I was en route to the Sterile Processing Department to urgently find an instrument that was missing from a tray in another operating room with a surgery in progress.
Helloooooo... Move out of my way!!!
Even though the temptation was there, I never said that. Instead, I had to explain that I would be with them as soon as I could put out the fire in the other room. I asked them to call the charge nurse who should be able to assist while I was busy.
In many cases, the questions were simple and almost ridiculous. Answers could be discerned through utilization of critical thinking skills, something that I remember using as a staff nurse before escalating anything to leadership. But I guess that was me. And that's how I ended up in this position.
Ahhhh... Leadership.
I know that I don't have all the answers, but when I took on the role of assistant manager suddenly, in the eyes of the staff, I was like the Dalai Lama. Seriously, I don't know EVERYTHING about every specialty in the OR. Like any good nurse, I know my resources --- people, websites, books, etc. Sometimes it is as simple as a phone call or a search on Google.
And the day continued... The running, the troubleshooting, the questions... And there was the service recovery.
Angry Surgeon? My pager went off and I ran to see what I could do to make things better. Most of the time, when I address a surgeon, I become a therapist who listens to them vent. And boy do they vent!!!
There was nothing that I could have possibly said to make this particular surgeon feel better.
"Management never does anything..."
"Management doesn't care..."
"There are certain surgeons that get everything they want, but when it comes to me, no one cares."
"Management is a bunch of people who don't think..."
"Management is all talk... They want to make changes and nothing ever happens."
"Management is completely useless..."
The insults went on and on. And on...
I was supposed to take this without batting an eyelash... Seriously???
My response was that I would look into the issues and then I headed out of the door. I had to leave that crazy man. No wonder no one wants to work with him.
After listening to his complaints, I had to debrief. No one was around, so I just did a "mirror check." I stepped outside of the department to catch my breath and remind myself of who I am.
First and foremost, I am a patient advocate. No matter what the surgeons or staff say to me, I know WHY I am there. There is no confusion on my part. Insult me if it makes you feel better, but at the end of the day that's who I am. I am a nurse and a leader.
To make myself feel better after such abuse, I have to remind myself who I am and from where I've been: a bachelors degree in business, many years under my belt in the Corporate World, a bachelors in nursing, and experience at a large university hospital and large, busy trauma center.
Healthcare has been, so far, the most unprofessional environment I have ever worked in. When I was in consulting, I had never seen anyone act like a raging lunatic in the office. That would have warranted an immediate call to security for an escort out of the building.
Here in surgery, behavior like this is tolerated. We are trying to change this, but Doctors are allowed to do things considered unacceptable in civilized cultures. I'm sure I could have done something different, but under the circumstances, I could not since a case was about to start.
As if that wasn't bad enough, there was yet another incident where I had to deal with an unhappy surgeon. You might as well hit the 'Repeat' button on this one. To make matters worse, there was a staff nurse who was only happy to throw me under the bus. She is notorious for this. I swear, she is spawn from The Devil himself. No one, not even regular staff, enjoys working with her.
On top of all this, I had the pressure of administrative deadlines that I missed or that I was straining to meet.
I wanted to wave the white flag, thrown in the towel, surrender to the enemy.
You got me, you big piece of crap...
I don't know when it hit me, but the tears started coming. There was nothing I could do to stop it. I ran for cover.
Get it together, MB, I urged myself over and over.
Um, yeah. That didn't work.
I gave up on trying to finish anything else on my To Do list, rushed to the locker room before the crowd got there, changed out of my scrubs, punched out, thus ending My Day From Hell.
I'm sure there are lessons that could be learned from this experience.
If you asked me that evening, my big takeaways were:
- Trust No One.
- Cover Your Ass.
- Plan Your Exit.
Today I see things differently.
- There is an urgent need for making people ACCOUNTABLE. I have been nice long enough. There is no more excuses. People are really taking advantage of my kindness.
- When a surgeon is acting like a raging lunatic, I need to ask if there's anything I could do to help at that moment. If not, we can debrief in my office after his case. And I should just WALK AWAY after that. I don't need to take that abuse.
- I need time away from work before I lose a passion for what I do. There is more to life than work... Really, there is.
It has taken almost all of this week for me to get over the trauma of that day. Sad, but true. This is what happens when you care about what you do.
Nursing is really more than a job. It's a vocation, no matter what your role - staff or leadership. You need to have a heart for it, otherwise you shouldn't be in it.
I'm not sure how much my little heart can take, but I'm pressing forward until it's time to do something else.
2.16.2012
New Year, Same Issues
Whoa. I can't believe it has been Christmas since I last posted an entry. The Wild Ride at LTC has continued and I'm still hanging on for dear life.
The Leadership Team at LTC has seen a lot of progress over the last year and a half, but unfortunately, there is so much more to go. One would think that the major issues of our department would be something like staff turnover and difficult surgeons. Not at all. All the challenges that we are experiencing center around a basic knowledge of working in an OR.
Practices of aseptic technique vary as people have their version of right. Ummmm... There is only a right way and a wrong way. My blood pressure goes up a little higher thinking about how many people have bad sterile technique or lack a surgical conscience altogether.
Another challenge is case preparation. Oh the running! There should be no running if all the supplies are pulled for the case and if the scrub tech or nurse scrubs in early enough to figure out what other needs they have prior to the start of the case.
While area hospitals have seen a drop in volume, we have increased ours for some reason. I'm not sure why that is, but our case load is heavy. The Charge Nurse begs for volunteers to work overtime almost EVERY DAY. There is no such thing as low census at LTC in surgery!
Lunch relief continues to be a challenge since we need to hire more staff. We are trying to add an extra circulator to rooms that have complex cases such as Neuro Spine, Ortho Total Joint Replacements, Open Heart, and Thoracotomies. Lately, I have had to do lunch reliefs because of short-staffing.
These days I am feeling very tired and spread thin. I don't think people can truly appreciate what my co-assistant manager and I go through. I really don't. It's like we are the dumping ground for everyone. Yes, I feel like I get shit on and am expected to take it with a smile.
Today I actually had to give myself a Time Out. I literally walked out of the department, went down to the Cafe to get a coffee and sat alone in silence. After about 15 minutes, I slowly climbed the stairs up to Surgery, stopped at our front desk to chat, and returned to the madness.
I'm not sure how tomorrow will go, but I will really try to maintain perspective as best that I can. That's all I can give at this point. At least until I find a way to rejuvenate my fighting spirit...
The Leadership Team at LTC has seen a lot of progress over the last year and a half, but unfortunately, there is so much more to go. One would think that the major issues of our department would be something like staff turnover and difficult surgeons. Not at all. All the challenges that we are experiencing center around a basic knowledge of working in an OR.
Practices of aseptic technique vary as people have their version of right. Ummmm... There is only a right way and a wrong way. My blood pressure goes up a little higher thinking about how many people have bad sterile technique or lack a surgical conscience altogether.
Another challenge is case preparation. Oh the running! There should be no running if all the supplies are pulled for the case and if the scrub tech or nurse scrubs in early enough to figure out what other needs they have prior to the start of the case.
While area hospitals have seen a drop in volume, we have increased ours for some reason. I'm not sure why that is, but our case load is heavy. The Charge Nurse begs for volunteers to work overtime almost EVERY DAY. There is no such thing as low census at LTC in surgery!
Lunch relief continues to be a challenge since we need to hire more staff. We are trying to add an extra circulator to rooms that have complex cases such as Neuro Spine, Ortho Total Joint Replacements, Open Heart, and Thoracotomies. Lately, I have had to do lunch reliefs because of short-staffing.
These days I am feeling very tired and spread thin. I don't think people can truly appreciate what my co-assistant manager and I go through. I really don't. It's like we are the dumping ground for everyone. Yes, I feel like I get shit on and am expected to take it with a smile.
Today I actually had to give myself a Time Out. I literally walked out of the department, went down to the Cafe to get a coffee and sat alone in silence. After about 15 minutes, I slowly climbed the stairs up to Surgery, stopped at our front desk to chat, and returned to the madness.
I'm not sure how tomorrow will go, but I will really try to maintain perspective as best that I can. That's all I can give at this point. At least until I find a way to rejuvenate my fighting spirit...
12.25.2011
Merry Christmas
Working at a Level I Trauma Center, the surgery department is manned 24 hours, seven days a week, including holidays. Yes, that means someone either picks Christmas or gets stuck working it. Tonight I'd like to say thanks to those who had to work today. Because of these men and women, people are still getting the care they need.
Merry Christmas...
Merry Christmas...
12.19.2011
From The Archives: "To My Favorite Residents"
LTC has surgical and anesthesia residents rotating through our department. Like anyone else on staff, there are good ones and some that are... Well, let's just say that there is room for improvement. They were accepted into the program because of their medical knowledge and potential. However, there is more to being a good surgeon than just knowing what to do with instrumentation.
To My Favorite Residents
from the archives of "Livin' Large"
Because of this...
....I don't mind answering your pager even when it goes off 10 times during a procedure.
....I will share my lunch with you when you haven't had a break and there's no food left in the doctor's lounge.
....I will provide positive feedback with the surgeons you work with.
....I will remember your glove sizes and pull them so that you don't have to worry about doing that for every case.
....I will save certain items that you need for learning/teaching purposes (within reason, of course).
....I will show you the respect that you give me.
Thanks to all my favorite surgical residents... I know you'll do great when you're finally on your own!
To My Favorite Residents
from the archives of "Livin' Large"
How do I like thee? Let me count the ways...
- At the beginning of your rotation you actually introduce yourself to the nurses and techs instead of, like a gunslinger, busting into a saloon as the "new sheriff in town."
- You ask kindly if I wouldn't mind answering your pager because you're on call. And you apologize profusely since it is my least favorite thing to do when I'm circulating.
- You don't stand there just watching while all 5 feet of me is struggles to hold a 300 lb. patient steady during a spinal. Not only do you help, but you refrain from short jokes - well, at least most of the time.
- You help me get the cart out of the room after transferring a patient to the OR table so that I can quickly put the safety strap on, help the anesthesiologist with the monitors, and provide comfort to the patient.
- When you're on top of completing the H&P (history and physical), initialing the surgical site, and ordering appropriate medication prior to me picking up the patient from holding, you help me keep things moving along.
- I'm impressed when you take the time to answer a patient's and his/her family's questions.
- You take patient care seriously by doing a thorough job closing the surgical site and putting on the dressings without getting blood all over them.
- Instead of answering your pages or checking your e-mail, when it comes time to transfer a patient from OR table to cart, you're ready to go.
- You don't purposely drop stuff on the floor (unless you really have to) 'cause you know someone else has to pick it up and I'm not your mother.
- Ultimately, you understand and appreciate that it takes teamwork to give good patient care in surgery.
Because of this...
....I don't mind answering your pager even when it goes off 10 times during a procedure.
....I will share my lunch with you when you haven't had a break and there's no food left in the doctor's lounge.
....I will provide positive feedback with the surgeons you work with.
....I will remember your glove sizes and pull them so that you don't have to worry about doing that for every case.
....I will save certain items that you need for learning/teaching purposes (within reason, of course).
....I will show you the respect that you give me.
Thanks to all my favorite surgical residents... I know you'll do great when you're finally on your own!
12.18.2011
Infection Control
What happens when a hospital discovers a spike in surgical site infections?
I can't tell you what happens at other hospitals, but at LTC, a task force is created, the troops are rallied, and all out war is declared on the whatever varmint is causing the trouble.
Task Force One consists of every hospital bigwig that has a connection to surgery: Hospital President, Medical Staff Director, Chief of Surgery, Director of Infection Control, Presidents of various specialties (all surgeons), Manager of Environmental Services, Director of Surgical Services, the OR Manager, and representatives from Pharmacy and Anesthesia. Somehow I (yes, little ol' me) made it on the list.
Over the last few months, we have had meeting after meeting creating a strategy to tackle this issue. Data collection and analysis is, of course, part of the search for the root cause. My mission, which I have accepted, is to oversee audits on aseptic technique. We want to see how well our staff, surgeons, residents, anesthesiologists, and ancillary staff (perfusionists, etc.) follow protocol. I won't be doing this myself because everyone minds their P's and Q's since I'm management. Just put a big sticker on my forehead. Seriously. People shouldn't do the right thing because I'm management. They should do the right thing because there is a human being's life and well-being at stake.
Instead of making my own observations, I have asked two nurses to secretly audit certain rooms. It has only been one week, but so far I think it has been quite challenging for them to be discreet. Should they be inside or outside the room? How long should their observation time be in order make this data valid? Should they observe an entire procedure? Honestly, I'm not sure how we can collect meaningful data.
I think I should channel Tom Cruise in Mission Impossible and rig microscopic cameras in each operating room. Perhaps I could hang out above the ceiling tiles and get a bird's eye view. If only I could...
We will try again this week. Stay tuned...
I can't tell you what happens at other hospitals, but at LTC, a task force is created, the troops are rallied, and all out war is declared on the whatever varmint is causing the trouble.
Task Force One consists of every hospital bigwig that has a connection to surgery: Hospital President, Medical Staff Director, Chief of Surgery, Director of Infection Control, Presidents of various specialties (all surgeons), Manager of Environmental Services, Director of Surgical Services, the OR Manager, and representatives from Pharmacy and Anesthesia. Somehow I (yes, little ol' me) made it on the list.
Over the last few months, we have had meeting after meeting creating a strategy to tackle this issue. Data collection and analysis is, of course, part of the search for the root cause. My mission, which I have accepted, is to oversee audits on aseptic technique. We want to see how well our staff, surgeons, residents, anesthesiologists, and ancillary staff (perfusionists, etc.) follow protocol. I won't be doing this myself because everyone minds their P's and Q's since I'm management. Just put a big sticker on my forehead. Seriously. People shouldn't do the right thing because I'm management. They should do the right thing because there is a human being's life and well-being at stake.
Instead of making my own observations, I have asked two nurses to secretly audit certain rooms. It has only been one week, but so far I think it has been quite challenging for them to be discreet. Should they be inside or outside the room? How long should their observation time be in order make this data valid? Should they observe an entire procedure? Honestly, I'm not sure how we can collect meaningful data.
I think I should channel Tom Cruise in Mission Impossible and rig microscopic cameras in each operating room. Perhaps I could hang out above the ceiling tiles and get a bird's eye view. If only I could...
We will try again this week. Stay tuned...
12.14.2011
Angry OR Bird
Sometimes it is really a challenge to control your emotions when you are part of the OR leadership team that is charged with improving a culture that needs a great deal of improvement. If only they can make a nurse version of this video...
And while we're on the topic of Angry Birds, I invited my colleague, AngryORBird, to contribute to this blog. She probably needs to vent more than I do! Hopefully, we will hear from her soon...
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