Negative Nellies and Nay Sayers

Glum is character from one of my favorite childhood cartoons "Gulliver's Travels." All he knew how to say was, "It'll never work..."

Once upon a time there was a surgical staff who had a routine. It wasn't necessarily good, but it was THEIR routine and it was comfortable.

Enter New Management. They were tasked with making improvements. This was great and overdue, but these leaders were disrupting the staff's workflow - the way things have been done for 20 years.

Two groups began to emerge as changes were being implemented:

Group A - the folks who were willing to go with the flow and give it a chance
Group B - the Negative Nellies who don't like change and were determined to sabotage anything that the New Management tries to introduce.

How did they handle these groups?

Well, this story is unfolding in my daily work. I encounter members from both contingents. In my leadership position, I try to listen and address their concerns, however, there are just some things that are non-negotiable.

A prime example is the role of the circulating nurse. Having come from larger organizations, my fellow leaders and I are accustomed to OR nurses taking charge of a room when they are the circulator. He or she should coordinate the day with the anesthesiologist and surgeon.

At LTC, you can ask a circulating nurse during room set-up where their anesthesiologist is and all you would get is a shoulder shrug. "I dunno..." says the RN.

Aaaccckkk!!! What do you mean you don't know??? That answer makes me CRAZY!

Keeping the surgery schedule moving is important, first and foremost, because patients are waiting to go into surgery. They haven't had anything to eat or drink since the day before. They are scared, nervous, and agitated. All they want is to get their procedure over and done.

Other than patient comfort, the charge nurse wants the surgery schedule to keep moving so that she doesn't have to ask people to stay late. The staff is already tired from working in an intense environment. On top of that, surgeons who have cases to follow complain about how long they have to wait.

Going back to the circulator, he or she has a lot of influence on the pace of the room. If she knows how to gather the troops and keep things moving, the room could finish on time.

This is only one of many examples of things that need to change at LTC. The difficulty with this kind of change is the culture there. The staff was not expected to step up and take charge. They are accustomed to leaving it up to someone else --- and who that would be was no concern of theirs.

Um, where is the ACCOUNTABILITY???

Sigh.

The leadership team is now enforcing accountability and reminding the staff that it all goes back to QUALITY CARE FOR THE PATIENT.

When I was a rookie RN - even in nursing school, I was constantly reminded that everything I do impacts a patient's care. To this day, even in my leadership position, where I'm only occasionally doing direct patient care, I know that decisions I make are based on what is safe for the patient.

My hope is that the Negative Nellies and Nay Sayers - the people who are resistant to change - will open their eyes and their hearts and see the rationale behind the directives from management. The surgery leadership team is not trying to give them more work. The ultimate goal is to provide the best care for our patients.

The road ahead is going to be challenging, but I believe that it is worth the struggle to get there.