Angry Scrub Tech

Today one of the scrub techs lashed out at me. I simply asked her, "how are you?"

Apparently, she was having a bad day because she paused then angrily (and loudly, I might add) answered, "Instead of management focusing on food in the OR, maybe you should focus on getting me the instruments I need for my cases!!!"

With that she walked into her room.

I shouldn't have yelled after her, but I said "Well, the department of public health is going to be here, so I have to..."

She didn't hear me.

I was shocked by her response because she isn't normally like that toward me. Sure, there has been evidence of negativity that she often shares with her co-workers. But I didn't think she would have the audacity to spew all over me like that!

Obviously, we need to have a private conversation about this.

Ugh.

This is the part that I DREAD about my job.

Looking back on the incident, I didn't know that she was aware that earlier I confiscated food in one of our storage rooms where we keep sterile supplies and instrumentation. She wasn't there, but the food must have been belonged to her.

In our unit there is a heightened awareness of Department of Health regulations since there will be construction throughout our facility over the next year. The inspectors can drop by at any time without notice. Any infringement would result in a hefty fine.

Why wouldn't I be diligent about keeping money in our department's funds when we desperately need it for additional staffing and instrumentation?

Angry Scrub Tech obviously doesn't get the big picture.

It's not that I don't understand where she's coming from. I know what it's like to be frustrated with instrument tray availability and turnover. I get it. Been there, done that.

We're trying to fix things, but obviously it can't happen overnight. It can't happen without the staff helping leadership pinpoint the problems, plus work with us to come up with the solutions. Whether they like it or not, we're all in this together.

After this experience, I had to collect myself as best as I could and wrap up my day. It was 3:30pm, I was stewing about the outburst, and I had no desire to put in overtime like I usually do.

"Take a deep breath," advised a colleague. I promised I would try to let this go - at least for the weekend.

Of course, here I am at home, obsessing a bit, but I've come up with an action plan.

1) Meet with the manager of our Sterile Processing Department and the Team Leader of this specialty to discuss issues with the "busy days." Do we need more instrument trays? What process can we implement to make sure that these busy days run smoother?

2) Meet with the Scrub Tech to address the way she spoke to me. Of course, she is free to voice her frustrations, but to take it out on me? No, ma'am. I'm not going to tolerate the disrespect. First of all, there are standards of behavior at this hospital. Secondly, I've been working my ass off for the past 7-8 months, and putting in more overtime than I care to report, just to fix things and make this is a better place to work. OK, I won't mention the second part in my discussion with Angry Scrub Tech, but I'm just sayin'...

This isn't the first time a staff member has displayed inappropriate behavior in front of me, and I'm well aware that it won't be the last. Now that I'm not so new to this unit, it's time that I address these behaviors and prepare myself to lose the popularity contest.

Lord, help me get through this...

Who's The Boss?

Almost eight months into my job as a new leader, I still don't feel comfortable when someone refers to be me as a "Boss." It just sounds....weird. I realize that I signed up to manage people, but to hear that word to describe me is strange. It doesn't quite fit.

Perhaps it's just the sound of the word "Boss" and all the negative images that it conjures up. I picture Dabney Coleman in the movie "9 to 5" or Sigourney Weaver in "Working Girl." Self-centered and power-hungry, these corporate predators could care less about their employees. A Boss is someone who says, "Just do it or else." Right?

In that case, please don't call me "Boss!"

I would rather be referred to as one of the Managers or that I'm part of the Leadership Team. Sure I still direct employees, but it's less of telling them what to do because I'm management and more like a being a teacher. With my instructions, I give them the rationale. Of course, there are times when I have to discipline someone, but it's after coaching and counseling have failed.

Eventually, the sound of the word "Boss" will lose it effect on me. In the meantime, I will just ignore the titles and focus on the challenges ahead me. Just because I've risen in the ranks doesn't mean I have less work to do!

Change of Shift: Vol. 5, No. 17-18

Enjoy another edition of CHANGE OF SHIFT! See what's happening around blogosphere in the world of Nursing.

Cheers!

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.