Another turning point in Jo's career....Of Magnet, of autonomy, of managing my license like a business

MyHospital (let's call it 'MH') is working toward Magnet status, and I anticipate this effort will be ultimately fruitless. I have been part of my Nurse Practice Council (NPC) for 18 months before I sent in my resignation on Saturday. I started the ICU's NPC with my co-chair, G. G resigned Monday. Several nurses on the ICU committee are also abandoning it now, too.

I'm not interested in telling you specifics, and MH may find an arbitrary reason to fire me if I do. (Not that I find this bothersome...I'm an RN, for chrissakes. How many RNs among you have gotten flyers/emails/recruiter taps in the past month?) Besides, the specifics of MH aren't interesting.

The point is that I believe MH has parsecs of vacant emptiness between the offices and the bedside. It doesn't appear to matter that some of those offices contain people who have sat for, and successfully passed, the NCLEX. No understanding appears to exist between the two. No honest conversation happens in both directions, it's radio broadcast from one side only.

I needed to get involved. I came from the consulting world. You hire a consultant for your organization to come in and identify the root of your organization's effed-up problems for you. They recommend changes, they help you implement the changes your organization can tolerate and they leave when the problem is resolved or at least tolerable. This suits my mentality. I am not interested in bandaids. I am interested in resetting the bone.

I believe this to be true of most bedside nurses.

It was natural of me to find stupid things on my unit, within the organization at large and try to become part of the solution. I observe the direct correlation between your overtime dollars timed to the implementation of your ludicrously obfuscating computer charting system, for one example. And I say you made a blunder of enormous proportions that can be salvaged with the more than willing cooperation and collaboration from the bedside.

But such observations are unpopular among administrators at MH. I was hauled into the principal's office for that one. (Remember when Linda Blair's head spun off her shoulders? Yeah. Dude, you should have seen it.)

But I can't do this anymore. It's not that I met a brand new managerial howitzer that is pointing directly at me and my partner, G. It's that the meeting was the last shred of proof to me that it's no longer worth the fight.

I'm not even sure if I believe in that Magnet crap, anyway. I only believed in the ability to work to improve things for my patients and my colleagues. I am afforded less and less an opportunity, as the tools of divide to conquer and fear of arbitrary reprisal are pulled out. As my friend, a charge RN (read: quasi-management), makes a sincere attempt to mediate and is told to 'keep her nose out of it'.

Another friend is talking to a recruiter. A third is now picking up shifts at a sister hospital. A fourth has switched to part-time. Etc, etc. The experienced nurses leave my unit, leaving an ICU full of cheaper new grads who don't know defib patches from pacer pads.

...

So now. If I'm mentally checked out of trying to fix the bureacracy from within, I'm left with what my next set of goals are. I'm the kid of person to grow in the job I've got until I've gotten all that I'm interested in getting from it. Then I find a new place to grow. I'm just started growing in the ICU, and I'm comfortable there. I know everybody; the things I know, I know well. I learn something new every day. I know the docs, work well with the majority. I'm friendly with the pharmacists; when I send a med-gram for drugs I need, I get them (a bit unfairly) fast.

But there are a lot of ICUs in town, and they might be interested in having some more prn nurses.

Considering looking at Jo, RN, as a business. A business needs to have something to offer (which I do), be fiscally sound (and there's certainly several ways I can improve that). And a good one continues to grow, refurbish, repolish, try new tools, new skills.

I love my unit, because I really care about the people there. It's one of the most fun, interesting curious bunch of people I've ever worked with. I'd rather not leave.

But a business can, and maybe should, have more than one client. Maybe I need to consider that, too.

Three to one...

We're running three patients to a nurse in the ICU.

They decreased the rate they want to pay travelers.

Every ICU RN on two nights ago was on an overtime shift.

....

What happens when your regular staff burns out on doing all this overtime on 3:1 ratios? The call-ins are just starting.

...

And at Nurse Practice Council, we spent thousands of dollars for a Magnet Consultant to come tell us we should be doing research and "shared governance" and "peer review."

....

I am just a stepdown nurse. I promised I'd go to this damn meeting next Monday. I think I'm gonna be a real pain in the ass and pull the CNO aside and relay those points to her.

The Nurse Practice Sticker Club

When I was 12, we had clubs. For stuff. Sticker club. Or, dancing club or roller skating club or bike-riding club. We'd take turns being president, and vice-president, secretary and treasurer and everybody got a job. Somebody would take attendance in a spiral notebook with a pink or purple pen. And we would have meetings. I don't remember what happened in these meetings. But we'd have our club for a week, and then we'd have a different club next week and somebody different would be the attendance-taker. I remember lots of meetings on the grass in my back yard. Or Jenny's. Or Melanie's. After while the meetings got held more at Melanie's house, because there were boys in the neighborhood playing basketball. And eventually, we lost interest in clubs.

NPC is having a lot of meetings lately. They're scheduling them for four hours in the middle of the day. Eight p.m. to midnight my time...after having woken at 4 a.m. to do a 12 hour, 7a to 7p for me. NPC wants to organize unit-based practice councils.

The trouble with this is....NPC doesn't do anything yet. It is a sticker club right now, and we listen to a consultant hired to help us attain Magnet status. And we do what she says. She says we need sticker clubs on each unit, so that there's communication between Big Sticker Club (us) and the little sticker clubs.

I ask around on my unit if anybody has opinions about NPC, and nobody does. Because we don't have a function. We don't have bylaws. We do not have action items (other than spawning more clubs). We don't know what we DO.

I joined because at another hospital I worked at, the NPC did stuff. They made charting consistent hospital-wide. They made practices about IV and tubing changes consistent. They do research. They provide continuing ed to the nurses on the units. They bring gripes from the units to the NPC table. Everybody knew who was on NPC. RNs were elected to council and expected to be accountable to their units.

So I inserted myself on NPC in the hopes of doing some of this stuff. I'm finding some frustration. I send suggestions to our council chair. Could we add this to the agenda? Would you like me to take the preliminary steps to do x?

No.

The other ICU rep (a sensible woman and incidentally, the only other NOC shifter at the table) and I were charged with finding more poor slobs who want to go to meetings of ill-defined purpose.

Trade you my extra sparkle roller-skates with hearts sticker for your round unicorn with rainbow sticker.

Pretend to care.

Once upon a time, there was a Dilbert computer game and the evil boss people would constantly chide you: "Pretend to care, PRETEND TO CARE."

Dilbert was funny until you lived it, and then it was humorous pain. Millions of people understand this same existential state. Sartre for Dummies. Doesn't matter what country you live in or language you speak. Absurdity is real and indomitable.

So PRETENDTOCARE was running through my head after a talk this morning with J, another NOC stepdown person. He was The New Guy until I arrived. For advanced practice school, they're having him attend Meetings. It's cruel of them, really. So he's going to QI meetings...QI means Quality I...Insects? I...I...nouns that begin with I.

(What does it mean if 'imbecile' and 'idiot' come to mind and oh, NOTHING ELSE?)

These QI people, however, are quite smart, regardless of what the ignominious (see? I can come up with adjectives with I) I nouns in their title. I faintly know two of them, and at least, they are smart. I'm gonna go with my gut and say other smart people are there, too. (My gut also tells me that at least one person at the table is somebody the rest of the people at the table want to throttle. It's a universal truth. You cannot come to a meeting without at least one village idiot.)

Improvement. I betcha it's 'improvement'. That took wayyyy too long. Sorry.

What's happening is that J is getting ensnared the way I feel like I am, too. Like a fly who touched a strand, and then another and another until I am a dry, hollow husk dangling in the breeze, discarded in a greyed and moldy cobweb.

Yeah, that really is preCISEly the image I'm living. It's corporate purgatory I fear.

J has the same problem as me. He cares. He, like me, may hate caring, but he cares. I do like going to work to do my job, leaving it there and coming home. This doesn't always happen. For anybody. But when I see something stupid, I kinda wanna fix it. MyHospital does some stupid things. And they're big stupid. It's not about my unit at all. When I hear things about how the big Meditech Rollout is er, NOT going, it irks me because it's gonna disrupt my ability to do things for my patients. When I know how rehab is kept attached to MyHospital like a gangrenous limb that nobody talks about, I kinda wanna say, "You wanna be a Magnet hospital with THAT putrefying thing dangling off 4east?" I go to these Town Hall Meetings with all the mucketymucks and they'll have FIVE new initiatives and directions for Porter. Who ARE you people?

They are MBAs.

And this is what they do.

Many wonder why they're ineffectual and the status quo is continually reconfirmed. They really do. Ask one, and many will have their insides chewed out of them wondering why their Visions don't get implemented. Many are genuinely baffled at why their efforts to improve x or y don't happen.

This is why I was a consultant. I really did read _Spiral Dynamics_. Cover to cover. (It's a sickness.)

And you know what? I just wanna be a nurse. I really love taking care of my people. I have a huge amount to learn still and I'm all elbows and scabbed kneecaps. I feel like a burden because I'm such a freshman in my new home. I'm really workin on it. I flub, and fatfinger, and I wish I were bulletproof.

And yet, some people want me to come to meetings. Somebody told J, "JustCallMeJo is just what we need at nurse practice council." For real. He told me that. He had Dead Serious Face. I was mortified. If that were true, we're doomed. Doooooooooooooom.



J's next. He is. They got him, too. He's gonna start coming to NPC, too. At least we can commiserate. Pretend to care PRETENDTOCARE.

Colorado SB10

The Colorado Senate Health committee heard opinions and discussion on this bill on 2/1. The bill is found here in entirety if you click on Senate Bills.

I'm feelin funny here.

I went to Nurse Practice Council last month, and my hospital is working on its Magnet stuff. Our CNO brought the bill up at the meeting and said that she intended to testify in opposition to the bill, but she wanted to hear what MyHospital NPC had to say on it. Was she speaking for us? She wanted to know.

So I stuck my hand up.

(Me and that sticking my hand up thing.)

I wanted to know why she thought it was a bad bill. Her rationale was brief because we were short on time, unfortunately. Her main point was that staffing metrics is not the best measure of good patient care, and that to mandate that we hire someone to do staffing ratio reporting was not in nursing's best interest. Any patient that wants to know staffing ratio can call and she is happy to tell them, she says.

Okay.

I listen. Unfortunately, I had not read the bill before this discussion, knew nothing about it. So when asked if I'm on board with MyHospital Nurse Practice, I kinda had to sit back and ....say I didn't know. I hadn't read the bill. I had questions. How did it work in California, and according to whom? Is the bill truly a slippery slope to mandating staff ratios, which I do think is a bad idea for some governmental body to be deciding how many patients a nurse can take. What does the government know about health care? About my patient? No, that's a bad idea. But do we throw out a good bill because there might be another proposed bill to follow? That doesn't make sense either.

Colorado Nurses Assn supports the bill. I'm a member of CNA/ANA, too.

I don't like kneejerk reactions to something important. I don't make quick decisions when it counts. I wished I'd had more time to sit and stew on this before being asked if I was on board.

The good news is that there's a staff RN from my NPC who's gone to the senate meetings, and he's telling us what's up. No votes were taken on it yet. I think the testimonials went so long they decided to re-address another day. Most of the testimonials are coming from administrators of CO hospitals. As these are people who will have to cut the checks for the fines, I'm not sure that they should be the only people to stand up and have something to say. By all means, participate in the discussion. I'm not a fan of fining hospitals either, as that helps neither the patient nor the nurse.

But.

There are some really good ideas in that bill. Ideas that can help patients. Ideas that can help nurses. Important implications for models of care.

I've heard, through my CNO, that "it didn't work in California when they tried it...they're not happier there." Okay. Except. I had a breakfast long island iced tea on Sunday with L. And I know L. I worked nights with L for a year, and I trust her and her thoughts on things. L was, incidentally, an administrator at a California hospital before she chucked that and came back to bedside nursing here in Colorado. I trust her. And the story she told me about how that staffing ratio reporting thing worked in California was different. Yup, hospitals got fined, but the nurses were happier with the care they were able to provide.

So I don't know.

Part of me really kinda wishes I worked some days and could go sit in on these meetings; I'm sure they're open to the public. I guess I'm not just "public" either...I'm an RN, BSN, member of CNA/ANA as well as my hospital's NPC ...but I think my primary distinction is that I'm simply Not A Schmuck and I know a thing or two about what I want and need to take care of my patients.

You know, I read Suzanne Gordon. I think every nurse ought to.

I'm thinkin this is where the rubber meets the road.

I wish my way here were clearer, though. If it's a good bill, heck yeah, I'll go write my letters to congress (and have written, incidentally, within the last three months). But good/bad isn't so straightforward here. I'll go stand up for the right thing. I'd even go stand up regardless of whether or not my CNO shares my opinion. She's a smart woman. I respect her. I respect that she'll go stand up because she thinks this is a bad bill.

I haven't decided if this is the right thing or not.