Toxic Nursing: the stories, the solutions

Politics and CYA (Cover Your Ass)

At St. Clara Hospital, nurse managers must obtain the approval of their nursing supervisor prior to discharging a patient. The policy was created when there was a problem managing empty beds and a physician complained to the CEO. Now, the director of nursing reasons that supervisors will know the status of a particular unit at all times.

“This is ridiculous,” Dolores, one of the new nursing supervisors, tells a coworker. “All I basically do is acknowledge what the nurse managers tell me. The computer could easily do the same thing.”

At the unit level, nurse managers are now requiring all nurses to “check in” with them prior to discharging a patient. “It’s stupid, I know,” says Jill, a nurse manager. “It creates an extra step for everyone, but I guess we’re all paying the price because a doctor blew his stack when his patient sat in the ED for two days, waiting to be admitted when there was really an empty bed.”

 The Expert Weighs In:

Top-down change is rarely successful because the people who understand the process the best aren’t involved in the solution. The more input people have in designing the change that affects their work, the more they will own the results.

Forced change is typically met with a cynical response, especially when it creates more work and frustration.

Managing change is difficult and challenging—even when new policies make jobs easier—and leaders must know their roles during these periods of change:

• Listen carefully to what people are talking about. Never make them feel like their comments are silly. Never make promises or try to convince people the change is good; they will come to their own conclusions.
• Allow people time to process the information and vent their feelings and concerns.
• It helps to have leaders highly visible during times of change. People must feel they have direct access to leadership.
• Remain calm and positive. Leadership will set the tone for the change.
• Remember, the people in the organization are the organization—they need to be involved and treated fairly.

–Sherry Kwater, MSM, BSN, RN, Chief Nursing Officer, Penn State Milton S. Hershey Medical Center

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