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Attention Nurse Managers: It's the 21st Century

This week seemed to produce a flurry of stories* from former students about management absurdities they have experienced in their first year on the job, from managers with associates degrees through masters. Here are the best gems of the bunch.  When reading the stories, think about how much these management decisions could cost a healthcare system.
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"I was written up for calling a doctor by his first name."

Last I checked, doctors have called nurses by their first names --without the "Nurse" prefix-- for at least the last thirty years.  As long as the other person is OK with that kind of informality, does this really merit disciplinary action on the part of management?  How far behind twenty-first social norms does healthcare have to be?  We are not practicing in a 1970s soap opera any more.

Managers who use these petty power plays, get over yourselves and focus on something that actually improves patient outcomes.

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"I was told I was really lucky to have a job as a new grad and that refusing to work my fourth 12 hour shift in a row would put my job in danger.  I'm also not getting overtime right now.  I'm completely exhausted and worried I'm going to make a mistake because I'm so tired."

Guess what?  It is US federal law that you HAVE to be paid overtime AND that you can refuse it.  Managers, pay attention.  You can bring on a federal investigation from the National Labor Relations board based on how you handle overtime.

Another thing Managers - there is a whole body of research out there about the conditions that cause burnout in nurses.  You can access, FOR FREE, the 2,411 articles published (to date and since 1979) from PubMed.  Don't know what PubMed is?  It is the National Library of Medicine's web-based search engine that stores all the research you could ever need for evidence-based management practices.  There is no excuse for not using evidence in your practice when how you manage contributes to patient outcomes.

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This last story bothers me the most because it put the nurse's life in danger and for crying out loud, it is the 21st century!

"Over the weekend, early in her shift, my co-worker got stuck by a needle from an injection she'd just given to an HIV+ and Hepatitis C positive drug user.  Her manager yelled at her for going to the emergency room, even though that's what the personnel manual said to do if she got a needlestick on the weekend, and told her she shouldn't have gone to the ER and used up the 'resources' needed for REAL patients.  She told her she should have waited until she got off her shift and gone to occupational health in the morning.  She's afraid to file a complaint against the manager because she retaliates when her staff have done that." 

A manager berates a nurse for following policy, for wanting to protect her own health and livelihood.  Never mind the complete and utter insensitivity to a very scary situation.  The manager showed unbelievable ignorance of DECADES of research that shows early prophylaxis prevents HIV infection from needlestick injuries and reduces the risk of infection from illnesses like Hepatitis C.  PubMed also tells us that twelve rather good studies show that when staffing levels for nurses are adequate, the risk for needlestick injury reduces significantly.

Hopefully the nurse will file a complaint because there are so many labor and hospital policy violations going on it's not even funny.
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One final comment, my perspectives do not just come from the academic ivory tower in this case.  I did actually work as a nurse manager and had an educator role that involved a lot of management work in it for five years of my eleven year career in US hospital settings.  Management in healthcare is a tough job, but there are no excuses for the kinds of practices these nurses are enduring.  Especially not when a wealth of evidence from within and outside of Nursing highlights the best practices managers can use in their toolbox.

*Stories have no names to protect those reporting them.  All identifying information has been removed and some quotes modified as a result.

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