Advice, p.r.n.

Nursing, Sep 1997

NO ORIENTATION

Going extra miles

Earlier this year, the small hospital where I've worked for 18 years merged with four others into a "health system." Now, when patient census is down, I'm expected to work at one of the other hospitals. The nearest one is twice my usual drive, and I'm not paid-or so far even thanked-for going the extra miles. Worst of all, I'm expected to work without orientation. Although some procedures are the same throughout the system, I don't know each unit's policies or layout, and I'm often told to attend to patients before getting any report on them. My co-workers, who are having the same problems, are as uncomfortable as I am.

When the merger first took place, we were all told that to refuse assignment to any of the hospitals would invite disciplinary action and maybe even the loss of our jobs. Does this seem fair?-W.A., OHIO All's fair in love, war, and health care employment these days-or so it seems. These distance assignments are happening whenever mergers occur. Sad to say, you could indeed face disciplinary action for refusing to work in another facility. And if you're disciplined at any one hospital in the system, you could have trouble being hired by any others-a major threat if every hospital in the area is part of the merger.

The good news about distance assignment is that working in other facilities while safely employed at your home base expands your learning opportunities. Not only do you have a window on what's happening in other facilities, but you also have a chance to establish yourself as a competent professional in more than one place and expand your network of colleagues.

So be sharp. At least in these early days, confine your observations and criticisms to patient-care concerns (orientation and report) and put personal issues (inconvenience) on the back burner.

Write up a memo identifying orientation needs and give some suggestions. For example, each unit could provide a written description of usual routines and a schematic drawing identifying where equipment, supplies, and policy manuals are kept.

Discuss your memo with your nurse-manager before sending it through channels. She and other managers throughout the system need to know about interfacility problems so that they can address them.

Remember, everyone in all five hospitals is working through this merger maze. As someone with 18 years' experience, you've already gone many extra miles. Don't lose your sense of direction now.

SALARY REQUIREMENTS

Jumping through hoops

At a recent staff meeting, we learned of two changes in our evaluation process. First, to qualify for the maximum raise, we have to perform community service on our time off. And second, we're supposed to send formscalled "appreciagrams"-to our co-workers after they do something special. At evaluation time, we'll be judged by the number of appreciagrams that we receive.

I have two kids, and I resent my employer telling me what to do on my days off. And to me, the whole appreciagram idea is phony and juvenile.

Any thoughts?-C.L., PA. In every field, employers expect employees to jump through hoops for maximum raises. They figure that it's the employee's choice whether to spend personal time working overtime, traveling on weekends, or whatever. And so it is with your new requirements.

We agree with you, though, that these requirements make little sense. Though laudable in themselves, neither community service nor thankyou notes have anything to do with your job performance. They're issues of the heart that should be voluntary-not mandatory. Using them as a gauge (or a club) to determine a raise percentage makes them meaningless and distorts performance evaluations.

Practically speaking, how will community service be weighted-by the mile, hour, or frequency? And will the appreciagram scramble end up like a valentine exchange in grade school, with the fewest going to someone who's not a member of the unit's inner circle? Hardly fair.

Of course, just agreeing with you doesn't help. You'll have to get your co-workers together to come up with some alternative ideas (such as a scheduled health fair, journal-of-themonth club, employee newsletter, or book swap) that will require extra effort but will be an incentive to improve performance and team spirit rather than a turnoff. Then send a memo outlining your ideas along with your reasons for objecting to the new requirements to administration and human resources. You might even get an appreciagram for your efforts.

DOUBLE-CHECKING DOSES

Second opinion

Where I work, before administering heparin or insulin, we're supposed to double-check the dose with another nurse.

In discussing this with a coworker, this question came up: Is double-checking a legal requirement or is it discretionary policy? -B.N., ALA.

The double checks you question are a matter of hospital policy, not law. In effect at many hospitals, this policy minimizes the risk of medication errors. By all means, follow it.

LVN PHASEOUT

Process of elimination

This week, the hospital where I work laid off several LVNs, and we were told that all LVN positions will be eliminated gradually over the next year. Some of us will have a chance to stay on as "clinical partners," a glorified name for certified nursing assistants. Or we'll receive career counseling to plan education toward an RN license, assistance in obtaining another job elsewhere, or help with changing careers to another health profession. This blatant rejection of LVNs is devastating to me. I started out as a nursing assistant. Then, with the help of a federal loan (which I'm still paying off), I obtained my LVN license. Sure, I'd like to get my RN license someday, but I have a teenage daughter to support, and the time isn't right.