Nursing Management Hates a Squeaky Wheel

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It’s clear that being and advocate automatically makes you a target, but does it make you un-hirable? Nurse K at Crass Pollination gives an interesting and valid perspective about the Amanda Trujillo case and advocacy. In her opinion, and likely many others, what Amanda has done by advocating for her patient, herself, and all nurses is tantamount to career suicide. She also discusses what happens when nurses within an organization speak up and the measures administration often go through to oil the squeaky wheel.

Let it Roll Off

When I was dealing with my issues with bullying, it always seemed like my manager was doing anything and everything she could to get me to shut up. She even said to me that I should simply “let it roll off.” Her frustrations were apparent with me as I was even written up  for “being unprofessional” while defending myself from a public nurse-on-nurse attack. The only write-up of my entire nursing career came after another nurse attempted to publically belittle and humiliate me and I responded “You’re not my momma or my boss. You can’t tell me what to do.” At which point the nurse blew up and made a huge scene at the nurses station asking 10 nurses if they heard me and couldn’t believe I would say such a thing. Most of them tried desperately to ignore her.

Nursing Management: Behind Closed Doors

I hadn’t thought about it at the time, but the points Nurse K makes about the conversations that go on behind closed doors in nursing management and healthcare don’t surprise me. They do, however, disgust me.

“The Budget”

In many healthcare environments it’s very much about the money makers (the doctors) and the policy makers (administration). If you’re neither of these you are often made to feel disposable. Heck, administration is often disposable as well, especially if you’re at a for-profit health system and they feel you aren’t profitable enough.

At my previous employer, I witnessed hospital administration trimming the fat for budget issues. As staff nurses we often wondered when our turn would come. It didn’t, that time, but it certainly sent a message loud and clear to all of us that they were in the mood to fire and we’d better not give them a reason to look at us. All the while they took our bonuses away, reduced our shift differentials, and enforced new uniforms (that we had to buy and monogram with the hospital logo). Funny how firing 25 in administration can keep hundreds of nurses quiet when they were loosing thousands of dollars annually and having their workplace change around them. Oh, yes, and the hospital was also in the process of spending millions on a major renovation. How could they be screaming budget concerns and cutting everywhere yet they were putting in fountains and glass facades?

But wheels that might have normally been squeaky, only whispered their frustrations. If you were an LPN you were going to loose over $500 a month because of changes, but none of them stood up and expressed their frustrations publicly. Any conversations about this occurred behind closed doors. I don’t know of one LPN that quit because of it or any that were allowed to be grandfathered in with their old shift premiums.

Fear is a Heck of a Motivator

They were scared. The economy is tough and in a right to work state you can be fired at will. A wrongful termination suit is difficult to win, not to mention you’ll make it even more difficult to gain employment. You’ll forever have that cloud hanging over your head of suing an employer. And think about it, if you were going to hire someone, would you be interested in someone that had sued their last employer after being terminated?

Picking Your Battles

Nurse K makes a valid point about picking your battles and saving yourself first. I often have to discuss with my husband the need to secure your own safety before risking your life to help others. If you die, then no one can be saved, right?

Employment After Public Advocacy?

I sincerely hope that Amanda Trujillo wins this battle and is able to find employment after. But Nurse K is right to state that it is going to be difficult for her. Amanda is all over google now. She is all over google for going against a former employer who terminated her. Regardless of it it was right or wrong, this is going to prove to be a challenge for for for the rest of her nursing career. I hope that she is able to leverage this experience to use in her future career path. I really hope she is. I know I would be honored to nurse alongside Ms. Trujillo, but it’s likely most HR will be terrified to touch her.

She has stated that she does not intend to return to the bedside. We will just have to keep supporting her and see where she ends up.

images: NursToon

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7 thoughts on “Nursing Management Hates a Squeaky Wheel”

  1. Greg Mercer, MSN

    This advocacy experience surely has taught me many things and shows no sign of that slowing down: all for the good. We end up debating many different points at once, unfortunately. There’s the issue of Amanda’s actions and the context on the night that led to her firing, etc. There’s her past history. There’s the regulatory systems’ response, which has been by main focus as it affects all Nurses and there are many well-established areas in need of improvement. There’s the question of publicity and Amanda’s future prospects. So many issues, and we each have our focus of choice in all this mess: for me, Amanda made her choice for publicity long before I heard of her, and her choice is the only reason most of us knows she or AZ BON exist. Certainly she’s put herself in a tough spot, although from what I’ve learned of Arizona and Nursing, it seems her situation was quite dire long before she went public, given conflicts of interest and the way Banner seems to use the regulatory system to its own corrupt advantage. To the extent that is true, her decision to elicit support would seem less radical than it would in a different context.
    But in the end, I’m not interested in arguing anyone is perfectly good or bad: we all exist in context, a horribly dysfunctional and corrupt health care system that gets in the way of good work by Nurses, Physicians, and Managers of all stripes. Nurse managers, as an example, typically bear far more responsibility than their counterparts in other industries, for less money, with less real power, and much less training and support. It’s no wonder the results are often poor. At all levels, we need to look less at individuals and more at context: the systems issues that drag us all down each day. With each such issues we address, all Nurses affected will function better. As an example, look at FAA. Despite many problems over the years with equipment and human failures, pilots and air-traffic controllers falling asleep, corners cut on maintenance, and so on, air travel remains extremely safe. Hospitals, per NEJM, accidentally kill 90,000 Americans a year: extremely unsafe. FAA focuses heavily on systems; health care on individuals, pretending otherwise at a superficial level. See a pattern? Personally, when I say I advocate for Amanda and Nursing simultaneously, I do not mean to imply that either of us are perfect. I mean that the very same systems issues affecting Amanda affect all of us, and that we deserve better, as do Physicians and our patients.

  2. I’m just curious about whether you’ve changed your mind with the new information revealed about Amanda. Her case is a learning experience for us all evidently.

  3. Greg Mercer, MSN

    A few points from my unusual perspective:
    1) Health care suffers dramatically from a lack of training or structural support for management. New Nurse managers generally have no training or education in their new role, little real power, and yet responsibility for budgets and numbers of underlings far in excess of those found in other industries. They are most often both allowed to fail and do so, and a pronounced shortage of managers has emerged, further contributing to lower quality candidates and failures, a downward cycle. I have been repeatedly advised over the years not to even consider such positions, in which your accrue 24/7 responsibility, a beeper, no thanks, no credit, and earn less than many of the Nurses you manage. Is it surprising under such conditions that we see so many completely ineffectual, bitter, or absentee managers? As with so much in health care, the root problems are clearly systemic, but all the offered explanations and solutions individual, a proven recipe for pain and failure that remains overwhelmingly popular in this surreal industry. Nursing Management problems mirror Nursing staff problems: it is always cheaper, easier and more comfortable to find a scapegoat than it is make substantive improvements.
    2) Regarding our decision whether to take a stand for Nursing, I think of the Prisoner’s Dilemma, a classic problem in philosophy. I’ll spare you all the details, but the end result is this: a rational individual choice, taken by each of the members of a group, often leads to predictably negative results for all. If every Nurse decides to avoid risk, to avoid standing out, we will all sink in the end. America exists today only because brave individuals thought beyond their individual needs, believed in their vision for a better world, and took action. As Lincoln said, a Nation divided against itself cannot stand. A time comes when one must think of the whole, and of one’s responsibility as a professional and citizen: it not, one becomes an accomplice to the very wrongs we all abhor. Nurses have earned renown and trust with service to others – the time has come for us to serve each other, and our collective future, as well.

  4. I knew a grad student that introduced a few ideas on workflow management (while working as a CNA) on a busy unit. She loved that place and everyone working there, including the managers. Although befriended by the working nurses whom she was writing about in her masters thesis, an imagined threat to the status quo caused her to “separate” from the hospital. Managing nurses are so shell-shocked, having been forced to use systems that they did not design that a new idea suggested by one of their sisters was perceived as a threat. She could not work anywhere in that town due to the false rumors about HIPAA violations that were spread by her former supervisors. True story.

    1. I’ve actually heard very similar stories from others. It’s unfortunate. Working in IT, where we frequently request nurses to use new things, I have seen slight resistance at times. I am fortunate to work in a health system where innovation and change are most often embraced and welcomed.

      When a threat is presented, be it real or perceived, nurses will react in whatever way they feel will best protect them. And often they don’t take into account how that may affect others.

  5. Not to put too fine a point on it, but bashing nursing management is just more lateral violence. Sure, there are evil nurse managers/directors/what have you out there, but in my experience, most nurse managers genuinely are trying to do what’s right for staff and patients.

    1. Not my intent.

      I know not all nursing management is like this. I should have mentioned that.

      This was what I experienced in corporate, for-profit healthcare.

      I know that nurse managers walk a fine line and have a duty to advocate for both their nurses and their patients. They also have to follow the law laid down by their superiors. It’s a difficult and stressful situation. There are some, however, who are so scared of getting fired themselves, they they will do backflips when administration asks it of them, and ignore the needs and requests of their nurses. I’ve seen this first hand.

      I have also, however, seen passionate and hands on nurse managers who are inspiring and caring.
      I will write a post about those to contrast this one. Just like staff nurses, there are the good and the bad.

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