October 4, 2006, 9:46 am

What Exactly Is My Motivation In This Scene?

uhf68nursedr.jpgOh dear!

With all due respect to my colleagues who actually had this cap, I ask you:

How on earth could anyone look at this without laughing?

Oh, I’ve seen it before.

On a rack of lamb.

Definitely a 1/10 on the Emergiblog Cap Scale.

Maybe this is the reason no one wears their cap anymore.

Those who decided to ditch the cap had to wear this piece of fluff.

This would have been a deal breaker in my choice of nursing school!

******************************

Starbucks has a thing for torch songs today.

But at least it’s Tony Bennett. I’ve liked that man since I was little!

Now, I happen to know that the Beatles’ “Revolver” is on the playlist – I saw it on Starbucks’ website.

And I know this isn’t a radio, it’s a tape they play.

So where, I ask you, are my Beatles?

Yesterday I walked in and said it felt like a Motown day. So they put on Motown for me!

That was totally cool!

But sometimes a girl just has to hear “Got To Get You Into My Life”!

******************************

I’ve decided there is no extrinsic reward for being an efficient nurse.

The urge to excel must come from inside.

Follow my logic here.

The faster you move your patients out of your assigned rooms in the ER, the more patients you get. Therefore, the harder you work, the harder you work!

And the more efficient you are, the more you are expected to “help” those who are less so!

Make no mistake, I’m not talking about pitching in and helping a fellow nurse who is sinking under multiple admissions, patient needs and high acuity levels. We help each other out – it’s the way we are.

My derriere has been saved more times than I can count by the co-worker who “had my back”, so-to-speak. And I like to think I’ve been there for them, too.

But what happens when your payback for being efficient is getting pulled to help the same folks over-and-over?

******************************

I have a specific example, of course.

It happened to me.

Many years ago, I worked on a Telemetry Care Unit. They had offered a modified “Baylor Plan”, meaning you would get 40 hours of pay for working two twelve-hour shifts on the weekend.

Sounds good, doesn’t it?

It was! I could work the weekend and stay per diem in the ER during the week.

Commence rolling in the bucks, baby!

Our shift was 11pm – 11am, and this was before the California staff ratios (thank you, CNA!) were in place. This meant 6-7 patients in an assignment, primary care RNs with the occasional LVN also taking a primary care assignment.

And these patients were heavy-duty! Some might be 2-3 days post-bypass with chest tubes still in. Others had post-op epidurals requiring every 30 minute checks on respiratory status.

The routine was:

  • Report (30 minutes), then assess, vital and pass midnight medications.
  • Take the new medication records that would come up from pharmacy (computerized, and this was back in the 80s!)
    • check them against the previous medication record (look for errors, discontinued medication)
    • sleuth out any problems or omissions encountered
  • Chart your initial assessment
    • This particular hospital required the use of SOAP charting (subjective sx, objective sx, assessment and plan – for those unfamiliar)
    • The assessment had to be written out in full nursing diagnosis mode, for every single finding.
      • So if your patient had chest pain you had to write: Comfort, alteration in, due to incisional pain secondary to coronary bypass surgery. Followed by, say, “circulation, potential alteration in, secondary to prolonged inactivity resulting from post-operative bedrest”
      • This meant a full two-page initial entry for the day on every patient. At least it did the way I charted. It was understood that all future assessments would be compared to your initial one, so it had to be thorough.

Needless to say, the MAR checks and the actual charting would often take you into the 0400 hour. Remember, you had to get up every 30 minutes for the 2-3 patients who needed respiratory checks and round on your other patients at least every hour and answer any call lights and give any meds scheduled after midnight.

Tired yet?

Well, then you were able to take a break of 45 minutes – no 15 minute breaks were possible, so adding 15 minutes to your lunch was a compromise. And no, this particular hospital was not represented by CNA (California Nurses Association) or any other bargaining association.

Then came the morning routine. Because of “downsizing”, the lab no longer did the morning blood draws.

Guess who did? Yep, the nurses! Commencing at the late hour of 5 am. We woke everyone up at 5 am for their blood draw, doing anyone requiring coagulation studies last because those had to be in the lab 30 minutes after the draw!

So, 6-7 phlebotomies. Then another assessment of everyone at 0600 and med passing.

Remember, I’m still doing q 30 minutes respiratory checks in the middle of all this.

Then, because we didn’t have an 0700 change of shift, I’d start getting everyone bathed before breakfast at 0830.

Oh, did I mention that in the middle of all this we were expected to review the entire care plan, which was written on pages and pages of paper, initial and date it every day and yellow out the parts that were no longer applicable?

And those were written in nursing diagnosis form, too.

I hate nursing diagnoses. Useless verbiage.

******************************

By this time, it is “day shift” and 0900 meds were passed, some patients were handed over to the 8-hour nurses who also worked and the doctors would make their rounds meaning new orders. Transfers would come in from ICU/CCU. The usual stuff.

But every patient I handed over to the 11 am nurse was bathed, medicated and their charts were immaculate.

I’m not bragging, I was just efficient.

So, I would finish my work and begin to read the patients’ charts. Their H&Ps, their lab tests, the doctors’ progress notes. You know, get some actual background on the patient so I might better understand the care plan?

Was that so wrong?

Well, yes it was. Because the minute I was finished with MY charts, I had to run and do the respiratory checks for the nurses who weren’t done and in fact were way behind.

Okay, no problem.

But the minute I finished with MY phlebotomies, I had to go draw the patients in the next pod for the nurses who hadn’t finished theirs and in fact were way behind!

Okay, no problem.

Oh, and could I please go hang the five IV piggybacks due at 0600 for the LVN in the next pod, whose patients I knew nothing about because the RN assigned wasn’t done with their phlebotomies and was, in fact way behind?

Uh, okay, no problem.

Except that after two months I began to notice a pattern.

I was always bailing out the same nurses. Every shift. For the same reasons.

The minute I sat to catch up on my patients or do my care plans, it was perceived that I was free and so I was asked to do the other nurses’ work.

To help them out.

I couldn’t say “no” or I wouldn’t be a “team player”.

So you know what I started to do? My work started to expand to fill the time alloted to it.

In other words, I took my time charting. I took my time drawing blood. I took my time passing meds. I took my time updating care plans.

I looked busy, so therefore I was.

Am I proud of this?

Not really.

But after two months of this happening every single shift, I realized that I was being used to cover the inability of other nurses to get their work done on time.

******************************

This is when it hit me.

The harder you work, the more you will be expected to do.

Not so much in the emergency department where the patient census fluctuates widely and we are all running to other assignments to help settle in a new patient.

But most definitely on the floors/tele units.

This is why I believe the motivation to work hard and efficiently must come from an ingrained work ethic, an internal source.

Goodness knows there isn’t a whole lot of external feedback to promote it.

You can be a “team player” and help those co-workers who are in a bind.

Just be beware of situations where that ability and willingness to assist is being exploited.

9 Comments

  • Wendy, S.N.
    Wendy, S.N.

    October 4, 2006 at 10:42 am

    Thanks for posting that.

    W. 🙂


  • Myssi
    Myssi

    October 4, 2006 at 12:03 pm

    Timely. I’m taking my afternoon break (whether anyone likes it or not) from helping my “snowed under” co-worker. And I’m the one who took the summer off to have a baby. LOL!


  • Susan
    Susan

    October 4, 2006 at 1:04 pm

    One of the first things you have to figure out when you start on a new unit is who’s lazy and who’s not. Nobody minds helping out a coworker who genuinely needs it, but we aren’t really helping them if they aren’t learning to budget their time and prioritize effectively.


  • Annemiek
    Annemiek

    October 4, 2006 at 2:14 pm

    Gosh, right on again! It is always the same nurses that are really busy and need all your help. I have learned when to help and when to say no, and to get a feel for how heavey their load really is. There are very few that I know that are lazy, it is more their way of working and lack of prioritizing.


  • Julie
    Julie

    October 4, 2006 at 4:27 pm

    Using computerized charting, I’ve noticed a trend of ‘follow the leader’ from the nurses who seem to get done sooooo fast. One can’t even use the pyxis. She can administer the meds, but can’t pour them because the machine never seems to cooperate with her. She overcomes these issues, though, by helping out on the floor, and the LPNs/CNAs love her to pieces. Sort of balances out, right?
    Great post.


  • RedNP
    RedNP

    October 4, 2006 at 4:56 pm

    And are we *really* helping our co-RNs by “bailing them out”? Or are we teaching them that their work habits are ok so they can continue to coast while they let thier coworkers take up their slack. Nursing has so many things wrong with it… And yet I still love it. And I get so so frustrated.

    Excellent excellent post.


  • […] My humble entry this week describes why the motivation to work hard has to come from inside because there is rarely an extrinsic reward for doing so. Read my example in What Exactly Is My Motivation For This Scene? right here at Emergiblog. […]


  • Mandie
    Mandie

    October 4, 2006 at 5:40 pm

    This made me laugh, as it’s similar in SO many jobs!

    I was working in admin in the radiology department in a children’s hospital. I quickly got the hang on audio typing and was able to complete all the dictated reports efficiently. Whenever I was done typing (as I was the “typist”), I was sent to help the people filing and doing the other jobs – I quickly noticed that THEY took extra breaks (man, non-smokers get totally ripped off!), and THEY worked really slowly, chatting and gossiping the whole time!

    I learned to do what you did.. I learned to take my time, to type slower, to take the FULL 45 minutes for lunch instead of 40, to take extra bathroom breaks – whatever, just to get my work done in the time allocated, and no less.

    It’s sad, but it happens. There’s lots of lazy people out there who will take advantage of you if you let them.. beat them at their own game. Get your own work all done, but be able to say “sorry, I’m busy!” when they want someone to do theirs for them!


  • NPs Save Lives
    NPs Save Lives

    October 5, 2006 at 5:54 am

    I totally agree with fellow co-workers taking advantage of each other. I am often the one who pulls the slack and will answer EVERYONE’S call lights, field questions from family members, etc. Thank God I pay attention to the entire hallway or the families get very upset. I can’t seem to say, “they’re not my patient” and walk away..
    I don’t take long lunch breaks and I don’t go downstairs to smoke. I am one of the nurses who is the last to leave after catching up charting.. Because I spent too much time talking to my patients and family members. That’s one of the most important aspects of my job.


About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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