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Excerpt
There have been four ingredients for change:
Journey with me as I give an overview of our adventures in developing leadership, a voice, real power, a philosophy, and the role of goals and indicators as our compass in helping us to navigate toward a better place.
Two-and-a-half years ago, at Northside Hospital-Cherokee, an 84 bed, not-for-profit community acute care hospital, we were facing our own overwhelming local nursing shortage. Almost 50% of man-hours in ICU and Emergency Departments were by agency nurses. More than 30% of total hospital nursing positions were vacant. We had just closed out our fiscal year with a 31% employee turnover rate. If this continued, we could not meet the needs of our growing community.
In the fall of 2000 when I interviewed for the Chief Nursing Officer position, I had 13 interviews with groups and individuals of staff, hospital management, administration, and physicians. I had the opportunity to listen to many people. What I heard convinced me the staff seemed to be on the verge of a “code blue.” We were “hemorrhaging” staff and morale was at an all-time low. Nursing was floundering. I saw devalued employees who seemed to be angry recipients of years of someone else’s decisions. We had many long-term employees, but we had rampant “AT&T” syndrome—absenteeism, tardiness, and turnover.
Our nurses were dragging themselves to work for a paycheck, and nursing wages were more than 15–20% below our neighboring hospitals. The nursing staff seemed over-managed, but under-led. No one wanted to take initiative or ownership. The nursing managers were invested in filing reports and documenting everything. If a staff member had a special request, the answer was anticipated to be “NO.” Even managers hesitated going to their own bosses with a request, fearing the same “NO.” These nursing managers ran for their cars at 4:30 p.m., and more than 70% readily admitted being miserable with their jobs. Each nursing area within our small hospital avoided reaching out to anyone else. They were truly islands. There was little interdisciplinary work. Add to this that most of our nursing workforce was menopausal or perimenopausal age. What a mess! You could almost hear the sound of nurses going down the drain.
There were few goals—not much common direction. Crisis management was the norm. It was obvious we lacked direction, so we had to accept some accountability for where we’d ended up. Clearly we didn’t know where we were going. With the change in the Chief Nursing Officer position, it seemed a good time to stop looking for a wizard, someone with magic to fix all the problems. It was time to stop blaming administration, the doctors, and salaries. Instead, it was time to roll up our sleeves and go to work. We had been riding a dead horse for too long and we could not rely on the traditional approaches nursing has commonly used to fix problems. Excuses had been woven deeply into the fabric of our nursing culture and these excuses had become automatic answers in justifying lack of change.
