MMM...Power

One of the people I work with has been awfully quiet lately. When he first started working there, about 2 years ago, he was full of energy and had all sorts of positive influence on morale and lots of people noticed. Somehow over the past several months he's faded, he doesn't smile or exude good energy anymore. He just comes to work, says little, and does his thing. I've been noticing this pattern over several months.

We've talked in the past about my frustrations at work. He's a good listener. I think he might be headed down the same road as I'm on. I think it's sad. I've heard rumors that they have decided they don't want him to be in charge anymore. I liked it when he was in charge. He was helpful. And work was fun.

Today when I was grocery shopping I found some small organic chocolate bars with "support endangered species" wrappers on them, and I decided to get one for him. I'm going to leave it in his box with a note of appreciation on it. I'm going to offer to lend an ear, too.

Lately I've been more outspoken at work and I'm really sick and tired of the bullshit. I am ready to leave and I feel empowered by the observations I've made over the past 6 months or so, since I had my epiphany and went part-time and went on antidepressants and have sought outside help to sort through all the muck that is a result of the powers-that-be dusting up the air.

This post is about power.

There's a difference between two types of power. There's MMM...Power, where someone recognizes that they can use power to their own advantage while stepping on other people's heads in order to climb ahead, which is the abuse of power.

The other type of power is Empower. Empower is when you use power to everyone's advantage and help other people without squashing them under your feet, and as a result, everyone gets stronger.

There's been some stirring of the pot lately and I predict it is just the beginning.

One of our most experienced nurses is leaving next week, she got a job out of state, she was one of the Baylor people. And another Baylor person has left to go to a different department. And several of the other Baylor people are looking to leave. These were our most experienced, competent, intelligent nurses. There is a lot of frustration with the way things are run, with the people who run the show and remain in their positions when none of the bad stuff ever seems to change.

Misallocation of talent. Good, smart people leaving, feeling disenfranchised, while the same old horrible people are not touched. Nothing changes. Misallocation of resources. Too many chiefs, and the numbers are growing every day. The boss didn't send out an announcement of the new CNS starting until the day the CNS showed up. Funny how her starting date coincided with the same week that the Baylors were ending. Of course we always need more chiefs when we're busy, right?

Meanwhile they're calling us on our days off, desperate for staff, offering us double time. I took it one day last week, and it takes a lot for me to go into work on my day off. I'll take the extra money, sparingly, without knocking myself out. If I have to be in that environment I might as well get paid well for it for a change.

The way ICU nursing is going, they were trying to push an "intermediate care" charge so that eventually they can justify giving us more than two patients when the patient is no longer "critical". It's like making a stepdown unit. But they can't predict acuity, so it's hard for them to do that. The other thing far out on the horizon, which hasn't touched here yet, is the virtual ICU concept, where a nurse watches ICU patients on a monitor, leaving fewer nurses, or maybe even low paid techs to do the task work. That sounds scary to me.

Time for me to pull the plug on ICU nursing, in my opinion.

Lately we've been staffed more lightly and the census has been higher, so they have been hurting. We've had a lot of sick, sick patients lately. Plus shooting themselves in the foot over weekends, doesn't help.

After my extra shift Friday, I went back to work Monday and Tuesday this past week and we were full again. Tuesday opened my eyes again, helping me see from yet another angle. It had originally been one of the competent charge nurses who was supposed to be there, but we got a patient who needed SLED (a type of dialysis) and very few of us are trained on SLED. So they ended up pulling her to do SLED and our oh-so-competent nurse manager became charge. Several of us were in the breakroom before the shift when we found out what had happened, and people started groaning and rolling their eyes. We're in for a fun day. I felt like throwing up.

The mix of staff that day was interesting too.

Our good, competent charge nurse was stuck down one end of the hall with her SLED patient, a 1:1, so she was unable to leave the room without a SLED-trained backup. The only options for that were the dialysis nurses, who were there for the day for two other patients.

The nurse with the next two patients was the one who has gotten quiet lately. He keeps to himself and isn't as helpful or outgoing as he used to be. The next two patients were being taken care of by our princess educator, who is in her own world. Then we had a resource pool nurse taking care of the next two patients, and she had a student with her. She is really nice and helpful, and having the extra body of a student was helpful too. Then there was one patient being taken care of by the charge nurse /nurse manager, and then me on the far end of the hall with my two.

My patients were extremely busy but stable enough, I was task-busy with hanging blood products, doing a bronchoscopy and lots of meds and family interaction in one room, while my other patient across the hall needed extubation, observation and eventual transfer to the surgical floor. I ran my butt off all day but it wasn't a stressful kind of busy, it was just physically busy.

I had the student and the resource pool nurse for help with turns and poop cleanups, and it really wasn't a bad day, by itself. Except when it was time to do the bronchoscopy. Because I had the resource nurse and her student close by, it really didn't matter that everyone else was down the other end of the hall. My patient was stable enough that we didn't anticipate any problems during the procedure. It was me, the pulmonologist, and the respiratory therapist.

I got plenty of meds beforehand so I'd have enough if we ended up needing to give a lot of sedation. I'm used to operating like this anyway, because I usually don't get help, unless we are well-staffed and there is a competent charge nurse. Otherwise, if it's a certain person in charge, I get no help anyway, so I know who to rely on beforehand and give them a heads up. I'm used to fending for myself, so I always try to anticipate all the things we might need during the procedure if something goes wrong.

When we were setting up for the bronchoscopy, the RT came in the room and brought all the equipment. I ran to get the meds, and the doctor was finishing up with another patient's thoracentesis, so I figured I had to time to go pee. On my way to the bathroom, the nurse manager said, "I'll call the outreach nurse and get her up here to be your runner".

I said, "That's okay, I have plenty of meds, we should be fine."

She replied, "Oh, so you don't want help? Okay. I won't offer help ever again."

I looked at her, with my head cocked, like, am I really hearing this? Then she said, "You're looking at me like I'm crazy for offering help." I just shook my head and ran off to the bathroom, deciding I would have to talk to her later. Peeing was my priority.

I came back and we did the bronch, while I was fuming, and figured that I needed to find a time to say something that day. So later on, after we were all done I found a moment to catch her. I said, "You know, the way you replied to me out there was not helpful at all."

She said, "I was offering help."

I said, "No, it was the way you responded to me when I said I didn't need help."

She said, "Well I just figured, in the past you said you would have liked more help, but I guess this means you don't think you need any help."

I said, "No, I appreciate you offering help, but I had plenty of meds and I didn't need help this time."

She said, "Well it sounds like you think you don't ever need any help."

I said, "Just because I didn't want help today doesn't mean that I never want help or that I'll never need help in the future. You're the only one who interprets it like that." I was trying not to laugh at the ridiculousness of the conversation.

After I said that, she stood there for a few seconds, looking totally bewildered.

Then she said, "Well if you want to talk about it more later, I'll be here."

The unit assistant heard most of the conversation and she later said to me,"I was waiting for fists to fly".

What kind of a person cannot understand that because you don't want help at one point in time, that it doesn't generalize to all other situations? Can't she possibly see shades of gray? Then it started to make sense about some other things. Obviously if she thinks that I wanted or needed something in the past, then she probably assumes that I have never changed, or grown, or learned. She probably still sees me as a new grad, being unsure of what I needed, not sure of my own judgment.

Three and a half years later, especially after the past year and a half of her not being in charge and working with me on the floor, she has no idea of what I can do now. And this woman has been responsible for evaluating me. And every year when my evaluation comes up I get the same pathetic useless comments that don't help me grow or learn. It's always some dumb thing like "time management". Hello? How about helping me become a better nurse? But they can't do that. This is the one who treated me like the village idiot.

The Peter Principle at work.

Speaking of power, next week is Nurses Week again. WAAAAHHHOOOOOOOOOOOO!!!!! Already!!???

I just LOOOOOOVE!!!!!! Nurses Week, it's another one of those Orwellian concoctions by management-type people who have to give their token expressions of gratitude for those of us who endure undercompensation, exhaustion, and abuse the other 51 weeks out of the year. We get special lunches and dinners and presentations for us, free pens, candy, cakes, pins, and none of us can take advantage of it because who ever gets to take a REAL lunch break? And who is going to want to go out to dinner and attend a presentation after they've been slaving at the bedside for 12 plus hours, and probably have to return to work at 7 am the next morning?

I signed up to take a "class", specially offered during Nurses Week. It's called "Horizontal Hostility Among Nurses" and is supposedly an opportunity to discuss strategies for dealing with it. Well it's nice that they recognize that it exists. But I would posit that horizontal hostility is not horizontal. It's vertical. Allowing an environment that fosters such abuse is a function of the upper management from the director down. If someone doesn't feel safe, then it's a good bet that others don't, either.

Another blogger I correspond with has a blog about recovery from dysfunctional family systems, substance abuse and other types of abuse. She recently wrote a post about dysfunctional family systems and as I was reading it, I thought, "this sounds as much like my workplace as any dysfunctional family".

Giving lip service to a healthy work environment is not enough. Hostility is a power play. Someone who feels justified in putting someone else down is a matter of power. They feel threatened somehow, by their own powerlessness, their lack of control, so they have to assert their power in unhealthy ways. They bring their own unresolved issues into the workplace and management lets it happen. Looking the other way is included. Fear of confrontation and where that will lead.

Failure to act is out of fear. People don't feel safe confronting it. Like the nurse who told me that she noticed the charge nurse was not very nice to me. Well did she ever say anything about it?

Or the comment from another charge nurse when I complained about a hostile physician, "I guess she knows who she can pick on."

Being talked to by the unit assistant in a hostile tone of voice, knowing that others have complained about the same thing yet nothing changes. An environment of favoritism allows this to happen. A weak director will surround themselves with weak leaders. They don't want to be challenged. They foster an atmosphere of denial and secrecy, where everyone is fearful. Lack of communication and trust, fear of change. People are afraid to talk to each other. People certainly don't feel safe going to HR to say anything.

Abuse is about power, the misuse of it to gain advantage over someone else.

I think that I have power in the organization where I work, but it's fledgling and not very well-defined. I have celebrity. People know me in the organization because of my running and fundraising. The people in my unit don't support me much, but outside the unit I know a lot of people and I would say that I am fairly well-received and well-liked by most of the people I know outside of my own unit. I smile and greet people, try to remember their names and acknowledge them whenever I see them.

I think that gives me a certain edge, a certain advantage, just for credibility and respect. I have to be careful about it because with that power goes a lot of responsibility. Wielding this kind of power, I need to be kind and non-judgmental of people, I need to be accepting and open, I need to be seen in a positive light when I'm there. I feel like being in ICU has the potential to erode that because I feel so unhappy and disgusted most of the time that anyone who comes to the unit must see or sense that.

I can use my power in order to do good things and advocate for other people, but I'm not yet sure how to take those steps. It requires tiptoeing and careful, well-planned actions.

One of the most well-liked, most respected nurses in the whole organization died from cancer this week. She was an advocate for other nurses, she had good energy, she was a strong person. I didn't know her well, only when I was a new grad I took some cardiac classes from her and liked her immediately. A couple of years later I saw her and she remembered my name. I hadn't seen her since I took the class.

I take comfort in the fact that she was recognized for her role as an advocate for other nurses. That is what nurses need. Desperately. She wielded her power in the organization to do good things. I wish I could have had some guidance from her on that.

She would have been a great role model.

Empower.