Issue link: https://nnumagazine.uberflip.com/i/198054
NewsBriefs:2 5/29/09 12:19 PM Page 7 What Model Are You? R ecently i had my annual evaluation. The air was thick with tension as my manager, with whom I had had a recent conflict over an overtime request, slid the evaluation across the table to me. I'd like to think that at age 51, with more than 20 years of nursing experience, I am not easily rattled by things like annual evaluations. After all, I am a bright, educated woman. I've raised a child on my own. I consider myself competent, fairly secure, and extremely efficient in my own life. But there is something about sitting in a small stuffy room with two supervisors that can turn a confident woman into a jittery kid who's just been called into the principal's office for something really, really bad. I started looking over my evaluation, down the columns with X's. The unattainable "exemplary" column was blank. "Kaiser doesn't give those," my supervisor told me last year when I asked how a person could ever move into that elite column. "That would mean you'd have to be ab solutely perfect." I shuffled through the pages. Ah, there it was: the "overtime issue." This January, Kaiser hospice managers had increased the number of patients nurses are expected to see in one day, along with the directive to provide more "excellent care." I read, "Needs to work on efficiency to meet department standards," "three incidents of overtime since productivity standards increased," and "too much focus on psych-social and not enough on nursing procedures." Where was the lovely narrative I usually get, praising my thoroughness and commitment to excellent patient care? Replaced with phrases like "needs to be more efficient" and "needs to be more concise in her documentation." The silence in the room was heavy as I tried to assemble my thoughts despite my increasing blood pressure. Then it happened. My manager spoke the following words which thrust me into a chilling clarity about what is happening to nursing, a clarity from which I have not yet recovered. She said, "You provide Cadillac nursing, Helen. You give Mercedes care. It's stunning. You have excellent communication. M AY 2 0 0 9 You are comprehensive. But we need you to move to Toyota care. We need you to be a sturdy little Toyota. Your only inherent flaw is in not accepting Toyota service as good enough." Had my jaw not been hanging below my knees after hearing those words, I would have said something articulate. Something like my 81-year-old mother said when I told her the story. "Kaiser," she said, lifting her coffee cup, "We aim for adequacy." At the moment, however, my mind was reeling with the implications of what had been said, and my breath was stuck in my throat. The pragmatist in me was deeply distressed trying to make sense out of this, recalling the recent instructions our managers had given us for increasing our numbers of "excellents" in patient satisfaction surveys. "How can one be both excellent and just good enough at the same time? Doesn't excellent service usually take more time than satisfactory service?" Oh, but the nurse in me! The nurse in me was down at the river wailing her outrage at the degradation of the Nursing Profession, the exchange of patient needs for corporate needs, the shift of focus from nursing process to productivity, and the loss of real heart in my beloved, chosen profession. To her credit, I think my manager very accurately articulated this incredibly disturbing trend in nursing. And I actually appreciate the way her words cleared up W W W. C A L N U R S E S . O R G some confusion I'd been having about Kaiser, and nursing, and things like thriving. But all that aside, I keep coming back to the question: Why are we comparing nurses to cars? I have pondered this question since my evaluation. It is disconcerting how I now find myself looking at my fellow nurses, trying to guess what kind of cars they'd be if they were, well, cars. "Now her, she's a Ford Focus. Gets the job done, and, with regular oil changes, she'll be reliable." "This one here, clearly a Honda Fit kinda car. Maximum efficiency. Zippy." "That one there, bad news. A real Ford Pinto." "Oh, and there's our Cadillac XLR. All the extra frills you could want. She actually listens to her patients." And if we are comparing nurses to cars, how did critical thinking, independent judgment, and patient education become luxury items in nursing—accessories if you will—like heated car seats, sentinel headlight systems, and embroidered car mats? Have our standards of practice, to which we are legally obligated to comply, those of observation, formulation of nursing diagnosis, evaluation, communication and patient advocacy, become optional extras like swiveling front car seats? Are they making cars now which can exercise independent judgment, provide in-depth assessments, and evaluate constantly changing situations? Heated seats aside, can a car provide real warmth and connection? Let us not forget that despite "these economic times" and the ever-growing demands on nurses to be more productive, more efficient, and more excellent, nurses are not cars. We never will be. To compare quality of car to quality of care is, in my opinion, a serious erosion of the nursing process. We owe it to ourselves, to our patients, and to our profession to stay loyal to our standards of practice (which, by the way, do not include efficiency, although most of us strive for it) and to remember our primary commitment is advocacy for and excellent care of our patients. —helen greenspan, rn REGISTERED NURSE 7