When a nursing policy platform results in a culture of fear and intimidation the policy must be revisited, redefined or removed.
My hospital has had such a policy in play which caused a group stress response this year which is unlike anything I have noted in my many years of nursing.
What can be said when a nurse shows up with major vomiting and Zofran 8 mg on board to then fall asleep in her car for two hours prior to then stumbling into a testing facility with hair uncombed?
What can be said when a hospital uses threat of termination against nurses who do not pass an in-house test by the third attempt? Yes. It was fear that caused the registered nurse to show up sick and (naturally) fail the test.
My hospital has an in-house bed capacity of less than three hundred beds. We are modest in size compared to some of our larger cousins in the regional market. Yet “the test” has been administered over 1,200 times this year with many registered nurses failing it twice and having to take the third test. Stress.
Here is the bottom line. In striving to create a pod of super nurses, nurses are undergoing tremendous stress which has nothing to do with our bedside care. We are tested to the point of fatigue and many tests require a score of “100” for passing. If we were only issued our capes and super powers we would fly away. smile
Is this reasonable? What is the test of the reasonable man.
Yes, we need to meet certain national standards. But we do not need to exceed them.
Yes, there are a few bad nurses, probably on less comparable scale than other industries. Physicians identify these nurses and the process of identification does not use a singular metric nor single incident for termination. The nurse trends badly on most decisions or shows a lack of conceptual grasp. Physicians also undergo the same process of evaluation by the nurses who carry out their orders. Safe or unsafe practice is a fluid measurement and not static in nature.
My hospital has responded to this massive display of stress with promised changes in the process. We will be an emotionally healthier and happier community for their decision. Beyond the numbers, the CQI, the nurse governance models (which can show a weak display of nurse autonomy) is a nurse with her story. This individual is a human being who has chosen a difficult career trajectory.
May hospitals learn how to make that journey pleasant, and not more arduous than necessary.