Undercover Boss

I love watching Undercover Boss.  The eye-opening experiences these executives encounter while actually working "in the trenches" so to speak ... well, let's just say they never cease to amaze me.
Now, I get that this is a slice of reality tv.  But still, I love it.  Why you ask?  Well...

When I was in middle management (as a head nurse on a busy oncology unit) my philosophy was to never ask any of my employees do anything I wouldn't do myself.  I never thought twice about answering a call light, doing bedpan duty, dealing with a difficult patient or family member, or whatever else was needed to get the job done.

I'll never forget the day a very flippant student nurse (who was nearing her graduation date) had not bathed her patients or changed their bed linens.  Her shift was about to end and it was obvious to me that she had no intention of providing this most basic of care.  I approached her quietly - and privately so as not to embarrass her in front of her classmates or instructor - and inquired:  "When were you planning to bathe your patients?" (Of note, she only had two patients and seemed to have plenty of time to stand in the hall and chat it up with her classmates so this only fueled my fire even more.) 

Imagine my surprise when she looked me straight in the eye and quipped "And just when was the last time  you bathed anybody Miss Head Nurse?"  WELL !  I was so incensed!  The fact of the matter was that I had bathed six patients that very morning because we one of our nurse's aides had called in and the other one had more than her share of work to do.  I was quick to point out to her that while she may think that becoming an RN relieved her of any of the "unpleasantries" of patient care, if her patient needed something she was ultimately responsible.  

But, I digress...back to Undercover Boss...

What I see happening week after week on this show is that the upper management has no clue what it's like to be an employee in any number of the types of jobs the company has to offer.  The other thing I see is that these bosses soon realize that there are communication problems between the workers and management.  And, the often find that there are some positions where the expectations are quite unrealistic.  Every single undercover boss I've seen has really had his eyes opened WIDE - and has taken to heart some of the lessons he learned while undercover.

Alot has changed in the more than 35 years I've been a nurse.   There was a time when the Directors of Nursing knew the challenges their staff faced at any given moment.  But, in recent times, consultants, corporate think-tank individuals, and various commissions that oversee health care have handed down many unrealistic expectations.  The rhetoric is often a mix of ways to cut costs and promises of improved patient outcomes.  But out there "in the real world" - on the busy med/surg units nurses just want to provide good/safe patient care to their patients.  And meeting the expectations of those who either never worked on the floor or who have been out of it for so long they've forgotten what it's like becomes a source of great internal conflict for the conscientous nurse.

We, as staff nurses, know that enforcing quick turn around time between written discharge orders and escorting out the door detracts from one of the roles that nurses excel at:  teaching - educating patients so that they are equipped to handle their health care needs at home  AND so that they don't bounce right back to the hospital within a matter of days.  Throughput they call it... Insanity I call it...We are seeing far more re-admissions than I ever remember in decades past.  And in 2012 Medicare will begin to deny payment for readmissions in a short amount of time for such diseases as congestive heart failure, diabetes andCOPD to name a few.  It would seem to me that we should be taking more not less time with our patients at the time of discharge.   I know for a fact that in the rush to get the patient out the door in one hour or less we short-change them in the education aspect of their care.  That, in my estimation is an injustice to our patients.  But, instead of allowing nurses to gauge how long it will take to teach a patient to self-inject a medication or recognize early interventions they can implement to help them stay at home and be healthy,  we are at a point where we spend more time explaining to management why we didn't meet the one-hour goal that the consultant said was attainable.

I wish that we could have our leadership team be like the undercover bosses I see on tv:  Doing every job that helps make the organization click and realizing that what they sometimes ask their employees to do is far more difficult than the paper pushers deem it to be....Listening to - and acting upon - some of the suggestions the staff have for improvement...Recognizing the goodness of their employees and their ideas...And trying to meet the expectations they have been led to believe are "good for all" only to realize that the system is broken....

I don't need these bosses to give big checks or vacations or help with school like they do on the show - although it would be nice - I just need them to "walk a mile in my shoes" and then come back with open eyes, hearts and minds to find mutual ways to deal with the challenges of today's health care world.