The Challenges of Bureaucracy in the Nursing Profession
Nurses are leaving the profession in droves. A lot of the nurses who remain are dissatisfied. Much of the dissatisfaction has to do with bureaucratic bungling.Nursing is a stressful occupation. We often work short-staffed and we deal with physically or mentally difficult patients. Sometimes there are erratic doctors, hostile relatives and malfunctioning equipment. The straw that breaks the camel's back is often the non-supportive bureaucracy.
Here are some ideas that could help change this:
1. More input into all levels of nursing from nursing. Often administration issues more and more directives but there is little or no input from the bottom. Typically it may go like this: there is a meeting to discuss some new policies. It lasts from 2-3:30. The administrator talks until 3:30 and then says, "If there are no questions, we will conclude." This meeting is frequently held on Friday or on a day before a holiday. Some administrators ask for pseudo input. They ask opinions of nurses but do as they want. I remember being asked at one hospital what color of paint I wanted for my ward (when I knew it had been selected). At another hospitalnurses were asked to look at furniture for hospital rooms. We tested it, tried it, considered the spacing and colors and all of us chose the same ones. Administration used another type. At another place, I was asked to decide what medication cart I would like for my ward. I picked a light, easy-to-maneuver, that had several nurse friendly features. The bureaucrats chose a cart two times larger, difficult to push and steer and it was twice as expensive. We are nurses. Give us input into important things. We know about patient care, safety, problems, and we know aboutstreamlining paperwork.
2.Administrators need to circulate and be available to staff. I remember the first hospital administrator I worked with came and brought coffee for the evening staff. He brought the coffee to the wards himself. This was his time to talk with us and to touch base with us. He could have sent it with the evening trays. We felt his caring manner. He could see what we did and how the staff worked.
3.Excellent patient care should be rewarded instead of rewarding the nurse who nurses the desk. Nurses should evaluate paperwork that doesn't work, critique it and meet with administration. Some hospitals use test programs or pilot programs before just jumping in and changing procedures and policies on a frequent level.
4. Can someone else do some functions that are dumped on nursing? This has been a problem for at least 20 years. Does it have to be an RN that calls to request a thermostat changed? Does a nurse have to graph a temp? Does the nurse have to be the one to make sure the doctor's history and physical is in the chart or can it be a secretary or a medical record person?
5. Is there bureaucratic micro managing? Any time a micro manager gets ahold of a ward, there are more problems for nurses. We all need some supervision and some direction but we need to be able to make some choices. We also need to have input for us and as patient advocates.
