I once worked with someone whom everyone referred to as a “lazy nurse”. It was because Tamara’s primary goal during a 12-hour shift was NOT to get an admission. Seriously, Tamara would do everything she could to delay transferring or discharging her patient until 30 minutes before the end of her shift. When I was in charge, I constantly reminded her that she needed to move her patients so that she could admit a post-op patient who was waiting for a bed. She gave me every excuse in the world – bed not ready – I tried to give report but the nurse was at lunch, the family wanted the patient to stay for a little while longer – on and on.
One day, after getting a litany of her excuses, I actually walked up to the receiving unit and found that the bed had been ready for hours and that the receiving nurse had never gotten a call from her. BUSTED!
Think about the time and energy spent trying to encourage her to transfer her patient – time and energy I could have used to care for patients. Think about those patients in the recovery room who were waiting for a bed and their families who were waiting to see them.
Lazy nurse or faulty decision-making?
In Peter Senge’s book, The Fifth Discipline, he talks about alignment; that when everyone is making decisions based on one primary goal, it takes less energy and you get things done faster. However, when everyone is running amuck doing their own thing based on their own goals, the result is wasted energy and unproductive time.
It’s not that Tamara was a “lazy” nurse (well, maybe she was). It’s that Tamara made decisions based on what was best for HER – not the team and not the patients.
I bet you’ve worked with someone who is like this too.
How the Military Makes Decisions
I read an article about teamwork and this particular excerpt really struck me.
“After dinner at the Quantico officers’ club, a Marine general explains to the MBA students that in combat a commander must unequivocally commit to two objectives: (1) Accomplish the mission, and (2) Bring all your people back from the battlefield, whatever their condition. Mission first, then team, then self.”
When I read this, I had an ah-ha moment. Think about it. Mission first, then team, then self. Tamara and others like her have it backwards. They focus on SELF, then the MISSION (patients), and then the TEAM.
I think many other nurses get it backwards too.
Perhaps the answer lies in how the military makes decisions.
A military mission is a coordinated effort by teams made up of individuals working together to accomplish a given mission. The mission always comes first. The team is second in that it takes a team to accomplish the missions. Individuals in the team must also focus and train on accomplishing not only the team mission, but the overall mission, putting self last.
MISSION – FIRST
Healthcare organizations have a mission, vision, and values statement. However, it’s also important for each specific department to create a specific mission (or you could call it a mantra) that conveys what they do – their purpose.
At the Healthy Workforce Institute, we work with organizations to create professional and supportive work environments and one of the activities we do is to create a mission/mantra statement.
This is one the staff created for a recovery room:
Our mission is to recover patients from anesthesia safely, then efficiently transfer them to the next level of care.
Here is one from a medsurg unit:
To always make decisions based on what’s best for our patients and each other.
Why not create one in YOUR department?
TEAM – SECOND
Nurses tend to get myopic when it comes to their work. My patients – my shift – my unit – my organization. They fail to see how everything they do or don’t do has a ripple effect on everyone else. How many times have you referred to one of your co-workers as a lazy nurse or nursing assistant because they do the minimum and nothing more? The nurse who retimes all of his medications for the next shift so he doesn’t have to deal with them or like my colleague who would hang onto her patient so she didn’t have to get an admission. Think about how that selfish behavior impacts everyone else. It does.
When I was a clinical instructor, I would take a group of students onto a unit for their clinical rotations. Our first day together I told them that when they were done with their work, BEFORE they were allowed to sit down, they had to check with every other student to see if they needed help. Then, they had to check with every nurse on the unit, and then they had to check with the support staff. Only when they offered to help everyone on the unit, could they take a break.
TEAM then SELF.
SELF – THIRD
Nursing is a service profession. We are inconvenienced every day we walk into work. Think about it. We should all be making decisions based on what’s best for the patients – not ourselves. When I was working as a bedside nurse the coordinator where I worked apologized because she had to give me an admission. I said, “That’s what I’m here for. To get admissions.” But the truth is, my INSIDE voice said, “Crap. I have to get an admission!” I had just gotten caught up and didn’t feel like getting a new patient. However, like it or not, taking care of patients takes priority over our own needs.
Self should be last.
There is another concept in the military that we can adopt in healthcare, “Mission first, people always.” It’s difficult to accomplish the mission when your people are distracted or not motivated or are motivated by the wrong things. A leader must know how to take care of their people so those people can complete the mission. If a team member is toxic, having issues at home, or is ill; they need to be taken care of so they can help the team complete the mission.
As nurses, our overall MISSION should focus on providing extraordinary care to patients and their families. However, it’s the little missions we face on a daily basis, accomplished by a passionate and committed team that results in a successful outcome, like winning a battle.
MISSION – TEAM – SELF
8 Ways to Stop Unprofessional Conduct
Powerful Scripts for Healthcare Leaders
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