Nurses are too afraid to speak up in their organizations and be vocal

I recently saw an article about Vanderbilt University Medical Center’s nursing staff.

The administration there came up with the brilliant idea of cutting back on housekeeping staff and making nurses do some of the cleaning, though it’s not specified how much. Nurses would be expected to take out the trash and linens, and mop up spot cleans on the floors, among other things.

They mentioned Florence Nightingale. But good ol’ Flo didn’t work these days when nurses do much more than light lamps, give baths and put warm compresses on people. She wasn’t responsible for titrating IV medications, giving chemotherapy, or bringing someone back from cardiac arrest. And she didn’t have to document everything she did in an EHR either.

The response of the administrators to backlash from the nurses was to tell them not to vent about it to the patients, to go to the administrators and vent. That heavy-handed approach always backfires. People are already talking about it in online nursing forums and other social media. No one trusts the higher-ups, few people want to risk their job by speaking up. The truth comes out in other ways, and makes its way to the mass media.

Does the administration really believe patients live in a vacuum and are incapable of independent thought? That they don’t  observe what their caregivers are doing as they watch them work and see how stressed they are? Does it make them feel good about their health care when they know their nurse is trying to juggle 5 or more patients at once and is being pulled in 3 different directions all at the same time she or he is giving them their medications?

I can vouch for the fact that my coworkers and I regularly remove trash, linens, and meal trays, clean chairs between patients, wipe down surfaces, keyboards, computer equipment, pumps, and so on throughout the day. I don’t have a problem with that. We do it when we have time, but if we don’t have time, we page housekeeping.

Spot mopping in a hospital isn’t just mopping up spilled Jell-O. It’s more likely drippy Clostridium difficile-infected diarrhea, that is super contagious. Or Hepatitis-infected blood that can carry transmissible virus from hours to days on a surface. Or any number of viruses, bacteria, or fungi that would like nothing better than to find their way to an immunocompromised host and have a feast, i.e. you or your family member in a hospital bed.

Housekeepers are trained in what cleaning solutions to use for different spills, how to properly dispose of things, and how long things need to be scrubbed, cleaned, and dried so they are infection-free. Nurses do not get that kind of training.

Nurses are trained in physical assessment, applying both critical thinking and highly technical skills to our knowledge of physiology, disease processes, pharmacology, safety, and optimizing patient outcomes for quality of life, along with saving lives.

Vanderbilt is a Magnet institution. These days, Magnet sounds like a bunch of academic and administrative types shilling for their own industries. It’s a marketing ploy that doesn’t even work as a recruiting tool anymore. Nurses see right through people spouting “Get a BSN” out one corner of their mouth, and talking out the other side, “Clean rooms too.”

I’m sure they have a special course in the bachelor of science in nursing programs for learning how to do basic housekeeping.

Magnet proponents prop up higher education, cranking out excuses for offering jobs that don’t show promise of any upward mobility. Promotions are few and far between in nursing. There’s almost unlimited lateral opportunity, if you’re interested in getting a few cents a year pay increase for experience and no more influence over the way things are done in your workplace. If you want nurses to get more education, great. Treat and compensate them like professionals, instead of slave labor. Don’t burn them out in a few years.

Do Magnet institutions back their claims of nurses needing BSNs with financial incentives? Sometimes they’ll offer a pittance for tuition reimbursement, with negligible or no increase in pay for the degree. Education is not cheap. It could take a working nurse with an associate’s, or even a bachelor’s in another field, five years to complete a BSN program going one course at a time in order to be fully reimbursed.

Nurses are too afraid to speak up in their organizations and be vocal. Is it really worth staying in a job that beats us up, burns us out, and ruins our health? If all we do is cower in the corner all the time, we might as well dig ourselves a shallow grave and tip over in it right now, next to Florence. Nurses, remember that apathy and fear are as good as death, and in the case of health care, might just be the equivalent thereof.

Alene Nitzky is a registered nurse who blogs at Journey to Badwater.

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  • laurie Watkins

    Awesome article. I now work in a retirement home.Not only do managers and owners not want to hire nurses,only psw , as an RPN I am required to do psw work and cleaning in my job spec.37 years as an RPN/PNA .rural comunities do not get enough subsities from government to retain or hire
    addequate nursing staff.Psw are taught to do medications,give insulin

  • Tiredoc

    Ah, my favorite kind of nurse. You’ll clean up trash, but leave the icky stuff to the peons.

    Your claims that housekeepers have specialized training in cleaning up excrement is laughable. There isn’t anything about housekeeping that can’t be trained in an afternoon.

    You signed up for the bodily fluid job. Ask for more money, fine. Ask for a better title, whatever. Too good to clean up? If I could have, I’d have fired every nurse who spouted similar sentiments.

    Sorry, housekeeping isn’t staffed for spot cleaning. They work all day going from one end of the hospital to the other. They have less down time than nurses.

    Feces is to be cleaned up immediately. No one is immune from that job in a hospital. Not even the doctors.

    • NPPCP

      Good Morning Tiredoc,
      Being very respectful – would you be okay with the employed Vanderbilt physicians having this requirement in their contract as well? If they are in a room and there is feces on the floor, they are required to clean it up. As a previous RN who has worked dialysis (can be very messy), ER, wound care – if something needs cleaned up on the spot, I will do it. In my private NP practice, I frequently clean up kid puke and urine off the floor. We all have our specialties and educational training. To me, in my opinion, this is the obvious point of the article. I would be okay with being required to housekeep as an RN if the hospital employed Vanderbilit physician is too. Praise the Lord and pass the mop to me and the doc!

      • Tiredoc

        Yes, I would be comfortable with that. And yes, I have said and done the same as you. I don’t anyone in health care should think themselves above bodily fluids.

        • PoliticallyIncorrectMD

          The question is not whether anybody should “think themselves above bodily fluids”. It is whether healthcare professionals should be bullied into accepting job responsibilities not related to their training, just because it is convenient for the employer. This is not simply a rhetorical question. Are we doing our patients a favor as we preoccupy ourselves with chores that should be somebody else’s responsibility?

          • Noni

            Spot on. I personally find the demands placed on these nurses to be unreasonable. Floor nurses are already worked to the bone and stretched thin; adding yet another task to their arduous workload is unreasonable. With no recourse or outlet to vent grievances what are the RNs to do?

            And I completely agree with you that after they are done squeezing the nurses they will come after the docs. You’ll go in to round with a stethoscope in one hand and a broom in the other.

        • goonerdoc

          I call BS (pun somewhat intended). You wouldn’t be OK with that and you know it. So you clean up every now and then….good for you. You get a pat on the back for going above and beyond. But having it mandated in your contract that you’ll do X amount of cleaning per week/month/year? Don’t kid yourself.

          • NPPCP

            You are correct in my opinion…and the RNs shouldn’t have that in theirs either.

          • goonerdoc

            Agreed

          • Tiredoc

            If they were OK with paying me my salary to do that there are days I would.

            My experience is this issue is one of lousy teamwork.

            In my hospital, housekeeping never did spot cleaning. The NAs did most of it. On the weekends, less NAs were staffed.

            Every once in a while, C. Diff. Would do its thing and there’d be a room full of it. The RNs would call for the NAs, and they would be gone on another ward, and it might be hours before they came back.

            If I was on call and the weekend nurse manager was just waiting, I would start cleaning. The regular RNs would almost always help at that point.

            I just can’t stand the idea of letting patients and their families smell that over a dispute with management. They didn’t pick the fight.

      • macbook

        NPPCP,

        Please do not lump doctors into this. By saying that if a nurse is asked to do something, then a doctor should be too means that there is no delineation between the twwo jobs. And obviously, that is completely not true. There is almost nothing similar between the jobs so that concept of if nurses are given a certain responsibility so should physicians, doesn’t make sense at all.

        • NPPCP

          Good Morning Mac!
          These thread replies get confused and sometimes it is hard to see what post someone is responding to. I was initially responding to tiredoc under the assumption that he was talking about firing nurses for not cleaning up floors – so my post above was a response to him. I obviously misunderstood him because he is willing to clean floors just like I am; and hopefully like we all would be (I already do in my private clinic).
          Concerning your post – I appreciate the comparison. You said so much in so little. I completely agree with you. The medical and nursing professions are not similar as you say. That is why I was commenting to tiredoc (in error) about “telling” my profession what to do. As you say, medicine and nursing are different professions and one does not regulate the other. Thank you for clarifying that. That is why medical boards regulate physicians and nursing boards (for the most part) regulate LPNs, RNs, and APNs. To take your comment even further, there are no similarities between BSN prepared RNs (the ones discussed in this article) and housekeeping. RNs are classified as professionals just as your profession is. It is my opinion (and pretty obvious) that RNs have much more in common with medicine than they do with housekeeping; that stretches out and reaffirms your argument just a little more. Thank you and sorry for the confusion.

          • macbook

            I really think that this concept of housekeeping being a distinct specialty that involves specific training to be somewhat of a ridiculous exaggeration. I am positive that their “training” is minimal and contained to maybe some introductory guidelines that took about a few hours to go over.

            Nursing involves taking care of the patient, carrying out the orders delivered by physicians, dispensing meds, as well as cleaning patients and their bodily fluid messes. I have worked with nurses on many different floors, from ICU to nontele floors, and I will tell you that all nurses understand this and accept this responsibility. Patient has massive diarrhea or vomits, they always clean it up and I’ve never heard complaints about this. It falls under the category of taking care of the patient in a way that they are assigned to do. There are other things that fall into this category as well. Its not a demeaning thing at all, its just part of the larger job description. Now do I think they should be mopping the hallways, etc, no definitely not.

          • NPPCP

            Again, agree!!! Hallways, rooms, closets, bathrooms; right – we are on the same page. Housekeeping responsibilities. I think we are both eating at different ends of the same piece of pie. :)

    • PoliticallyIncorrectMD

      I wonder how often you clean up feces. I mean personally. And if you do not now, you will soon. You already doing secretaries’ and social worker’ jobs. Why not sweep the flors. Beware, once they are done with nurses, you’ll be next.

      • Tiredoc

        Currently, in my private office about once a month. In the hospital, about once a year.

        It’s basic management. If you advertise that any job is beneath you, then you are stating that the person whose primary job to do the task is beneath you.

        Swinging a mop in front of the nursing staff adds teeth when you lecture them that they’re not above it.

        When they do it, housekeeping becomes more likely to come and help.

        It makes for less crap on the ground and less crap between staff members. Well worth a little manual labor now and again. Besides, I always need exercise.

        • PoliticallyIncorrectMD

          I am not saying such job is beneath me. I applaud you for not shying away from doing it. At the same time you should see a major difference between doing it occasionally on your own volition and doing it routinely because you are mandated to do so out of your employer’s convenience.

        • Suzi Q 38

          I agree.
          I am a teacher at an adult school. We noticed how the main office was so dusty, and there were lots of cobwebs. I got a rag and started dusting the copy machine, and the head custodian was very annoyed and apologetic. The next day, everything was cleaner.

          I noticed my classroom needed vacuuming, so I called the custodian and asked to borrow a vacuum cleaner. I said that he did not have to vacuum, but I needed it vacuumed so I could do it. He did it after my class that afternoon.
          I understand your logic…it is aggressive, but sends a message to all.

          It is not my job to be a custodian and dust or vacuum.

    • Alene Nitzky

      Tiredoc, I’m sorry you feel that way about housekeepers. They are made of the same flesh that you and I are made of and deserve respect. They also do get trained in a lot more than you realize. Maybe you ought to get to know a housekeeper or two, and maybe you ought to read the blogpost again. Nursing isn’t staffed for spot cleaning, either. I think you have gravely misinterpreted the point of my blogpost. It’s not about status. If a job needs to be done, it should be done, doesn’t matter what letters are behind your name. The problem is when administrators are too interested in capital expenditures, public relations, and increasing CEO salaries to bother staffing their facilities adequately. I get paid the same whether I clean feces or not. I just don’t feel like spreading Cdiff to my oncology patients. If I had all the time in the world to change clothes or gown up in between running back and forth between very sick patients, I’d gladly do that. The demands on nurses are much more intense than you realize.

      • Tiredoc

        I’m not sure where you got that I do ‘t respect housekeeping. Just because a job isn’t complicated doesn’t mean it isn’t difficult. Nor does it mean that it isn’t valuable.

        In my opinion, your post dances around the issue of what to do with a room full of C. Diff. I agree that hospitals should be appropriately staffed, and that most staffs could benefit from more ancillaries and less administrators.

        I do not agree with organized labor type job duty exclusions, because then the people who most suffer are the patients.

        As for the changing clothes, everyone on my ward had the same access to gowns, gloves, masks and shoe covers. As for infection control, nurses doing cleanup is less risky than housekeeping that goes throughout the entire hospital.

        Saying you don’t want to do it is understandable. Saying that you don’t have the training, or it increases the spread of disease, or that you don’t have access to the proper materials is not believable.

        • NPPCP

          Although I agree with tiredoc for the most part, I think it is the “you will do this” aspect that is not acceptable. This practice will not last at Vanderbilt.

          • Tiredoc

            The nurse manager needs to be able to insist that a ward nurse performs the task. Thus, if duties are contractual, there must be a line that states that spot cleaning may be required if directed by the nurse manager. I would not allow MDs or administrators the authority to direct ward nurses to spot clean. I never directed nurses to clean, but acted to support the nurse manager.

          • NPPCP

            I understand. I misinterpreted your initial post as if you would fire the nurse. I think you were saying everyone, including physicians must address a potential health hazard. Thank you.

          • Tiredoc

            Sorry for the confusion. It was always frustrating to me to defend nurses against disrespect from doctors and then have the same nurses publicly disrespect the NAs and housekeeping. The cleaning isn’t fire worthy, The public disrespect is. Sometimes you take one for the team.

        • Alene Nitzky

          Tiredoc, not sure what kind of unit you work in. When you work with people who have compromised immune systems, you take extra care to avoid spreading infection. Where I work the housekeepers are quite well trained in infection control. If I’m juggling four or five patients, I don’t have time to gown up, put shoe covers on, get the proper cleaning solution (yes there are specific things that need to be used for certain spills) and take all the precautions necessary to adequately prevent cross contamination. I have to wash my hands between patients, and I That’s why I call housekeeping. It’s not just poop. It’s blood, people coughing, vomit, and other things that are in public areas likely to transmit disease. It is a team effort in health care. I have never seen a doctor offer to clean up body fluids. A paternalistic attitude that casts doubt on the competence, skill or knowledge of housekeepers and makes statements such as, “I would fire any nurse who spouted similar sentiments” does not serve the best interests of the most important member of the health care team: the patient.

          • Tiredoc

            “I don’t want to do it.” is fine. “I shouldn’t have to do it” is marginal in public but fine in discussion with management.

            I’m not sure what you found paternalistic about my comments, other than my insistence that lousy team players should be fired. They should.

            As for infection control, you know as well as I do that you as nurse have to gown, glove and shoe cover to walk into a room with a C. Diff. or VRE patient. You obviously also know which solutions to use to clean up.

            As for the doctor issue, most doctors don’t work for the hospital and are not directly subject to managent. As a Medical Director, I was a part of the team and acted as such.

            I will agree that the vast majority of doctors wouldn’t do what I do. In my residency, though, I did fight and win a mandate that residents are expected to change and clean soiled adults when changing a sacral ulcer dressing.

            Of course, there net result was that patients stopped getting their sacral ulcer dressings changed by residents, so it was a win for patients in two ways.

  • SuzanShinazyRN

    Great article! This is telling of a horrible management system that would not survive anywhere but in healthcare. Clueless to the responsibilities of an RN, but strong on skills required to degrade them. Worse, threatening them regarding speech, and saying, ‘Come see me.’ We all know what that means! In other industries these person would have been fired.

  • Noni

    I’ve often wondered how desperate I’d have to become to become an administrative shill (assuming they’d even consider allowing a physician amongst their ranks). Sometimes resignation (if you can’t beat em, join em) makes sense.

    • EE Smith

      I think it would be soul-destroying. Unlike a straight admin type, you’d actually have some inkling of the ways in which the policies you were enacting, in aid of the bottom line, would be negatively impacting both medical staff and patients. Unless a critical mass of working medical professionals (MDs, NPs, PAs, RNs) infiltrated the ranks of the administration, enough to actually make a difference, I just think it would be too hard.

    • buzzkillerjsmith

      A lot of these folks, and I’m not just talking about nurses, have had their eye on the business side since they started.

    • Tiredoc

      I chose the other kind of resignation.

  • May Wright

    I think the powers that be who made this decision should start closer to home. Roster all non-medical admin & support staff, even executives, on to a 4-hour-per-week “janitorial float crew”. In their given four hours per week, they will be on call and will go wherever they are needed within the hospital system to do whatever clean-up is needed. It would only be a half-day of training to get them up to speed.

    The average patient would be more likely to be directly adversely affected by a nurse taking time out of their nursing duties to empty trashcans (“sorry you had to push the call button 30 times to try to get help for an actual medical problem, but they had me doing housekeeping”) than by a middle manager in HR or a VP of Marketing & Sales doing the same.

    • EE Smith

      You’re assuming that whoever thought this up had the best interests of the patients at heart. I’m not sure that’s a safe assumption.

  • captainbub

    This is the institution that pays $20 million to just 10 employees. And they want to talk about saving money? Start at the top.

    http://chronicle.com/article/Vanderbilt-Sets-a-Precedent/66218/

  • SarahJ89

    What a terrible idea. It’s a waste of resources and only increases the likelihood of exposing patients to germs. The nurses can now carry germs from dirty areas to clean on their clothes and persons.

    A good well trained housekeeping staff is a bulwark against infection. Our local ER is so filthy my EMT sister warns people not to touch anything. I was there for eight hours once with a friend, never saw a housekeeper.

    • Suzi Q 38

      I was at a major teaching hospital for major spine surgery and my hospital room (where I was supposed to spend 5-7 more days) was filthy.
      I could visibly see the dirt on the floors, and the bathroom and counters were not clean. I never saw a cleaning person during the whole time I was there.

      I decided to leave. I envisioned MRSA and c difficile.
      I had enough problems.

      I felt fairly good, and my daughter is a nurse. My husband was home for the weekend, and could take a couple more days off of work to help me. I had friends and family that could bring me lunch thereafter.

      I left within 30 hours.

  • SarahJ89

    It also betrays a profound ignorance of the role housekeeping plays in health care. No one should be doing direct, hands-on care and then doing cleaning of dirty areas. The two roles are complementary and should be kept separate for disease control.

    • Tiredoc

      I have to disagree with you on that. I personally think housekeeping should be limited to room turnover and that daily and spot cleaning should be performed by ward staff, like NAs.

      If you’re doing cleaning in a way that can transmit disease, by definition you’re not doing it right.

      In general, less number of patients a staff member contacts, the less transmission of disease. The tendency for hospital-wide ancillaries always needs to be balanced with infection control.

  • SarahJ89

    Not any more. But they used to be.

    • gwen rothberg

      They were at the last 2 facilities that I worked at. They attend OSHA safety, training on biohazards, and are even issued scrubs that never leave the facility to prevent community contamination. They have protocols that are effective. Why anyone would cut cleanliness in a hospital is just ham fisted direction. The wheel will turn when there is enough litigation to force it around.

  • Suzi Q 38

    True, but they are not going to do that.

    If patients do not complain, they are not going to do anything.

  • Suzi Q 38

    I guess I will watch this when I have the time.
    I felt like cleaning my own toilet when I last stayed at the hospital.
    It depends on the hospital. I was at a different one three years ago and everything was very clean.

  • Rob Burnside

    When health care as we knew it lost its way and transitioned from “service” (non-profit in the main) to “industry” (for profit), a whole host of changes occurred, and short-staffing quickly became a major issue. Short-staffing brought many changes on its own that have yet to be successfully resolved, and may never be satisfactorily addressed for those of us who remember “the good old days.” But, minus the ability to perform time travel, we can’t go back. Going forward, then, my hope is that nursing will someday be properly represented on hospital executive boards–not theoretical nursing that can easily become captive to the omnipotent, omni-present business model, but actual nursing as it is practiced on the floors or wards. This might help everyone considerably.

  • Suzi Q 38

    How does a patient go about getting their Magnet Status yanked?

  • gwen rothberg

    We had a new NA who, bless her heart, thought she would ‘help out’ by cleaning IV pumps, and promptly sprayed about 8 of them with cavicide and then gave them a cursory wipe and left them to ‘air dry’. By spraying the pump chamber while open, she destroyed the mechanism in 5 of them. At $8,000 a pop, maybe some housekeeping by trained staff would have been in order, as it turned out to be an expensive day. Our housekeeping staff will not break down suction, or remove anything that resembles a med in the room, and in the case of a ‘spill’ of fecal matter, etc we do ‘get the big chunks’ but it still needs to be sterilized. They do remove and replace blood or stool contaminated privacy curtains, so THAT’s good as I can’t say I would always have the time to jump up that ladder and disconnect all those curtain clips and get my IV meds started on time.

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