Stop shoving metrics down nurses’ throats

One time, I applied for an emergency department (ED) nurse manager position. I thought I had the job locked up until I was asked during the interview how I would “enforce metrics.”

“Enforce.”

My holistic, qualitative research-based response to this authoritarian-style question was: “I’ll find more organic ways to achieve your metrics without shoving numbers down their throats.”

I didn’t get the job. Someone told me I wasn’t “MBA enough.”

Yet, I stand by the concept and would say it again (maybe with a different word choice). Why does it matter? Because, health care leaders, you’re completely missing why nurses are leaving. Worse yet, perhaps you do know but you keep perpetuating it anyway. The MBA part of health care management is a big part of the problem of nurse burnout by metrics. Too much “numbers management” and not enough human leadership. The metrics you’re shoving down our throats are asphyxiating us. In the midst of a nursing shortage, more focus is on tedium ad nauseam than taking care of the members of the clinical team who help you reach your goals. The only way for us to breathe again — to escape the suffocation — is to leave.

Health care executives, directors, and managers: Does nurse turnover burn through your budget? According to Nursing Solutions Inc.’s 2016 National Healthcare Retention & RN Staffing Report, the average cost of one nurse turnover can exceed $58,000, with the annual hospital loss of up to $8.1 million.

Health care managers and leaders, do you feel the need to hide your nurse turnover rate behind things like “magnet status?” Healthcare Finance News reported as far back as 2010 that Magnet facilities don’t really affect nursing work conditions. Our work conditions include tedious, maladaptive, counterproductive systems that add more work for us in order to make your jobs easier. Whatever you’re doing to retain nurses clearly isn’t working. Not only are nurses suffering, but, worse, our patients suffer.

Basic root cause analysis (RCA) would help you identify the exorbitant focus on metrics as one reason for nurse turnover. The goal of RCA is to identify and directly treat the problem, rather than react to symptoms. Why not apply RCA here? Is it because nurses don’t generate revenue? Because we’re viewed as disposable commodities rather than necessary members of the team that help you meet your goals? Would it cost too much to invest in nurses in truly human ways? If so, would it cost more than what you’re losing in turnover?

I have spent time over the years asking ED nurses what causes undue stress, burnout and ultimately walking away. The answers resoundingly fall into four categories, but today the focus is on metrics.
What kind of metrics? Here’s a non-exhaustive list of metrics we’re consistently peppered with. Usually, the focus is on failure to meet pre-determined standards:

Medication scan rates, time to pain medication administration, HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) scores, patient (even non-urgent) wait times in lobby, HPPV (hours per patient visit) staffing calculator, time for provider to see patient, time to admit or discharge patients, timed core measures, door-to-EKG time …

I’m not saying these numbers and standards aren’t important or that they shouldn’t be considered in daily operations. What I am saying is that shoving them down our throats is part of what’s making us leave because none of these data consider the human aspect of nursing, nor do they acknowledge the intangibles of our profession. I assure you there’s a better leadership method to achieving goals while simultaneously placing value on the ones who do the work.

Mandating metrics-based health care creates a fear-based environment sold to us behind a veil of patient-centered rhetoric. Fear-based management makes managers say things like what I heard very recently: “No one’s asking your opinion. You’re killing me. This stuff is simple — just do it.” This manager’s condescending tone and threats to micromanage metric attainment made staff want to work against her rather than for her. Comments like hers are unfortunately part of canned management methods straight out of the corporate health care handbook of values determined by executives who are out of touch with our profession.

Nursing leaders: ask yourselves why you went into supervision, management, directorship, or the C-suite. Was it so you could get out of clinical nursing? If so, why did you want out of clinical nursing? Did you want to be an admirable leader? What changes did you want to see? Are you working to remedy those things or are you falling into the same canned corporate expectations? Are you bold enough to be a disruptor? Are you courageous enough to be a real advocate for nurses?

You can only add “just one more little thing” to our growing list of little things until time and resources are taken away from what really matters. When nurses are repeatedly told we’ve failed to meet metrics-based goals, no responsibility is placed on supervisors, managers, directors or the C-suite for failing to recognize the impact of the requirements that hinder us in our work. Metrics are stifling us.

Nurses handle all these things because we’re awesome. Also, because we don’t hold any power to say “no.” Lip service telling us to create balance, be empowered to say “no,” or to pace ourselves is useless when none of those things are supported, encouraged or accepted. Nurses, please share what’s happened when you tried saying “no” or tried advocating for yourself at work!

We can only handle the pressure of metrics so long. We’re burning out. Every day.

Solutions: Start asking staff nurses what the best ways are to meet patient care standards. Stop soliciting opinions from non-clinical people. Examine your leadership. Invite us to your board meetings. Help us; don’t hinder us — ask us how. Stop paying lip service and make your actions match your words. Give us a reason to want to stay instead of reasons why we need to escape suffocation. Maybe you don’t care about us as humans, but you might care to know you’ll profit by focusing on our needs.

Sarah E. Jorgenson is a nurse.

Image credit: Shutterstock.com

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