Readyto Break Away?

Ready to Break Away?

By Patricia Raymond, MD, FACP, FACG

I’ll spread my wings
And I’ll learn how to fly
Though it’s not easy
To tell you goodbye I gotta take a risk, take a chance, make a change
And break away.

~ Kelly Clarkson, “Breakaway”
(Written by M. Gerrard/B. Benante/A. Lavigne)

“I gotta get out of this place,” Steph moaned. “It’s driving me crazy!” Stephanie, a senior nurse at my hospital’s endoscopy unit, generally rock solid and unflappable, was being chipped away. She had developed a faraway look in her eye — which I noticed after several endoscopic episodes of repeating the word “open” to her deaf ears. We cornered her over lunch to conduct the inquisition.

She spilled the beans, unwrapped the whole enchilada. She told the table that her family and friends had started pointing out to her that every evening she would fume and rant about her day in endoscopy. How the SAU treated endoscopy like an ugly surgical stepsister. About unrealistic, overloaded endoscopy schedules. And about her colleagues who she felt rarely said thank you or paid back call-related favors. She was over it.

So she’d started to look for something different, something better. Others who also noted her distress began to court her for their office endoscopy suites. And she was now ready to break away.

“Too late,” I mused. “Managers often don’t notice ‘til staff passes the ‘stick a fork in me; I’m done’ stage.”

I had presented on “GI Nursing: Cure Your Retention Deficit Disorder” at SGNA’s Minneapolis meeting. It was directed at enlightened managers — managers who realized that there was a problem before the wheels fell off the endoscopy cart. But how might unhappy staff give an overwhelmed manager some clues about the health of the unit before it exsanguinated?

Healthy staff are “engaged” rather than simply “satisfied” ... that is, staff who want to come to work for the recognition, for the teamwork, for the friendship. The Gallup Organization developed a 12-question survey as a sphygmomanometer of staff engagement, published in First Break all the Rules. The actual Gallup survey involves rating each question on a one-to-five scale, but to heck with that — just give me a straight ‘yes’ or ‘no’ for each of the questions, adapted to the healthcare workplace. To how many of Gallup’s 12 questions of employee engagement can you answer ‘yes?’

1. Do you know what is expected of you at work?

2. Do you have the materials and equipment you need to care for your patients?

3. At work, do you have the opportunity to do what you do best every day?

4. In the last seven days, have you received recognition or praise for doing good work?

5. Does your unit director, or someone at work, seem to care about you as a person?

6. Is there someone at work who encourages your development?

7. At work, do your opinions seem to count?

8. Does the mission of your unit make you feel your job is important?

9. Are your fellow healthcare workers committed to providing quality care?

10.Do you have a best friend at work?

11.In the last six months, has someone at work talked to you about your progress?

12. In the last year, have you had opportunities at work to learn and grow?

Got your number ... now what? We want your score to be higher rather than lower. There is no correct number, no expectations of a perfect score, and no cut-off number above which you’re perfectly content. I have not yet found a job, nor will my own employees attest to, a score of 12.

Assuming a score less than 12, there’s room for improvement on your unit. Now’s the time to give your own manager a gentle nudge, or even a 2x4 to the noggin, that things are unwell. I encourage you to follow the example of Mr. Nathanial Hawthorne.

Those who know me know that I groove on applied trivia. My summer reading right now is A.J. Jacobs’ quirky The Know It All, in which Jacobs highlights amusing points in his reading of the entire Encyclopedia Britannica. The Encyclopedia Britannica discloses that toward the end of his life, our venerated American author Mr. Hawthorne “took to writing the figure ‘64’ compulsively on scraps of paper.”*

Take your own non-identifiable scrap of paper today (no personalized letterhead recommended), and write your Gallup poll number on it, then surreptitiously put it in your unit manager’s box right now. If you think it will not be understood (your manager foolishly not being an avid reader of this esteemed publication), make a copy of this article to which you can clip your scrap. Fire a warning shot across his or her bow. Make your dis-engagement a scarlet letter. Likely you will then see changes. Why? Because all managers are aware that an ounce of retention is worth a pound of recruiting.

First, try to fix your unit’s culture. But if you can’t, dare to break away.

* Remember please, that “64” is not a valid answer to our little quiz above, unless you are a descendant of Hawthorne.

Patricia Raymond, MD, FACP, FACG, is a Virginia gastroenterologist who writes and speaks on resuscitating nurses’ and physicians’ passion for their medical careers. Her complimentary electronic newsletter Passionate HealthCare, which offers twice monthly medical humor and simple tips to boost your joy in our healing profession, is available at www.RxForSanity.com.

Works Cited

1. Buckingham M., Coffman C. First, Break All the Rules: What the World’s Greatest Managers Do Differently. 1999.

2. Jacobs A.J. The Know It All: One Man’s Humble Quest to Become the Smartest Person in the World. 2004.

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