Welcome to Ask Nancy, a place where you can ask me, Nancy Ray, Chief Nursing Officer/Associate Administrator, questions regarding health care related issues here at University Health System. I want to hear about some of your concerns regarding the delivery of patient care as well as current UHS processes and procedures that either work well or not very well at all.
Just email me your question using this AskNancy@uhs-sa.com email link and I will post a reply right here on this page. So, continue to visit my page to see my response to your particular question or to just read about some of your co-workers concerns or observations.
Thank you,
Nancy Ray, MA, RN
The concept of clinical ladders arose to allow nurses who chose to stay at the bedside to advance without going into management. If nurses are required to re-apply on a yearly basis to maintain their status on the ladder, then why aren't managers expected to do the same to retain their positions in the management hierarchy?
Every manager gets an annual evaluation as part of evaluating their success and the commitment to stay a manager for both the manager and the supervisor. I would be happy to personally discuss this with those who are interested.
I am a Staff Nurse III in Pediatrics and have been with the System since May of 1992. As an Incarnate Word graduate, I have never utilized tuition reimbursement for ongoing education. I have used the continuing education money. I and my colleagues with similar concerns need your advise:
- I am not a good test taker and have significant test anxiety. It would be wonderful if the hospital would provide a course to enhance test taking skills.
- Since I have never used tuition reimbursement, and I bet many of my tenured colleagues have not used any either, do you think the hospital would consider letting us use it for certification preparation and to register for the exam?
I know that we receive a 6% differential in the clinical ladder for certification but the upfront costs for many of us are very difficult to plan for and it is a hardship. With the review course and test, it can cost up to $1,000 (including registration and other expenses, e.g. travel).
We would truly appreciate any support that you could find for this. We truly support the need for certification as an effort to improve the professional practice environment for nursing. However, the funding and the preparation is a big roadblock for many of us. Thank you so much for your consideration of this important career matter.
I continue to work with the Department of Education here at UHS to broaden what qualifies for tuition reimbursement. As for test taking, did you know that the UTHSC no longer requires the GRE? I will continue to work on making more funds available for certification. It is important to me that talented people in our organization feel supported by their work place.
Most of the nursing staff on OB/GYN are upset about having to use up all of our PTO time by being placed on call. This is not voluntary, we are placed on call when the census is low, and have to use PTO or not get paid. We all have bills to pay. And when we want to take time off, we don't have PTO time accrued and we are being counseled for taking the time off anyway! Also, we are being placed on call on our scheduled days off which is definitely dissatisfying for the staff. What are our options?
First, I would talk with Pam Higby about your concerns and feelings of dissatisfaction. Second, I would suggest that you consider being available to other units that are short staffed. Your competency to work with GYN patients would be valuable in other med-surg units that have surgical patients. Let me know how I can support you further.
Recently I requested a Chaplin to visit a patient and say a prayer at the bedside, to my surprise the priest would only come see the patient if he or she's denomination was Catholic and unfortunately the patient was not. This has happened several times with other nurses. My question is why we do not have a Chaplin available to see a patient regardless of their denomination?
Ruth Lazano, Director of Pastoral Care, shares with me that she has a group of volunteer lay chaplains who are on call to meet patients spiritual needs after hours and can be reached through the Hospital operator. The lay volunteers will see anyone. The Catholic Priests who volunteer from the archdioceses take care of catholic patients. Please let me know if you have any further problems.
A large facility such as ours generates huge amounts of disposable plastic bottles and aluminum cans and other recyclable items. Is it possible to have a city recycling bin on the hospital grounds? We would be recycling more items and collecting less trash for the city landfill. Another advantage is that more individuals would get into a mind set of recycling while at work plus at home thus conserving even more of our world resources and environment. Wouldn't our efforts be advantageous toward our goal of Magnet Hospital designation?
This is a great question and a worthwhile cause. Let me discuss with environmental services to see what our institution can do to improve our environment. Stay tuned.
Several months ago in Nursing Leadership Rounds, I asked you if there would be consideration on increasing our annual reimbursement from $200.00 to cover certification exams and annual renewals. Has there been any decisions on this?
We discussed this issue when revamping the clinical ladder and it continues to be the group's consensus that your 6% adjustment in moving up the ladder and in continuing to stay at that level is compensation for these certifications. Thanks for the question.
What actions are being taken to address nursing empowerment, pride, mentoring, nurturing, respect, and integrity?
(Answer provided by Barbara Sutherlun, RN and Olga Giddens, RN) Hospital wide nursing empowerment is in the form of Shared Governance with numerous committees for anyone to be a part of. Monthly meetings are held with Nancy Ray to hear what is available in the system to empower nurses. And Nancy Ray has always had an open door policy to all nurses who would like to share their concerns.
As for the NICU, Mrs. Freeman has an open door policy to hear concerns from all of the staff. As a teaching institution the nurses have an advantage in empowerment when it comes to patient care giving. The nurses are taught to be active care givers at all times for the sake of the patient. Mentoring has always been a part of the system through Mentoring/preceptor classes for staff nurses. After taking the classes one would need to notify their supervisor that you would like to be a mentor.
Pride and integrity should come from within oneself. When one arrives at a place in their own life that they are comfortable with the job they do everyday, pride and integrity will exude from this person. The system has an integrity line that is available to all staff. The integrity line has been a benefit to the system to keep those with the lack of integrity in line. But if the integrity line is not made aware of a breech of integrity, nothing can be done to correct it.
Nurturing is a basic part of nursing, we should all be nurturing to our patients, their families and each other. It is human nature to desire to be nurtured and to nurture. But once again this must come from within first. Once you have accomplished this, you will be able to see and feel the nurturing that is all around the system.
As for respect, once again...this must come from within oneself. There have been many times all of us have experienced the lack of respect shown to nurses in the system. Try to accept that we as nurses deserve much more respect than we get, but we have to start with ourselves and show respect for yourself and our co-workers at all times.
Overall University Hospital has overcome many faults that all institutions face on a daily basis and continues to face many more situations that are perceived as faults by some.
What is being done to improve nurse retention...incentives, tuition reimbursement, raises, sign on bonuses, etc?
(Answer provided by Barbara Sutherlun, RN and Olga Giddens, RN) Over the last 18 years nurse retention incentives have greatly improved. For example, the NICU has many RNs that were once LVNs and received tuition reimbursement when they were in school. We have had some RNs receive their Masters Degrees in nursing and received tuition reimbursement. The starting pay was $10.00 per hour, and agency nurses had limited care they could give to the patients but were paid far more than the staff RNs on the night shift. All aspects of nursing was dictated to the nurses and very few had any input as to how our jobs were done.
Shared governance has improved the system by allowing us to be a part of how our jobs are done. And we can be involved by sharing our ideas and concerns. We have come from paper charting to computer charting and for this, most of us are grateful!
(Response from Nancy)It is nurses like yourself that bring about the best retention. People want to work with you because you role model beautifully empowerment, pride, respect, nurturing and integrity. Thank you for being Magnet Champions!
The theory in the 80s-90s was that hospital occupancy would diminish. The experts told us treatments would overwhelmingly be done on an outpatient basis. Only the very sick would require hospitalization. San Antonio hospitals are often closed to trauma and patients are often having to wait to be admitted. What went wrong with the experts' predictions?
San Antonio and Texas are rapidly growing as is the age of our population. Also our physicians are much more aggressive than they were a few years ago in attracting patients. Patients who are hospitalized are sicker and we need to increase our bed complement and increase our Nursing Staff.
What is UH's policy regarding allowing children under the age of 12 to visit a family member who is a patient?
When we care for a patient we are actually caring for the whole family. Each member is under stress and we need to consider how that family member's stress will compromise the care of the patient. In this case the son was very worried about his father and nothing but seeing him was going to relieve his stress. The father was also worried about the son and wanted to visit his son. Rules are important but patient care is not black and white and exceptions are often important to make as we consider caring for our patients in a holistic compassionate manner.