Thursday, February 28, 2013

TING AND I, Managing Nurses

Managing nurses is like trying to herd cats, I jokingly told our nurse of greatest seniority here (six years). She agreed. They are very independent. They can be warm and purr. They seem to be listening to you, and yet….

We have had excellent nurses, judging by their behavior and by Tina’s health. I jokingly say that they are a hand-picked crew, but that the next time I have to choose, I’ll use a computer. Only kidding!


“Trust, but verify.” That may seem contradictory, but both elements are needed. You cannot supervise and observe everything, and you have chosen people who are trained to do what you need and generally want to do it right. Not keeping track is a recipe for failure, however. At the least, communications have got to be confirmed as received and understood. Beyond that, good practice needs to be acknowledged and bad practice corrected. Overly close observation breeds tension and resentment, but a lack of observation may communicate that you don’t care, or it simply may contribute to missing something significant.

Agency Woes

We started by using a nursing agency to get our round-the-clock nursing shifts covered. The agency charged IBM about twice what it paid the nurses, which may have been a fair reflection of the need for administration and profit. The nurses they supplied were highly variable in quality, however, some excellent, some poor. Getting coverage for certain shifts, such as weekend overnights, was uncertain. Sometimes I was the overnight nurse, which I could handle as long as the night was routine, the equipment functioning properly. Sleeping or resting beside Tina, I gave medicines by the gastric tube, responded to high-pressure or low-pressure alarms from the ventilator, If we had lost electrical power, it would have been difficult though not impossible to handle alone, as I touched on above.

Hiring Our Own

“Who pays the piper calls the tune.” I decided to do the hiring and paying myself. The extra trouble of doing so was offset by the improvement in quality it led to. Within six months, I was hiring our own nurses, supplementing and finally replacing the agency. I advertised in the local paper, interviewed them and made the hiring decisions. We live in the country, so finding our house was part of the intelligence/diligence test. About half made it to the interview, and about half of these were hired.

I paid them more than the agency had paid theirs, but charged IBM less than what the agency charged, using our best approximation of the actual costs, which included a variety of government surcharges.

There were no “off the books” dealings, as this is a sure-fire way to get in trouble or leave you open to blackmail by a disgruntled employee. And Uncle Sam needs our money, right?

“You get what you pay for.” I would not expect our nurses to work for nothing, and I know they don’t work here only for the money. By paying wages somewhat above average and by providing a pleasant working environment, we have been able to attract and keep an outstanding crew. The doctors have commented on Tina’s excellent condition and care. The nurses in the hospitals have commented on the high quality of our nurses when they have seen them in action. We have our nurses stay with Tina during her rare hospitalizations, even though we are not reimbursed for this.


Interviewing the candidates, I had to get a sense of not only their skills but also the reasons they wanted this job. The salary was attractive, especially for LPNs (Licensed Practical Nurses), who often elsewhere would get only half the hourly pay of RNs (Registered Nurses). To eliminate RN-LPN rivalry and to acknowledge that their duties at our house were identical, we paid both the same rate, giving RNs some preference in choice of shift hours.

Home care does not provide much career advancement, does not offer the opportunity to meet a nice, eligible doctor, does involve getting along with the family, and–in our case–a seventy-pound Golden Retriever with an alpha-dog temperament. Smoking was taboo, given the oxygen in use and the difficulty there would be in evacuating Tina safely in case of a fire. Nurses were told not to come to work with a cold, as a respiratory infection was the likeliest cause of death in cases such as Tina’s.

The highly successful coach of Penn State’s football teams, Joe Paterno, recruited far more high school quarterbacks than he was going to play in that key position. They were typically outstanding athletes, and they proved their prowess when he deployed them in other positions. When I interview, I look for something like that, some outstanding strengths that will add to our team. The nurses vary in their stronger and weaker areas, but as Rocky and Adrian said, they “fill gaps.”

1 comment:

  1. Great advice. Nurses thrive on little thank you treats, clear protocols, plans of care, smiles, pats on the shoulder,schedules around their needs.