Regardless of how good we may feel about the work we do, hospital nurses work in bureaucratic organizations which sometimes make our work and how we feel about it difficult.
Recently, I have been involved in a process at our hospital to improve the quality of nursing services. Oddly enough, however, no interest is expressed in improving the autonomy of nurses.
Although the nursing staff constitutes the largest group of employees at the hospital and generates the overwhelming majority of direct patient care hours (approximately 95%), we are not empowered by administration or the board of directors to conceive of ourselves as a organizational entity that may have interests and concerns that do not mirror the organization's as a whole. Hence, we are permitted minimal self-determination.
This is disastrous when the objective is to improve nursing services. Nurses who see themselves as a group taken seriously by administration and other professionals within the organization (e.g., physicians) are nurses who will seek to improve themselves.
An example of how this is not being taken seriously. I am a member of the team that is looking at our compensation package. There is an expressed understanding that all nurses within the organization receive the same base rate wage, and despite this, anecdotes abound among the staff that some nurses are paid more. (Individual nursing wages are kept confidential, unless nurses chose to share this information with other nurses.)
Part of my compensation team's objective was to empower nurses to know whether they are making the correct wage based upon the organization's wage matrix. We suggested making the wage matrix public so that each nurse could figure out on their own how much they should be making. Human resources and administration are adamant that we don't do this. They would rather nurses seek the information from the human resources director or their departmental managers.
Can't treat nurses like adults. Need to have them petition their organizational "leaders" to figure out whether the organization's commitment to equal base rates is true. This is ridiculous and disheartening.
Nurses who are treated by the organization as valuable AND intelligent will be nurses who seek to improve themselves. Hasn't anyone in administration read Maslow?
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2 comments:
The purpose of a wage matrix is to make the basis of compensation objective.
The purpose of making such considerations objective is to maintain fairness.
Withholding wage matrix information (or creating bureaucratic channels with the effect of making employees extremely unlikely to access the basis of their compensation) has the potential to mess up the whole system.
It is possible that compensation could be objective and fairly distributed, even if the basic matrix were kept secret. But it is also possible that improper compensation could be made, either by deliberate intent or old fashioned mistakes.
Whatever motivation there is for keeping the wage matrix out of sight is surely grossly outweighed by the benefits that disclosing the information would provide. Right?
Bingo!
I think it should be remembered that Max Weber's famous sociological study of organizational structure, "On Bureuacracy," was about the Prussian Army! The essence of military structure is the inviolability of command, and it is this that I think some in hospital administration would like to effect.
And it is true that both mistakes and intentional unfairness occur. I was a "victim" of the former, despite the fact that the discrepancy was in my favor. If similar "mistakes" are made, then the publication of the matrix could potentially make that apparent, a fact I think administration, especially the human resources director, appreciates and fears simultaneously.
It is also true that publishing the matrix would reveal to other hospital employees how much nurses make. This may cause upset. I remember when the CNAs found out they made less than the admitting receptionists.
Still, a rising tide raises all boats, so they say. I think administration feels a subtle tidal wave coming on.
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