Inpatient Losing Its Appeal

[TerraceHouse]

Hello all, wanted to welcome other perspectives on this recent feeling I've been having about working inpatient. Throughout training and as an attending, I've always enjoyed inpatient work (the flow, the quick change in presentation, team environment, walking around vs sitting, etc). However, lately, a few things about working inpatient have changed its appeal to me:

Whether it's the IMO noticeable decrease in competency in nursing, lack of professionalism (on cell phones whole shift, knowing nothing about the patients), or whether it's the new grad social worker adamant about a patient's diagnosis and treatment with little evidence for it (and being looked at as uncaring if we don't provide the BPD patient with a substance dependency problem a stimulant or benzo they're really pushing for), or whether it's the balance of having patients stay for x amount of days but then getting pressure to discharge when no longer being covered, wonky processes in place to facilitate surprise DC requests for voluntary patients who don't meet hold criteria in the afterhours...

These things have really sucked the joy from inpatient work which I always loved before. Perhaps it was because it was more academic but these things were not prevalent in my training. Seeing it more and more as an attending.

Always open to the possibility of a "maybe it's me," perspective but wanted to vent and hear feedback.

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[solitarius]

Inpatient is like a factory process that lasts 5 - 7 days on average. Then ship them off somewhere else.

It's still better than being the outpatient follow-up for many of those patients.

 

[thelastpsych]

I always felt that inpatient seeemed like I was treating the inpatient unit, and not individual patients, if that makes sense. A lot of bureocracy, and doing X and Y for patient Z for him to get discharged in an almost streamlined fashion. Now dont get me wrong, you can actually have meaningful and impactful interactions with patients, but I felt that it wasn't all that important as in the outpatient setting, so it always seemed like a hassle. Just my two cents, though, and other doctors can say that the opposite was the case for them (outpatient feeling like a grind).

Do you feel like a different unit could help you feel different about inpatient? Some of these problems you mentioned are systemic aspects of inpatient, but can surely be mitigated or amplified by specific settings.

 

[drechie]

Inpatient is like a factory process that lasts 5 - 7 days on average. Then ship them off somewhere else.

It's still better than being the outpatient follow-up for many of those patients.

Any area of psychiatry that you feel more optimistic towards? Early career asking.

 

[Stagg737]

Whether it's the IMO noticeable decrease in competency in nursing, lack of professionalism (on cell phones whole shift, knowing nothing about the patients), or whether it's the new grad social worker adamant about a patient's diagnosis and treatment with little evidence for it (and being looked at as uncaring if we don't provide the BPD patient with a substance dependency problem a stimulant or benzo they're really pushing for),

This specific part sounds like an issue at your unit. Is this a decline you've seen specifically on your unit or are you comparing to previous settings. If the former, then I'd talk to admin about it and see if anything can be done (good luck, but worth a shot if admin is decent). If it's the latter, may just be best to look for another inpatient position more like your previous academic experience. Sounds like where you're at has policy issues that need to be addressed. If you can implement better processes, then maybe it improves. If not, then in my limited experience you're likely on a sinking ship.

I would still prefer inpatient to outpatient if I had to pick, but would completely depend on the actual unit as bad support staff and admin can make the experience completely miserable.

 

[TheRightMedication]

I enjoyed my time on the unit for a few years post-grad, but I'm glad to say good-bye to it.

You didnt ask for advice, but I have some anyways - a lot of what you are struggling with can be helped by physician leadership. You can praise nurses when they know the patients, and gently explain why its a problem when they dont. You can contend with social work, and grow your respect for one another. Ask nurses for their opinion on nursing stuff, care coordinators for their stuff, ect. It shows you care and are paying attention.

People watch us and follow our lead. They may not act like it in the moment, but if you are a positive force in the hospital, you may be surprised.

 

[jbomba]

I was a grad last year, have been doing inpatient along with a bunch of other things. I feel like initially I hated it, but around 5-6 months in I started to really like it. Yes there's a bunch of people who come through like a revolving door and will likely never get better for a variety of reasons, but every now and then you are able to make a significant difference for someone. I like that you can get your work done early and then be free in the afternoons. Working with other people in the hospital is nice too. I also think it helps you be better in the outpatient setting. I'm not sure if I'll do it forever, but it's definitely a good gig imo.

 

[TerraceHouse]

This specific part sounds like an issue at your unit. Is this a decline you've seen specifically on your unit or are you comparing to previous settings. If the former, then I'd talk to admin about it and see if anything can be done (good luck, but worth a shot if admin is decent). If it's the latter, may just be best to look for another inpatient position more like your previous academic experience. Sounds like where you're at has policy issues that need to be addressed. If you can implement better processes, then maybe it improves. If not, then in my limited experience you're likely on a sinking ship.

I would still prefer inpatient to outpatient if I had to pick, but would completely depend on the actual unit as bad support staff and admin can make the experience completely miserable.

I think this is it, maybe. Average length of employment before folks leave in the big roles is less than 2 years (admin, docs, nurse leaders). Previous talks with admin = CEO will agree with need for improvement, will tell dept head, dept head defends dept, nothing changes. New roster of staff few months/year later. Start from scratch.

 

[TerraceHouse]

Inpatient is like a factory process that lasts 5 - 7 days on average. Then ship them off somewhere else.

It's still better than being the outpatient follow-up for many of those patients.

Don’t mind the patient care at all. More concerned with less ownership from support staff without a path to improve quality. Previous system I was a part of never required repeated requests of more effort from team or if there was, one mention to dept head and it was remedied swiftly.

 

[TerraceHouse]

I enjoyed my time on the unit for a few years post-grad, but I'm glad to say good-bye to it.

You didnt ask for advice, but I have some anyways - a lot of what you are struggling with can be helped by physician leadership. You can praise nurses when they know the patients, and gently explain why its a problem when they dont. You can contend with social work, and grow your respect for one another. Ask nurses for their opinion on nursing stuff, care coordinators for their stuff, ect. It shows you care and are paying attention.

People watch us and follow our lead. They may not act like it in the moment, but if you are a positive force in the hospital, you may be surprised.

Definitely agree w the sentiment and will try my best until I can change jobs.

 

[Merovinge]

I think this is it, maybe. Average length of employment before folks leave in the big roles is less than 2 years (admin, docs, nurse leaders). Previous talks with admin = CEO will agree with need for improvement, will tell dept head, dept head defends dept, nothing changes. New roster of staff few months/year later. Start from scratch.

This is a big life lesson when looking for employment. You always want to be in contact with the other docs and seeing what employee retention is like. There has been a large shift in race to the bottom economic policies in most of healthcare so when you can find a place that is not in that model it's certainly something to pay attention to.

If you are looking for an option that has significant patient acuity but where people can get sustainably better, PHP/IOP would be worth considering. I think most of these jobs are a bit oversubscribed (particularly compared to IP) since young docs are flocking towards this treatment setting as a best of both worlds between IP and OP, but they have also had a meteoric rise in pt volume and many places are often hiring.

 

[comp1]

Oh I love this discussion. Definitely second that this is a unit specific problem, not an inpatient in general problem. By the time that you are starting to get these opinions and feelings (which are normal), it's also time to start looking at being in management! These are FIXABLE! However, they are not fixable by a front line psychiatrist who spends the entirety of their day with patients. That only leads to burnout, frustration and despondency in the long term. Leave the pure front line work to brand new grads. It sounds like you're starting to form opinions about how a unit should run and what good care looks like. That's great! Now it's time to implement those opinions through SOPs and hiring staff who align with your values. Of course you may be in a relatively unique facility that has major core issues that a good manager can't fix, at least a physician new to management. In that case, it might be good to start looking for a different facility to begin your management career in. They are all over and they desperately need caring and interested physicians to be medical directors and hiring officials.

 

[solitarius]

Any area of psychiatry that you feel more optimistic towards? Early career asking.

I think our field is great, including inpatient. I would argue that psychiatric inpatient work is still far better than internal medicine hospitalist work. Nonetheless, the bean counters are determined to shorten stays to keep costs manageable.

To find an area of psychiatry that you would be more optimistic working, you have to do the same self-discovery process that you did in medical school when deciding on a specialty. What patients do you want to work with? What settings do you like? What type of treatments do you want to do? What I would feel more optimistic about is not the same as what you would like.

 

[Sushirolls]

This is the norm, not the exception, and it will be difficult to find a unit that flows smoothly.

Time for outpatient. Build your own practice and you'll have more control over things. Don't like something in your practice? Oh, that's right, you are the CEO, mid management, etc and can make and implement the changes. A meeting of one, and implemented as fast as you want.

 

[Stagg737]

This is the norm, not the exception, and it will be difficult to find a unit that flows smoothly.

Time for outpatient. Build your own practice and you'll have more control over things. Don't like something in your practice? Oh, that's right, you are the CEO, mid management, etc and can make and implement the changes. A meeting of one, and implemented as fast as you want.

Disagree. It may not be totally the norm, but it's not an exception either. In the past 3 years I talked to several inpatient docs in different cities who were very happy with their workplace with reasonable workloads (<15 encounters per day) and decent pay. Good support staff is key, but it's not some unicorn that's impossible to find. You just have to do some homework before you sign a contract. Outpatient can have some of the same problems, and being your own boss comes with all the administrative crap and dealings with insurances, CMS, and drug companies. No thanks.

I think this is it, maybe. Average length of employment before folks leave in the big roles is less than 2 years (admin, docs, nurse leaders). Previous talks with admin = CEO will agree with need for improvement, will tell dept head, dept head defends dept, nothing changes. New roster of staff few months/year later. Start from scratch.

As Comp said, seems like it's time to step up and tackle some of this yourself. If you can't d/t other admin powers pushing back or just don't want to, probably time to start looking elsewhere.

 

[comp1]

Incompetent staffing is NOT the norm. There are many, many excellent nurses and social workers out there, you just have to hire them.

 

[TerraceHouse]

Disagree. It may not be totally the norm, but it's not an exception either. In the past 3 years I talked to several inpatient docs in different cities who were very happy with their workplace with reasonable workloads (<15 encounters per day) and decent pay. Good support staff is key, but it's not some unicorn that's impossible to find. You just have to do some homework before you sign a contract. Outpatient can have some of the same problems, and being your own boss comes with all the administrative crap and dealings with insurances, CMS, and drug companies. No thanks.



As Comp said, seems like it's time to step up and tackle some of this yourself. If you can't d/t other admin powers pushing back or just don't want to, probably time to start looking elsewhere.

I imagine it's like joining the Chicago Bulls (haven't had good management or haven't been a serious playoff contender since the Derrick Rose days) vs the San Antonio Spurs or Miami Heat? (great franchises, constantly in the running for championships, reputation of great hiring/firing decision-making, etc)...

 

[TerraceHouse]

Disagree. It may not be totally the norm, but it's not an exception either. In the past 3 years I talked to several inpatient docs in different cities who were very happy with their workplace with reasonable workloads (<15 encounters per day) and decent pay. Good support staff is key, but it's not some unicorn that's impossible to find. You just have to do some homework before you sign a contract. Outpatient can have some of the same problems, and being your own boss comes with all the administrative crap and dealings with insurances, CMS, and drug companies. No thanks.



As Comp said, seems like it's time to step up and tackle some of this yourself. If you can't d/t other admin powers pushing back or just don't want to, probably time to start looking elsewhere.

Can I ask if the inpatient colleagues that seem to be happy with good support staff are part of the big systems (HCA, UHS, Springstone/Lifepoint, Acadia) vs academic (University of X) vs Non-profit (St Mary's, St Joseph's, Adventist, etc etc)? I think some of the big systems are similar nationwide regardless of hospital

 

[TerraceHouse]

This is the norm, not the exception, and it will be difficult to find a unit that flows smoothly.

Time for outpatient. Build your own practice and you'll have more control over things. Don't like something in your practice? Oh, that's right, you are the CEO, mid management, etc and can make and implement the changes. A meeting of one, and implemented as fast as you want.

I'm kind of glad you put the laughing emoji for the post by TheRightMedication because on one hand, I think his advice is absolutely right: one should always strive to be the light in the dark, and it reminded me of a book I read about "Extreme Ownership." On the other hand, it can also be viewed as either the gaslighting of boomer generation after bastardizing medicine (and I say this with respect if my senior) or naive because some institutions are so systemically flawed even great leadership seems to be suffocated out by bureaucracy (ie government).

 

[Candidate2017]

When has inpatient ever had any appeal? The history of psychiatry is about trying to flee the asylum by encroaching the turf of outpatient PP therapy.

In large organizations, psychiatry is a service. Sure, it's better to be in a physician run organization, have good nurses, veteran social workers (it's always a recent SW grad who loves to demonstrate ignorance of their ignorance). But psychiatry is merely a service. How else is the hospital going to push psych patients out the ED (and med floors) quickly and fill beds with more profitable patients? Our overlords wish they could magically ban psych patients and turn psych units/clinics into chemo infusion centers, cath labs, colonoscopy suites, ortho ORs etc.

Practicing inpatient psychiatry (i.e., adhering to standard of care) does make a difference on a population level. Just remember psychiatry is not the specialty bringing in bags of life changing cash that will get an admin promoted to senior executive VP, a new boat, a new vacation house, and fund their kids' college. It's clear to everyone in the baboon troop who gets to call the shots, and the other baboons know they can fling poo at us and get away with it.

I enjoyed my time on the unit for a few years post-grad, but I'm glad to say good-bye to it.

You didnt ask for advice, but I have some anyways - a lot of what you are struggling with can be helped by physician leadership. You can praise nurses when they know the patients, and gently explain why its a problem when they dont. You can contend with social work, and grow your respect for one another. Ask nurses for their opinion on nursing stuff, care coordinators for their stuff, ect. It shows you care and are paying attention.

I'm sure if OP hasn't tried this, other psychiatrists have tried and gotten nowhere other than realizing they need to... say goodbye.

Organization dysfunction can only exist and persist if it benefits those in charge. Good luck to any admin (and their chances of getting a bonus) who ignores the local GI or ortho group requesting improvements in safety, efficiency, and better trained staff. If psych complains? Whatever, blah, blah, can you recode this note for charge capture?

 

[the5thelement]

Inpatient is "treat 'em and street 'em" dictated by insurance but supremely useful when patients decompensate . I have worked as an outpatient psychiatrist for many years and I would say It has been and continues to be my pleasure to try to help our (mostly) severely mentally ill patients.

 

[bashir]

I think the hard thing about responding honestly to this post, as an OP psychiatrist who could not imagine ever wanting to do inpatient work, is that it could have been written by either of two excellent inpatient psychiatrists at hospital down the street from my office. To them I say "please please don't ever leave." They are the only ones I entrust my patients to when I have any say in the matter and I will go to great lengths to get my patients admitted to one of them when hospitalization is required. They make a huge difference for individual patients, even though the whole enterprise of acute care psych hospitalizations is pretty broken IMO and their jobs are made much more difficult by chronic staffing shortages and poor quality staff. So rather than tell you to leave for greener pastures I am going to agree with the suggestion to consider going into management if you have an affinity for inpatient work. Someone has to do it!

 

[Stagg737]

Can I ask if the inpatient colleagues that seem to be happy with good support staff are part of the big systems (HCA, UHS, Springstone/Lifepoint, Acadia) vs academic (University of X) vs Non-profit (St Mary's, St Joseph's, Adventist, etc etc)? I think some of the big systems are similar nationwide regardless of hospital

One location is HCA, two were OSF affiliated, several were/are academic. Could be the case with larger systems, I saw significant variability in quality of care and facilities at HCA locations and rotated through 4 in med school at one point or another. Not sure about the consistency of the admin side, I assume there would be similar policies.

ETA: the rotations at HCA hospitals in med school were not all psych. Included ER, IM, peds, and surgery.

 

[mistafab]

I know two people who started at inpatient attending rank but went into psych director rank to fix problems like what you are seeing.

Thats how you make things better. And you knowing what IS better, and HoW to make it better (within reason) will be why you get a bigger check.

Good luck.

 

[psych_0]

Inpatient here. I love my job most days. Sure, there are some minor annoyances like dementia rocks that should have never been admitted, but I see them quickly and life goes on, until they get placed. Are there some social workers that are useless to me? Sure, but they are few and far between. The majority of them at least superficially appear to care and try hard, and that's all I ask. Are there some nurses who have no business being on a psych floor? Sure, but we're short staffed and they're all we got so I deal. I just make a point to boast about the good ones (SW and nursing) and hope that the others catch up. If they don't, fine. I don't let it effect my attitude towards my job or the patients.

Plus, I get paid incredibly well so I will put up with just about anything within reason.

 

[TerraceHouse]

Inpatient here. I love my job most days. Sure, there are some minor annoyances like dementia rocks that should have never been admitted, but I see them quickly and life goes on, until they get placed. Are there some social workers that are useless to me? Sure, but they are few and far between. The majority of them at least superficially appear to care and try hard, and that's all I ask. Are there some nurses who have no business being on a psych floor? Sure, but we're short staffed and they're all we got so I deal. I just make a point to boast about the good ones (SW and nursing) and hope that the others catch up. If they don't, fine. I don't let it effect my attitude towards my job or the patients.

Plus, I get paid incredibly well so I will put up with just about anything within reason.

How would you navigate repeated pattern of specific RN/SW flat out refusing requests at times? Ex: RN refusing to redirect patients, instead repeatedly requesting benzos bc they’re too bothersome at nurse station or SW refusing to try harder for dispo instead of just sending to shelter every single time, refusing to scan over documents necessary to facilitate surprise late day discharges after docs have gone home, etc. Have gone to heads of depts for this issue previously and dept heads became defensive and enabled such behaviors to continue. Very much a “the docs get paid a lot and get to go home before us” type of resentment we feel. At other facilities, writing up such behavior led to swift correction or firing. Not where I’m at now.

 

[TerraceHouse]

Plus, I get paid incredibly well so I will put up with just about anything within reason.

I get paid about 500k with productivity. Likely taking 300k pay outpatient job. Used to think I was more financially motivated but wondering if longevity and less stress is more worthwhile at this point. Might even be more financially beneficial too if I’m not so burnt out and can/enjoy working 30 more years versus grinding it out 5-10 years and physically/mentally unable to any longer.

 

[TerraceHouse]

psych_0 said:
Southeast. Inpatient. 5 days a week + 1 weekend/month. 4 weeks vacation + 1 week CME ($4500/CME). Salary + wRVU bonus. Commonly see between 11-14 pts/day, some weeks more if a colleague is on vacation but never usually more than 16-17/day even on the worst days. Weekends 18-23 pts depending on census. Being "on call" during a weekday is taking home call until early evening.

Before-tax 550-600k. Only leaving this job if they fire me.

===
Thought maybe we work at same place but seems like you get more CME, less patients per day, less weekends required, weekend census about half as much as ours and call stops early evening (as opposed to our all night long until morning). Also sounds like you have better support staff and about 50-100k more. Don’t blame you for wanting to work there forever.

 

[ObsequiousAplomb]

How would you navigate repeated pattern of specific RN/SW flat out refusing requests at times? Ex: RN refusing to redirect patients, instead repeatedly requesting benzos bc they’re too bothersome at nurse station or SW refusing to try harder for dispo instead of just sending to shelter every single time, refusing to scan over documents necessary to facilitate surprise late day discharges after docs have gone home, etc. Have gone to heads of depts for this issue previously and dept heads became defensive and enabled such behaviors to continue. Very much a “the docs get paid a lot and get to go home before us” type of resentment we feel. At other facilities, writing up such behavior led to swift correction or firing. Not where I’m at now.

The bolded: never in my life has a nurse tried to give a patient a benzodiazepine when they were not indicated. Plenty of antipsychotics demanded and plenty of benzodiazepines NOT given when they were indicated, but never have I ever had a nurse ask me for a benzodiazepine order that wasn't indicated.

The italicized: what? You think that the reason people are discharged to shelters is because SW "didn't try" and not because the shelter is the appropriate LOC?

 

[TerraceHouse]

The bolded: never in my life has a nurse tried to give a patient a benzodiazepine when they were not indicated. Plenty of antipsychotics demanded and plenty of benzodiazepines NOT given when they were indicated, but never have I ever had a nurse ask me for a benzodiazepine order that wasn't indicated.

The italicized: what? You think that the reason people are discharged to shelters is because SW "didn't try" and not because the shelter is the appropriate LOC?

Yea only found out from calls with peer review docs wondering why pts weren't sent to ATU/CSU/SNF/ALF that pts wanted and payors approved. Learned attempts to coordinate weren't being done.

 

[ObsequiousAplomb]

Yea only found out from calls with peer review docs wondering why pts weren't sent to ATU/CSU/SNF/ALF that pts wanted and payors approved. Learned attempts to coordinate weren't being done.

now that's crazy. I would address by not working with someone like that.

 

[comp1]

So I mean you all know that I love the VA. It's particularly great inpatient because the discharge resources are IMMENSE and funding for such essentially unlimited. In terms of RN or LCSW "refusals," what I have found is that we sometimes don't explain the why of our decisions. This is absolutely critical, even though it is time consuming, to have a well functioning team. And yep, you're probably going to have to go over the why several different times across a couple of shifts. You want BUY IN from social workers and RNs on pretty much all of your decisions. Yes, you can place "orders," but both the LCSW and RN really have to be on board to get those orders followed through in anything like a reasonable manner. So...benzos. Yes, many nurses would like patients to be unconscious during their entire shift. Most would, actually. However, it's your role to explain that long term, that's not good for them (or the patient). How it doesn't benefit them is that if we become the candy man, they're going to keep trying to get back into the Chocolate Factory. Yes, it might make one single shift go a little better, but it's going to make their year go a heck of a lot worse. Motivating LCSWs is a bigger challenge quite honestly and the challenge is that unlike med passes, discharge planning is actually everyone's responsibility. As manager, I drill this into everyone's head every chance I get. I've found that unfortunately some MDs find discharge planning below them. Well...no. Discharge planning is, by far, the hardest part of an inpatient stay and as the nominally most educated person on the treatment team, the MD is going to be play a huge part in it. Medication management is rock solid simple 90% of the time for inpatients and, at least long term, not really why the patient is there. So the first part of motivating LCSWs is getting down and dirty with them. Ask specifically where they have referred people to, what the response has been. Offer to call challenging places yourself. An MD after your name has bizarre (generally inappropriate) power relative to LCSW for some placements. Talk about what your dream placement might involve. Always commiserate with them and provide empathic reflection of their frustration. It's VERY challenging to place some patients, like say the incorrectly admitted dementia patients as above that now also have the scarlet P on their record. Shelter is going to be where a lot patients end up (sometimes sadly even wealthy vets with lots of resources), but you do want to always try to get people to look towards the future and how shelters...tend to lead to readmissions. The biggest thing you can always for LCSWs is offer to help, however.

 

[TerraceHouse]

So I mean you all know that I love the VA. It's particularly great inpatient because the discharge resources are IMMENSE and funding for such essentially unlimited. In terms of RN or LCSW "refusals," what I have found is that we sometimes don't explain the why of our decisions. This is absolutely critical, even though it is time consuming, to have a well functioning team. And yep, you're probably going to have to go over the why several different times across a couple of shifts. You want BUY IN from social workers and RNs on pretty much all of your decisions. Yes, you can place "orders," but both the LCSW and RN really have to be on board to get those orders followed through in anything like a reasonable manner. So...benzos. Yes, many nurses would like patients to be unconscious during their entire shift. Most would, actually. However, it's your role to explain that long term, that's not good for them (or the patient). How it doesn't benefit them is that if we become the candy man, they're going to keep trying to get back into the Chocolate Factory. Yes, it might make one single shift go a little better, but it's going to make their year go a heck of a lot worse. Motivating LCSWs is a bigger challenge quite honestly and the challenge is that unlike med passes, discharge planning is actually everyone's responsibility. As manager, I drill this into everyone's head every chance I get. I've found that unfortunately some MDs find discharge planning below them. Well...no. Discharge planning is, by far, the hardest part of an inpatient stay and as the nominally most educated person on the treatment team, the MD is going to be play a huge part in it. Medication management is rock solid simple 90% of the time for inpatients and, at least long term, not really why the patient is there. So the first part of motivating LCSWs is getting down and dirty with them. Ask specifically where they have referred people to, what the response has been. Offer to call challenging places yourself. An MD after your name has bizarre (generally inappropriate) power relative to LCSW for some placements. Talk about what your dream placement might involve. Always commiserate with them and provide empathic reflection of their frustration. It's VERY challenging to place some patients, like say the incorrectly admitted dementia patients as above that now also have the scarlet P on their record. Shelter is going to be where a lot patients end up (sometimes sadly even wealthy vets with lots of resources), but you do want to always try to get people to look towards the future and how shelters...tend to lead to readmissions. The biggest thing you can always for LCSWs is offer to help, however.

Very helpful, thank you.

 

[SeniorWrangler]

I did inpatient for a long time and eventually started to feel like Dr Daneeka of Catch-22 fame, an enthusiastic cog in a hideously broken system.

 

[SeniorWrangler]

How would you navigate repeated pattern of specific RN/SW flat out refusing requests at times? Ex: RN refusing to redirect patients, instead repeatedly requesting benzos bc they’re too bothersome at nurse station or SW refusing to try harder for dispo instead of just sending to shelter every single time, refusing to scan over documents necessary to facilitate surprise late day discharges after docs have gone home, etc. Have gone to heads of depts for this issue previously and dept heads became defensive and enabled such behaviors to continue. Very much a “the docs get paid a lot and get to go home before us” type of resentment we feel. At other facilities, writing up such behavior led to swift correction or firing. Not where I’m at now

This will sound dumb but the only way to motivate people like that is to befriend them so they want to be in your team and help you out. Giving little presents helps, too.

 

[bashir]

This will sound dumb but the only way to motivate people like that is to befriend them so they want to be in your team and help you out. Giving little presents helps, too.

This is the way.

 

[psych_0]

This will sound dumb but the only way to motivate people like that is to befriend them so they want to be in your team and help you out. Giving little presents helps, too.

Definitely agree. When they like you, they will put in above average effort.

 

[calvnandhobbs68]

However, it's your role to explain that long term, that's not good for them (or the patient). How it doesn't benefit them is that if we become the candy man, they're going to keep trying to get back into the Chocolate Factory.

Great line, that's my only contribution to all this