Me

I have been applying to various hospitals as I see jobs I am interested in. I had never tried job search companies before, so I signed up for Monster, Indeed, and Zip recruiter. That turns out to have been a mistake on my part.

My phone won’t stop ringing with calls and text messages, and my email box is inundated with recruiters trying to offer me jobs that I am not interested in, with many of them being jobs I am not qualified for. Most of the people sending them have Indian names. It goes like this: “I just reviewed your impressive resume, and I have a job I think perfectly suits you. One of my clients is looking for” then the job title is totally inappropriate- things like Physician, Neuro Surgeon, Physician Assistant. There are also the offers for night shift jobs in Indiana or New Mexico. I have gotten calls to sell insurance on commission, and even to be a night shift janitorial supervisor. Why are they wasting my time and their own?

It’s a pain in the ass. Avoid those three companies like the plague.

Last month, I finished my MBA. I talked to my supervisor and told them that I wanted to move into management. I was told that there were no positions available. Rich W said in comments to the post that I had just placed a target on my back.

I think you have run up against a problem of being a threat to those that interviewing you. Any time you apply for a position where the interviewing group is less qualified than you, they will see you as a threat to their position. 

It turns out that he was correct. Instead of being used for my talents and efforts, management has apparently decided that I am a threat. I was written up this week for a couple of items. This is my first time being disciplined on the job (any job) in 10 years. (The last time being when I was attacked at work)What did I do?

• I made a charting error by listing a patient’s current medication at home as an allergy. I spotted the error and changed it less than 30 minutes later. Then, on the same patient, I didn’t give an ordered medication (a laxative called “Golytely”) until three hours after it was ordered. They didn’t even ask why I delayed it. Had they asked, I would have pointed out that I couldn’t give him the medication because he spent two hours of that time in surgery, then had to remain lying flat for an hour, thus being unable to drink the laxative. Hence, the three hour delay.
• The second item on the discipline was that, four months ago, I was ordered to perform an EKG on a patient and company policy says EKGs need to be done within 10 minutes of the order, but I didn’t do it for almost 45 minutes. This was used, the discipline said, as evidence that my not following orders in a timely manner is a pattern. I can’t tell you what happened there, because this was the first I heard of it. My annual evaluation in September made no mention of it, and I have no emails or other documents that I can see that mention it, either.

How can you use an item from 4 months ago (August) that I was never told about or disciplined for as evidence to upgrade discipline? Only if you are trying to hang someone out to dry. See, you can’t discipline someone for a one-time error in charting or a delay in medication administration. That’s why they needed to come up with the event from August.

The odd thing is that I was just given an award in October for “exhibiting excellence in supporting the mission of quality nursing at [company].” I was also recently mentioned for kudos (last week) in having a 98% accuracy rate in carrying out tasks like medication administration and lab work.

At the same time, my employer has been editing people’s time cards, and the last time an accrediting body came to visit, management rushed to hide the hallway beds that were being used to hold patients, because that is a violation of Joint Commission rules. Is committing wage theft by editing time cards and demanding that employees attend unpaid training.

The dominant operational priority is door-to-bed time, regardless of nurse workload, intake status, or downstream care capacity.
• Admitted patients awaiting inpatient beds are frequently placed in a back hallway to free ED rooms.
• Boarding volume can range from none to 20–30 patients.
• This hallway boarding practice resulted in a Joint Commission citation and financial fine.
• Despite the citation and fine, leadership has continued the practice.
• During regulatory visits, management scrambles to hide hallway boarding to avoid detection.
• A manager explicitly stated that increased throughput generates more revenue than the cost of paying the fine.
This reflects a conscious decision to treat regulatory penalties as a cost of doing business, rather than a boundary for patient safety and ethical practice.

A critical insight from these observations is the erosion of ethical decision-making and lack of deference to Joint Commission standards:

Joint Commission guidelines are treated as obstacles to be managed, not standards to be upheld.

• Known violations are concealed during inspections rather than corrected.
• Financial and throughput incentives are prioritized over patient dignity, safety, and monitoring standards.
• Leadership behavior demonstrates normalization of deviance—unsafe practices become routine when no immediate harm occurs.
• Staff are implicitly expected to participate in practices that obscure reality (e.g., hallway boarding concealment, paper compliance).
• Serious safety concerns (e.g., patients left unassigned and alone in rooms without monitoring for extended periods- as long as four hours) have been raised and dismissed.

I no longer believe this organization:

• Operates in good faith with regulatory bodies
• Prioritizes patient safety over metrics
• Protects frontline clinicians from systemic risk
• Aligns with my professional values

The cumulative pattern reflects cost-driven operational collapse with intentional regulatory noncompliance, erosion of ethical standards, and displacement of organizational risk onto individual clinicians. Joint Commission guidelines are treated as negotiable, fines are internalized as acceptable expenses, and frontline staff are expected to absorb the consequences.

It’s obvious to me that my time with this employer is coming to a close. It will be a race to see if I can find a job before they can find a reason to fire me. I have an interview scheduled for the week after Christmas. Let’s hope it works out.

If I have to, I can take a non-management position. The recruiters won’t leave me alone about that, but I don’t want to settle unless I absolutely have to.

What do you know, as of today, I am a board certified Nurse Manager. This is in support of my goal to move on from direct patient care, and get a job that is away from what has, to me, become a dead end job with no chance of promotion.

This latest certification is my first management certification and is in addition to my 3 other board certifications, although those three are purely clinical.

Sooner or later, I will have so many qualifications, I will be out of here. Now to begin working on the next one…

Once I got my MBA, one of the first things I did was to sit down with the director and her assistant. I pointed out to them that nurses who get a master’s degree do so because they don’t want to stay in their current role. The response was that there were no promotions available. They explained that we were budgeted for 10 assistant managers, and we currently have 14. Additionally, five people have been here longer than I have were promised any upcoming promotions. The result of all of this is that I would have to see nine people leave before I would even be considered for an assistant manager role. Assistant manager doesn’t even require a bachelor’s degree, as there are several who only have an associate’s in nursing.

I pointed out that I had more certifications and more education than any of those who were currently in roles over me, as many of those in line ahead of me don’t have a bachelor’s or a single board certification, much less a master’s and multiple board certifications. I am more qualified and certified than any other nurse in the department, including the director herself. That apparently didn’t matter.

My hospital is getting ready to open a free standing ED about 20 minutes down the road, and the staffing for that unit is coming from the staff of my current hospital. I asked them if I could apply to be the director of that facility. She told me that she was planning on running it directly and remotely herself, so there would be no director position to apply for. It’s more cost effective to not hire a new director, don’t you see…

The director then said, “I understand what you are trying to do. Just stick around, because there is a lot of growth planned over the next two years. There will be other opportunities for advancement, and you can apply for one of them.” To me, this was like being placed in the friend zone, where a woman leads you on in order to get you to continue to act like a boyfriend to take her out to dinner, but had no plans of ever letting things go any further.

So I began applying for other jobs. I first tried to get an assistant manager spot at other hospitals within the same company. I was offered one, but at the same pay that I am currently being paid, and I would no longer qualify for some of the incentive pays that I currently receive. In other words, a cut in pay. Topping it off, the position was an hour’s drive away. I turned it down.

So I applied to positions outside of the company. One of the interviews I went to lasted over 2 hours. I found myself saying things like “You hire professionals. They want to succeed and work for a place that is winning. A leader is there to give a team a common vision so they head in the direction that they already want to go, and the result is usually excellence.” They loved me. I was told that I could take a current position as an assistant manager, or I could wait and see if my other application for a more senior position would bear fruit. I elected to go for the higher position.

I then was asked to a second interview with the hospital’s board of directors. I went and got a Brooks Brothers suit for the interview. I got an email on Saturday, and the woman who would be my boss at the new hospital told me that she thought I was a great fit and this second interview was to be on Wednesday.

Then on Sunday, I got an email that the second interview would have to be postponed. Two days later, I was called by HR and told that I was no longer a candidate for either position, because the positions would be eliminated. As of this morning, both positions remain posted on the company’s job board.

I continue to search for a better job. It’s all good, I’ve only had an MBA for 2 weeks, and I have already had 6 job interviews. It will happen.

If we learned anything about the murder of United Healthcare CEO Brian Thompson, it’s that it is dangerous to be in liberal controlled areas, even more so if you don’t practice OPSEC. For that reason, I try to edit out any identifying information or anything that telegraphs my future movements. By the time you read this, I will be home, so security is not an issue for this post.

I have been in Boston at a conference for the past few days. The number of people who knew where I was can be counted on my fingers. We stayed at a nice hotel near Boston Common. We sampled plenty of local restaurants: Saltie Girl Seafood, Lucca Italian, Mike’s Pastries, M.J. O’Connor’s Irish Pub, and others. I spent a day riding the hop on/hop off bus to see some sights, and then it was time to come home.

Some of the things I wanted to see were closed because of the government shutdown: I couldn’t get in to the Bunker Hill memorial, the old Boston Naval Yard, the USS Constitution, or the meeting place of the Sons of Liberty because they were all closed. Shame.

A couple of people made comments to my post on earning my MBA. I did it for a number of reasons-

At nearly 60 years old, I go home at night with a sore back, feet, and legs. I was upset about being forced to take unpaid training, and other things. I am a huge proponent of this:

If you are unhappy with your job, you have two choices: you can improve your worth and get a better job, or you can bitch about it and become miserable.

I decided to do something about it, I thought long and hard about what I wanted, and how I needed to get there. I went back to school to get a master’s degree- a business one. Getting an MSN would not change things, but an MBA would qualify me for management or at least an administrative position.

That’s great advice for anyone- if you don’t like your job, what are you doing to better yourself? How are you going to move forward? You can complain, or you can DO something about it. Which plan is more likely to get you what you want?

Exciting news- As of today, I am an MBA-holding graduate. I have completed my MBA. I have requested a meeting with hospital administration concerning my future with the hospital. Ever since I let it be known that I am looking for work and have an MBA, a BSN, and multiple board certifications, recruiters have been blowing up my email with pitches about why I should work for them. I have agreed to six different meetings with the administrators of other hospitals in the coming two weeks.

I am going into that meeting with my hospital’s admin holding all of the cards. I’m going to attempt to leverage this into a major opportunity. Big changes coming.

The training was stupid, and the instructor actually admitted that it was designed to absolve the hospital of any liability of a patient were to attack a nurse, because now we can’t sue the hospital for not providing us with training. If a violent event happens, it must be the nurse’s fault for not properly de-escalating the patient’s behavior.

Today’s class was 8 hours long. The first four hours was on how to redirect the patient’s behavior. The training said that all behavior is a form of communication, and the patient is simply trying to tell you that there is some sort of problem that the health care provider needs to address, but doesn’t have the words to be able to express it, so this manifests as “Risk Behavior.” The only proper reply to this “risk behavior” is to safely, and in a non-confrontational way, control and redirect the patient until the patient can realize that what he is doing isn’t productive. It’s called nonviolent crisis intervention, and I think it is bullshit that is designed to cover the employer’s legal ass, and who cares if employees get hurt? Healthcare systems hide behind the workers’ compensation immunity shield, so you can’t sue them if they trained you to avoid violence. They can, however be sued if one of their employees defends themselves from a violent attack using a violent response.

The next hour was all about how employees need to remain detached and not allow the patient that is in crisis to goad or bait you into engaging them.

Then we broke for lunch before returning to learn the practical skills. The first step to each one is to “take a non-threatening stance that is designed to not provoke the patient into engaging in risky behavior.” Then, if the patient tries to hit, grab, bite, or shove you, how to break free and escape to run away and call for help. The key is for the employee to avoid violence.

I was the only male there, so I got to be the one that the instructor kept using for demonstrations. One of the scenarios was how to escape a front chokehold where the patient is facing you and attempts to grab you by the throat. The instructor, was roughly my size, had us watch a 1 minute video on how to escape this and said let me demonstrate, then spun around and grabbed me by the collarbones with both hands. I swear with all of my being that I didn’t do it on purpose. He caught me by surprise because I was zoned out and not really paying attention. What happened was reflex.

I brought both hands up through the middle of his arms, then palmed his face with my left, causing him to lean backwards slightly. Once he was off balance, I stepped into him, put my right leg behind him and shoved. He landed on his ass. The entire class got to hear about how what I did was a violent response, and would get you in a discipline issue of we were ever to do that to a patient.

I don’t give a shit. I will not allow myself to be some crackhead’s punching bag and spend the rest of my life eating through a straw from my wheelchair. A couple of events from Florida this year drive that point home:

A nurse for Palms West Hospital had every bone in her face broken by a patient who attacked her. It was two months before she could walk well enough to go to a rehab center. She is still there, and hasn’t yet returned home, as far as I know. The hospital responded by designating a desk in the ED for the use of a sheriff deputy, to encourage them to hang out there. Also, that makes them a substation, which many hospitals use to declare that they are a police station, so concealed carry is off limits. Most hospitals only use unarmed security, and many times those security guards are unarmed women and old men.

A pair of nurses in Port Charlotte, FL were attacked in March. No one was arrested.

I am having to take de-escalation courses for my employer this week. There is an online component and a classroom component on how to handle patients in a crisis. The online is supposed to take 2 hours and the in-person class is another 8. Sure, I will take 10 hours of overtime. The online class consists of videos that constantly ask for interaction, so you can’t just hit play and walk away. Things like

• “Click next to continue”
• Click on each image to read more. You have to click on all of them, or the class won’t go on.
• and quiz questions on the material to test if you are listening. If you get any of them wrong, you have to start that section over.
• If the video isn’t the only window open, it stops playing.

So I am sitting here having to let the video play on a laptop while I type this on my desktop.

The way online training works is they tell you how long it should take. In this case, 2 hours. That’s all they will pay you for. I have stopped doing the training, since they aren’t paying me for it. I got talked to last week for that. It seems that they are not happy that I am not completing the required training. I told them that I only do the training that I am paid for.

Back to today: I have been watching this video for an hour and 15 minutes. I haven’t failed one of the 4 built in quizzes that I have taken so far, so I haven’t had to repeat any sections. According to the progress bar, I am only 19% complete. At this rate, it will take me 6 and a half hours to finish. Remember, they will only pay me for 2. For that reason, I am stopping at 2 hours.

I dare them to try to tell me that I need to do more.

I know that many of you are saying that I should just get a different job. The issue is that this is how every health care job that I have ever had is. They demand as much as they can get away with, which is why, in my opinion, there is a shortage of nurses. So I just set clear limits and refuse to do work unless I am paid to do it. I also make sure that I put it off so I can do as much training in a single week as I can get away with, as well as doing it on a weekend. That way as much of it as possible is at time and half and with a weekend differential. If you are going to make me do it, I am going to maximize my pay for doing it.