WOW. That Sucks

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.