Category: Observe & Report

WARNING

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Extremely LONG Post

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(Don’t say I didn’t warn you)

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AN ESSAY FOR MY MOTHERSHIP FAMILY

I have always believed that certain elements in life have a purpose. When I found myself at odds with my personal beliefs in my previous position, I was unable to search for employment within the healthcare insurance business. I had signed a non-compete clause preventing me from finding employment at a competitor within a 50 mile radius of this particular company.

I had no idea what I would do next. I had worked as an RN Case Manager within the Healthcare Industry for more than 15 years. I had also been away from bedside nursing for close to 20 years. My only recourse (other than moving 50 miles away) was to look for Care Management positions in an office setting or return to the hospital setting.

When I saw a posting for Care Management positions at The Mothership as well as our oldest Legacy Sister, I knew I had to try for both. I felt good about the Legacy interview, but I was secretly hoping I would get a chance to interview at The Mothership.

After all, I had started my nursing career at this place some 25 years ago. I formed lifelong bonds with many of those that worked alongside me either at the bedside on the unit or as a Case Manager. They were my “family,” everyone throughout the Mothership knew or knew of each other. Despite the size at that time, going to work mostly felt as if I was going over to a friend’s house to work on a project.

The only reason I left was because I had the opportunity to work for Big Blue’s Younger Sister. It was a Monday thru Friday gig with no weekends or holidays or working odd hours. A welcomed relief from rotating days and afternoons and making sure that I worked at least 3 of the 6 holidays of the year.

Imagine my surprise when I arrived at The Mothership and the interviewer was the Case Manager (CM) I worked with as a staff nurse. In fact, I credit this person with steering me into a career in Case Management. I consider this person to be one of my Touchstones; showing up (even after I left the hospital) during those times I needed an ear to listen or a hug to tell me that things would be okay. Knowing that I was interviewing with her (now in a leadership position) was the moment I realized that the purpose for leaving my previous job was to return to the hospital setting.

It was like coming home that first week at Beaumont. Besides Touchstone, I ran into several members of my Mothership “family” who remained at the Mothership for all those years. I was happy that they remembered me; from the transporters that brought up our post-op patients to the unit. To those RN’s who worked side-by-side with me during some of the toughest days as a brand new (and even seasoned) nurse. I was even caught off guard when I ran into my former Nurse Manager (another Touchstone who had graduated from the floors to become a high-ranking RN at The Mothership). At first walked passed me, but stopped in her tracks, turned around, and called out my name, genuinely happy to see me back at The Mothership.

I also found out that many of the Case Managers I worked with during my first stint at the Mothership were still in the same department. In fact, when given the opportunity to choose my assigned unit, I chose the one where I knew two of the CMs in that office. Best. Decision. Ever.Seeing many familiar faces at The Mothership was a testament that these long-standing employees were valued and respected. Sure, there had been a few changes (holy huge new tower, Batman!) to The Mothership since I was last there; but overall, there was still that element of pride for working at an established well-known hospital. These employees were proud to say where they worked, because The Mothership only hired the best.

Flash forward to The Mothership today, seven years later. So much had changed in that amount of time, including Headquarters (HQ) attitude towards patient care and employee satisfaction. Within those 7 years, The System changed CEO’s and expanded their reach to the south-/south-western part of the Metro Area. Suddenly The System was obsessed with the merger; streamlining processes so that ALL Ships were doing the same thing.

The new CEO, though he tried to sound down-to-earth (Folks, anyone?), was somehow never visible at The Mothership. In fact I only recall him showing up at The Mothership ONCE for a Town Hall Meeting with the employees. I’m sure CEO – who, BTW is an accountant – had been to The Mothership several times, probably for other executive level meetings; however, in the 5 years that CEO has been with The System, I had never seen or met him in person.

This was a departure from past CEOs who made a point to sit with employees to take The System’s pulse, ask us how we felt and what we think should change. I just felt I couldn’t trust someone who didn’t make an effort to understand how The Mothership’s engine worked and how The Mothership remained afloat.That was the first inkling of concern I had about the direction of The System. CEO would “advertise” that he was “rounding” with multiple departments and units throughout The System. There would be videos of CEO at all the other Ships, but I had never (to this day) seen CEO do the same for The Mothership. While boasting about being transparent on his weekly email blasts, many of his decisions were made without the input of any of the “worker bee” employees. Many times The Mothership employees felt as if the wind had been knocked out of them, because changes that CEO helped implement were never clearly communicated. I quickly realized that CEO could talk the talk, but could never walk the walk. Or rather WANT to walk the walk.

What cemented my concern was two-fold. The first event was when they moved the entire Care Mgmt Dept from under Nursing’s umbrella to Finance’s umbrella. It was certainly a shift when we were used to having support from Nursing leaders. Now it felt that Finance didn’t understand (or care to realize) the importance having clinically experienced nurses and MSWs to assist in coordinating patient care during and after leaving in the hospital.

In fact The Mothership’s new CFO asked to shadow a CM to see what our day was like. I was apparently one of the CM’s who was chosen. Of course the day she sat down with me, there was none of the constant interruptions by multiple healthcare disciplines including outside vendors & insurance companies. There was no irate patient or family member who was insistent that they needed to remain in this step-down unit.

CFO lasted for less than 1.5 hours that day; often telling me that the “issues” we were experiencing were “normal” because she saw the same exact issues as the former CFO of another Out-of-State hospital. It was clear that this CFO had never spent time at the bedside; nor did CFO care to understand how many facets of Case Management there was.

CFO likely never had to explain to a patient or family member why he/she didn’t meet the “criteria” to go to Inpatient Rehab and therefore, his/her insurance wouldn’t pay for an IP Rehab stay. All while simultaneously encouraging family to choose from a list of Subacute Rehabs, which any lay person may see as a putting their loved one in a “Nursing Home.” (FYI, it’s not. There are multiple “levels” of care at any Nursing Facility.)

Better yet, I’m sure CFO had never had to participate in a Multidisciplinary Meeting with the family of a patient — who could no longer breathe on his/her own and was unable to communicate his/her wishes — to discuss goals of care for their loved one, even when every discipline & specialty consultants agreed that the current course of treatment was futile in nature. More often than none, these family meetings would turn into a WWE-like match; family members uncontrollably sobbing. Parents & Siblings screaming expletive words at one another or — better yet — throwing things at one another.

Sometimes just being in the vicinity, that flying object would veer off track and hit you instead. Sometimes meetings ended with a family member grabbing you and begging you to pull out my “magic bag” and “fix things.” Tell me that, while still trying to maintain professional composure, you wouldn’t feel some sort of responsibility to help that family … even if it is to assure them that we’ve exhausted all possibilities.

Instead what was often seen by CEO and CFO was the “number of days” (or “Length of Stay” in healthcare terms) that the patient had accumulated while in the hospital. Or the cost that The Mothership was incurring because of a complication that occurred during a patient’s hospital stay. In short, HQ and The Mothership had no experience in having those face-to-face conversations. They had never had to explain, in person, why the patient’s insurance won’t cover his / her IV antibiotic and was unable to find the right resources for any type of medication assistance. Or sat next to a patient to tell him / her that there were no other places that they can go (other than home) from the hospital because his insurance terminated, or the benefit wasn’t available. Or speak with families who insists they can no longer take care of their loved one at home but aren’t financially able to afford personal caregiver services or an apartment on an Assisted Living Campus.

The Mothership suddenly felt like a “fantasy football league.” It was all about statistics, what the “player” can bring to the table, and the resulting money they would save / make on this particular activity. Patients no longer were human in their eyes; instead, they became numbers & stats in the literal Game of Life. And us employees were just pawns (or “players”) in helping them achieve a championship title. Which would then result in vast improvements for their chances of success (aka the ability to increase The System’s revenue … or their pockets).

The second concern presented when they hired an “Interim” Director of Care Mgmt for The Mothership to “overhaul” the way that us “players” approached every single activity / responsibility assigned to our department.

Nicknamed Hurricane, she tore through The Mothership, many times treating us as second graders. The best description I could come up with was that she reminded me of Professor Dolores Umbridge in the HP series — she talks all sugary and sweet; all while demeaning you and relishing the power that she had been given.

Hurricane destroyed the Care Mgmt Dept’s confidence; often pushing activities that may work at the The System’s smaller Ships onto The Mothership, who had double (sometimes triple) the number of licensed beds. The Mothership was where the other Ships tended to transfer their complex patients. The Mothership had world-renown physicians in pretty much every specialty of care.

I don’t disagree that a hospital of this size can be difficult to “manage” and HQ often has to reel in departments where their activities may have pushed things too far. However, the one thing that had always (previously?) been true is that The Mothership was able to quickly adjust to the needs of the community, sometimes finding ways to achieve outcomes that would best serve the patient. Often times, The Mothership’s various departments would try their best and work *together* to achieve the desired results.

This didn’t matter to Hurricane. She forced her beliefs onto the Care Mgmt Dept, often threatening that we needed to “get on the bus” and get with the program. (Seriously. we were actually given a “ticket” to get on the damn bus.) If we didn’t then we should stay off “the bus” because there were other people “standing in line” willing to “get with all the changes.”

In other words, we were replaceable.

Hurricane stayed on until a new permanent Director of Care Mgmt was hired; she was to “mentor” this New Director (to “continue the work” that she had started). Unfortunately, our hopes of having someone that could understand the nuances of The Mothership while confidently, yet calmly assist us through change and adjust course as needed (as we had multiple times), were dashed. After our experience with Hurricane we were hoping that our New Director (ND) would advocate for our department.

ND often had a way of making decisions without thoroughly understanding what the results of her actions would be down the road. It didn’t help that ND was (like most of leadership after current CEO took the reins) came from outside The System. They often failed to get any input from other seasoned CM’s or Leadership on what has / hasn’t worked in the past. Once she made her decision, ND typically stood her ground; never acknowledging that her “change du jour” wasn’t achieving the outcome she wanted. As a result, she would try out another change (again without others’ input), which would result in yet another change in process. Wash. Rinse. Repeat.

If Hurricane didn’t completely destroy our self-confidence, the snap-decisions that ND made certainly did. More than often, no one could remember what the “latest process” was for an activity. Everyone felt as if ND+Minions were trying break us; aiming to pit us against one another. CM’s felt as if the Auth Coordinators (we won’t even get into THAT role) and the MSWs were out to “get them,” and vice versa. ND in essence, silo’d each of our roles; shifting responsibilities to and fro, all while adding new non-essential tasks that didn’t require an RN or an MSW to perform. Hurricane and ND’s actions ultimately had their employees questioning all the smart, talented, dedicated, and hardworking employees were even marginally “good” at our job.

They turned those employees who used to be proud that they worked for The Mothership into employees who were embarrassed to say where they worked. This type of behavior ultimately resulted in the employees resenting both The Mothership and The System.

Between Hurricane and ND’s actions (or lack thereof), the Care Mgmt Dept has lost (at the very minimum) 20 or so highly experienced CM’s, MSW’s, Auth Coord’s, and clerical staff. Many of those who had years of experience working at The Mothership.

Our department was already stretched thin when COVID-19 hit. Rather than showing support for the frontline employees, The System’s CEO (an accountant; likely with no bedside experience), had already began to complain about the loss of revenue that would occur because of this pandemic. CEO talked about how canceled surgeries and cardiac procedures, which are the main bread & butter (for The Mothership, anyway) and the payroll for the Frontline workers would result a major net loss for The System.

Let that sink in: While the community-at-large was showing appreciation for us frontline workers, The System’s CEO was complaining about having to pay them.

Bravery at that time, apparently became a detriment to The System’s (already) Deep Pockets, which ultimately led to many positions being terminated or placed on furlough in the “April Sweeps.”

Unfortunately, The Mothership’s Care Mgmt Dept seemed to turn into a microcosmic version of HQ; of what was going on systemically at The System’s Executive Level. Just like the other employees throughout The Mothership (and likely throughout the other Ships), there was an overall feeling of oppression; of feeling that you weren’t allowed to make any decisions without leadership’s approval.

And if the Head Cheese acted in such a manner, then this allowed other leaders below CEO to act in the same way to their peers under them. And so forth and so on, until it reaches those frontline workers, who have no recourse but to remain silent.

The frustration most of us felt throughout The Mothership was *never* about appreciation. It was (and still is) about feeling respected and valued. Of what we could bring to the table. It was about The System voicing that they were being transparent and honest with all their activities when they really weren’t.

In the Mothership’s Care Mgmt Dept, this ultimately lead to the lack of trust in our department’s leadership. Often times, we felt as if there was Game of Thrones-type scheming behind our backs; leading us to feel as if our jobs were in peril.

As most of us (especially the RN’s) went into the healthcare industry to *help* our patients & family members during a time wrought with uncertainty, the tendency was to make sure that we were providing the best care possible while in the hospital. In short, we practice empathy; constantly working hard for our patients & families, often at the expense of our own family and personal lives.

Things get difficult when what Management deems that their “priority” is more important than what should be best for the patient. (I’ll let you decide what our priority is: Making sure The Mothership gets paid? Or making sure the patient is discharged safely? Hint: it’s all about the Benjamins.)

Never mind that some of these “priority” tasks do not require an RN or an MSW to complete. Yes, some of those tasks are driven by the government (IMM letters, anyone?) but it doesn’t require assigning an RN (who sometimes has the clinical knowledge that could sometimes rival a first-year resident) to perform them.

If ND+Minions could understand that taking these non-essential tasks off our plates will result in improvement in The System & The Mothership’s outcomes. By doing this, it would allow us to perform more value-added tasks in addition to addressing all activities that the CFO & ND deemed as priorities which would ultimately improve our “stats.”

Unfortunately, our current Administration (at both The System & The Mothership) are too short-sighted to realize that what they consider a priority now will only hurt them financially in the long run. Fast Cash followed by Free Fall.

Long-winded, I know … but these are the reasons why, despite absolutely *loving* what I do, I feel I can no longer work for The Mothership and The System. For those that know me, I’m extremely passionate about everything I do; especially with Care Management. Unfortunately, right now there is way too much on our plates that I feel that I’m unable to give the 100% I typically do. As it is, I am OCD enough where I need to make sure that things are done in the correct manner. To do that, I would find myself working 12 hours a day, but only get paid for 8 hours. Anything to help the patient and the healthcare team.

Quite frankly, going in to work (especially of late) had been a struggle. I often felt defeated by the end of the day because I couldn’t do the necessary tasks that were needed before I left. This had affected my confidence to the point that I felt I was always angry at what was going on … not only at The Mothership level, but The System level as well. I knew I needed to get out of that toxic environment (which instilled fear and mistrust in CEO, CFO, ND as well as among ourselves) not only for my own sanity, but my Dear Husband’s (DH) sanity as well.

It breaks my heart that I’m leaving my family once again. For the past 7 years I’ve had the pleasure of working with incredible nurses, physicians, APPs, Physical & Occupational therapists (PT/OT), and other ancillary healthcare staff. From the pharmacy & their techs to nutritional support dietitians. From the cashiers in the cafeteria & concourse (who pretty much know my breakfast order) to the environmental service staff that always pop their heads into our office to see if we need our trash emptied. (We always said ” No, thank you,” only in part because it was cathartic hearing the trash bags clank down the chute. It was like throwing out all the negative juju we experienced that day.)

The people who I will miss the most are those that have been in the trenches with me … The RNs (including their management team) that work bedside us on the Medical Purgatory – I mean Progressive Care Unit I was assigned to. The PT/OT staff who was always available to do a session for patients whose insurance required their notes to determine what the most appropriate level of rehab the insurance deems most appropriate for the patient. The Respiratory Therapists who put up with all my questions about Vent / BiPAP settings and trach sizes & types; especially because I’m constantly pestering them to perform home O2 evals.

I will miss the incredible Liaisons from all the different facilities, agencies, companies; especially my favorite LTACH girl (who gets things DONE) and the Home & Hospice agency who always reminds me that the tasks I perform do not “succ.” I will certainly miss those physicians / residents and APPs who were always ready & willing to be participating team players in coordinating post-discharge care needs.

Most of all, I will miss the ladies that have sat side-by-side pretty much every day; my office sisters. They have been a constant influence in my life and have gotten me through some pretty rough patches. I will also miss all the other CM’s, MSW’s, Docs, APPs, and staff RNs who knew that our office door was always (figuratively) open for those that needed a place to decompress, vent, or even swear or cry. They knew that what happened in office stayed in our office.

I will miss those Touchstones, old and new. I will miss my Mothership Touchstones I had as a staff nurse. I will miss the Touchstone who fueled my passion for Care Management.

In fact, I relish all of my Touchstones. Though we no longer work together, I appreciate the lessons my Manager at Younger Sister taught me when I decided to try my hand at leadership. The Number One lesson was the first lesson this Touchstone ever taught me; and I continue to carry this lesson today even if I’m no longer in a leadership role. This Touchstone taught me that the most important thing about being a good leader was not to mess with people’s time (both as it relates to time-off AND length of time of any interaction/task) & pay.

Though they may no longer be my boss, these Touchstones have provided me with the confidence I needed to remember; that I am ten times better than what I think I am.

Yesterday was my last day at The Mothership. On Monday I start a new position at The School. It had always been a dream for me to work at The School. When the opportunity came up, my confidence was so shaken that I didn’t think I would get the job. At the persistence (and blessings) from my office sisters, I went for it and was genuinely surprised when I was offered this position.

I believe that going though the past seven years has lead me to this new path in my career. Despite what HQ and the leaders at The Mothership have put me through, I believe that my stint here had *purpose.* You have all lifted me up at one time or another. You are the people that gave me my courage and confidence.

I am truly sorry to those I haven’t been able to see before I left. The last two weeks have been a whirlwind of activity and — in true Mothership fashion — my last day was fraught with issues requiring my immediate attention. Please know that, despite my current feelings for The Mothership, I will miss what She used to be.

I will miss every one of you. I will miss my Mothership Family

PS. For those wondering why I kept the d*mn ticket. This is why: