In a message dated 4/26/03 4:04:00 PM Eastern Daylight Time,
[log in to unmask] writes:

> Two months ago I quit my hospital lactation "counselor" job to start a
> private practice business.  Within 3 weeks the rest of the staff were "laid
> off" and the lactation department closed down.  This includes someone who
> quit her job at another hospital to take my position.
>
> Tell me they didn't know they were going to close the department down at
> the
> time I quit and the other person came on.  I'd really have a hard time
> believeing you if you did.  That doesn't show any caring sentiments to me.
> A definite show of poor priorities -- money over patient care -- and as for
> the money, they saved exactly 1.4 FTE's for that decision.  No other
> departments in the hospital were closed nor were any regular nursing
> positions in the hospital laid off.  Interesting that this was supposedly
> an
> economic decision.
>

I'm not trying to defend healthcare org. Administrations. I can only speak
for the ones I've been involved with. I can say that the only person with
real direct-patient-clinical experience on most such administrative teams is
the chief nursing officer/exectutive. (Occasionally, a MD is a president or
CEO and sometimes the Support Services VP has a non-nursing clinical
background.) Most have backgrounds in business/finance. The middle layer of
management, which is supposed to be meeting with its clinicians, often has
had little management training--especially in manager-clinician
communication.

The external and internal pressures, including major economic ones, on
healthcare organizations in the US at present is incredible. And the
administrative teams are looking at measurable outcomes. When I'm out and
about, I often hear lots of grumbles from clinicians via their mid-managers,
but rarely (if ever), do those same clinicians (with or without their
managers) develop on paper justification to maintain or increase services
that may seem an "extra" or even "extraneous" to nonclinical administrators.
If the CNO/E's early clinical experience was outside the OB area, there's a
good bet she/he won't know to (or how to) advocate for the role without the
documentation. They can't know what they don't know--they can't know what
isn't brought to them. (This also may be the fault of inexperienced, poorly
trained, or just plain poor mid-managers who are supposed to advocate for
their employees/roles to higher levels of management.)

If bottom line is an issue, what do postpartum patient satisfaction surveys
show? Are there questions about lactation consultant services on the survey?
Would the availability of such services affect a woman's decision to give
birth in that hospital or affect what she tells friends? For many hospitals,
feedback on such surveys has reinforced budget and respect for the LC role
and related services.

Also, how effective is the manager you report to re: advocating for the
unit/department needs to/with administration, which is part of her/his role?
How effective are employees in advocating with the mid-manager via attendance
at staff meetings (or complaining if there are few/none or they are lecture
meetings), documenting validation of role, etc.?

Also, we can be our own worst enemies at times. We say "yes" when we
sometimes need to say "no" to maintain sanity, a personal life and longevity
without burnout or resentment. When working on my Masters degree about 10
years ago, I once did a research paper re: "codependency" among nurses. No
surprise--about 70-90% of nurses, depending on the particular study,
demonstrated traits associated with the term. (I've done conference
presentations on this topic because I think it's important to recognize,
especially to avoid burnout. Mothers and babies of the future depend on LCs'
longevity. Who will be there if LCs burn out--or we may be there but bitter
and unpleasant.)

Again, I'm not defending HC organizations. There are some real losers out
there. And I have yet to hit one hospital that has really good, up-and-down
communication processes in place so much can fall between the cracks. Also,
we sometimes we unknowingly contribute to the problem by complaining without
validating or saying "yes" when it might be better long term to say "no."

Karen

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