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Superficial Workplace Reforms
Management analyses of the nursing shortage often offer recommendations aimed at superficial improvements in the workplace atmosphere without significant change in the basic parameters of the job. Thus, for instance, the American Hospital Association has advanced a "strategic recommendation" calling on hospitals to "increase the time caregivers can spend in the actual care of patients." But their recommendation for achieving this goal has nothing to do with staffing levels. Instead, the organization encourages its members to "introduce new technologies that reduce paper records and the repetitive entry of information."227 While such technological advances might be helpful if they were implemented together with staffing improvements, by themselves they will prove futile.
Similarly, the Nursing Executive Center offers managers a matrix to help identify RNs who are at high risk of leaving and whose departure would also have a great impact on the unit. The goal is to give managers an early warning system that would enable them to pay special attention to their most critical personnel and devise tailored solutions for retaining these individuals. Possibly such a strategy might succeed on an occasion, but it cannot succeed as a systemic policy, because the problems that are driving nurses out of the industry are global rather than individual or idiosyncratic. So, too, the NEC promotes a management checklist of strategies for improving retention within a unit, including weekly staff brainstorming sessions, a nurse-manager open door policy, suggestion boxes, physician-nurse communication programs, unit equipment audits, and a personal nurse-manager skills improvement plan.228 Somewhat more troubling is the group's recommendation of such model retention practices as pizza lunches with the CEO, an internal public relations team, thank-you grams, and "professional nurse" image campaigns.229
All of these might constitute worthwhile initiatives if done together with better staffing ratios. When promoted as a substitute for improved staffing, however, they are doomed to fail.
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