Robert Malone just wants everybody to get along.
Malone is the assistant nurse manager for the Surgical Service Department of Kaweah Delta Medical Center in Visalia, Calif., a 581-bed hospital that handles about 8,800 surgical cases a year.
Like many nurses, he has worked a variety of assignments with a variety of colleagues. What nobody can seem to do is this profession is get out of his or her own way long enough to help people, he says.
“Health care in the last five years has gone through some major changes, but through all of that, we’re still in the people business,” he says. “And if you care about people and do the right thing every time, everything else will settle itself.”
Nursing has everything to offer, Malone says, because it’s unlike other businesses where an employee can get stuck in one field out of which transition is a challenge.
Originally from Providence, R.I., Malone’s family moved to Visalia when he was a child. He entered a surgical technician program right out of high school, and found he was “hooked” on the surgical suite when his first gunshot wound came into the ER. He earned his nursing certificate in 1990, his first assistantship in 1992, and eventually his BSN and then his MSN in healthcare administration.
But years ago, Malone says he had to take a break from nursing because, like many nurses, he was starting to get burned out.
“I came to the conclusion that it was time for me to move on, and that’s why I did home health,” Malone said. “I took a break for a while—I really enjoyed it—but I also knew in the back of my head that nursing was where I really belonged.”
Malone loves the autonomy that nursing provides; loves the way it connects him with people and the control it allows him to exercise over his work environment. If he’s feeling overwhelmed, he can shift gears and focus on a different specialty, he says – there are plenty of opportunities.
Yet not every nurse sees it that way, Malone says.
“Burnout is quite common in nurses; their attitude towards taking care of patients,” he says. “The biggest thing I tell people is this: Only you can make the choice. I hate the real nursing taboos, this mentality of ‘You can’t do that.’”
When nurses are challenged, he says, they immediately become defensive. Health care is a serious job that makes people very serious, and people aren’t having fun at work, he says.
At the same time, he says, when the going gets tough, that’s when a light touch is needed most. Instead of bracing for a fight, he says, nurses should be prepared to learn something new.
“It’s okay to not know everything,” Malone says. “The important thing is knowing how to use your resources. Some of the nurses get out of nursing school and refuse to learn anything else. The only thing, especially in health care, that’s guaranteed to happen is change is going to come.
“The sooner you identify that and accept that, your life will become easier,” he says. “I’ve grown just because I realize change is guaranteed.”
Management can do a better job from its perspective, he says, if they take a stronger interest in cultivating new talent.
“If we keep biting the heads off new nurses and don’t allow them to grow, we’re not going to have anybody to take care of us later in life,” Malone says.
What’s worse, he says, is that when some nurses ascend to the management track, they do so because they don’t want to be staff nurses anymore, or they climb the ladder, and then forget what it’s like to do their old job.
“I’m a manager because I’m a firm believer that I’m a liaison between the nurse and staff and I can give them what they need,” Malone says. “I’ve worked with some managers who are great, and I’ve worked with some managers who were piss-poor because their attitude.
The same kind of dissatisfaction, complacency or burnout that affects nurses form a professional standpoint also keeps them from effectively coming together to actually change the things that they’re concerned with, Malone says.
“Often times nurses won’t stick together,” he says. “They’ll bitch about something, but they won’t stand united. [We’re] the majority of the labor force in health care and, we’re a very powerful group. Physicians won’t say anything bad against another physician; nursing needs to do that [for] ourselves. We need to do a better job of peer reviewing each other in a respectful manner.”
By not coming to the table to participate in discussions that affect their day-to-day working lives, Malone says, nurses often “allow things to happen to them,” which feeds into their dissatisfaction and makes them further retreat when they should be self-advocating.
“I think it’s a nurse’s responsibility and their accountability to themselves and to other nurses [to address problems],” he says. “A lot of nurses will complain to complain, but they won’t work to make changes happen. If [something’s] not there at your institution, what is the real problem?”
In a shared-governance mentality, which is taking hold in places like his institution, Malone says, nurses are more involved in making changes that improve their work environment. Those nurses that are less confident about speaking up for change need to be brought along as well, he says.
Half the battle can be won just by properly identifying the skill sets of hospital personnel and applying them to the appropriate tasks, Malone says.
“Some people are really good doers, but not good teachers, and not good examples to other nurses,” Malone says. “Don’t be afraid to show them how to be successful.”
The other half is coaching nurses to be able to speak confidently about their needs in front of the right audience when it becomes available to them. Networking is the biggest area in which nurses must become proactive, he says, “and that really is the dilemma because they don’t want to talk to anybody.
“You’ve got to identify people and when issues come up, grab the right nurse and say, ‘What do you think? What are the issues we should take care of?’” he says.
“If you talk to them in more of a one-on-one, they’ll tell you, but you’ve got to use that and say, ‘You should come to the meeting and express that idea because you can really articulate it better than I can.’
“It’s very difficult but that’s something that nurses really have to do,” he says.