Friday, April 7, 2017

Kindred Accelerates Nursing Turnover Strategy

Strange Tony,

Kindred Hospice designed and implemented new procedures that are driving our hospice nurses away.  The basic features are:

1)  Nurses must enter information into the computer using various forms, including the form the team prepares for our regular Interdisciplinary Team (IDT) meetings.
2)  Nurses must have the IDT form completed in the computer two days prior to IDT for supervisors to review.
3)  Nurses must update the IDT form with new information that arises in the forty eight hours between electronic submission and the actual IDT meeting.  After completing and updating computerized forms nurses must park their electronic medical record device outside the IDT room.
4)  Nurses must be prepared to discuss each patient during IDT.  As they are not allowed to use the computer they used to perform steps 1-3 nurses must create paper documents that pull together key clinical information from a number of computerized clinical forms.  Our nurses are relegated to hand scribing, a tool that existed prior to the printing press, for sharing the written word.  The company has no plans to create this optimal IDT discussion document in the computer system so nurses can press print and meet the company's expectations.  
5)  The nurse cannot make a correction or enter a physician's order during IDT.  They must scribble notes on paper to remind them of computer entries they must make after IDT.  This separation in time and space from the original doctor's medication order introduces an increased opportunity for error at both the nurse's and physician's end.
6)  Phone use is prohibited in IDT.  Nurses are not allowed to take calls, text or use any of their smartphone functions during IDT.
7)  Management can assign any task at any time to any nurse, a death, patient care crisis or admission, and it does not alleviate expectations 1-6.
8)  Nurses must fulfill their clinical load plus the computerized and paper procedures in expectations 1-7 during their 40 hour work week.  Overtime is an absolute no no.
9)  Any nurse that cannot meet expectations 1-8 with a smile and happy face is clearly incompetent and has a bad attitude.  They must be micromanaged, which consists of 99.9% criticism and 0.01% neutral feedback.  Positive judgments are prohibited by branch management and Kindred's Human Abuse department.

The rules are different for nurse managers:

10)  Nurse manager work is too important to take them away for menial tasks like patient visits or a customer service crisis.
11)  Nurse manager work is so stressful that they must take frequent breaks to catch their breath, chit chat in each other's offices and plan what their clique will have for lunch.
12)  Nurse manager work is so routine that they can enter the building at 8:00 am and leave at 5:00 pm each and every day.  
13)  Nurse managers, who don't see patients or know their sex, race or name they like to be called, are allowed to have their computer, use their personal phones for calls and texting, and e-mail one another during the IDT meeting.
14)  Nurse managers endorse and enforce Kindred's opposition to multi-tasking, distributed real-time information sharing and timely processing of physician orders to ensure accuracy.  Nurse managers say "Comply with what does not make sense and maybe corporate will give us permission to do what does makes sense."  That in itself is a form of abuse.

Kindred's nurse turnover strategy is already effective in driving away skilled and competent nurses.  It's early in its rollout.  An exodus is building at our site.

Kindred loves metrics.  Employee turnover increased under Kindred at Home President David Causby.  It rose from 22.6% in 2015 to 23.6% in 2016.   For driving more people away Causby got $245,344 of his $2.7 million in executive compensation for 2016.

How much of our hospice will be left when Kindred at Home President David Causby qualifies for his next $1 million bonus on August 1, 2017?  I expect our nurse quitting statistic to enter record territory.

Anonymous (from the Kindred Kindergarten)

Postscript -- On May 4, 2017 Kindred President Ben Brier said in the first quarter earnings call "We’re going have is we've now talked about, the biggest, I would argue, best run, I would argue most valuable home health, hospice and community care business asset probably anywhere in the country."

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