Nursing, LTC mainly, and the broken window theory

Hopefully, you already read my post with "The Broken Window Theory" in it, if not, please go here:
Broken Window Theory and then come back.

After reading this, I really got to thinking about how this applied to message forums, and how namecalling gets started, then escalates, and gets worse, and of course, the civil people give up trying to fix things and eventually leave.

Heck, when I started this site, it's all I thought about. How do we keep this place civil enough to keep good people here and bad people out!

Anyway, that led me to thinking about nursing, and patient care. Remember when you were just learning during clinicals, and all of the things that you weren't suppossed to do, but saw them being done by everyone but your clinical instructor? How many of those things do you now do?

Sorry, I'm getting away from my original point again.

After doing clinicals in nursing homes, and working in a few, (this goes for hospitals too, and any care setting for that matter, but I feel like it is really true in LTC centers) I have noticed that if something is NOT acceptable by any means, then it just doesn't happen. It also seems that if something can be gotten away with, it is done, or in most cases NOT done...

Many times I have seen CNA's or Nurses NOT doing their job because others accept the behavior. Residents laying in wet beds, not being turned, treatments not being done, etc.

I've only been out of school Since September of '03, so I don't speak from a lot of experience, however, I do remember being a student in some places and thinking, "how could you do this to someone!".

After being in and around a few places, I started work at a new job to make ends meet in addition to working on this site, and having a regular job. I work in a nursing home part time. After being at this job, I realized that it is much better in terms of care, than any other place I've seen.

I've decided that the reason for this is that complacency is not tolerated. CNA's will report other CNA's who do not do their job. The level of care there is good. I like that, and am enjoying working there.

However, one certain nurse had not been doing all of her treatments. This is something that isn't hard to do, and there is plenty of time to get them done if you just do your work. She was reorientated, and reprimanded, but allowed to keep her job. In my view, she continues to be apathetic in the care she gives. When a treatment is initialed and dated on a wound, then I know it wasn't done when it was suppossed to be done.

If that isn't done, and she knows it will be noticed, what about all of the little things that should have been done that couldn't be caught?

What about the people she works with and around, or anyone, God forbid, that she might train?

To me, this is the broken window theory at work and the reason so many LTC facilities don't provide proper care to their residents. The more it happens and is accepted, the more it will continue to happen, and even get worse...

Please share your thoughts on this theory and what you think. Do you agree that it has some bearing on our profession?

I know this wasn't presented in the best way, but I just decided to post about it and just started writing so please forgive me for that...

Aaron

Aaron IF you think the broken window theory really applies to nursing you probably won't get many replies here..



JMHO.. But we'll see...


WR,,, three commas for Becca

why is that?

Do you disagree?

how many times have you heard a nurse say they left their job because they thought their license was in danger at that place? ALL THE TIME!

Tell me those aren't the people who leave!

I do disagree because I think you can lead by example. And I believe that some people are never gonna change. No matter how much you try to change them.

I think the theory is one of self fulfilling prophecy and I don't want that in my life. Look for trouble and it will find you..

I would suggest another theory and that's the theory of attraction.. Wanting what you want and getting it.

I would suggest you read Excuse Me YOUR Life is Waiting by lynn grabhorn.

And I do think nurses are apathetic or they would defend each other but they don't...

JMHO..

WR,,, three commas for Becca

I don't think you will get much response because so many just don't care.. But we'll see.. We'll see if your theory holds true.. Maybe WE can prove it wrong..

Ya know many theorists just love it when they prove their theory correct.. After all isn't that the whole idea????

The theory seems to imply that upstanding people wouldn't trash a car without someone starting it.What the theory didn't explain was who was doing the trashing.. Could it have been the low life living in the area.. Maybe it wasn't the people who hadn't trashed it in the first place? Did they ever figure that out..


See, it's like some laws that are passed .. Every one thinks they are gonna solve problems. Now take the seat belt laws.. They do save money because people aren't in wheel chairs and unable to work and "taxing" the country with expensive care.. And besides the government seems to think it needs to protect it's people. And death has always been an unacceptable fate. But is it?? Is death worse for the dead than living? Or is it worse for the people left behind.. You loses?? Now one can say that seat belts saves the government and ultimately all of us money.. But let's look at it a different way.. Animals have a natural culling going on in their lives. Predators, diseases etc.. Now let's say that the car was invented to help with that culling process so we wouldn't overpopulate the earth. We have conquered many diseases, polio, smallpox etc that culled us previously.. But wait if all those people who should have died from diseases and car accidents etc don't die doesn't that put a huge burden on Medicare and our LTC and probably more of a monetary burden on us in the long run.. Think about it.. What appears as "good" may ultimately not be so "good"


WR,,, three commas for Becca

You're missing the point. It's about knowing right from wrong, but doing the wrong thing because it is "acceptable"

For instance:

A CNA leaves a resident in a wet bed for hours because she doesn't want to change them and knows she won't lose her job.

or...

The CNA knows it is unacceptable so she does the right thing.

The LPN doesn't do the wound care EVERY SHIFT because no one else ALWAYS does it and really, it isn't that big of a deal.

or...

The LPN does the wound care even though no one will find out if she did or not because that is the level of care that is called for and anything less is unacceptable...

I'm NOT going to work somewhere if the people on the other shifts aren't doing their jobs and the management won't fire them because they are short staffed.

I can't care for people 24/7...I can only care for them on my shift. It is up to management to make sure people are doing their jobs and when they don't have enough staff to begin with, they have to "settle"...

Therefore, you have to make the staff you DO have, realize that proper care is the ONLY OPTION...

wandering, your argument doesn't hold water. If you're going to say that then why don't we stop trying to find a cure for cancer, aids, diabetes, etc. because, after all, if we let everyone live, then there will just be too many people in this world!

Natural Selection and the food chain keep nature in check. The healthy survive because they can outrun their predator and the weak are killed off, strengthening the species...

I hardly think you can talk about humans in the same context.

So you are apathetic. You're gonna leave a patient without a wound dressing changed??? Because if you fold you let them know that it's ok too..


I do get the point .. The people who didn't trash the car lead by example.. Are you telling me that you know a CNA is not changing a wet bed and you are not doing any thing about it?? Are you telling me that you know anothe LPN isn't changing a dressing and you aren't doing anything about it.. YOU can't change a wet bed. YOU can't do a dressing change.. I've found in 24 years of nursing that when I do a better job those around me for the most part step up to the plate..

This is what I am saying you are looking for problems not solving them ... If you leave do you suppose that CNA is gonna change the bed now or that LPN is gonna start doing that dressing??? You are prepetuating the theory.

WR,,, three commas for Becca..

That lead by example is right. Some people are just plain lazy and will get away with doing as little as possible (that's in life not just in nursing) That's why there are supervisors around who should be telling them what to do. Some areas require less supervision then others.
If you are in that nursing home and in charge of those patients maybe you should be saying to that CNA several times a shift lets regroup what else needs to be done. Same with the LPN that is doing that dressing change. Have you asked those people why things aren't getting done? Maybe they have more on their plate then they can handle and need help but won't ask or maybe they are just putting it off.
The laziness is in every job not just nursing, but I've found that if I say come on let's (us) go change this bed, time for vitals, etc etc then the lazy do get moving more.

You are so right Cass you get what you expect out of people.. If you don't expect much you won't get much. As Dr. Phil says people treat you the way you allow them to treat you..

Interesting 54 views on this thread and How many posts??? So far......


WR,,, three commas for Becca

It doesn't happen when I'm there...That's my POINT!

You're still missing the big picture. Stop looking at just one place. Obviously, I can't work in every facility in the country.

So you are going on hearsay.. HMMMMMMMMMM interesting.. If you can't work there DON'T... Simple as that.. Like you say you can't work every where..



WR,,, three commas for Becca

I still see flaws in the theory.. I think it's looking for trouble and they found it. Like Cass says I can't believe the police allowed this to happen in Palo Alto. I smell a rat....

Wandering, you are still being myopic. Look at the big picture. I'm trying to paint an example...

It would be easy to prove without hearsay by looking at a dressing with an old date on it...

I believe putting people in a group is quite myopic too..

A date is easily changed on a dressing.. Doesn't mean it was done.. Just take off that piece of tape and put on another with a new date..

Did you expect nurses to be perfect?? Maybe if you had just stated your problems with this job it would have been better.. The Broken Window Theory just doesn't fly with me..


WR,,, three commas for Becca

I don't believe alot of people follow the crowd .. If I lived in Palo Alto I wouldn't have trashed the car even if it had a broken window..What this proves is that there will always be people who don't have any character. It doesn't mean that people follow the crowd.. I still say it might not have been the people of Palo Alto..

okay, first of all, I don't have problems with THIS job. This job is great. I just listed one example in this job, that worries me. If you read, I stated that this facility is a good one and takes good care of it's people.

Now, if you change the date on a dressing, but don't actually change it, that is like vacuuming your house but not turning on the vacuum cleaner--which is totally idiotic.

I am pretty sure this is what happened with you. You read the theory, and instead of putting some thought into it, decided it would be easier to shoot it down. Now, you are working very hard to defend a very weak argument...

Regarding people following the crowd. The theory states that not everyone would go for this...

Listen, instead of looking at a 24 hour period and thinking what you would do, look at it in terms of a 10 year period...

HUH?????

WR,,, three commas for Becca


Why did you need to throw out the theory to begin with. I don't believe it applies to anything other than the theorists need to be "known".. I don't believe one apple spoils the barrel in relations to people ..We are not apples.. My intent here was to see if we could prove your theory and so far we haven't.. No one is flocking to the kill here or the broken window as you state.. They are here by the numbers but not doing anything.. I wonder how many people saw that broken, trashed car and passed it by without contributing.. Did the theorists tell us that.. And in Palo Alto it was probably a great number...HMMMMMMMMMMM


WR,,, three commas for Becca


You said you could NOT work somewhere that had employees as these or did I miss something?

But I have seen it done.. Real easy to just pull off a piece of tape and write a new date on it.. Helps keep your job...

OH I have put much thought into it.. I wonder how much you have put into it.. YOu just accepted it as true. And I didn't... I don't often accept theories.. They are so easily shot down.. I don't believe mine is a weak argument. You haven't answered many of my questions.. Why did the theorists have to break the window ..They already found that the people of Palo Alto weren't gonna do it. And how do we know if the people who wouldn't do something first did it after the window was broken.. I just think the theorists had a hypothesis and they maniputlated the experiment to get the outcome they wanted.. And you say there is only one LPN and one CNA not performing up to snuff so how are they perpetuating the theory..Seems they don't have many followers.

WR,,, three commas for Becca

Aaron there used to be a theory that the earth was flat..Heck some people still believe it.

Ya know I think the "I'm gonna lose my license" is a cop out. I think many don't want to work or don't like their schedule and that's the easy way out.. What about all those who stay??? are you saying they don't have a clue as to the seriousness of the situation???

Please....


WR,,, three commas for Becca

What I said was what we think the outcome of somthing would be doesn't always come to fruition..Seat belts were really meant to save money not lives. But in the end they don't save money by allowing more people to live..That's the crux of the matter.. It was never about saving lives.. It was about the God almighty dollar...

WR,,, three commas for Becca

Saying the seatbelt law was for saving lives was for saving face....

not that this is the case but have you ever not been able to get something done that you'd planned to so you delegated it to someone else or told the oncoming shift then when you come back the next day it's not done so whose "fault" is it? I've taken care of patients that never had a dressing change in the hospital (when I did home health) or had them come from LTC to the hospital with a big sore that you know didn't happen overnight but you're the 2nd or 3rd shift to get that patient and you can't find anywhere any documentation about any wound.

You know I work a unit were most patients are pretty self sufficient so when a doc called ranting because a patient had a dressing on for 2 weeks when they came to see him after discharge nobody had told the lady to take the dressing off to shower she'd just left it on and showered for 2 weeks and put more tape on it. I guess whoever got her up the first day redressed the incision and then whoever did the discharge didn't think she would leave a dressing on in the shower. So you can never 2nd guess what someone else thought or their reason for doing so.

Good morning SHORTBUS!

Hay bud I understand what you say about the broken window theory. I have studied it in environmental psy.

And yes, it sure does apply to nursing. If you do not take care of the problems and fix them when they start, they become the norm and part of the organizational culture. Once that happens the wrong becomes the norm. I have seen nurses get in trouble for attempting to change unit cultures and fix problems. Why? Because they were acting out of the norm even though the norm is disfunctional.

The only why to change a disfunctional culture, is to have new management and use a Macavelion management style. DO IT RIGHT OR OFF WITH YOUR HEAD. It all starts with management or should I say Leadership.

If your are in an organization that is disfunctinal, GET OUT.

So are you saying leave a sinking ship..How does leaving fix the problem? Do you suppose those other nurses are gonna say..OMG he left I better do my work???? Apathy.. And you think people would work in a dictatorship?


Wow that surprises me of you...



WR,,, three commas for Becca

You paint a very negative picture of nursing.. That we are no better than low life who would break windows just because they can..We still don't know from the theorists that the up standing people of Palto Alto trashed that car. I don't see that at all.. I say if you expect nothing you get nothing.Is that your expectation of your fellow nurses.. Yes, there will always be lazy no good nurses.. We are human, remember. And you don't win if you just leave because the next place you go you'll find another one. I see it in travel nursing. Having worked from Maine to Cali and several places in between and ya know what... they don't last long.. I think good always wins... You just have to be strong..

JMHO..BTW...

There's another theory... You catch more flis with honey than vinegar...................

Ya, leave a sinking ship if you like you license or you like beating you head agents the wall.

The license losing thingy is a cop out... OMG..How do you lose your license because a nurse on a day you didn't work didn't change a dressing or a CNA didn't change a bed???


So leave but don't lump the rest of us into a barrel we don't belong in....

WR,,, three commas for Becca

Ever hear of an incident report?

I GIVE UP!!!!!!!!!!!

If every nurse who said she didn't want to WORK some where and I believe that's what it amounts too most of the time,, we'd have a real nursing shortage.. How do you account for all the nurses still working someplace that another nurse was a afraid of losing her/his license left??? Are they all wearing rose colored glasses or stupid??? I don't think so...

So are you saying you haven't heard of an incident report??


WR,,, three commas for Becca

I suppose you "guys" believe that violent video games or TV programs don't cause violence.. $$$$$$$$$$$$$ talks..



WR,,, three commas for Becca

Boy how I agree. I was working in a nursing home and asked someone to feed another patient their thickened fluids. She doesn't want it,she said. I told her to go back and try her on thickened water with cordial and I will be along to see how you're going! I hate laziness. This person does 2 showers to everyone elses 6. I am only a Nursing assistant but in my last year of nursing degree. I hate picking up the slack for others but I want the job done..so guess who does it. Because to me it's more than just a wet sheet, or a feed and sometimes these old people just don't have any other comforts. In six years of nursing I actually reported two nurses because I wasn't sure which one was the lazier
and I was fed up with carrying them the entires shift.thinks aren't much different in Aussie.
trier

Your analogy to the "broken window theory" and some of the unacceptable practices in LTC was an interesting one. True the DON and administrator set the tone. They have to lead by example. They have to have a monitoring system that provides feedback. It is the DON's and the Adminstrators responsibility to communicate to the staff what is acceptable and what is not and to impose consequences as well as positive feedback as they see fit. The supervisors of every shift need to do walking rounds and check the residents. They need to communicate to the staff any problems they might find and offer suggestions so that they can be corrected. Then they need to go back and make sure the problem was addressed. If an LVN for example is not doing her treatments the person in charge needs to follow the discipline policy outlined in the employee hand book. Most problems develop for one of two reasons the number one issue is understaffing and the other one is lack of supervision.

This is so correct. Some one must set the standard to what is acceptable and enforce it with consequences. NO Matter WHAT THE SITUATION. This can also apply all the way down from children up to communities. IF the standards are set and enforced people will understand what is accepted. But then, you always have that 10% theory. That is some thing I learned in the USMC. No matter what, you will have 10% of people, in any culture (LTC, Hospital, School, Unit or Department.) in non-compliance of the accepted behavior.