I'll spread my wings
And I'll learn how to fly
Though it's not easy
To tell you good­bye
I gotta take a risk, take a chance, make a change
And break away ~Kelly Clark­son, Break­away (Writ­ten by M. Gerrard/B. Benante/A. Lavigne)

€I gotta get out of this place€, Steph moaned, €It's dri­ving me crazy!€

Stephanie, a senior nurse at my hospital's endoscopy unit, gen­er­ally rock solid and unflap­pable, was being chipped away. She had devel­oped a far-away look in her eye€" noticed after sev­eral endo­scopic episodes of repeat­ing the word €open€ to her deaf ears. We cor­nered her over lunch to con­duct the inquisition.

She spilled the beans, unwrapped the whole enchi­lada. She told the table that her fam­ily and friends had started point­ing out to her that every evening she would fume and rant about her day in Endoscopy. How the SAU treated Endoscopy like an ugly sur­gi­cal step­sis­ter. About unre­al­is­tic, over­loaded Endoscopy sched­ules. And about her col­leagues who she felt rarely said thank you or paid back call-related favors. She was over it.

So she'd started to look for some­thing dif­fer­ent, some­thing bet­ter. Oth­ers, who also noted her dis­tress, began to court her for their office endoscopy suites. And she was now ready to break away.

€Too late€, I mused. €Man­agers often don't notice €til staff passes the €Stick a fork in me, I'm done€ stage.€

I had pre­sented on €GI Nurs­ing: Cure Your Reten­tion Deficit Dis­or­der€ at SGNA'sMinneapolismeeting. It was directed at enlight­need man­agers. Man­agers that real­ized that there was a prob­lem before the wheels fell off the endoscopy cart. But how might unhappy staff give an over­whelmed man­ager some clues about the health of the unit before it exsanguinated?

A healthy staff is €engaged' rather than sim­ply €satisfied'€¦that is, staff who want to come to work for the recog­ni­tion, for the team­work, for the friend­ship. The Gal­lop orga­ni­za­tion devel­oped a twelve ques­tion sur­vey as a sphyg­mo­manome­ter of staff engage­ment, pub­lished in €First Break all the Rules€ byrnesmedia.com/articles/breakingtherules. The actual Gal­lop sur­vey has you rate each ques­tion on a one to five scale - but to heck with that€"just give me a straight yes or no for each of the ques­tions, adapted to the health­care work­place. To how many of Gallup's 12 ques­tions (Q12) of employee engage­ment can you answer yes?

‚· Do you know what is expected of you at work?

‚· Do you have the mate­ri­als and equip­ment you need to care for your patients?

‚· At work, do you have the oppor­tu­nity to do what you do best every day?

‚· In the last seven days, have you received recog­ni­tion or praise for doing good work?

‚· Does your unit direc­tor, or some­one at work, seem to care about you as a person?

‚· Is there some­one at work who encour­ages your development?

‚· At work, do your opin­ions seem to count?

‚· Does the mis­sion of your unit make you feel your job is important?

‚· Are your fel­low health care work­ers com­mit­ted to pro­vid­ing qual­ity care?

‚· Do you have a best friend at work?

‚· In the last six months, has some­one at work talked to you about your progress?

‚· In the last year, have you had oppor­tu­ni­ties at work to learn and grow?

Got your number€¦now what? We'd rather your score be higher rather than lower. There is no cor­rect num­ber, no expec­ta­tions of a per­fect score, and no cut off num­ber above which you're per­fectly con­tent. I have not yet found a job, nor will my own employ­ees attest to, a score of twelve.

Assum­ing a score less than twelve, there's room for improve­ment on your unit. Now's the time to give your own man­ager a gen­tle nudge, or even a 2x4 to the nog­gin, that things are unwell. I encour­age you to fol­low the exam­ple of Mr. Natha­nial Hawthorne.

Those who know me, know that I groove on applied trivia. My sum­mer read­ing right now is A. J. Jacobs' quirky €The Know It All€, in which Jacobs high­lights amus­ing points in his read­ing of the entire Ency­clo­pe­dia Bri­tan­nica. The EB dis­closes that toward the end of his life, our ven­er­ated Amer­i­can author Mr. Hawthorne €took to writ­ing the fig­ure €64' com­pul­sively on scraps of paper.€*

Take your own non-identifiable scrap of paper today (no per­son­al­ized let­ter­head rec­om­mended), and write €Q12 = your num­ber€ on it, then sur­rep­ti­tiously put it in your unit manager's box right now. If you think it will not be under­stood (your man­ager fool­ishly not being an avid reader of this esteemed pub­li­ca­tion), make a copy of this arti­cle to which to clip your scrap. Fire a warn­ing shot across his or her bow. Make your dis-engagement a scar­let let­ter. Likely you will then see changes. Why? Because all man­agers are aware that an ounce of reten­tion is worth a pound of recruiting.

First, try to fix your unit's cul­ture. But if you can't, dare to break away.

€Twenty years from now you will be more dis­ap­pointed by the things you didn't do than by the ones you did do. So throw off the bow­lines. Sail away from the safe har­bor. Catch the trade winds in your sails. Explore. Dream. Dis­cover.€ ~Mark Twain