Incrementalism: bad or good?

What is incrementalism? Merriam-Webster defines it as a policy or advocacy of a policy of political or social change by degrees: gradualism. Why do we as nurses need to be aware of incrementalism? Because it’s a double-edged sword and it can cut deep.

On one side it can look like small, seemingly inconsequential takeaways at the bargaining table. Slight changes to the language surrounding how and when you are afforded time with your union rep during orientation, or whether you must click just one or two more boxes in the electronic health record. It can look like the RN needing to stock their own carts and linen, and it can look like joining a committee is “optional.” Not that big of a deal, right? Wrong. That’s what they want you to think. This approach to change is effective and dangerous.

These scenarios can gradually diminish your ability to safely perform the work you trained to do by overburdening you, under informing you, or just plain excluding you when your workload is being assessed. The concepts of “the nurse is there, let them do it,” or “a nurse, is a nurse, is a nurse,” or “they’re busy, we can decide without them” can have devastating workload and safety implications.

There are not enough hours in the day to complete all the tasks being assigned to nurses. Cutting other skilled staff in favor of reallocating those functions to the nurse because they are already there is a shortsighted and dangerous management practice. Also, nurses are the experts in nursing practice and should be at the table where decisions are being made. Both practices are disrespectful and unacceptable management behavior. It’s what is driving some from the profession and creating a shortage.

The good news is that the other edge of that sword cuts the other way. We as nurses have the power to push back against these policies little by little, step by step. We have not only the privilege to advocate for our patients, but also the obligation to advocate for ourselves. If you are not practicing in a safe and sound manner, that means your patients are at risk as much as you are. What can you do about it?

1. Pay attention. When a communication comes from your employer or your union, read it closely. All of it. Every time. Many of these policies or practices are hidden in otherwise innocuous communications and can be easily overlooked. Or they may appear to be nothing big. “Just do this and you’ll get that” is one way to slowly waive your rights. “Wear a button to support your team” is one way to fight back by showing you stand together.
2. Think critically — we’re all trained to do it. You should be comfortable applying this skill to your workplace as well as to your patient care. Both are equally important. When something sounds off, pay attention. If someone else says it sounds off to them, listen carefully.
3. Get involved. When something doesn’t sit right with you, don’t just complain, do something about it. Show up and shout out. Work to fix the problem by utilizing the tools at your disposal. Many of them are guaranteed by your union contract.

The point I’m trying to get across is that as much as there is a slow erosion of our labor rights and our practice happening in our profession, there is equal opportunity to fight back. You are the solution. If we stay aware, stand together and think critically, we can protect not only our patients, but our practice and our profession too.