By now many of you have read about Vanderbilt University Medical Center’s new policy requiring nursing staff to perform janitorial tasks.

Many points have been raised including the possibility of cross contamination (scrub a toilet, administer IV meds – what could go wrong?) There’s also the illogical decision to eliminate lower paid employees and reassign their tasks to higher paid employees (staff retention, anyone?) But probably the worst aspect of it, as NotRatched points out, that lately nursing seems to be a dumping ground for extra tasks and responsibilities.

One thing that particularly bothered me was that Vanderbilt nurses were told to “refrain from speaking negatively about this in an open forum where our customer can hear.” So in other words, be quiet and do your job. Whoever wrote that must have a very limited view of how information is transmitted these days. When an unpopular policy is enacted, word gets out, and it spreads quickly. It’s unrealistic to think your employees aren’t talking about it, and pretty much everything is an open forum these days. Sure, you can have an explicit social media policy, but you can’t stop people from sharing information anonymously.

The other thing that troubled me was this: “The priority will be what the patient sees.” That’s kind of implying that there will be other messes that employees won’t be able to get to. Don’t worry about the messes that are tucked into a corner, or hidden in a closet. A nice dark closet, perfect for breeding aspergillus.

To be fair, Vanderbilt has responded to comments on their facebook page. But their twitter account has remained silent on the matter, and that’s where a lot of the sharing and discussion is occurring. Is this deliberate non-engagement, in the hopes that the discussion will die down? If so, perhaps they are savvy, because these things do have a way of dying down. But maybe the Vanderbilt web strategy team simply never had to face a situation like this, and are wondering what to do.

This is the important thing: A discussion has opened up and nurses need to lead it. We all know the situation. The economy is still sputtering. Employers in all industries are in a position to dump extra tasks on employees, knowing that the job market is still lackluster. The Affordable Care Act, while providing affordable care to more people, is completely disrupting the hospital revenue model. And no, this isn’t going to be a discussion about why admins and CEOs should make less money. Cut their salaries and they will leave the health care industry for better pastures. This is a discussion about how hospitals are going to prevent their doors from closing. But the cost-cutting decisions don’t need to come at the expense of nurses. Nurses need to stay on top of these policy changes, and start thinking about how we can improve the care model. How can we as nurses create innovations to make patient care more efficient?

Believe me, we need to start answering these questions immediately. Otherwise you will find yourself standing there with a dirty mop in one hand and a handheld device in the other displaying your patients vital signs and you’re going to be asking, “How did I get here?”