In the 1990s, health management reduced staff rather than perform the precise surgery needed to reduce waste. And now is the right time for healthcare organizations to take better care of one of their most important resources – their nurses.
Create Bridges Between Management and Nursing
Our value statements influence strategic planning because they are the result of employee decisions and behaviors. Long-term strategic goals: Long-term goals are a measure of departmental and organizational efficiency.
Prepare Staff for Strategic Planning
We obtain leadership input through formal meetings and quarterly retreats where we critically review where we are going and how we are going to get there.
Vision Statement
Guiding Principle s
A greater proportion of hours of nursing care provided by registered nurses and a greater number of hours of care provided by registered nurses per day are associated with better care for hospitalized patients. A greater number of licensed nursing hours per day was associated with a shorter length of stay among medical patients.
First-Order Problem Solving
Researchers at Harvard Business School looked into these issues and came up with the following results. We are repeating the same mistakes over and over again, a very wasteful and unsafe practice.
Second-Order Problem Solvin g
If a nurse runs out of towels, for example, they can be borrowed from someone else. It can also create a problem for someone else because the department where the towels came from may run out of towels.
Why Is This Study Important?
Many healthcare organizations are just like the nurse who borrowed the towels and never learned why there was a shortage. Organizations poach nurses from others without using second-order problem solving to diagnose the underlying cause of why their nurses are leaving.
Implications about Safet y and Quality
Ideas for Positive Chang e
As a result, many poorly treated but caring nurses have left healthcare for other work. Smart nursing strategies allow you to make the most of scarce healthcare resources and do more with less.
How Managers Can Encourage th e Critica l Thinking of Clinical Nurse s
How Clinical Nurse s Can Cultivate Critical-Thinking Skill s
Rigidity Is Expensive
Patient Dissatisfactio n
The Patient's Perspectiv e First Scenario
Jones will likely eat even more after his stay in the long-term facility ends. I had to fight strong battles for privileges that are taken for granted in the real world.
Times Are Changin g
Following hospital policy to the letter and denying Mitchell a hotline sabotaged this goal and would have decreased his mental and physical functioning, the opposite of his plan.
Clinical Nurse s and Staffing Flexibility
But she also knows that the patient's acuity is very high, and if she agrees to a task that is too difficult, she risks making serious mistakes. Sally knows that if she is too flexible, management will not address the root causes of the staffing problems and she will end up enabling a dysfunctional system to continue.
A Manager's Perspective on Staffing Flexibility
Although Sally wants to be a team player, she knows that these types of situations happen often, resulting in a vicious cycle of nurses burning out and seeking another career.
Obsolete Power Structure s
Exploitation
If they decide to take a stand, they will have to choose the best way to be effective. And they will also have to decide if they are willing to accept the possible consequences.
Peer Pressure
However, comfort zones eventually become more like a prison when people constantly refuse to accept new experiences and opportunities. As health care changes rapidly, nurses who refuse to change may find their employment opportunities greatly reduced because their skills no longer match the needs of patients.
Create Flexibilit y
Encourage a Healthy Work/Life Balance
Offer Self-development Opportunitie s
It is time for healthcare organizations to respond to our rapid changes in society and technology and be more flexible. Remember, relationship building is one of the best free strategies for improving health care. Healthcare companies need positive organizational cultures because well-treated employees promote patient satisfaction.
The Benefits of Learning Organization s
Managers, who have denied the severity of the nursing shortage in the past, must now pay attention to nursing perspectives. Most nurses are proficient with informal nurse-patient communication, but may need to expand their repertoire of some or all of the following skills. Amy had the opportunity to showcase her communication skills in front of most of the senior managers of the company.
Writing for Publication
Amy's manager planned to host a retirement party for a high-level manager, but was called away due to a serious family illness. Shortly after Amy's successful hosting gig, she was given the opportunity to expand her management skills by rotating into several key corporate positions. Following her positive performance in these roles, Amy received a promotion to a key, high-level management position.
APPLYING COMMUNICATION SKILLS
If you're having too few informal conversations with nurses, improve your availability by scheduling non-structured time to talk to your staff. When no volunteers showed up, she asked them this question: "If you were going to bring refreshments, what would you bring?" She then asked the group to vote on their favorite choice for refreshment. If you divide your energy into small pieces, you may not be able to achieve your most important goals.
STAFFING CHALLENGES
Instead of taking the necessary time to arrange adequate staffing, many organizations abuse mandatory overtime because it is convenient. When our coercion of mandatory overtime forces nurses to choose between being a responsible parent and remaining in their profession, there is nothing terribly wrong with a system that requests such a choice. The real problem is that nurses are unable to improve their situation and are worn down by mandatory overtime and unrealistic staffing ratios.
Inadequate Staffin g
A 3-to-11 nurse in a long-term care facility receives a report from a nurse at 3 p.m. Staff turnover at Wilma's long-term facility is very low and staff function as surrogate family members. LPN's head nurse, Sandra, knows both Wilma and her daughters well because she is a permanent employee.
Unlicensed Staf f
She anticipates the kind of information that family members need to know and calls them periodically. Wilma's daughters are very grateful that Sandy provides such personal care and keeps them informed about their mother.
Critical Care in the "Business as Usual" Culture
Critical Care in a Staff-Friendly Culture
Home Care in a Staff-Friendly Culture
However, when she calls her home care office to report delays, the supervisor lightens her patient load so she can provide all patients with quality care and stay healthy herself. The supervisor knows that one nurse had a cancellation and another had a light patient load that day, so she rearranges the patient assignments. Medical-Surgical Care in a "Business as Usual" Culture (Note that medical-surgical units now care for acute and complex patients who would have been in the ICU 10 years ago.).
Psychiatric Care in a "Business as Usual" Culture
Psychiatric Car e in a Staff-Friendly Culture
Reputation in society is one of the factors that influence where nurses want to work. Nurses do not apply if they know that the glowing words in the ads are a hoax. They may know from conversations with other nurses in the local community that the facility is severely understaffed, that care is unsafe, or that they will be treated with disrespect.
View Your Nurses as Asset s
Document Nursing Value Quantitativel y
Autocratic management styles are still quite common in health care and have contributed to the nursing crisis. You get ahead of healthcare change when your staff members have habits of lifelong learning. The anger I felt, and continue to feel, about the attacks on the World Trade Center was healthy—the challenge was to put it to work in ways that would make me a stronger, better leader.
5 Ways to Use Coaching and Mentoring to Retain Employees
Health care managers without clinical experiences need the perspectives of clinical staff if they are to be effective leaders. You can use this process to turn healthcare challenges into opportunities by creating your own innovations. Review some of the following health care challenges: safety, role change, productivity, and innovation.
Role Change
Nurses know that patient care success depends on framing their explanations in terms of the patient's point of view. Cost cutting may be necessary, but nurses can best advise their organizations on where to make the cuts without reducing the quality of care. Frame your requests in terms of benefits to your organization, and show that your requests bring value.
Productivity
Nurses who advise their organizations are able to identify new services that patients need. For example, this could be a good opportunity to launch a new transport service or add stops to an existing one. What we need is more collaboration between nurses and managers to find ways to improve nurse productivity without increasing the rate of medical errors.
Innovation
Health care problems are an opportunity for nurses willing to work toward positive change. The stakes are high: Health care costs are rising, and the medical error rate has increased. Without better outcomes, Americans may prefer that a single, non-profit agency administer health care.
Benefits to Consumer s
Benefits to Physician s
Benefits to CEOs and Trustee s
Benefits to Managed Care Professionals
USING SMART NURSING TO ACHIEVE THESE BENEFITS
According to another Modern Healthcare article (Tieman, 2002), more than 30% of nurses have known a nurse who quit because of poor physician treatment. Ronstein said 92% of respondents said they had witnessed disruptive behavior by physicians, such as inappropriate conflict involving verbal or even physical abuse of nurses. Several doctors have asked me to include some ideas for them in this book because many doctors have become just as disillusioned with the health care system as nurses.
How Physicians Ca n Raise Their Own Satisfaction
How Physicians Can Raise Nurse Satisfactio n
Consider the following example of a physician using nursing data to improve patient care: A nurse notices that a psychiatric patient appears anxious. He reviews her medications and finds that she has medications available to relieve her anxiety. He contacts the doctor and requests a lower dosage of the medication so that his patient can relieve her anxiety and also attend groups.
Patient Safety
Health care needs nurse education programs that prepare new graduates who are able to function well in their first job. One cause of the nursing shortage has been that many health care organizations have viewed nurses as all the same. It has been my experience that you will find something useful about health care in every single book.
Reframe Your Perspectives
Look for Ways to Add Value to Your Organization
Focus on improving your critical thinking skills so that your suggestions become pathways to the future instead of retreating into the past.
Initiate Partnerships with Management
Be Business Savvy
When staffing is insufficient, point out (in business terms) that your facility can no longer afford the financial loss caused by short staffing. Short staffing forces nurses to find other jobs or leave the healthcare industry for good. Frontline employees are entrusted with the responsibility of satisfying customers because they have the most customer contact.
Be Accountable
