RSSArchive for October, 2011

Kathleen Bartholomew, RN, MN, answers questions about ending nurse-to-nurse hostility

Kathleen Bartholomew, RN, MN, dared to ask the question, how can a profession that is based on caring include such uncaring behaviors? Her powerful research exposes the toxic relationships and bullying behavior that causes nurse burnout and threatens patient safety. Here’s a question and answer session where she offers practical advice to real-life problems.

Q: It’s often easy to point out the shortcomings in others. What do you do for people to help recognize and overcome their own bad behaviors?
A: Peer evaluations are effective, but a critical conversation is the most powerful tool both peers and managers have. I ask, “What do you do well?” “What would you like to do better and how can I help?”

Q: What is the most important thing we as nurses can do to turn around toxic work environments that are deeply rooted in bullying and disrespectful behaviors?
A: SAY WHAT YOU SEE. Your voice is your power. These behaviors will be NORMAL until someone stands up and says, “Hey, this is impacting the patients and morale. This needs to stop.”

Q: Any suggestions on how to handle shift-to-shift complaining and bullying?
A: I know this one is hard. When I was a manager, no amount of teaching or counseling could change the shift-to-shift so I asked the nurses to switch shifts for a week. Then I never heard another word. The “walk in their shoes” experiment also worked for nurses complaining some floors were easier. Next, I worked closely with the charge nurses and gave them the knowledge, skills, and confidence to stop these behaviors when they saw them (that took almost two years).

Q: Have you actually seen the “turnaround” of a bully in the workplace work other than dismissal of that employee? Isn’t the bully in a person part of their personality trait?
A: Great question. Personally, it’s been 50/50 in my experience. And if you are a leader/manager and start drawing the line, there is a high chance of the bully going on FMLA/being injured etc.  It takes a lot of people skills to turn them around because if they are not going to be the bully, then who are they? How do you create an alternative role for this nurse in the unit? Also, don’t think of a bully as an individual problem. It’s the unit’s problem because many nurses have tolerated the behavior for years (even decades).

Analyzing nurse staffing: Understanding FTEs

Staffing: what a problem! Developing and monitoring the staffing budget is one of the most, if not the most, difficult responsibilities of the nurse leader. Labor consumes the majority of the financial resources of the organization. Therefore, everyone must act responsibly in order to ensure the financial health of the organization. But how do you know how many staff you need on your position control in order to meet the needs of the department (not too many, and not too few)? That is a $100,000 question! [more]

Performing a SWOT analysis

One of the most important, although sometimes time-consuming, activities that are frequently completed in financial planning sessions is the Strengths/Weaknesses/Opportunities/Threats (SWOT) analysis. This analysis can be useful in many problem-solving situations that you may face. The SWOT exercise may seem very time-consuming; however, this planning will again help direct where resources are needed and to what extend the resources should be allocated.

As a nurse leader, sometimes you may be part of the group being asked to identify SWOT. This selection usually occurs if your director or vice president is conducting the session and you are a group member. In working with just your area of responsibility, you might be the leader guiding your direct reports through this exercise. In both cases it is important to understand the SWOT analysis to gain the full benefit.

Strengths are what the organization, division, or department identifies that they do well and have success in above the competition. When identifying strengths for your organization ask yourself: “What would the community say that we are best at providing?” The answer to this question will help you get started with your list. Maybe it’s your strong orthopedic program and the total joint camp that you’ve developed. Maybe it’s the great oncology doctors that you’ve been able to recruit. This list should include both internal and external views. Here are some other examples of possible strengths:

  • Strong name recognition of the organization
  • Stable workforce
  • Strong succession planning
  • New facilities
  • Private patient rooms
  • Strong financial position
  • High-quality care delivered

Weaknesses, of course, will be just the opposite. The weakness assessment should openly and honestly describe what the organization currently does not do well or is seen as a weakness to achieving the desired goals for the organization. Weaknesses are identified by asking the question: “What currently causes us trouble in providing the exceptional patient experience that we strive to provide?” [more]

Determining financial goals and objectives

It is common for highly driven organizations to develop goals and objectives annually. In healthcare, just as in many businesses today, rules, regulations, customers, workforce, and technology are changing at such a rapid pace that it is impossible to effectively operationalize goals for further than a one- to five-year period. At the senior level of leadership, goals are developed in conjunction with the board of trustees and senior leaders of the organization. A complete assessment of the community, the patients, physicians, employees, and services is reviewed.

In addition to internal assessment, much attention should be paid to external factors affecting the organization. This is important in every market but particularly important in markets with more than one facility that offers similar services. If the competition across town is the known market leader in one service line, does it make sense to compete for the patient population? In some cases the answer to this question will be yes, and in some cases the answer will be no. Some of the factors affecting this decision include:

  • Number of patients in the market
  • Quality of the competition’s service
  • Expense to provide the service
  • Reimbursement for the service
  • Projected life of the technology or equipment

Let’s assume that your competitor is providing a very highly specialized cancer radiation treatment program. [more]