RSSAuthor Archive for Administrator

This post was compiled by members of the Strategies for Nurse Managers staff.

Quality improvement through auditing

by Deanna Miller, RN, MSN/Ed, HCE

Okay, so as managers we all know what audits are and what data collection means. We audit the charts, we collect the data and we graph the statistics. Where is this really getting us? After we analyze what we have collected we recognize areas that need improvement and then we relay this message to our staff along with a plan. Sounds great, but does it really work?

Recently, I have given a couple of my nurses “paper days” and provided them with the audit tools so that they could audit and collect the data. It was astonishing to see them come to me with eyes and mouths wide open. “I didn’t realize that we had such a problem.” “Oh my gosh, does anyone chart anything?” These are just a couple of the responses. My next step was to have them develop an improvement plan. The results have been incredible…..

Try it…it really does work.

Calming the hysterical

by Deanna Miller, RN, MSN/Ed, HCE

The other day I was spending much of my time out on my Medical Surgical unit because of an increase in census and acuity. As I was walking down the hallway one of my seasoned RN’s approached me with eyes bugging from her head and the fear of the unknown on her face. Before she could say a word I asked her, “What’s wrong?” As she wiped the beads of sweat from her brow she stated, “I have been trying to get that PCA pump to work for the past half hour and I just can’t get it to infuse.” She was frustrated, agitated and I knew that the patient was having to observe this during her entire time of troubleshooting that darn PCA pump.

I asked the RN to remove the pump from the room and bring it to the medication room so that we could trouble shoot together. She obtained the pump and we did work it out. My words of wisdom were these; if you are having difficulty with a piece of technical equipment in a patient’s room and you are not able to resolve the problem quickly, sometimes it is good judgment to remove the equipment from the room, if you are able. Work on it in another area. Reason: Your frustration may be perceived by the patient as hostility, lack of knowledge or frustration. You can also take a minute and get a cold beverage……Have any of you experienced the same?

Managing those “special” requests

by Deanna Miller, RN, MSN/Ed, HCE

We have all had our staff come to us because of a special need or request. Perhaps they need a day off for an event or opportunity that could not be planned ahead of time. Maybe their child is ill and needs to be taken to the doctors, or the parent of a staff nurse’s boyfriend dies and it is not covered under the facilities bereavement policy. How do you handle these. When I was a new manager I can remember not making any exception and following the “rules” to the T. Over the years I have learned that, just as in nursing practice, I must think outside the box when handling the personal issues also. Here are my decision process steps for those personal requests:

  • I first place myself in the shoes of the requester. How would I feel if I were in their predicament.
  • Is it a “Once in a Lifetime” opportunity?
  • Will saying no have a negative affect on the emotional or physical well-being of the requestor or their loved ones?
  • How will it affect my unit if they are absent and do I have alternative to replace them during their absence.

Having a heart and being fair exposes the “human” side of you. This helps to gain trust and comradery. How do you handle the special requests of your staff?

Promoting evidence-based nursing practice

by Deanna Miller, RN, MSN/Ed, HCE

Recently I discovered that some of my nursing staff had decided that they would no longer utilize filter tubing with central lines. Because the facility policy did not state “to use” or “not to use,” I could not refer them to policy as a directive or a guideline. There were other staff nurses that were fit to be tied because of the non-use. The debate began. My final words were these: “Bring me the evidence that states “to use” or “not to use” and we will make the determination together.

I am a huge proponent of autonomy but weeks went by without any evidence being provided to me. This had to be settled once and for all. I finally contacted an acquaintance from the Nursing Infusion Society who was able to give me the information and the “Evidence” that I needed. I then provided the information to my staff nurses. They were astonished that this type of information could actually be found so easily and it triggered their curiosity. My plan is to challenge them weekly with a question to be answered with “Evidence.” If you can give me the evidence, we can change the practice …

How do you get your staff involved in EBP? Share your ideas.

Engaging the unengageable

by Deanna Miller, RN, MSN/Ed, HCE

As managers we often hear the terms “engagement” and “employee satisfaction” interchangeably. Even though you are a great manager and truly care about your staff it is often difficult to get them motivated and engaged in what they are doing. I was off on leave for about a month and during that time period I continuously brainstormed to come up with interventions to “get them engaged.”

Here are my secrets to successful engagement….please share yours.

1. Eat lunch with your staff with an “anything goes conversation.” (They love seeing that even the manager is human…it has proved to be a blast)

2. Plan an outing away from the facility. (I have planned an early dinner at a nearby lodge on two consecutive Fridays so that everyone can come regardless of scheduling. Budget for special events)

3. When they bring concerns, work related or personal, listen to them and make great eye contact. Always keep those personal conversations confidential.

Take the fear out of performance reviews

Nurse managers and staff communicate effectively every shift, about a number of topics, and usually with little anxiety. But put staff performance up for discussion and the tension rises.

Performance reviews are critical to staff development; therefore nurse managers need to know how to minimize this tension and make them as productive as possible. To conduct the most effective and painless performance reviews, follow these tips:

Remove the shock. The feedback given in a performance review shouldn’t be a surprise. Make sure you communicate and provide staff members with constructive criticism throughout the year, instead of springing it on them all at once. Also, never miss an opportunity to let staff know when they set a positive example for your facility. For example, if you notice a staff member has done well during the past few months, pull him or her aside and tell them how much their good work is appreciated. In doing so, you will minimize the chance of the employee getting defensive when you discuss areas that need improvement and they will know their hard work is not going unnoticed.

Give them time. Performance reviews are most effective when both the nurse manager and the staff member prepare for them. Inform employees of their performance evaluation at least two weeks ahead of time so they can organize their own materials, such as an informal evaluation of their performance or a list of goals they wish to achieve in the future. Employees will arrive for their review collected and more open to discussion.

How do you reduce staff anxiety during performance reviews?

Read more tips on conducting performance reviews.

Rev up your resume

by Phyllis Quinlan, RNC, MS, CLNC, CEN, CCRN

I am frequently asked about the best way to revise a resume. Many nurses find it challenging to identify and present their accomplishments. Here are some suggestions for getting started:

  • Begin to revise your resume today even if you are not planning a career move. This will allow you time to truly consider your strengths and accomplishments without the pressure of submitting something by a specific date.
  • If you have practiced in a clinical setting for many years, outline your abilities in a manner that shows some range. For example, instead of documenting 10 years of experience in pediatrics, consider stating your experience in terms of “neonate to seventeen.” This offers the reader more information about where you may fit into a potential position and is especially helpful when you are applying for a position outside of the traditional settings.
  • Develop the strongest generic resume you can and use a cover letter to outline your qualifications for a specific position.
  • Your cover letter can also help to clarify your experience. Recruiters in acute care may not fully realize that your long-term care (LTC) experience is relevant to what they are presently seeking. A few sentences discussing the co-morbidity and clinical complexity of your LTC residents drives home the point that your skill set is more evenly matched with acute care then they may have realized.
  • Be sure to present your experience in precepting new staff members, participating on committees, and unit-based special projects in the best light. If you have not been involved in these areas to date, get involved.
  • If you were is a position that was not a good fit for six months or less, there is no rule that states you must note it on your resume.

Revising your resume today also gives you the opportunity to identify any skills that you should develop in the future. Is it time to attend some computer classes and work on those PowerPoint and Excel skills? Has it been awhile since you attended any continuing education? Are you prepared to claim 10 years of experience in a specialty and answer questions about why you are not certified in that specialty? Act now. Be proactive. You will be amazed at how empowered you can feel.

What’s the first step you take when updating your resume?

For more information about professional life coaching email Phyllis Quinlan at

Professional life coaching: Put your own oxygen on first

by Phyllis Quinlan, RNC, MS, CLNC, CEN, CCRN

So you still love nursing, but the stress, frustration, and sometimes confusion can be a real barrier to personal and professional satisfaction. You sense you want something more, although you can’t quite identify what that might be or how to achieve it. A professional life coach may be just the solution to figuring out exactly what the next step is. Nurses have a longstanding reputation for eating their young. Wouldn’t be great if there was a way to change that perception?

Professional life coaching for nurses can be one approach to doing just that. Coaching is not a clinical or therapeutic process. Coaching has its roots in wellness. The starting point for a professional life coach is that the person seeking the coaching is a healthy individual who is already competent and capable. He or she is in need of a safe sounding board, encouragement, and empowerment. The coaching relationship is based on mutual respect, trust, and honest communication.

Coaching is distinctly unique from and not to be confused with mentoring. Mentoring usually prepares you for a particular professional role while coaching is focused on a self-development process. Coaching sessions are private, conducted one-on-one, either in person or by phone. Nurses can be comfortable sharing their strengths, shortcomings, and concerns–knowing that what they share will be used to their benefit and doesn’t threaten the security of their job.

The literature demonstrates that the cost of recruiting and training a new employee to fill a vacated position can be equal to a nurse’s annual salary. Perhaps nursing leaders should consider collaborating with their human resource departments to embrace the use of coaches to retain nurses.

Nurses actually get a kick from helping other human beings when they are most in need. This is an amazing characteristic that usually does not end when the shift is over. We’ve chosen giving and nurturing as a way of life. Self care is not something we place high our lists. However, we could take a huge lesson from the airline stewards. Put your oxygen on first so that you are safe and therefore capable of helping others.

For more information about professional life coaching email Phyllis Quinlan at

Does professional life coaching interest you?

MRSA is not a scarlet letter

by Sharon L. Taylor RN, BSN, MS, CIC, CPHRM

MRSA is fast becoming a household word. It is seen in the national media on a frequent basis. Healthcare workers are being scrutinized by patients and their families for their infection control practices, especially handwashing. While this publicity is good in that it has increased the attention paid by healthcare workers to their practice, it also has a scare effect on patients, the public, and surprisingly some healthcare workers. While being afraid of “catching” something is good because it puts us on alert, it can also cast a stigma on those who have an infection or are colonized with bacteria such as MRSA.

I propose that it is part of the nurse’s role, as patient advocate, to be sure that MRSA patients have the information needed to live their lives while minimizing the risk of transmission. If the appropriate information is given to patients, situations such as the one that occurred last fall where a young elementary student was banned from attending class because she had a MRSA skin infection will not exist. She was subsequently allowed to return after the appropriate information was given to school officials, but had the damage already been done?

How can nurses help prevent these situations from occurring? First and foremost–by being a role model. Healthcare workers need to realize that what they do and say is deemed important in the public’s eyes. Also, by using teachable moments and scripting, patient teaching does not have to be burdensome. For example, you can teach your patient by simply saying, “I’m washing my hands after changing your dressing and before helping you to the chair to prevent the spread of the infection.” They learn by watching and listening to why it is important to wash their hands after touching or handling dressings.

For the patient with MRSA, (either active infection or colonization) and other multi-drug resistant organisms (MDROs), there are many printed resources available free off of the Web. State Health Departments and the Centers for Disease Control and Prevention are all good resources. The state of Washington has a particularly good pamphlet available on their website entitled, “Living with MRSA.” This publication covers items such as cleaning, not sharing towels, disposing of dressings, etc. Pamphlets such as this can be printed and given to patients and their families. The same information is helpful to healthcare workers who continue to be worried about passing something on to their families.

Because we live in an era where MDROs are increasing in frequency–as well as is the public outcry about healthcare acquired infections–I believe nurses have not only a duty, but an opportunity to become known for their knowledge and ability to teach our patients how to exist in this new world without constant fear. While MDROs are real, are here, and are a serious health threat, nurses must use their knowledge to teach patients so it does not have to be a scarlet letter for them.

What other ways do you think nurses can help the public deal with issues such as MRSA?

Preparing your business plan

Every business plan begins with a brief executive summary introducing the key components of the project. It is knowing how to tailor it to your audience that will lead to the project’s success.

When writing the executive summary—or any presentation for that matter—learn who your audience is before you begin. Be sure to mold the presentation to your audience’s needs and desires. If you are speaking to the chief executive officer, make sure your presentation solves a problem that directly affects the hospital’s bottom line or addresses specific regulations such as those mandated by The Joint Commission or the state.

Other things to factor into your presentation are relativity and timing. For example, if your hospital chose to close its obstetrics business, then writing a business plan for an obstetrics clinic would be a waste of everyone’s time, plus you would seem uninformed about the hospital. Timing also is important. For example, if you are requesting money, be sure your request does not follow closely on the heels of layoffs or after the executives have just revealed less than satisfactory financial statements to staff.

How have you prepared for business plans?