RSSAuthor Archive for Administrator

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

Budgeting for orientation, education, and training

Do you get a little stressed out when it comes time to budget for orientation, education, and training? You might find it helpful running through these questions beforehand:

1. How many orientees does the hospital expect this year?
2. How long is orientation for experienced hires? For new graduates?
3. How many education days does the hospital provide for each staff member?
4. How many mandatory classes does the hospital require each employee take?
5. How many outside training classes does the hospital pay for per employee each year?
6. Does your hospital pay for staff meeting attendance for days the employee is out?

How do you plan your budgets?

MRSA me, what are we to do?

By Sheila Gerald, RN, CIC, CLNC

The average person trembles with fear when he or she hears the word staph or MRSA, and most healthcare workers are sick of multiple drug resistant organisms (MDROs) making their daily service more challenging.

Many infection control experts will agree that MDROs have rocked our world for the past 10 years in dramatic ways. We now have to use resources for increased compliance monitoring, surveillance, and tracking. And let’s not forget about the increased need for education. How many times must we say “gel in-gel out,” “glove/gown each time,” only to get those phone calls over and over reporting it not being done?

I have a question: Why haven’t hospitals addressed this problem? Why not simply tell the public, “No, you can’t bring that child in to visit,” “No, you can’t go in the room without a gown/glove/mask,” “No, you can’t come in if you are sick,” and “No, we won’t do your surgery until you have your blood sugar under control, have lost weight, and have stopped smoking,” which all increase the risk of a poor outcome. Can you imagine the outcry from the public if we put our foot down, instead of catering to the general public’s desire to be in control?

Would we truly see some dramatic improvements if the Healthcare Infection Control Practice Advisory Committee (HICPAC) came out with stern guidelines making contact precautions the new standard precautions? After all, when you start checking for colonization you wind up putting the majority of people who are admitted under the contact precautions umbrella. How much would we save in resources if we just put all admitted patients in precautions and forego the screening? Yes, the studies have shown these people get seen less often, but what if it became the norm to gown and glove upon entry to every room and continue the hand hygiene before and after contact with the environment of care?

I think it is time to change our norm and stop whining and moaning about it. Our germ cheese has been moved and we have hemmed and hawed long enough! If we are to survive and if we expect our patients to survive this germ war, we must change the way we practice healthcare.

How do you feel about current infection control practices? What changes would you make?

Sister Nurse: The other side of the bed

By Karen L. Madsen, MSN, APRN-BC

Blog admin note: While different from most blog posts on, this is a captivating, inside look at nursing today. It is, at the same time, a look through a professor’s eyes and through a mother’s eyes. The article first appeared on and was quickly picked up by Comarow on Quality, the U.S. News & World Report blog on medical safety and quality.

I don’t like this side of the bed. No, I take that back. I loathe this side of the bed. It scares me, it makes me angry, it makes me cry. I have no control over this side of the bed, I have little identity, I don’t have much of a voice. All this and more ran through my mind as I sat at the bedside of my 15-year-old daughter recently. It had been a long time since I had been part of the patient equation of the hospital rather than the nurse. It was just as much fun as I remembered.

Our daughter, Grace, is our baby, the youngest of our four children. Grace is a typical teenage girl. She slams doors, she cries at the drop of a hat. She grazes all day rather than sitting down to a meal. She is funny and emotional and dramatic, and she is a world class champion at texting on her cell phone. All of our children have been blessedly healthy, but Grace is our emergency room child. You know, she is THAT child, the one who falls, who hits her head, who goes through a fence on a horse, the one who had more stitches by age 5 than her other three siblings had, combined, by age 20!

A few weekends ago, she came home from a school-sponsored trip on a Saturday afternoon unexpectedly pale and pouty. She can be dramatic, but is rarely pouty. I should have known then something was up or something was wrong. Her group had stopped for lunch at KFC and then she had ridden in the back of a school bus home for about 90 minutes, so I wasn’t overly surprised or alarmed when she complained of feeling nauseated. I checked her forehead with the inside of my right wrist, my trusty mother thermometer. No fever. It was Saturday afternoon and I wanted to spend some time with my husband doing something we liked to do to relax. So, I basically told her to suck it up and quit whining.

We walked around a couple of flea markets and hit the grocery store for supper supplies. Once we were home, she took a nap and woke feeling a little better. Later that night, she had several episodes of vomiting and I began to think food poisoning rather than a virus was affecting my girl. Still, she had no fever, no localized pain, certainly no pain on either side of her abdomen. “Relax,” I thought, “there are a million viruses out there right now. She’ll be better in the morning.”

And she was. Or at least I believed she was. As we had been up late the night before, both she and I slept until around noon. She woke up, ate a bite or two of breakfast, and had another nap.

It was another story when she woke about 5 p.m.

Read the rest of Karen’s two-part column.

Filling the pockets of retention

By Lydia Ostermeier, RN, MSN, CHCR and Shelley Cohen, RN, BSN, CEN

When it comes to retaining staff, sometimes the hardest part is finding the dollars to drive your efforts. Too often, managers are unsure about the resources and support available to them when they budget for retention.

One of the first questions to ask yourself is, “What is my greatest resource to obtaining funds?” Whether you are determining the resource most likely to provide you with funding or the people most able to play a supportive role in validating the need for retention budgeting, the identification of these valuable sources is a key step toward monetary resources.

Here are some tips to keep in mind when working toward acquiring retention funds:

  • Always combine your budget request with ideas and plans that do not require funding, such as employee retention committees
  • Determine alternative methods of communicating retention tips, such as a monthly email sent out to managers
  • Listen to your staff to find out what things are really important to them; you don’t want to spend money on things that they do not value
  • Make a strong business case to your executive team, including the increased cost of turnover that would occur without retention efforts

If you are lucky enough to receive some specific funding for retention programs, build them in to a special general ledger in your budget so that you can keep track of your spending. And if you don’t succeed the first time, try again with a different angle. For example, it is not only important for retention of staff, but it may also help with recruitment as well; talk about the potential recruitment benefits.

If you are still not able to secure the funds that you need, take a look at your current programs, benefits, and perks. Are they all still important to your staff? Is there something that you can give up to reinvest the funds in something more worthwhile?

Many other strategies are taking place at hospitals nationwide, and communicating successful efforts is a retention strategy in itself. What have you found to be your most successful methods of gaining funding for retention efforts? How were you able to get the budgeted resources you needed to keep your nurses happy and by the bedside? To respond with questions or comments, just click on the comments link and let your voice be heard.

Frequently asked questions about blogs

What is a blog? A blog (short for Weblog) is a Web site where you post thoughts, articles, and ideas on an ongoing basis. New posts show up at the top, so visitors can read what’s new. Then they comment on it. The posts can be broken down into categories and topics for easier navigation.

For more information, watch this video.

What is a blogger? A blogger is someone who posts an article on a blog. (Email the blog editor at for more information on how to become a blogger on this site.)

What is the benefit of a blog? You can network with peers, gather new insight, and share stories and successes. More specifically, on our blog, you can learn about new ideas, programs, and best practices at facilities across the country, get some tips to help you in your daily life, or share some advice or an opinion with others in the nursing industry.

How can a blog help you, specifically, in your job? Our blog is filled with valuable articles, insight from others in the nursing industry, and links to other items of interest. Because your time is tight, we try keep posts short and to the point. Feel free to share any of the information you find with peers or employees or post your comments on a particular topic with others who visit the blog.

What is the difference between a blog and a discussion board? The idea is basically the same: People can read what has been written and add their own comments. However, a discussion board usually begins with a single idea or question. A blog begins with a longer post, something that typically portrays a certain idea or opinion. Then, people can comment on that particular topic.

How do I comment on the blog? It’s easy. Click on the headline of a post to go to that particular post. Scroll down and click on “Add comment.” Then, simply fill out the fields and click “post.”

How do I comment on a comment? The same way that you’d comment on the blog.

Can anyone comment on a blog? Yes. The blog is open for anyone to comment on any topic they wish.

Getting another chance . . . thanks to robots

By Charlene Gordon, RN, Emergency Preparedness Manager at Huntsville (TX) Memorial Hospital

Ever have a patient go bad and just wish at the end of the day you could get a chance to replay it and fix what went wrong?

I just got done with a three-day WMD (weapons of mass destruction) course that had a robot for a victim. And this guy was so real, it was scary.

“The guy” was a manikin that blinked, had pupils that were reactive to light, and emitted pulses from every place a real person would. He made different heart sounds and different lung sounds (from rales to wheezing to rhonchi) while his chest rose and fell. He had an IV site that takes into account which drug you are pushing, how much you are giving, and how fast you are giving it! He responds by computer to all your interventions, including reading an exact Oxygen saturation to see if you are bagging correctly. (Don’t push the versed too fast!)

Crashing him is okay . . . just re-boot and start all over again. With this one, you can play it again. And, what a learning experience it was!

It would have been awesome for just basic assessments or regular ACLS (advanced cardiac life support), but this guy put ER nurses, ICU nurses, floor nurses, respiratory techs, and paramedics through their paces for a WMD treatment roundtable. We treated chemical emergencies, including viral and biological illnesses that were bad and getting worse.

The real beauty of the course was that several of the nurses have been around the emergency/ICU block a few times and were pretty sure this class was going to be a dud. They were one wound up bunch of nurses after three days. They loved it! This guy is spooky real and it really feels like he is dying, but unlike ACLS, where you alone have to answer, the group cooperates just like a real crashing patient.

The class really helped to prepare us to understand these complicated patients during a critical time where hesitation or a wrong choice could mean life or death for them. I just wish every nurse and all healthcare professionals could take this course every year. This was a great experience!

Don’t you wish you could get another chance sometimes?

Merging competency validation and performance evaluation

A new way to look at competencies, from the pages of our Briefings on Long-Term Care newsletter:

Making sure nurses are competent in their skill sets is one of the most important responsibilities of a director of nursing. But as the need for validation goes beyond technical skills and focuses on professional development as a whole, the traditional methods of assessing competencies need to be examined in a new light.

“It has always been important to validate competencies, but how some institutions are choosing to look at it is taking a different spin,” says Sheila St. Cyr, MS, RN-BC, OCN, performance-based development system coordinator at the University of Oklahoma (OU) Medical Center in Oklahoma City. “Now we’re not just looking at technical skills, we’re validating interpersonal skills as well. It used to be more about the technical skills checklist. And that’s just not how it should be.”

With the recent shift in focus, directors of nursing must arm themselves with the necessary tools and information to think beyond simply validating skill sets.
St. Cyr says there are two main areas of assessment on which to focus: competency validation and performance evaluation. Recently, the shift has been to combine the two efforts rather than have an instructor simply check off that a nurse is able to complete a particular skill.

Developing a definition of competency validation for your facility must take place prior to any assessments, says Diana Swihart, PhD, DMin, MSN, CS, APRNBC, clinical nurse specialist in nursing education at the Bay Pines (FL) VA Healthcare System.

When you begin working with staff members to validate competencies, St. Cyr says one of the best strategies toward education is to play the what-if game. “Use a questioning technique with staff members,” she says. Give your nurses a scenario, then ask the following questions:

  • What complications can happen?
  • What are the signs or symptoms?
  • Would you need to call the doctor?
  • What assessments would you need to make?

Other methods for validation, adds Swihart, can include:

  • Case studies, which can help measure critical thinking
  • Quality improvement monitors, which are a strong determinant of competency because they reflect an individual’s overall performance
  • Mock events, which are useful in measuring cognitive knowledge

What methods are used at your organization?

Learning Management Systems: Their place in healthcare

By Diane M. Billings, EdD, RN, FAAN

Following our discussion during today’s audioconference, we realized that one big component of implementing new classroom technology includes bringing in a Learning Management System (LMS). Basically, an LMS includes software tools designed to manage learning. Many LMSs are Web-based and are able to facilitate “anytime, any place, any pace” access to administration and learning content. LMSs are especially relevant in healthcare as compliance training remains essential. Characteristics of LMSs often include:

  • The ability to manage users, courses, and instructors
  • The inclusion of a course calendar
  • Access to messaging learners
  • The chance to display scores and transcripts

There are many different types of LMSs that are available, including Blackboard Inc., Saba Software, and ATutor. What have your experiences been with using LMSs, and which ones have you found to be most effective (or ineffective) in your educational endeavors?

Shhh! We’re preventing medication errors here!

A creative way to prevent medication errors from the pages of our Briefings on Patient Safety newsletter:

Citizens Medical Center in Victoria, TX, took a creative approach to cut down on medication errors when it created a “no-talk zone.”

“Distractions were definitely becoming an issue with medication errors,” says Gail Martin, MBA, RN, quality analyst at Citizens Medical Center. The main problem was that two of the facility’s busiest and most critical floors had Pyxis medication dispensing machines located out in the open-next to the coffee pot and across from the nurses’ station, says Martin.

Though the obvious solution was to relocate the Pyxis machines, it was not feasible at that time, says Martin.

“That costs money. And we’re a county hospital, so it wasn’t happening,” she says. “It is in our future plans, but for the immediate future, we needed to do something.”

So, Martin’s team brainstormed different signage asking staff and hospital visitors not to disturb anyone using a Pyxis machine, especially in a busy area. They eventually settled on a simple “no-talk zone” sign much like a “no smoking” sign. The lettering is black, and the symbol is red. The sign is displayed on the floor in front of the Pyxis machine, kind of like a mat slicked on the floor, says Martin.

The “no-talk zone” has been in place for a year and has paid dividends. Since the start of 2007, five medication errors have been attributed to frequent interruptions, lighting, or noise level; this is a decrease from the entire year of 2006, in which 23 medication errors were attributed to the same causes, according to Martin.

What does your organization do to prevent medication errors? Do you think something like this “no-talk zone” would work where you are?

Essential business skills for nurse managers

By Denise Danna, DNS, RN, CNAA-BC, FACHE

For a nurse manager to be successful in today’s healthcare environment, mastery of basic business skills is essential. No longer are nurse managers expected to be clinical experts but, instead, must be equipped and skillful in “running their business.” Each nursing unit is a component of a larger organization that depends on qualified nurses to manage the business and to understand the “big” picture. Nurse managers are the change agents and leaders in improving the work environment where nurses practice, so it is essential that they have the required skills.

What are the essential business skills?

As you think about business skills, the first thing that probably comes to mind is the budget or the finances, but business skills include so much more. Business skills frequently include human resources, strategic planning, and systems thinking, to name a few.

The following three categories identify several of the business skills that are essential for nurse managers:

  • Financial management
  • Human resources
  • Strategic management

For more of Denise’s article, visit our Reading Room.