RSSAuthor Archive for Kenneth Michek

Kenneth Michek is the Associate Editor for nurse management at HCPro.

New Release! Nurse Manager’s Guide to Retention and Recruitment

NMGRRWith the current nursing shortage, recruiting and retaining the best nurses has implications for all levels of practice and all care delivery settings. Nurse Manager’s Guide to Retention and Recruitment is a user-friendly guide for nurse leaders that provides sound theoretical perspectives, evidence-based practices, practical strategies, and tools for achieving the best recruitment, engagement, and retention outcomes for their organization.

In addition, this book includes examples gleaned from the authors’ collective years of experience and expertise in a complex urban healthcare market with large for-profit, not-for-profit, and public (county, state, and federally funded) healthcare organizations and systems.

Click here to order now!

Excerpt: Dealing with the cyberbully

October is National Bullying Prevention Awareness Month, highlighting the dangers of bullying in all settings. The following is an excerpt from Ending Nurse-to-Nurse Hostility: Why Nurses Eat Their Young and Each Other by Kathleen Bartholomew, RN, MN that explores the dangers of cyberbullying in the nursing unit.

Facebook boasts more than 1.86 billion monthly users worldwide, with more than 40% of Americans logging in every single day. In 2007, Twitter reported 5,000 tweets a day; and in only six years, tweets jumped to more than 400 million. Ten years later in 2017, we tweet 6000 tweets per second. (Zephoria) Without a doubt, we have entered the digital world:

  • Fifteen nurses received letters of warning from their State Board of Nursing after they were reported by their nurse executive for “liking” a derogatory comment that one nurse posted about a husband who was uncaring and unsupportive during childbirth. They did not heed the first warning.
  • A nursing student was dismissed from the program after taking a picture of herself holding an unidentified placenta and proudly commenting how thrilled she was to assist at her first birth.
  • A group of nurses who were friends started a conversation on Facebook which included several disparaging comments about a nurse they didn’t like, as well as remarks on the safety of the organization’s staffing levels.

We talk to each other on online chat rooms in casual conversations that feel so real we forget that no discussion in this virtual world is ever private. Every one of the nurses in the above situations had no idea that they were violating professional ethical guidelines by breaching confidence.

As social networking becomes more integrated into our daily lives, the boundaries between social conduct and professional misconduct are becoming increasingly difficult to navigate.

—Rose Sherman, EdD

While it is generally accepted that we cannot speak about our patients, even anonymously, many nurses do not realize that it is also not professional to speak about a coworker. According to the National Council for the State Board of Nursing policy on Social Media, any online comments posted about a coworker may constitute lateral violence; even if the post is from home during non-work hours. Communication modes for cyberbullying include: instant messaging, email, text messaging, bash boards, social networking sites, chat rooms, blogs, and even Internet gaming.

Nurses often fail to realize that deleting a comment does not erase it. Talking about coworkers is unprofessional and contrary to the standards of honesty and good morals (moral turpitude). Depending on the laws of a jurisdiction, a Board of Nursing may investigate reports of inappropriate disclosures on social media by a nurse on the grounds of:

  • Unprofessional conduct
  • Unethical conduct
  • Moral turpitude
  • Mismanagement of patient records
  • Revealing a privileged communication
  • Breach of confidentiality

Guidelines for nurses victimized by cyberbullying

  • Save all evidence. Copy messages or use the “print screen” function. Use the “save” button on instant messages.
  • First offense: Ask to speak to the person in private and bring a copy of the evidence. Use the D-E-S-C communication model.
    • Describe: “I was on Facebook yesterday and my friend sent me this post because it was about me.”
    • Explain the impact: “I was really surprised because I had no idea that you didn’t like working with me, or that that was the reason you switched weekends.”
    • State what you need: “No one is perfect. Next time could you come to me privately and let me know if you are having any issues so that we can work together to resolve them?”
    • Conclusion: “I am willing to learn how we can be more mutually supportive of each other for the sake of our relationship, our team, and our patients.”
  • Document the conversation and the outcome.
  • Second serious offense: Report to manager (if not serious, try a mediated conversation).
  • Third serious offense: Report to the chief nursing officer.

Manager guidelines

  • Verbalize that no bullying or hostility of any kind will be tolerated, including online.
  • Set the expectation that all staff are responsible for monitoring their virtual world. Don’t assume the parental or vigilante friend role.
  • Educate staff on standards and policies, and provide examples.
    • National Council of State Board of Nursing Guidelines
    • Hospital/organizational policy (including use of hospital computers, cell phones, etc.)
    • Review common myths. Use case studies from NCSBN YouTube.
  • Be supportive of online targets and take derogatory online comments seriously.

 

Source: National Council for the State Board of Nursing: www.ncsbn.org/2930.htm

The 2017 Nursing Salary Report

HCPro recently conducted a survey among 291 nursing professionals in the healthcare industry regarding their work experience, environment, salary, and benefits. The results show that while careers in nursing careers are more varied and higher paid than ever, nurses are working later in their career and the age gap is growing.

A majority of the respondents were over 50 years old with over 10 years of experience. Respondents had a wide variety of education background, job titles, and salaries. While salaries overall are higher than ever, most respondents say that wages have not increased in the past year, and that benefits for many positions are lacking.

Click here to download!

 

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Guidelines for the critique of nursing research articles

The overall goal of a research critique is to evaluate a study’s merits and its applicability to clinical practice. A research critique goes beyond a review or summary of a study, and it carefully appraises a study’s strengths and limitations. By evaluating a study’s component parts, the critique should assess objectively a study’s validity and significance.
Several guidelines for the appraisal of evidence—in the form of meta-analyses, systematic reviews, and clinical practice guidelines—have been published in print and online. In addition to nursing research textbooks, several published guidelines for how to review single research studies can help nurses in their journal club endeavors. The following resources specifically target the critical appraisal of research studies:

  • Critical appraisal tools developed by the Critical Appraisal Skills Program, (suitable for all types of studies) NHS Trust-Public Health Resource Unit. (www.caspinternational.org)
  • Critical appraisal worksheets in the EBM Toolbox, Center for Evidence-Based Medicine at Oxford (www.cebm.net).
  • Users’ Guide to Evidence-Based Practice. Site maintained by the Canadian Centre for Health Evidence (www.cche.net/text/usersguides/therapy.asp). (Originally published in the Journal of the American Medical Asociation.)

The level of discussion at the initial journal club meetings will depend on the facilitator’s knowledge base. Nurses who have completed graduate-level research courses will be able to guide the group so that all questions can be answered and discussed. It may not be possible, however, to have a registered nurse with a master’s degree serve as a facilitator for every journal club. If this is the case in your organization, consider limiting how many journal clubs meet to ensure adequate mentorship. Another choice is to have baccalaureate-prepared nurses serve as facilitators and understand that, in the beginning, certain questions may pose a challenge to the group. In that case, the group should agree to discuss as many of the questions as possible and to skip over questions they find difficult. The facilitator can then follow up with someone who can clarify the difficult areas of the critique. With experience, educational sessions, and mentoring, nurses’ knowledge and confidence levels will continue to increase. Evidence-based practice, like any new skill, takes practice. Journal clubs are a great way to learn the skills necessary to evaluate the evidence and to decide whether it’s applicable to specific practice areas.

Source: Evidence-Based Practice Made Simple

Time management and preceptorship

This is an excerpt from The Preceptor Program Builder

The three primary tasks affecting time management in healthcare include organization, prioritization, and delegation. It is especially challenging for preceptors to manage their time when given the added responsibilities of working with preceptees. Only by developing their skills in these three tasks can preceptors gain perspective and control over their time in any effective way when working with preceptees.

The following tips should help you to manage your time more effectively:

  • For example, schedule interruptions. Do not chart every event as it occurs. Set aside time once or twice during your duty hours to stop what you are doing and update your reports:
  • Keep your work and practice settings clear and ready for action. Papers, tools and supplies, and items waiting for attention should not clutter the desk or work area but rather should be organized and easily accessible.
  • Do one thing at a time. Studies suggest that multitasking is not effective and can lead to increased errors. Complete one task before moving on to the next.
  • Determine what must be done versus what you would like to do. They are not always the same. Say “no” if you have too many duties to handle responsibly or safely. Preceptees try very hard to please preceptors, coworkers, managers, and educators. They may take on too many tasks or responsibilities if they do not know how—or when—to say “no” occasionally.
  • Avoid time wasters: the activities, things, people, habits, or attitudes that divert us from our primary objectives. They reduce our effectiveness and interfere or prevent us from completing our tasks or achieving our goals. Time wasters result from ineffective or a lack of planning, ineffective or a lack of priority setting, over commitment, clutter, interruptions, failure to delegate, unnecessary telephone calls or emails, paperwork, perfectionism, procrastination, conflict, ineffective problem-solving skills, daydreaming or escape activities, and hurrying (haste makes waste).
  • Increase time savers: the activities, things, people, attitudes, or habits that direct us to meet our primary objectives or goals. They increase effectiveness and efficiency and enhance completion of tasks. They include planning and controlling time, making lists, setting priorities, creating agendas for meetings (Do we really need to meet? How much can be done by email, for example?), handling paper only once, not procrastinating (do it now), and delegate, delegate, delegate. Preceptors and preceptees need to know how to:
  • Manage interruptions, emergencies, and crises with tact, diplomacy, and courtesy
  • Become better at solving problems and resolving conflict (use tried and true models)
  • Be assertive (say “no”)
  • Control the controllable and accept the uncontrollable
  • Keep interruptions short—be ruthless with time, generous and kind to people
  • Occasionally become invisible and not so completely available
  • Avoid getting angry or hurt if possible—these waste time and energy
  • Maintain a sense of humor
  • Remember to plan and make personal time for fun and recreational activities
  • Delegate routine tasks or projects. Set deadlines when you delegate. Ask for help from coworkers and specialists (e.g., educators) instead of trying to do everything alone. Delegate a task to your preceptees that you thought only you could do. Encourage preceptees to delegate tasks to coworkers when appropriate.

We all are given 168 hours per week, no more and no less. How we spend those hours affects our outcomes, professional and work goals, and job satisfaction. Preceptors can increase efficiency and induce wiser use of time through planning, thereby increasing productivity and decreasing stress.

Preceptors should determine the best use of time and help their preceptees do the same.

ANA comes out against latest GOP healthcare proposal

In a statement released today, the American Nurses Association (ANA) said that the organization “adamantly opposes” the Graham-Cassidy healthcare proposal being considered in the Senate.

The ANA expressed major concerns about the Senate’s proposal, saying that it would make severe cuts to Medicaid, erode protections for pre-existing conditions and other essential health benefits, and wipe out subsidies for the purchase of private health coverage.

ANA President Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN, gave the following statement: “ANA denounces the latest Senate proposal as its worst yet. This proposal limits care for those that need it most and fuels greater uncertainty in the insurance market. It poses a serious threat to patients’ care, especially those that need coverage for illnesses or pre-existing conditions. Patients deserve better and we won’t rest until they get it.”

In the wake of disaster, nurses answer the call

While most people were running away from Hurricane Harvey, a team of nurses from the Christus St. Michael Health System flew into the storm to help others.

With just two hours’ notice, the 13 nurses boarded a plane to San Antonio, arriving shortly before Hurricane Harvey made landfall in Texas. Word had spread throughout the health system that patients from around the state were being transferred out of the hurricane’s path into hospitals in the San Antonio area, and they would need more nurses to handle the influx of patients.

By the time the nurses reached the Christus San Antonio Medical Center and Christus Santa Rose New Braunsfel hospital, an additional 70 patients were transferred to these facilities and needed care. One of the nurses, Kelli Thompson, BSN, RN, WCC, SCRN, ended up working the night shift in the MICU with other volunteers. “We helped with admissions, started IVs, cleaned up patients. We did whatever they needed us to do,” Thompson said. “They had patients who were very sick and needed a lot of care.” The MICU had a significant increase in patients, over 150% of its regular capacity. “It was a big difference from what they were used to,” Thompson said.

The volunteer nurses slept in empty patient rooms on cots and hospital beds; flooding concerns meant that they stayed in the hospital for four days straight so they wouldn’t miss a shift. Though the experience was trying, the volunteers felt welcomed by both the patients and the staff nurses. “The nurses who were based there were wonderful and very appreciative of us being there,” Thompson said.

Micah Johnson, MSN, RN, director of nursing at Christus St. Michael Hospital-Atlanta, was also one of the volunteers; for him, the biggest take away was how nurses were able to rally together in a time of crisis and help patients in need.

Source: Nurse.com

The Roots of Peer Review

The following is an excerpt from Nursing Peer Review, Second Edition

Medical staffs have been peer reviewing their cases for decades, and as fellow professionals, we must hold ourselves to the same high standards. Nurses are professionals who must hold each other accountable and evaluate patient care so we can eliminate system and human errors. Nurses are no different than physicians in this way.

 

An early crusader for quality improvement, E. A. Codman helped develop the concept of outcomes management in patient care. He was a proponent of peer review and quality programs for healthcare delivered at the hospital level.

 

Practicing in the early 20th century, Codman was a founder of the American College of Surgeons and its Hospital Standardization Program. Eventually, that program would morph into what we know today as The Joint Commission. His statement from 1916 calling for review and transparency are as relevant today as they were a hundred years ago:
I am called eccentric for saying in public that hospitals, if they wish to be sure of improvement, must find out what their results are, must analyze their results to find their strong and weak points, must compare their results with those of other hospitals, must care for cases that they can care for well and avoid attempting to care for cases which they are not qualified to care for well, must welcome publicity, not only for their successes, but for their errors. Such opinions will not be eccentric a few years hence.

—E. A. Codman, A Study in Hospital Efficiency, 1916

 

Codman would likely be happy to see today that the practice of physicians reviewing the work of other physicians—peer review—is a common practice and is considered to be a crucial element of ensuring that quality medical care is provided to patients.

 

That element is just as crucial in the nursing profession. The major reason for implementing a peer review process is to improve patient care. If nothing else, peer review is the right thing to do to protect the patient from potential harm. It is just a matter of time before external accreditation agencies, the government, and your hospital will require a formal peer review process of nurses.

 

More and more, healthcare organizations are required to be transparent about quality performance metrics. While the information that is publically reported is aggregate data, it is important for the healthcare organization to know person-specific performance data so that they can drive improved patient outcomes.

 

Typically, the outliers or underperformers are a small number of nurses who may not know they are not performing to the standard of care. It is important to give them specific and periodic performance feedback so that they can adjust their care model. Additionally, providing performance data to nurses helps them understand where they rank among their peers. When doing so, it is important to report the data in an anonymous way so that each nurse is uniquely identified using a coding system. This can be useful when metrics are performance based and specific in nature. Transparency is the way of the future, and moving in that direction will help the nursing infrastructure catch up with performance models used by physicians.

 

The goals and benefits of peer review include:

  • Improving the quality of care provided by individual nurses
  • Monitoring the performance of nurses
  • Identifying opportunities for performance improvement
  • Identifying system-wide issues
  • Identifying educational needs of nurses

If the process of peer review is to be effective, then a formal structure must be created to allow for the tracking and trending of information and the identification of potential system or human failures. Case review is useful for this, as it presents opportunities to identify failures through investigation so nurses and other team members can correct them before injury occurs in another patient or patients.

The key to nurse retention

The following is an excerpt from Essential Skills for Nurse Managers.

Put aside all the tips and tools for retention for a moment and remember this:

Of 1,500 nurses surveyed, their #1 incentive was noted to be personal recognition by their manager.

Imagine you are a staff member who helped out the department by covering an extra shift due to a sick call. Sure, at the end of the pay period they will be smiling with the overtime in their check. Do you know what will make them smile just as much, or for some even more? If the next time they worked an envelope was in their mailbox or locker and inside was a single wrapped life saver with a note signed by their manager that simply read:

  • Many thanks for helping out by picking up the extra shift. You are a life saver!

After much conflict in the department related to precepting issues and a lack of interest among the staff to contribute to the ongoing educational needs of the new graduate staff, one employee stepped forward to offer to assist. He understood there was no extra pay differential for taking on this challenge when he agreed to the role. However, that did not matter because he found in his locker an envelope with a single wrapped “treasures” chocolate candy and a note from the manager that read:

  • Many thanks for volunteering to work with our new grads—we treasure you as part of our team!

Sometimes a trip down the candy aisle at the grocery store with a pad of paper is not about the eating; instead, it is about creating a memorable message that means something to an employee. Be sure that part of your retention strategies include your “shining stars.” Many managers assume these high-level performers do not need or desire recognition or praise; this is far from the truth. They may want to be recognized in different ways from the rest of the staff, but they still deserve to be reminded of the vital role they hold in the department. Sometimes the employees we desire to hold on to the most are the ones for which we use the least retention efforts. Do not make this mistake and be alert to the fact that many assumptions are made about top performers.

Rewards for employees should match and be in line with how and what they contribute to the department/organization. Just because employees perform well does not mean they are easy to get along with, welcoming to new hires, etc. And always remember that current performance may not be an indicator for future potential in a “shining star” Schmidt (2010). Be sure to balance your attention and recognition efforts among all of the team members, shining stars or not.