Kenneth Michek is the Associate Editor for nurse management at HCPro.
Human nature contributes to bias by allowing us to use psychological “shortcuts” to reduce complexity and ambiguity in the world. We all wish that life were simpler, and our brains try to accommodate this wish by finding shortcuts to decisions by relying on past patterns of thinking. This enables us to provide a rational response within the context of a simpler and less-threatening world. The two main types of bias related to human nature are personal bias and group bias.
Personal bias has two aspects: emotion and thought. These biases come from our view of the world that is created by the sum of our individual experiences: where we grew up, our parents’ values, how our friends act, and how we were trained. Although we might make conscious efforts to overcome personal bias, we all retain some degree of it as part of our individuality.
Personal bias is more likely to affect peer review when individuals are not accountable for their decisions. This is not because these are bad people—they are simply good people in a flawed system. The case studies in this book provide several examples of peer review structures and procedures that, prior to redesign, increased the likelihood of personal bias, such as having a department chair conduct the entire case review process from case screening to decision. To reduce personal bias in peer review, consider requiring reviewers to provide a written rationale for their findings (even on care-appropriate cases), having a committee make the final decision on all cases, and implementing clear conflict of interest practices.
Group bias occurs when a group of individuals has a shared set of beliefs or experiences that result in a relatively predictable way of thinking or responding. This concept of “groupthink” results in the group tending to accept information that meets its common paradigm and reject, or at least not consider, information that doesn’t fit within it.
Lack of diversity in a group can create this bias. Therefore, to avoid group bias, structure the group to ensure that other views are included. There are two types of group bias that tend to affect peer review: professional bias (e.g., physicians think differently than nurses) and specialty bias (e.g., surgeons think differently than internists). One of the main reasons that medical staffs implement some form of multi-specialty peer review committees is that such committees reduce the likelihood of groupthink by bringing all perspectives to the table.
Source: Peer Review Benchmarking
With the time-crunch worse than ever, it can be difficult to find the time to keep up with the latest in your facility, let alone the wider world of nursing. Early research conducted by Critical Care Nurse (CCN) suggests that blogs can be an effective means of communicating the latest hospital policies and best practices.
The cardiac intensive care unit at Brigham and Women’s hospital found that while many of their nurses attended professional educational opportunities, the staff had difficulty sharing information with the entire nurse staff. The staff simply did not have the time for peer-to-peer sharing of educational information. To facilitate educational sharing, the nursing practice council at the facility set up a simple private blog where staff could share what they’ve learned from various educational opportunities, such as professional conferences and panels.
After fifteen months, the hospital conducted a survey to measure the effectiveness of this approach. They found that 86% of their nurses thought the blog was an effective way to share professional education, 81% felt the blog kept them up-to-date on evidence-based practices, and 59% thought the blog led to changes in their practices. While the results are anecdotal and early, the authors of the study suggest that more rigorous research is required.
Does your facility use blogging tools or social media for education and professional development?
If a nurse is unsatisfied with their career or feeling burnt out on nursing, taking an evidence-based approach can help them rediscover their passion for nursing. Robert Hess Jr., PhD, RN, FAAN and co-author of HCPro’s Shared Governance book, recently wrote a piece about EBP and nursing careers; here are some ways to apply EBP in your career:
- Update your practices. Nursing is changing all of the time! If you feel like you’re stuck doing the same thing every day for years, you’re probably not using the most up-to-date practices. Nurse scientists and researchers are studying and updating practices for nurse specialties all of the time, and these changes can benefit patients and nurses alike. Try joining your specialty group’s professional organizations, attend professional events, and subscribe to specialty journals to keep abreast of the latest practices in nursing. Changing up your routine and increasing your engagement can bring the excitement back to your career!
- Use EBP in your career. Evidence-based research is not just conducted on healthcare practices. There is organizational research that provides indicators for when nurses should consider a career change, such as switching roles, going back to school, or even leaving their current job. Burnout has been measured for decades, and evaluating your own signs of job fatigue can be instructive for potential career decisions. Nursing has a plethora of opportunities outside of the hospital bedroom, and feeling burnout could be your signal to explore them.
- Evaluate your environment. Research has found the workplace satisfaction can correlate with career satisfaction. Observe your colleagues; do they seem happy? Do they participate in work group activities, both at work and outside of work? Having coworkers that are satisfied with their jobs has a positive impact on your own satisfaction, and if you’re feeling career fatigue, sometimes your coworkers can fuel your enthusiasm.
For more tips about career satisfaction and burnout, check out these articles from the Strategies for Nurse Managers’ Reading Room:
Last year was a tumultuous one for Allina Health in Minneapolis and its nursing staff. After a week-long walkout in June, Allina nurses went on strike in the fall as part of ongoing contract negotiations centered around the elimination of union-backed health plans. After a six-week strike, both sides finally reached an agreement that ended the strike and sent the nurses back to work.
As part of its 2016 earnings report, Allina Health reported that while revenue increased over the year, operating income dropped, thanks in part to expenses related to the nursing strike. Allina recorded a $30 million operating loss, a significant $179-million-dollar swing from the $149 million operating gain Allina posted in 2015. As part of its report, Allina cites a $149.3 million of strike expenses, which included hiring 1,400 replacement nurses to cover for the striking staff.
For more information on nursing strikes, check out the Strategies for Nurse Managers Reading Room.
The responsibility of educating patients and their families often falls to nurses, from explaining procedures to providing discharge instructions. This can be one of the most difficult parts of the job, and your staff may have limited time due to staffing issues or an emergency situation. Here are some tips to help educate patients quickly and effectively:
Handouts are your friend: Patients are often given a lot of information all at once, and it can be hard for them to remember every detail, especially in a stressful hospital setting. Having notes and props ready for them can save time and prevent miscommunication, especially when discharging patients. Have your nurses write up the specific instructions and go over them with the patient; use highlighters to mark the most important information. There are a lot of resources and tools available (we have some here) about common procedures and practices that you can use as handouts for patients as well.
Stay concise but informative: Patients are probably only going to remember one or two learning points, so try to emphasize the most important takeaways and leave the rest for your handouts.
Test understanding: It’s important not to assume that your patient is well-informed about their own condition. Even if you think something is obvious, say it anyway! Once you go over the key points, make the patient repeat them back to you; it’s one thing to listen to an explanation, but quite another to have to explain it yourself.
Encourage questions: Even if a patient seems to understand, it’s important to leave time for questions. Ask if they have any concerns about medications or follow-up care; this will help prevent confusion going forward and negative health outcomes.
You can go here for more advice about patient education.
Rarely are we genuinely thoughtless—that is, without thought. But often we are not giving our thoughts much consideration. In today’s world, there is much distraction and sometimes we are guilty of distracting ourselves just to prevent our minds from focusing on the things that are most important (electronic devices proliferate and give us many opportunities to engage in mindlessness). So, to be genuinely able to think about thinking, we must avoid going onto autopilot.
Autopilot is the state of being where we are largely going through the motions, not thoughtfully engaged in the activities of life. It is when we arrive at our destination but cannot remember the traffic on our commute, or taking the last turn or even whether we stopped for the traffic signal or not—it happens to all of us, and that is autopilot. The key is in recognizing when it is happening and being willing and able to intercept your unconscious mind and instead coax it to be present in the real-life situation you’re living. It is learning to move our conscious mind from nowhere to now here—a subtle but essential difference!
Being present in the moment is the essence of mindfulness, and it is powerful! Mindfulness wakes us up to sensations we have been failing to notice. It reveals patterns in our activities that we’ve become blind to. It permits us the full engagement in the reality happening in front of us and even within us, silently, steadfastly, sacredly. Mindfulness may enable us to improve our health, connect more successfully to other people, enlarge our thinking, focus our perception, and even strengthen our intuition. Mindfulness is the polar opposite of autopilot!
To read more, visit the HCPro Marketplace
The new year is often a time for retrospection and reflection, especially when it comes to your career. If you’re starting to feel burnt out on nursing but not quite ready for a career change, here is some advice to freshen things up in the new year.
- Reflect on your past: Sometimes the best way to go forward is to look back. What drew you to nursing in the first place? Why was a career in nursing right for you? Think about the positive experiences you’ve had as a nurse that reaffirmed your career goals. Treat your next shift like it’s your first day; what excites you? What makes you nervous? Sometimes asking these questions can reinvigorate how you approach your work.
- Connect (and disconnect): If you’re feeling down about your job, sometimes the best solution is to ask for help. Reach out to your peers and develop a support system to help yourself and others. If you think there’s something that could make you happier at work, talk to your managers about it; sometimes a small change can have a profound effect.
It’s also important to let go sometimes. Being a caregiver, interacting with patients at some of the worst times in their lives can negatively impact your outlook and make your job even more difficult. Try to focus on the good you’ve done for patients and don’t take it personally when a patient struggles or suffers.
- Commit to the new: Even though it doesn’t always feel like it, taking on new challenges can be a great way to energize your career. Seek out new experiences and opportunities; take the frustrations of the day and channel it toward learning a new skill or pursuing additional training options. Reflecting on your weaknesses can be difficult at first, but identifying them and working towards improvement can be satisfying and build you confidence.
Another great way to embrace the new is working with nursing students or new nurses. They bring energy and enthusiasm to the job, and becoming a preceptor or informal mentor can be a great way to grow your own enthusiasm while furthering your career.
For more articles about avoiding burnout and developing your career, check out the Health & Wellness section of the Strategies for Nurse Managers Reading Room!
For the 15th year in a row, the Gallup’s annual honesty and ethical standards poll has named nurses as the most trustworthy profession.
Released last week, the Gallup poll shows that 84% of respondents said they rate nurses’ ethical standards and honesty as very high or high. Pamela Cipriano, PhD, RN, the president of the American Nurses Association, said that trust plays a vital role in the relationship between nurses and their patients, and because nurses are at the frontline of healthcare, they offer a unique point of view to their patients and the facilities they serve.
Healthcare professions took the second and third rank as well, with pharmacists receiving a positive rating and medical doctors receiving a 65% rating.
Read more here.
This year has seen the release of multiple virtual reality (VR) headsets aimed at the home consumer. As they are becoming more affordable, hospitals and companies are researching the benefits in a healthcare environment, and the early results are positive.
Cedars-Sinai Medical Center and Children’s Hospital Los Angeles are conducting studies using the software, and the early results are positive. Cedars-Sinai researchers found that 20 minutes of using the VR software reduced patients’ pain by almost 25 percent; patients had an average pain score of 5.5 out of 10 before the VR experience and an average score of 4 after using the software. The researchers say this is a dramatic reduction, and not far from the effect of narcotics. At Stanford Children’s Health, they speculate that VR can be valuable for helping children get through tedious or uncomfortable procedures, such as physical therapy or imaging studies.
Though providers are cautiously optimistic about the possibilities, there are still some hurdles to overcome. It is difficult to find developers who want to target medical issues, because of the unclear path to profitability. One startup company, ApplieVR, is building a library of content designed to help patients “before, during, and after medical procedures” It’s also important to determine when the technology can helpful and when it can’t; some patients won’t respond to the applications as well as others, and researchers are careful not to oversell the value of VR at this early stage.
For more information, check out the MIT Technology Review article.
Do you think VR might replace Opoid use eventually? Let me know in the comments!
Nurses face challenging patients and their families every day, but understanding the causes of patient stress can reduce the patient’s anxiety and ultimately make your job easier.
Healthcare can be confusing and distressing for many patients. Being admitted to a hospital for any reason can be one of the more stressful events in a person’s life. Because of this, it is important to remember that anxiety is the root cause for many conflicts in healthcare settings; so a difficult patient or family member isn’t necessarily a rude or ornery person most of the time, they may just be experiencing symptoms of anxiety.
The first step in mitigating a patient’s anxiety is to introduce yourself and explain your role in their treatment plan. Explain everything you are going to do and why you are doing it. Patients are inexperienced in healthcare procedures, and it can be easy to take your knowledge for granted. Come armed with hand-outs and as much information as you can; the more knowledgeable the patient feels, they more comfortable they will be.
Next, it is important to listen to your patient and take their needs seriously. Active listening techniques, such as asking open-ended questions, taking an interest in their lives, or checking in on their feelings, can be a vital lifeline to someone suffering from anxiety. Check in with them often, and give them a venue to voice their concerns.
Instead of instructing the patient to relax, demonstrate it! Your demeanor can have a profound effect on a patient’s emotional well-being, so staying cool and collected can relax them in turn. Consider using relaxation techniques like breathing exercises to help them cope with anxiety.
For more tips, click here.