RSSAuthor Archive for Shelley Cohen

Shelley Cohen

Shelley Cohen, RN, MSN, CEN, is the owner of Health Resources Unlimited, a company she founded in 1997 to meet the ongoing professional development needs of nurse managers and emergency department nurses. With a passion for dealing with the realities of the challenges in healthcare delivery, she embraces a direct and humorous approach to problem solving, her consulting work, and training programs. As an author and national speaker, she brings more than 30 years of nursing experience to a platform that is relevant and timely. Her ability to maintain a current perspective of nursing issues is accomplished through her role as a prn staff nurse. As an advocate for children in foster care, Shelley and her husband, Dennis, operate a non-profit organization, DoubleCreek, at their home in Tennessee.

Manager tip of the month: Be a good boss

Bob Sutton, a professor at Stanford University, is the author of the book Good Boss, Bad Boss. He reminds us of the balancing act related to being effective while also being respected in a leadership role. During his podcast “How to be the best boss”, he reveals the following considerations:

  • You must combine competence with compassion.
  • Many leaders are out of tune with what it is like to work for them! Get feedback from your staff.
  • Long term loyalty is your goal.
  • Your enemies “lie in wait,” waiting to crush you – be alert.
  • The skill of being a best boss is learned over time – it is a “craft.”
  • Listen to staff and encourage them to be engaged in dealing with conflict.
  • Be respectful of differing opinions.
  • Understand the work that the people you lead actually do.

Listen to this free podcast at: http://www.bnet.com/blog/management/how-to-be-the-best-boss-useful-commute-podcast/3077?promo=665&tag=nl.e665

Visit Shelley's website, Health Resources Unlimited.

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Tip of the month: Guidelines for using social media as background checks

By Shelley Cohen

Custom writing sevice

The Internet has proved to be a great resource to managers with the greatest challenge seeming to be finding the time to research all that is available to us. Along with medical and nursing resources, the Internet has become a social highway for individuals as well as organizations.

As the generation gap continues to grow, managers are continuously amazed to hear of personal concerns being posted to social networks such as Facebook. On one hand, some of these sites may provide an opportunity for “pre-screening” job applicants. On the other hand, we see the benefit of looking up a prospective applicant and finding out they are a source for purchasing drugs or the real reasons they were fired from their last job.  A question raised on the other side of this is one of discriminatory action. What if you declined to hire a person based on a social networking site story about them and you later find out, the posting was unreliable?

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Survey staff to shape up the nursing image

All nurse managers desire to work in facilities which demonstrate a positive, professional image of nursing. But many barriers exist—often differing within each facility—to cultivating such an environment.

However, nurse managers can work to improve the nursing image by reviewing staff perspectives on the unit’s nursing image. Performing some inventory will allow you and your staff to identify any problem areas and discuss how to resolve them. Consider sending out a survey asking your nurses to rate the image of their peers on a scale from 1-10. [more]

Hone your hiring skills

by Shelley Cohen, RN, BS, CEN

Selecting new staff to add to the team is one of the most important roles nurse managers play in relation to recruitment and retention, yet their interview skills are typically lacking. In order to improve the interview and hiring process, nurse managers must be educated and provided with the right resources: [more]

Use surveys to motivate your staff

Motivating staff is not a once-a-month or quarterly item on a manager’s to-do list. It is a process that requires constant grooming on your part. Understanding that what motivates one person does not necessarily motivate another is a fundamental aspect of your efforts. Setting realistic goals for your motivation efforts keeps the manager from making assumptions about what does and does not work Variety is the key to success and your willingness to incorporate a buffet of motivational strategies will result in positive behaviors.

So, how does a manager know what to put on this buffet table of prompters? Ask your staff!

You can do this through a brief email or survey. Consider these questions for your survey:

  • What motivator was used at a previous job that would encourage you to become more actively involved in change at this job?
  • Which of the following would you include in your top three motivators?
    • Understanding not just what is being asked of me, but why it is important enough for me to care
    • Points toward a higher level as a staff nurse which would result in an increase in pay
    • Knowing my involvement improves patient care
    • Knowing my involvement improves our working conditions
    • Certificates to use as money in the gift shop or cafeteria
    • Knowing my manager is holding my co-workers accountable when necessary

What questions would you add to this list? Have you done a similar survey in the past and, if so, how did the results help you as a manager?

Get your facility into debate mode

p>by Shelley Cohen, RN, BS, CEN

Most of your staff members are probably keeping an ear tuned to the presidential prospects for the upcoming election. With this is mind, many will be listening to and watching the debates between both the presidential and vice presidential hopefuls. This is a wonderful opportunity for nurse leaders to take advantage of the debate and relate to the workplace.

The structured debate can serve as a springboard for initiating change, implementing evidence-based practices, or even defining unacceptable behaviors for a department. When staff have a chance to hear the pros and cons, as they do in a debate, they learn how to validate their needs. A controlled, professional, yet fun, environment of presenting both sides is what the debate process has to offer. Examples include debating changes in holiday scheduling, or how patients are assigned.

To get into the debate mode, start with these steps:

1. Provide the staff a list of current practice issues and have them vote on the two issues of greatest concern to them
2. Post the date you will be holding the debate (in place of a staff meeting) in emails, on bulletin boards, or both
3. Invite someone from fiscal services and administration to evaluate the debate
4. Display a poster of five keys to effective debates for one week
5. Post Web sites where staff can learn more about debating, such as www.articleinsider.com
6. Have staff select one peer who will oversee/facilitate the debate and develop the ground rules for the debate
7. Provide a debate worksheet to get them started

What are some other ways to engage staff in the debate process?</p

Legislative lessons from school

Many of you have been following my intermittent posts on my journey, at the age of 54, to pursue my MSN degree. In just a few weeks, I will have completed course No. 4 on healthcare delivery systems. One of our assignments was to interview a person in a legislative position and discuss the many facets of his or her role as it relates to how healthcare is delivered to his or her constituents. The legislator I selected happened to also be a family practice doctor. I just couldn’t resist. Oh sure, I could have picked a female legislator, or one whose name has been in a headline more often than deserved, but not me. I went straight for the jugular-a doctor who is my state rep, which brought me to an interview that was more of one as a constituent that that of a master’s level student.

The interview was a grand opportunity to better understand not only how the state process works, but how and why many decisions are made regarding healthcare bills. In the state of Tennessee, our legislature had been handed a bill that would make it optional for adults to wear helmets on motorcycles. Being an ED nurse, I am sure you can guess what my vote would have been on this! This motorcycle-riding physician, father, and state legislature felt otherwise. He strongly felt his job was to represent all of his constituents who wanted the helmet option. We agreed to disagree on this issue and I left the interview feeling our county/district was in good hands.

As we look to the last quarter of this year, by the end of December, I will be halfway through the program. I feel like my brain is packed with so much information, I will have to upload more GB to store any new lessons for 2009!

Are you still wrestling with whether or not you should go back to school? Are you having an argument with yourself over what to specialize in?

The power of improvisation

One thing you can say about most nurse managers is that they are incredible at improvising, both at work and in their personal lives. Nurse managers also know that typically-although not always-if things seem to be going smoothly, one of two situations is pending:

  • Something bad is happening behind the scenes and the scoop just has not gotten to you
  • Strap in because something is around the corner just waiting to tip your boat

I thought I had this whole back to school thing figured out. I was keeping up with assignments and my workload, even planned a trip home for mom’s birthday. And then, “it” happened. I fractured the head of my distal radius (Of course it had to be my dominant hand.) I wish I had some fancy, courageous story about how it happened while working in the ED or falling off my horse. Basically, it was a scenario where I tripped and I fell. Support is all around me, everyone is sharing their version of recovery nightmares with elbow fractures, and it’s not pretty. Did I mention this happened the week my 21-page final for one of my courses was due?

I have learned that graduate school professors can be very understanding, and by the way I got an “A” on that paper. Typing with one hand takes more time, medication, and patience. Keeping up with school reading takes longer now as the books are much too heavy (I am up to lifting one pound at this point.) As time moves along and I am starting week three after the fracture, the physical therapy journey begins. This is where you appreciate the relevance of the 1-10 pain scale. I will never roll my eyes again at a patient who responds to the pain scale with the number 100. Did I mention the thank-you note I am considering sending to the makers of pain medication?

Oh, and did you know that if you hold a jar of peanut butter between your legs and use your non-dominant hand, you can still make a pretty good sandwich for kids? And did you know that even if you cannot sign your name to your credit card purchase, the store thinks nothing of you just scribbling anything on the receipt?

Anyway, with two courses down and a third halfway completed, I begin health care delivery systems next week as my 4th class. To stay motivated through this process, one has to keep the end in sight and I have done this with a wall chart that I peek at. At a glance, I can see the courses done (or at least 50% completed) along with my target date for completion.

If I can keep my clumsy self intact through the remainder of school, I just might make that target.

What about you? Do you have a story of improvisation when you made the best of a tough situation?

Learning a new definition of health

Starting next week, I will be carrying two courses at a time, and I am told it can be done. I have spoken to several other classmates who have management jobs, families, etc., and some of them are actually taking a bigger course load. I don’t think I will ever go there. Just the thought makes my critical thinking skills kick in and ask, “Are you nuts?!”

The three credit course I am in the midst of is related to public health nursing, and I know what you are thinking-the same thoughts I had as I poured over the course objectives. With a bottle of Phenergan at my side, I was ready for boredom and nausea. What I found was an inspiring faculty member whose pointed questions got me thinking about healthcare and how it is delivered to the patient, the family, and the community. The course puts an emphasis on the effects of prevention on public health and assessing the health care needs of communities. Think of all the times staff approach you whining on and on about non-compliant patients. The course delves into the compliance obstacles for some of our population, such as making bad choices in their lives.

The most important questions we had to ask ourselves is to define the word health: What does it mean to each of us? Now I am asking you for your definition of health, and also your staff’s definition. Mine is printed below:

Health: A state of wellness for that individual

I anxiously await my grade for my mid-term paper, which brought back memories of why I do not work the night shift anymore. My final paper is due mid-June and no, I have not started it yet. For my final exam, I have to find a grant available for a vulnerable population we identify in our mid-term paper. Can someone please help me? I feel ischemia creeping into my brain. What was it I identified? Can Phenergan ever be used to help brain perfusion? Hmmm…..

Who is accountable to the cost and use of patient supplies?

Are you finding yourself spending more time with a budget sheet, calculator and bottle of Tylenol these days? If you answer yes, that makes you normal as a Nurse Manager. With all your fiscal responsibilities do you ever wonder how much accountability staff should have?

Of course, their first response will be, “you make the big bucks you should take care of the money stuff. I’m here to take care of sick people and be a nurse, not an accountant”. Sound familiar to anyone? You might be wondering, where is Shelley going with this? Think about your role as a manager as it relates to sound fiscal practices in your department. With that in mind, how do you see your role as it relates to holding staff accountable from a fiscal perspective?

Have you wondered what goes on in the mind of the staff nurse when he/she reaches for supplies? You may be hoping they are calculating the cost to purchase the item vs the amount you are actually reimbursed. But, let’s be real here, after all a good professional blog prides itself on reality. When I work my prn shifts as a staff nurse and I am in need of a supply for a patient, my thoughts are (in order of priority);

Do I remember where this item is stored?

  • Will the item actually be there on the shelf?
  • What is going on with my other patients while I am in the supply closet?
  • When can I finally get to the bathroom (ok, maybe this is a number 2 priority)?
  • What time is lunch?

Can you put yourself in the position of your staff as they make selection decisions related to supply use? How can the manager educate and coach staff to lead to a more fiscally realized use of supplies? If the nurse needs one sterile 4×4 for a procedure and they have the following to choose between, how do they make their decision?

Option 1 package with 2 4×4’s
Option 2 package with 4 4×4’s

Some staff will select the item based on which one they see first. Another staff person may consider/rationalize the following;

If a liter of irrigating solution costs the same as a 250cc bottle, maybe the same applies to other supplies.

What do you think your staff consider as they make decisions about selecting supplies for their patients? How have you educated staff to details regarding costs vs reimbursement? If you had the opportunity, what would you implement that would hold staff more accountable to areas related to the costs of providing health care?