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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

Study finds medical blogs risk patient privacy

Blogs have emerged as great tools for nurses and physicians wanting to spread healthcare information. For some, they serve as emotional outlets to share experiences with others in the field. But could they be relaying too much to the public?

A study recently published in the Journal of General Internal Medicine examined 271 medical blogs to determine how often nurses and physicians wrote about patients, violated patient privacy, or displayed a lack of professionalism. Of the findings, 42% of blogs had content describing private interactions with patients. Seventeen percent of blogs disclosed information sufficient for patients to recognize themselves or their doctors and about 18% portrayed patients “negatively.” A few displayed pictures of patients in which they could easily be identified.

Tara Lagu, a Robert Wood Johnson Foundation Clinical Scholar and an internal medicine specialist held the study, who also found 65% of the blogs were written anonymously, with the remaining blogs identifying the names of the authors. View an abstract of the study.

What are your thoughts after seeing these results?

Benchmarking report explores state of nurse-physician collaboration

The nurse-physician dynamic has been found to shape various aspects of the healthcare environment. Research has uncovered that nurse-physician collaboration can affect patient care, patient satisfaction, hospital costs, and turnover. But as a nurse, how do you see it affecting your facility?

HCPro, Inc., recently surveyed 67 nursing professionals in the healthcare industry about the issue of nurse-physician collaboration within facilities of various sizes and settings nationwide. Participants responded to questions about nurse-physician collaboration barriers, strategies facilities are using to improve nurse-physician collaboration, and the influence poor nurse-physician collaboration has on stress. Take a look at some of the results:

  • 91% of nurses that rated their facility as having “excellent” nurse-physician communication came from organizations that employed fewer than 100 nurses
  • 82% of nurses surveyed said positive steps have been taken at their facilities to create work environments with better nurse-physician collaboration
  • 80% of nurses said poor nurse-physician collaboration brought stress to the workplace
  • 75% of nurses admitted to knowing other nurses who have vacated positions due to poor nurse-physician collaboration

What are your first impressions of these results?

View the rest of the results from this benchmarking report

Safe Staffing Poll reflects significant need for nurses

As a nurse, the obstacles you face on a daily basis increase the difficulty of your job regardless of the pressure for you to deliver quality patient care. You might feel many of these obstacles are unnecessary and unfair. If the sufficient amount of nurses were employed at your facility– these obstacles might not even exist.

Have you ever wondered how staffing issues at your facility measure up to those around the country? Take a look at the results below from the American Nurses Association’s Safe Staffing Poll that more than 10,000 nurses participated in. The findings emphasize the ongoing need for adequate staffing.

  • 73% of nurses asked don’t believe the staffing on their unit or shift is sufficient.
  • 59.8% of those asked said they knew of someone who left direct care nursing due to concerns about safe staffing.
  • 51.2% of nurses believe the quality of nursing care has declined in their unit over the past year.
  • 48.2% would not feel confident having someone close to them receiving care in the facility where they work.
  • 46% of nurses that were considering leaving their position associated it with inadequate staffing.
  • 36% rarely or never take their full meal break.

Do these results surprise you?

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?

Don’t let Dr. Jekyll turn into Mr. Hyde

Is there a physician, possibly your medical director, who has been non-supportive behind your back?

You know who these people are. At a meeting or in front of your boss, they are supportive and, at times, encouraging of your work and efforts. But once the meeting is over and everyone goes their own way, they are completely different. You would think it was a “Jekyll and Hyde” experience!

This is not to take away from all the providers we collaborate with who are ethically strong and committed to being part of a team. This hot topic is not about them; we are grateful for strong collaboratives with many providers we work with.

But believe it or not, some people are unhappy when they see your successes. Now that I spurted that out, think about it. You already knew that, but most people won’t say it. You are that multi-tasking, confident, caring, empowering nurse leader and some folks out there want to burst your bubble.

How do they burst your bubble?

  • Going behind your back and planting seeds among those who look up to you. What are they planting seeds for? They are hoping to grow their own cheerleaders and take your squad away from you.
  • Relaying misinformation about what you said or wrote
  • Discouraging staff from following policy or procedure
  • Verbally defaming your ability to perform your role
  • Identifying staff members vulnerable to getting on their bandwagon

How would you approach this professional? Or, if you have already faced a situation similar to this one, how did it go?

Every manager’s discrimination fears

Managers are forever grateful for the supportive teams they work with and all have staff they wish could be duplicated on a copy machine. Because we work with a variety of people, challenges will always be present. Our “Hot topics” will look at the reality of these challenges, helping managers by sharing their experiences. We can all benefit from those who have had success in meeting these situations of conflict.

How do you handle the employee who “everyone” knows needs to be shown the door, you have all the necessary documentation, but there is a “discrimination fear”? The employee may be obese, have a physical challenge, be from another country, or be in a recovery program for an addiction. According to the EEOC (US Equal Employment Opportunity Commission), types of discrimination include;

  • Age
  • Disability
  • Equal pay
  • National origin
  • Pregnancy
  • Race
  • Religion
  • Retaliation
  • Sex
  • Sexual harassment

Some employees may verbally threaten their manager by using the term discrimination and others use the weight of the nursing shortage as ammunition. The most recent case I was involved with was an employee who had threatened both the manager and the HR director with racial discrimination as they were walking the employee through the steps of termination.

In 2006, 75,768 individuals filed charges with the EEOC with almost 36% of them related to racial claims. gender discrimination was the next most commonly field charge at a rate of just under 31%. Of all the claims made in 2006, there were 403 suits actually filed. You can read more details about the charges, claims and outcomes of the cases at the Web site www.eeoc.gov.

What experiences have you had with this and how did you handle it? Were you surprised by the outcome? Who was your greatest resource that helped to guide you through the process? Did you find yourself in a situation where the organization was best served by “settling” the case?