All Entries in the "Leadership" Category

Nurses Week: Lead! Becoming and effective coach and mentor

As a nurse manager you are called upon to lead, inspire, and coach your nursing and take on a leadership role within your organization. That’s why today, in honor of Nurses Week, we are offering a 30% discount on our book Lead! Becoming an Effective Coach and Mentor to Your Nursing Staff, by Patty Kubus, RN, MBA, PhD.

Lead! Is an invaluable resource for nurse leaders and contains communication strategies and management skills that will inspire you to become a role model for your staff. The book includes downloadable materials such as development worksheets and tools.

Visit HCPro’s Healthcare Marketplace to take advantage of this great deal! Please enter source code NRSWK2012 at checkout to receive your 30% discount.

Tomorrow we’ll post a new special offer in honor of Nurses Week!

Live webcast on staffing costs, featuring Pamela Hunt, BS, MSN, RN

Join Pamela Hunt, BS, MSN, RN, vice president of patient services and chief nursing executive at The Indiana Heart Hospital in Indianapolis, on May 9, 2012, 1:00-2:30 (Eastern), for a live, 90-minute webcast, Creative Ways to Trim Nurse Staffing Costs: Answers to the Six Most Pressing Concerns for Any Nurse Leader .  This webcast features expert advice from the coauthor of The Nurse Leader’s Guide to Business Skills: Strategies for Optimizing Financial Performance, and will focus on practical solutions to the financial challenges nurse managers and leaders frequently face.

During the presentation, Hunt will use real-life examples to explain practical solutions for meeting productivity targets, getting the most from nurse labor budgets, and ensuring high-quality patient care.  She will discuss important considerations for nurse leaders regarding employee satisfaction and staffing concerns. The webcast will conclude with a live question and answer session.

Hunt is an authority on the challenges of nursing leadership and business plan development. Her articles have been published in nationally recognized journals and she has lectured on the national and international levels.

Please visit www.hcmarketplace.comto learn more about this program.

Board membership and the role of nurses in healthcare decision making

Nurses hold leadership roles in healthcare organizations, yet nurses are not perceived as leaders in healthcare decision making, according to an article in the March issue of American Journal of Nursing (AJN). The article investigates the lack of nurse representation on hospital boards, drawing data from a 2010 American Hospital Association survey of more than 1,000 hospital boards that found that only 6% of board members were nurses, compared to a 20% board membership comprised of physicians. The Institute of Medicine urged healthcare decision makers to include nursing representation on boards and management teams in its report, The Future of Nursing: Leading Change, Advancing Health, but nurses must also take initiative in developing their own skills and acquiring the competencies necessary for leadership, according to the AJN article.

What are some of the essential capabilities of board members? According to the article, nurses already possess several: personal skills, professionalism, and collaboration. Other qualities, such as an understanding of business, finance, and human resources, can be developed over time with the help of continuing education. The article also profiles several nurses who serve as board members and who share the personal traits and professional competencies that are crucial to their success.

As a nurse leader, it is important for you to establish not only your capability in managing your staff, but also your ability to contribute to the development of your organization and the services it provides. Continue to demonstrate and enhance the skills and knowledge you bring to the board, and encourage your fellow nurses to do the same. Serving as a member of the board can be a rewarding and instructive experience.

Share your thoughts: Does your board have sufficient nurse representation? Would you want to take on a more active role in leadership and decision making as a member of the board? Leave a comment below!

Ask your staff: How can we earn your trust?

Every time I explore a quality improvement initiative with a hospital for Patient Safety Monitor Journal, I always ask two questions:

• What was your biggest challenge?
• What advice would you give to other hospitals?

Especially as of late, the answers revolve around just culture. Quality directors, nurse managers, patient safety professionals, CNOs all tell me the biggest challenge is staff trust and buy-in; the key to success is involving them in the process. We all know the key to improving is knowing what’s wrong, but unless there’s trust between the organization and the staff, you won’t find out that information.

The most recent AHRQ Culture of Safety survey – Hospital Survey on Patient Safety Culture: 2012 User Comparative Database Report – leads me to believe perhaps the knowledge of how to improve culture and safety is there, but it’s not yet in practice to the fullest extent.

This is a big survey, including data from more than a half million healthcare staff from more than 1,000 hospitals, and deserves a good look:

Teamwork within a unit was strong; 80% of respondents agreed or strongly agreed to that sentiment. Generally, staff felt that management supported them and a culture of safety, and that the organization was including systems meant to support staff and reduce errors. To me this says that the talk is there: Staff members are aware that managers and leadership care about safety, and those systems should support them, not hinder them. Seventy-five percent say that management’s actions show dedication to patient safety; 72% believe the systems are in place to prevent mistakes.

Yet when it comes to reporting or speaking up, staff are still wary. Only 62% felt there was communication openness in their organization, and the lowest scoring domain was nonpunitive response to error, with only 44% positive response to questions related to the subject.

When it gets more specific – and more personal–the rates drop lower. Most interestingly is the difference between these two questions:

• Staff will freely speak up if they see something that may negatively affect patient care: 75% agree/strongly agree
• Staff feel free to question the decisions or actions of those with more authority: 47% agree/strongly agree

To whom staff must speak their concerns seems to be a critical indicator as to whether they actually will. This is certainly an issue with culture. The vast majority of respondents (76%) had direct patient involvement, and 35% were nurses. Considering disparate levels of authority create the team responsible patient care, I find this low response to that particular question quite concerning.

Also noteworthy: exactly half believed mistakes are held against them. It’s no wonder the survey indicates vast under-reporting of adverse events, a claim supported by the recent report by the inspector general of the Department of Health and Human Services.

I think the next step for hospitals is to find out what it will take for staff to trust hospitals. What will it take to get a nurse to report an adverse event he or she was involved in? Or demand a time out be performed to a surgeon?

Such a large shift in thinking might take time, as we all know in decades past healthcare has been notoriously punitive. Still, perhaps we should start by asking our staff what it will take to earn their trust. After all, involving them has been the key to so many other instances of quality improvement success.

First published on Patient Safety Monitor Blog

How to retain nurses by focusing on the reasons they entered the profession

Recognizing and building upon nurses’ dedication to their line of work could be essential to improving nurse retention rates. A survey of 900 nurses revealed that the single common variable reported by nurses from all age groups regarding why they chose nursing was a commitment to healing and an attachment to the nursing profession. As a nurse leader, it is important to acknowledge the reasons your staff chose to pursue a career in nursing and reinforce those choices.

Nurses in the 29 to 43 age range (Generation X) also indicated that the quality of their relationships with their supervisors was a factor in considering whether or not to continue nursing. Nurse leaders can address these reasons by working on good relationships with nursing staff. These efforts could include monthly or quarterly check-ins rather than annual reviews, open and frequent communication with all members of the staff, and encouraging all staff to share thoughts and ideas to address issues or concerns.

Additional variables identified by the oldest group of nurses (Baby Boomers) surveyed included work-family conflict, the quality of relationships with colleagues, and being allowed to decide how and when to carry out tasks. Try reviewing policies and obtaining feedback from staff about potential changes to improve work-family balance. Encourage nurses to alert you to any issues between colleagues and address those concerns promptly. Improving the quality of the work environment and fostering positive relationships between nurses could lead to better retention rates and a rewarding career for staff.

Medical News Today recently reported on the findings of the study, in which Australian researchers gathered data from 900 anonymous surveys completed by nurses at seven private hospitals. Though researchers noted a need for additional research, they emphasized the importance of identifying the variables that inspire individuals to continue nursing and addressing each of those variables to improve retention rates.

How do you address the variables discussed here? Have your nurses indicated any additional factors that influence them to continue nursing? Share your thoughts in the comments section!

How effective are you unit-level shared governance councils?

During the November 10th audio conference “Put Shared Governance Into Practice At the Unit Level: Strategies for Running Effective Meetings,” speakers Diana Swihart, PhD, DMin, MSN, CS, RN-BC, and Solimar Figueroa, MSN, MHA, BSN, RN, asked the audience how long their organizations had been living shared governance for nursing service?

Forty-three percent responded they had just started or were less than a year into the process. Thirty-three percent had been working at shared governance for one to three years and 14% had enacted it for four to six years. Ten percent of listeners have had shared governance in place for more than 10 years.

They were also asked about the effectiveness of their unit-level councils. Unsurprisingly, 47% responded their councils were marginally effective. Twenty-six percent had not yet implemented unit-level councils. Of the rest who had, 16% said they were highly effective and 11% said they were essentially another staff meeting.

How do yours stack up?

Practical tips for implementing shared governance

Diana Swihart, PhD, DMin, MSN, CS, RN-BC, shares the following practical tips and best practices for ensuring success when building shared governance.

• Schedule a day-long retreat away from the organization to prepare organizational and nursing leaders to implement shared governance. Discuss the role shared governance plays in the ANCC Magnet Recognition Program(r) (MRP) journey. Have subject matter experts present topic discussions on specific points: leadership, shared governance partners, steering committee formation, design team for the shared governance model, a business case for MRP and shared governance, and roles of direct-care nurses and the multidisciplinary team members.
• Create expectations for staff contributions, beginning in the new employee orientation and continuing throughout their careers.
• Communicate, communicate, communicate! Have a nursing town hall meeting at least once a quarter to facilitate open communication among nursing staff and leaders.
• Administer the Index of Professional Nursing Governance surveys and see how your organization “measures up”-help build the repository of information on the efficacy and value of shared governance in healthcare settings.
• Use journal clubs, for example, to bring nursing research to the bedside and engage direct-care nurses in evidence-based practice for developing and implementing advanced decision-making and critical thinking.
• Let direct-care nurses meet each year to review organizational competencies and unit/area needs and determine which competencies they will focus on for that year (high-risk/time-sensitive, changed, problematic, and/or new).
• Train every registered nurse on each unit/area to be charge or lead nurse. Rotate the role and responsibilities to encourage leadership skills development and shared decision-making among all team members.

Source: Book excerpt adapted from Shared Governance: A Practical Approach to Transform Professional Nursing Practice by Diana Swihart, PhD, DMin, MSN, CS, RN-BC. Click here to visit www.hcmarketplace.com.

Performing a SWOT analysis

One of the most important, although sometimes time-consuming, activities that are frequently completed in financial planning sessions is the Strengths/Weaknesses/Opportunities/Threats (SWOT) analysis. This analysis can be useful in many problem-solving situations that you may face. The SWOT exercise may seem very time-consuming; however, this planning will again help direct where resources are needed and to what extend the resources should be allocated.

As a nurse leader, sometimes you may be part of the group being asked to identify SWOT. This selection usually occurs if your director or vice president is conducting the session and you are a group member. In working with just your area of responsibility, you might be the leader guiding your direct reports through this exercise. In both cases it is important to understand the SWOT analysis to gain the full benefit.

Strengths are what the organization, division, or department identifies that they do well and have success in above the competition. When identifying strengths for your organization ask yourself: “What would the community say that we are best at providing?” The answer to this question will help you get started with your list. Maybe it’s your strong orthopedic program and the total joint camp that you’ve developed. Maybe it’s the great oncology doctors that you’ve been able to recruit. This list should include both internal and external views. Here are some other examples of possible strengths:

• Strong name recognition of the organization
• Stable workforce
• Strong succession planning
• New facilities
• Private patient rooms
• Strong financial position
• High-quality care delivered

Weaknesses, of course, will be just the opposite. The weakness assessment should openly and honestly describe what the organization currently does not do well or is seen as a weakness to achieving the desired goals for the organization. Weaknesses are identified by asking the question: “What currently causes us trouble in providing the exceptional patient experience that we strive to provide?” [more]

Determining financial goals and objectives

It is common for highly driven organizations to develop goals and objectives annually. In healthcare, just as in many businesses today, rules, regulations, customers, workforce, and technology are changing at such a rapid pace that it is impossible to effectively operationalize goals for further than a one- to five-year period. At the senior level of leadership, goals are developed in conjunction with the board of trustees and senior leaders of the organization. A complete assessment of the community, the patients, physicians, employees, and services is reviewed.

In addition to internal assessment, much attention should be paid to external factors affecting the organization. This is important in every market but particularly important in markets with more than one facility that offers similar services. If the competition across town is the known market leader in one service line, does it make sense to compete for the patient population? In some cases the answer to this question will be yes, and in some cases the answer will be no. Some of the factors affecting this decision include:

• Number of patients in the market
• Quality of the competition’s service
• Expense to provide the service
• Reimbursement for the service
• Projected life of the technology or equipment

Let’s assume that your competitor is providing a very highly specialized cancer radiation treatment program. [more]

Winner of HCPro’s nurse leader best practices contest

Editor’s note: This best practice was submitted by Anjie Vickers, RN, BSN, NE-BC, Carolinas Medical Center, Charlotte, NC. Anjie won a free book. Congratulations Anjie and thanks to everyone who submitted a best practice!

I am the nurse manager of a 19-bed progressive care unit, which I have managed for almost 11 years. The culture has dramatically changed from that of the one I started with. That was one in which the nurses exhibited horizontal violence, resisted change, and lacked shared ownership. How I changed it to one that is now a healthy work environment that embraces shared decision making, learning, and engagement involved a combination of the following.

I created an expectation of peer accountability. If the employee came to me with a complaint about someone else, I set clear expectations asking if they had spoke to their peer first and foremost. Peer review and accountability has evolved over time and continues to improve even more. We have most recently adopted the practice of bedside report and have expectations that peers will communicate, mentor, and develop each other with peer-to-peer feedback and expectations of each other.

We created our unit-based council (UBC), which has grown over time to now include each of the following:

• Quality unit-based council
• Professional development unit-based council
• Coordinating unit-based council

We have sub-committees off these councils that include our Sunshine Committee, Peer Interviewing team and Self-Scheduling committee. We also empower our staff to be the champions of different goals and areas, such as restraint champion, skin care liaison, and falls champion. This helps to create an engaged workforce where everyone is part of our success.

Our community liaison assists with coordinating and organizing our volunteer events such as volunteering at a men’s homeless shelter.

Areas that we have been successful include:

• Falls champion-Quality UBC: Reduced our falls from a total of 25 in 2010 to eight in first quarter 2011, one in second quarter, and zero in third quarter
• Skin care champion-Quality UBC: Reduced unit-based pressure ulcers from 18 and 20 in last two quarters respectively of 2009 to zero in first half of 2010
• Professional Development Council achieved recognition of Hallmarks of a Healthy Work Environment in 2010

The feedback from patients and families speaks highly of the engagement of this department and includes many compliments.