RSSAll Entries in the "Staff motivation" Category

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 Reportleads 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 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?

Helping new graduate nurses over transition shock: Part 2: The “being” stage

Kendra Varner, MSN, RN, nurse residency program coordinator for the Kettering Health Network in Dayton, OH, wrote in the book Nurse Residency Program Builder,  that new nurses go through many experiences as they transition to become competent nurses. In the second part of a three part series, Varner describes the second stage.

Judy Duchscher elaborated on the concept of new graduate nurse shock by describing the transition process as a nonlinear “Process of Becoming” a nurse (Duchscher, 2008). This process has three stages: doing, being, and knowing.

During the “being” or transition crisis phase, the real work of role transition occurs, beginning around the fourth month. During this stage, new nurses have consistent and rapid knowledge, skill, and critical thinking acquisition, but at the same time begin to experience a paradoxical loss of confidence resulting in uncertainty, confusion, and even depression. Consciously aware of competency level and significantly doubting their own abilities, new nurses seek validation of decisions from more experienced coworkers, which may be met with mixed reactions. While examining inconsistencies and inadequacies within the healthcare setting, graduate nurses struggle to reconcile their previously held view of self and the world with current reality, or they cognitively adapt to the change. Described by Bridges (2009) as a psychological wilderness state between identities and realities, this stage is profoundly frustrating, as well as irritating for nurses, impacting both personal and professional lives.

You can’t teach with apathy: Why it’s important to support your preceptors

by Julie Harris, MSN, RN

I occasionally peruse online nursing forums to see what the hot topics are. Last night, I was on a highly popular forum and came across an interesting discussion. A new graduate was being oriented and her preceptors were not interested in training her. She perceived their behavior as intimidating and somewhat hostile and she didn’t know what her next step should be. Should she quit and look for a new job? Should she stick it out?

Responses to her post ranged from “This is part of orientation. Try not to take it personal,” to “Those nurses shouldn’t be preceptors. If this facility supports that kind of behavior, you need to leave and find a new job.”

I find myself agreeing more with the last response. Nobody should be forced to precept. Some nurses are wonderful caregivers with excellent clinical skills; however they do not possess the desire to train orientees. Other nurses have a strong craving to teach and pass on their knowledge to orientees. Both options are perfectly acceptable.


Take a vacation: Why nurse leaders need time off

By Marsha Egan, CPCU, PCC, ICF

You’re more likely to get burned if you don’t spend some time outside the hospital walls this summer. Burnout is a leading downfall for many busy nurse managers, but here’s one way to prevent it.

Take a vacation! Even if you only have a couple days, it’s vital to maximize your R&R.

Being a nurse leader is not easy and comes with a lot of responsibility, but even you can beat the heat of job stress with the following vacation strategies.

Take the time: Even if you haven’t racked up enough hours for a week-long vacation, make time for a mini vacation. Use the weekend or two days in a row that you have off to take trip to a friend’s or family member’s house to relax.

Plan it out: Plan your vacation months ahead of time. It can be almost as gratifying just thinking about an upcoming trip as it will be to actually take it. Also, it will help get you through stressful times when you know you have something fun coming up. Put up reminders that you’ll see every day. Mark the trip on the calendar, put a picture of the beach you’re going to in your purse or wallet, and make the background of your computer something you’re excited to see on your trip.


Bedside nurses encouraged to be patient safety champions

The University of Kansas Hospital (KUMED) in Kansas City, KS, has created a program to encourage nurse involvement in patient safety. The program, Quality Safety Investigators (QSI), is a way to improve bedside nurses’ involvement in championing quality and patient care. KUMED provides each nurse involved in the program with tools, resources, and training that focus on unit-specific initiatives. [more]

Improving nursing culture in your organization

Nursing culture is shaped by many internal factors, including barriers such as poor communication between leaders and frontline nurses or a lack of respect from medical staff. If nurses are not well respected by their colleagues on the medical staff, then how do you think you can create a culture of excellence?

Leadership plays a critical role in affecting culture throughout the organization. As a leader, it is important to create an environment for a culture that is professional, reaches excellence, has mutual respect, and inspires values.

Here are steps to help change the culture in your organization.

Step I: Define your current nursing culture (positives and negatives.) What are things that you like and dislike about the nursing culture in your organization? What are the things that you need to change? What are the barriers that will block change?

Step II: Identify the changes needed to enhance professional culture. Some changes take time, but there may be policies or changes in practice that can occur immediately. Don’t forget to recognize and praise changes made throughout the year. Have you ever looked back and wondered what did we accomplish this year? Keep a log of all the changes made in nursing for the year, and then communicate this to your nurses.

Step III: Create a nursing vision and mission and then communicate this to the nursing staff. Creating a vision and mission will guide and provide structure for the nurses. [more]

New findings say progress means more than recognition

A new report in the Harvard Business Review contradicts the idea that employees value recognition of their efforts higher than anything else. Amabile and Kramer write that the top motivator of performance is progress.

The study involved gathering more than 12,000 e-mail diary entries from the participants, which revealed that making progress in one’s work, no matter how little or big, is associated with positive emotions and high motivation. The survey notes when participants experienced progress in their jobs, 76% of people reported it as their best day. [more]

General Test-Taking Guidelines

Successful test-taking is a learnable skill. Some people freeze up when faced with taking a test and find themselves forgetting facts that they knew well only hours before the exam. Others become physically ill or very nervous. However, there are specific strategies for taking tests, which sometimes depends on the nature of the test themselves. There are also general strategies for preparing tests. These often pertain to ensuring learners’ general health and well-being.

The following are some general strategies to suggest to nursing students and staff members to avoid test panic and to do their best on examinations: [more]

Different ways peers are improving nurse satisfaction

The July 28 blog post discussing ways to boost nurse morale in a time of uncertainty has been one of the most popular recent topics. The post provided quick and helpful hints on no- or low-cost ways to boost the morale of nurses in your organizations. The post also generated a lot of discussion and many readers shared their own tips and strategies about what they have been trying.

Here are some of the highlights of the suggestions:

  • Caught red handed campaign: Recognize staff members who have been “caught” doing their job well.
  • Gift cards: Present a gift card to acknowledge a nurse who has gone out of his or her way to be an excellent nurse.
  • Strive for five: Leave small questionnaires in plain sight of patients, visitors, and hospital staff members and ask everyone to fill them out. The person can comment on a particular staff member doing an excellent job, similar to a comment card at a restaurant. Any staff member receiving a good comment earns $10 on the next pay check.
  • Hand written thank-you cards: Thank-you cards are always a great thing, but hand written ones can be the best. Instead of sending an email about a job well done to a staff member, write a thank-you card and leave it in their locker. After a tough shift, whether it’s night call or day call, the card will surely bring a smile to their face.
  • The stupid nice game: Be over-the-top nice to everyone and overly complimentary to everyone at the hospital. Laughter is contagious, and sometimes taking the compliment to the next level, or having staff members realize how over the top you are being, could make their day that much better.

What are you doing at your organization to help boost staff members’ morale?