Taking the pulse of nurse-physician relationships

Taking the pulse of physician relationships is a good starting point for change. Doing so allows you to dissect the current relationships in your facility and make sense of the problems you face. Five categories can be broken down to define the types of relationships:

1. Collegial: Relationships between the nurses and physicians have mutual respect and power. Because of this, both parties feel empowered. When both nurses and physicians have power, they are better able to recognize the value in each other’s education and experience. With this environment, physicians and nurses consult each other frequently and seek each other’s advice, to the full benefit of patients.
2. Collaborative: Physicians and nurses participate together in the plan of care to produce positive outcomes for patients. The nurses and physicians have a mutual respect for each other. The key difference is that the power is not equal between nurses and physicians. The power difference does not interfere with the working relationship, and both parties are able to work together for the benefit of the patient.
3. Teacher-student: The physician or the nurse takes on the role of mentor. Typically, the physician educates the nurse. Often, however, nurses are in a position to teach physicians what they have learned from their experiences.
4. Neutral: These kinds of relationships evoke only indifference. Such relationships originally cropped up in healthcare when, in an effort to increase productivity, hospitals decided to move patient charts from the main nursing station to outside patients’ rooms. Now, physicians can come to the floor, write orders, put up the yellow flag on the chart rack, and never speak to anyone.
5. Negative: Nurses report that negative patient outcomes occur more frequently when nurses interact with difficult physicians. After physicians establish a negative reputation for themselves, nurses will go out of their way to avoid them. The critical common thread in every disturbing physician-nurse interaction is that the patient loses.

How does your facility deal with difficult relationships between nurses and physicians?

Source: Speak Your Truth: Proven Strategies for Effective Nurse-Physician Communication

Managers’ role in promoting a professional image

We all try to shape up our physical appearance at one time or another. Or we may make an internal change in our personal attitude that eventually reflects on the outside with a positive change in body language or tone of voice.

Our actions—or lack of action—appearance, voice inflection, and ability to convey empathy and concern all play a role in our image. There are four categories we can focus on when considering as image makeover:

1. Professional work environment and interactions
2. Appearance
3. Collegiality/team member role
4. Professional accountabilities

Nurses in various areas of the profession—nursing departments, nursing individuals at all levels and practice, nurse faculty, and nursing students—can select a category and develop a program that reshapes their image at the individual or group level.

For instance, when making changes to professional work environment and interactions, remember:

• Do not carry on a discussion in the nurses’ station that you would not want others to hear
• Respect the equipment you work with and handle it as if you paid for it out of your own paycheck
• Support other nurses who are being approached unprofessionally
• Do not display any behaviors or gestures in view of coworkers, patients, or families that you would not want seen or heard

Managers can set expectations for professional appearance and should never forget to set a good example. Share with your staff these points:

• Dress for the respect you feel you deserve
• Follow your organizational dress code policies and procedures
• Recognize that your appearance affects perceptions of your competency
• Differentiate yourself in dress from the unlicensed members of your healthcare team

The stresses of the profession are minimized when nurses are able to care for patients in a collegial, supportive environment, where everyone is striving to provide the highest-quality patient care and deliver the best possible patient outcomes. Set expectations that your staff members will:

• Proactively offer to assist other members of the team to demonstrate team commitment
• Actively become involved in the orientation process of all new staff
• Not allow someone else’s unacceptable behavior to become their own behavior
• Be open to constructive criticism and feedback

Finally, managers should encourage their staff to hold themselves accountable to high standards as well. Remember to:

• Acknowledge that it is your name on the license, not your manager’s or your organization’s
• Maintain a current knowledge of your nurse practice act
• Belong to and support at least one professional nursing organization
• Document appropriately and according to nursing standards of practice

Source: The Image of Nursing: Perspectives on Shaping, Empowering, and Elevating the Nursing Profession.

Americans spend millions on alternative therapies

A recent study of 23,000 Americans by the Centers for Disease Control and Prevention and the National Institutes of Health found that Americans are spending $34 million a year in alternative therapies that are not covered by insurance, which is a 25% increase within the past decade. Alternative therapies can range from taking herbs to yoga classes, and are popular for both adults and children.

The study found that $22 million of the $34 million is spent on “self care,” where patients use an alternative therapy, such as taking fish oil supplements or homeopathic medications, without their health practitioner’s advice. As more and more Americans seek alternative therapies, it is important for nurses to be aware of how these drugs or methods may effect patients’ prescriptions or treatment. [more]

Providing culturally competent care at the end of life

Among healthcare professionals, nurses have been leaders in recognizing that cultural factors influence healthcare practices and disease processes. It is useful for nurses to be aware of the beliefs and understandings of various patient populations when discussing end-of-life care and recognize that end-of-life decisions are made within the cultural context.

The significance of autonomy, informed decisions, and control over the dying process are understood differently by different ethnic or cultural groups in America. Autonomy, to the level often expected by European Americans, may not be expected in many cultures that have a long tradition of family-centered healthcare decisions. 

For example: [more]

Improve nurse satisfaction in a time of uncertainty

Improving nursing satisfaction is tough in bad economic times, when many hospitals are experiencing census dips and cost cutbacks that are forcing reductions in work force, benefits, hours, and pay. But the state of the economy doesn’t need to bring your nursing satisfaction scores down—there are ways to boost morale immediately.

For example, you can:

• Begin nursing staff meetings by asking, “What was the best thing that happened to you today or during your last shift?” The meetings should focus on improving care and team-building.
• Focus on improving the image of nursing by gathering a group of nurses to volunteer with a community or organization project.
• Ask creative nurses to develop banners or posters that showcase nursing excellence and hang them around the unit or facility.
• Thank nurses for their fortunate choice of profession. In Gallup’s annual honesty and ethics professional survey, nursing has been rated No. 1 for the past seven years.
• Ask a nurse to create helpful hints on how to deal with stress and print them in your nursing or hospital newsletter.
• Ask the CNO to visit each nursing unit to listen and discuss why he or she is encouraged and hopeful about the future. Now is the time for leadership to paint an accurate but hopeful picture for nurses.
• Keep up the budget-friendly celebrations and recognitions for staff nurses. You can celebrate by handing out coffee coupons or recognizing a staff nurse during every unit meeting for his or her excellent patient care.

Supporting nurses through those terrible, horrible, no good, very bad days

It comes with the job of being a nurse: dealing with the injured, the sick, and the dying; constantly trying to do the best for your patients with limited time; and always asking “How are you feeling?” But nurses are rarely asked that question. Peers, patients, family members, physicians, and even the nurses themselves are too concerned about the health of the patients to take a step back and make sure those giving the care are doing all right.

In a study of 1,215 nurses conducted by the University of Pennsylvania School of Nursing  published in the journal Social Science and Medicine, 25% said moral distress made them want to leave their position. Moral distress can leave nurses feeling powerless because if they feel they did not carry out their duty to the best of their ability, even after exhausting all possible options. [more]

Generational dress code gaps: Tattoos and piercings uncovered

In the nursing world, first impressions are everything. How patients perceive their nurses affects how patients interact with them throughout their entire hospital stay. But what happens when a 23-year-old female nurse with visible arm tattoos and a nose piercing walks in to a patient’s room to take vital signs and the patient is obviously uncomfortable by the body art?

Such interactions and concerns are increasingly common. Body art and piercings are no longer the preferred form of expression solely for rebels and misfits. A study recently conducted by the American Academy of Dermatology found that 48% of American workers ages 18 to 29 have a tattoo or something other than their earlobe pierced. [more]

2.0 Web technology integrates a nursing program near you

As the terms “podcasts”, “wikis”, and “blogs” fill the vocabulary of nurses, physicians, students, and hospitals nationwide, more and more facilities are finding ways to integrate these new technology tools into the everyday hustle and bustle of the healthcare world.

In a recent study published in the Journal of the Medical Library Association, 53% of nursing schools and 45% percent of medical schools are now using Web 2.0 tools in their curricula. Also, 58% of nursing schools and 50% of medical schools intend to include Web 2.0 tools in the curricula within the next year. Web 2.0 is a term defining the second generation of Web development that allows users to do more with Web sites. Rather than just passively retrieving information, Web 2.0 technology allows users to own and exercise control over the data.
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Schwarzenegger replaces most of California’s State Nursing Board

On Monday, July 13, Californian Gov. Arnold Schwarzenegger replaced most of the members of the state’s Board of Registered Nursing after reports of potentially dangerous nurses continuing to work even after being accused of egregious misconduct.
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Correlating study tips with learning styles

It can be helpful for adult learners to identify their own learning style so they can determine study strategies that work best for them. The main types of learning styles are:

• Right brain
• Left brain
• Auditory
• Visual
• Tactile

What kind of learner are you? Visit www.StrategiesForNurseManagers.com to download a free tool to assess your auditory, visual, and tactile learning preferences. You can also use this tool to assess others’ learning styles as well.

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