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Apologies and action for famous actors only?

Hospital chief Sandra Coletta is making waves throughout the healthcare community after being frank with her audience of hundreds at the 10th annual dinner of Medically Induced Trauma Support Services (MITSS), a widely respected group that aims to support patients, families, and staffs after things go medically wrong.

She spoke about the death of James Woods’ brother in the emergency department at Kent Hospital in Warwick, RI, after orders were not carried out in a timely manner.

“Quite honestly, I did nothing other than what my mother taught me,” Coletta said of apologizing.

James Woods and the hospital settled the suit, in the process created a foundation, the Michael J. Woods Institute, in honor of his brother. The institute aims to recreate healthcare from a human factors perspective.

Similar action was taken after Dennis Quaid’s twins were put in peril because of a medication administration mistake. (According to an April 2010 USA Today story, Quaid said Cedars-Sinai hospital in LA “stepped up to the plate and spent millions of dollars on bedside bar codes.” He and his wife also created the Quaid Foundation, which has merged with the Texas Medical Institute of Technology.) Do you think these cases are addressed more swiftly, and more apologetically, because of their high-profile nature? Or do you think the tides are turning?

Of course, Sorrel King, without being famous (at least then), spurred plenty of action on her own. But are hospitals finally reacting with action and apologies, even without fame and publicity?

Source: WBUR

First published on Patient Safety Monitor Blog.

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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.

Nurse leaders upbeat at Nursing Management Congress

I just returned from the annual Nursing Management Congress and it was a pleasure to meet so many nurse leaders who are committed and passionate about nursing.

The conference was held in Las Vegas and for three days the 1,000 plus attendees ignored the lure of the bright lights outside and focused on education and networking. The three topics on everyone’s lips were transforming care delivery, the changing role of nursing, and how to be a better leader.

Many of the most popular sessions focused on transformational leadership and how to find more time in your day. I particularly enjoyed one called “Why am I so tired when there’s still so much to do?” by Rhonda Lawes, RN, MS, CNE, assistant professor, University of Oklahoma College of Nursing, in Tulsa. Lawes explained the nine myths for why we’re so tired and what we can do about it. I am going to implement several of her suggestions as they were so practical and straightforward. She certainly left me invigorated and feeling like I can make some changes in my life that will make me feel like I have more time and can get more done.

The conference also covered the changing face of healthcare and provided a chance to discuss pressing issues such as value-based purchasing and nursing’s role. Attendees were buzzing about:

  • The Future of Nursing report: How to implement its recommendations and how it will change the profession
  • Value-based purchasing: How this will affect nursing and what do we need to know
  • Patient engagement: There’s more reason than ever before to pay attention to this topic, which nursing can really own
  • Quality: Preventing HAIs and all quality improvement initiatives
  • Leadership: Being a better manager, improving communication, and retaining a committed and engaged nursing staff

Keynote speaker Tim Porter-O’Grady, DM, EdD, ScD(h),FAAN, said it’s time for nursing to unbundle its work and decide what it will no longer do so that nurses are able to focus on what’s most important in the changing face of care delivery.

Click here to read a longer article on his fascinating and informative presentation and learn the strategies he shared that nurse leaders can implement now.

Kathleen Bartholomew, RN, MN, answers questions about ending nurse-to-nurse hostility

Kathleen Bartholomew, RN, MN, dared to ask the question, how can a profession that is based on caring include such uncaring behaviors? Her powerful research exposes the toxic relationships and bullying behavior that causes nurse burnout and threatens patient safety. Here’s a question and answer session where she offers practical advice to real-life problems.

Q: It’s often easy to point out the shortcomings in others. What do you do for people to help recognize and overcome their own bad behaviors?
A: Peer evaluations are effective, but a critical conversation is the most powerful tool both peers and managers have. I ask, “What do you do well?” “What would you like to do better and how can I help?”

Q: What is the most important thing we as nurses can do to turn around toxic work environments that are deeply rooted in bullying and disrespectful behaviors?
A: SAY WHAT YOU SEE. Your voice is your power. These behaviors will be NORMAL until someone stands up and says, “Hey, this is impacting the patients and morale. This needs to stop.”

Q: Any suggestions on how to handle shift-to-shift complaining and bullying?
A: I know this one is hard. When I was a manager, no amount of teaching or counseling could change the shift-to-shift so I asked the nurses to switch shifts for a week. Then I never heard another word. The “walk in their shoes” experiment also worked for nurses complaining some floors were easier. Next, I worked closely with the charge nurses and gave them the knowledge, skills, and confidence to stop these behaviors when they saw them (that took almost two years).

Q: Have you actually seen the “turnaround” of a bully in the workplace work other than dismissal of that employee? Isn’t the bully in a person part of their personality trait?
A: Great question. Personally, it’s been 50/50 in my experience. And if you are a leader/manager and start drawing the line, there is a high chance of the bully going on FMLA/being injured etc.  It takes a lot of people skills to turn them around because if they are not going to be the bully, then who are they? How do you create an alternative role for this nurse in the unit? Also, don’t think of a bully as an individual problem. It’s the unit’s problem because many nurses have tolerated the behavior for years (even decades).

Analyzing nurse staffing: Understanding FTEs

Staffing: what a problem! Developing and monitoring the staffing budget is one of the most, if not the most, difficult responsibilities of the nurse leader. Labor consumes the majority of the financial resources of the organization. Therefore, everyone must act responsibly in order to ensure the financial health of the organization. But how do you know how many staff you need on your position control in order to meet the needs of the department (not too many, and not too few)? That is a $100,000 question! [more]

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]

Visiting hours

How do you feel about unrestricted visiting hours? More and more organizations are moving toward removing restrictions and allowing family and friends to visit at any time.

Sixty-two percent of respondents to our StrategiesForNurseManagers.com poll said they have unrestricted visiting hours.

Thirty-eight percent said they have visiting hours that allow patients time to rest and helps staff organize their work.