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Nurses are still America’s most trusted professionals

Americans trust nurses more than any other professionals. Nurses have topped Gallup’s list every year since they were first included in 1999—except for 2001 when they were briefly replaced by fire fighters.

Members of Congress were the least trusted professionals. Sixty-four percent of Americans rated politicians as having low or very low honesty and ethical standards, tying the record for lowest any profession has ever measured.

The honesty and ethical standards of nurses, pharmacists, and medical doctors were listed as the top three on Gallup’s poll.

“The public’s continued trust in nurses is well-placed, and reflects an appreciation for the many ways nurses provide expert care and advocacy,” said ANA President Karen A. Daley, PhD, MPH, RN, FAAN in a statement. “Major national policy initiatives also show trust in nurses. The Affordable Care Act and the Future of Nursing recommendations call on nurses to take more leadership roles and collaborate fully with other professionals in providing essential healthcare to a growing number of people who will have greater access to services.”

Tip: Assess patient suicide risk

Many patients who kill themselves in general hospital inpatient units don’t have a psychiatric history or a history of suicide attempts, says Sharon Chaput, RN, C, CSHA, director of standards and quality management at Brattleboro Retreat, in Brattleboro, VT.

Furthermore, most medical-surgical units and EDs are not designed to care for suicidal patients and they don’t routinely assess every patient, says Chaput.

Screening for suicide risk in the ED should include ordering a psychiatric consultation to assess the immediate risk of individuals admitted for medical treatment following a suicide attempt, communicating suicide risk screening results at handoff, and interventions to prevent suicide in those patients at increased risk, she says.

This includes the following measures:

  • Checking patients for contraband that could be used to commit suicide
  • Involving patients in care planning and decision-making
  • Ensuring that patient care considers age and cultural considerations
  • Providing opportunities for visits by family members or volunteers who can alert staff members about warning signs that may indicate imminent action
  • Involving patients at risk and their families in the discharge process and aftercare recommendations

Editor’s Note: This tip is adapted from an article in the November issue of Patient Safety Monitor Journal.

Choosing the winners of the 2011 Nursing Image Awards

I helped pick the winners of the 2011 HCPro Nursing Image Awards, which marks the third year that I’ve had the privilege of being allowed to read through all the hundreds of entries. Click here to read about the winners. The runners up will be profiled next week.

The awards require nominators to submit a 500-word essay about their nominee and describe what makes the person or team of nurses special and how they embody a positive image of nursing. It’s no small task to pen a 500-word essay and include pertinent facts as well as capture the essence of what makes someone stand out, so I am endlessly amazed at the number of people who take the time to craft well-thought out essays.

These essays are both heartwarming and inspiring and often tell me as much about the nominator as they do about the nominee. In some instances, groups of people come together to write a nomination essay. In most, one person crafts his or her personal story about an outstanding nurse.

All of these essays paint a picture of nursing in America that is often lost in the headlines about nursing shortages and picket lines. They provide a look into the heart of the profession and the individual men and women who dedicate themselves every day to their patients. These nurses refuse to accept mediocrity and push themselves and their organizations to continually improve. Whether returning to school for higher education or launching performance improvement initiatives, these nurses embody professionalism, intelligence, and compassion. They are a true representation of the image of nursing.

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?

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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One of your nurses will make an error today. Will she report it?

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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).