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All I’m asking is for a little respect

It’s no secret that nurses and physicians do not always maintain the friendliest interactions, and occasionally nurse-physician relations can become downright hostile. Poor relationships between nurses and physicians can lead to communication issues, increased errors, and a lower quality of patient care.  Although both parties might feel as though they are behaving cordially, a recent industry survey by HealthLeaders Media revealed a disconnect between nurses and physicians when asked about disrespect and physician abuse. While 42% of nurse leaders felt that disrespect of nurses was common, only 13% of physicians perceived disrespect as a common occurrence.

Communication issues seem to be the major cause for the disparate perceptions of disrespect toward nurses, according to the survey. For example, physicians who are looking to save time and want to hear only key data tend to interrupt or cut off nurses giving a more detailed report. Physicians often don’t realize their actions may be perceived as rude or disrespectful, according to HealthLeaders Media.

But what about physicians who are intentionally disrespectful of nurses? In his blog post “Listening to nurses is key to being a good doctor,” a physician who writes under the pen-name Doctor Grumpy, MD, asserts that “if you come out of medical school with a chip on your shoulder against nurses, you better lose it fast. Because they will make or break your training, and often know more than you do.” He continues on with an example of a fellow physician who ignored a nurse’s concerns about a patient’s heart, telling her rudely that he had already looked at the EKG. The patient, as it turned out, had developed a heart murmur, and listening to the nurse would have addressed the issue sooner and prevented the physician from being reprimanded. Doctor Grumpy demonstrates that an amiable relationship between nurses and physicians is not only possible, but also beneficial to both parties, and to the quality of care provided in an organization.

How can nurse leaders help improve nurse-physician relations? Communication is a major step in the right direction. Remind your nurses to treat physicians with respect, and encourage them to bring up any concerns about physician behavior. If nurses are uncomfortable directly addressing a disrespectful physician, they should share their concerns and perceptions of physician behavior with you. Communicate with the physician that his or her behavior has been perceived as rude or disrespectful, and take the conversation from there. By raising awareness of how actions and words are perceived by others, you can move toward creating a respectful and productive work environment.

We want to hear from you: have you noticed a lack of respect between nurses and physicians in your organization? Have you taken any steps to address these concerns?

Technology and healthcare: nurses’ use of mobile devices

New technology has been steadily working its way into all aspects of daily life, and healthcare is no exception. More organizations are adopting electronic medical record systems and incorporating tablet computers into those systems. Individuals are also bringing technology into their work day, which can have positive and negative effects. Last week we posted about a nursing app that allows nurses to quickly access relevant information, a seemingly useful tool, but there have also been stories of technology distracting physicians and nurses from performing their jobs effectively and safely.

A recent poll on asked nurse leaders to weigh in on how often nurses use smartphones and tablet computers to perform their duties. The responses were split almost evenly between nurses who use these technologies on a daily basis (46%) and nurses who never use these technologies for work purposes (44%). Other respondents answered that nurses on their units used technology weekly (6%) or monthly (3%).

How does your organization compare? Do nurses on your unit use smartphones and tablets as part of their jobs? Does your organization have a policy in place to address the growing use of mobile devices in the healthcare setting? Leave us a comment and let us know!

Cool app for nurses, but does it foster bad habits?

Robert Freeman, a registered nurse at Beth Israel Hospital in New York, designed an mobile app for nurses that includes a database of more than 10,000 medical abbreviations and a news feed specific to the nursing profession, according to the New York Daily News. Freeman said the idea for a nursing app came to him when a colleague could not decipher an abbreviation on a patient’s chart. He indicates that nursing students will benefit the most from using the app as a learning tool, but that it will also improve efficiency and productivity for all nurses by quickly answering queries.

Freeman spent three months researching the information necessary to design “Nurse Net,” his free app. The app includes tools such as the Credentialer, which clarifies the abbreviations for various certifications and credentials used by health professionals, and the Abbreviation Assistant, which interprets abbreviations found on medical charts. “Nurse Net” became available in the Apple Store in November and has been downloaded more than 12,000 times since then.

I wonder how patient safety and quality professionals (yes, you) felt about these kind of apps. Personally, I worry about a nurse who, instead of clarifying an abbreviation (which may be a “do-not-use” abbreviation!) with the physician, consults an app. I would always prefer communication between humans when possible rather than consulting a third source, even if it is a bit of effort. Also, speaking directly with the physician might help avoid future issues with that physician’s notes. Is consulting the app a workaround here? And don’t forget, an app isn’t responsible for being right; it’s not responsible for being updated, and most importantly, isn’t responsible for keeping your patients safe. It’s a product, like anything else, even if it’s free and developed by a nurse with the best of intentions.

Are we teaching the right thing here? Weigh in below.

First published on Patient Safety Monitor Blog

Does being a nurse make you fat?

Is being a nurse bad for your health? A new survey indicates that this might be the case, and offers managers an opportunity to help staff be healthier and take care of themselves so they can take better care of patients in return.

The survey of more than 2,100 female nurses, conducted by the University of Maryland’s School of Nursing, revealed that 55% of participants were obese. The study used body mass index (BMI) as the primary measure for obesity. The nurses who participated in the survey indicated factors such as jobs stress, poor sleep habits, and long, irregular work hours as the primary causes for their excess weight.

This study comes among other recent reports that overweight physicians are less likely to advise obese patients about the benefits of dieting and exercising to lose weight and improve their health. A common thread among these studies is that physicians and nurses who are at an unhealthy weight are unable to provide the highest quality of care for patients, because they are not caring for themselves and feel they cannot lead by example.

Kihye Han, author of the University of Maryland study, recommended better scheduling methods to allow nurses to practice good sleep habits, and noted that an increase in the availability of healthy food could also make a positive impact. An experiment conducted by Massachusetts General Hospital found that simply labeling hospital cafeteria items with red, yellow, and green stickers to distinguish healthier choice from less healthy options led to an increase in healthier foods and beverages. Busy nurses and physicians could quickly determine the best foods based on the label.

None of the resources referenced above explores another option for encouraging nurses to make healthier choices: nurse leaders. Nurses who are struggling with getting adequate sleep or maintaining a nutritious diet could benefit from the advice, guidance, and support of not only staff leaders but also other nurses in similar situations. Providing resources and healthier options for staff nurses would not only benefit their overall health, but could also lead to improvements in patient care quality.

We want to hear from you! Have you encountered issues with sleeping and eating habits among your unit’s nurses? Does your facility offer flexible scheduling and more nutritious food options to encourage healthier lifestyles? Let us know in the comments section.


Flu vaccinations among nursing units

Despite a relatively mild flu season so far in 2011-2012, the Centers for Disease Control and Prevention (CDC) maintains its recommendation that anyone older than six months should receive a flu vaccine, particularly those at high risk for developing serious complications from the flu. These high-risk individuals include pregnant women, children under the age of five, adults over the age of 50, anyone with chronic medical conditions, and people who live with or care for high-risk individuals, such as healthcare workers.

In a recent poll on, 52% of respondents indicated that more than 90% of their units’ nurses had received a seasonal flu shot, and 18% reported that 70%-89% of staff nurses were vaccinated.

Only 5% of respondents replied that less than half of their units’ nurses have received flu vaccines.

Does your hospital have a policy regarding flu shots? Are most of your nurses vaccinated? Share your thoughts in the comments section!

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!

Three creative ways to cut nurse labor costs

In previous posts on the Leaders’ Lounge we have featured advice from nursing finance and budgeting expert Pamela Hunt, MSN, RN, co-author of the book Nurse Leader’s Guide to Business Skill: Strategies for Optimizing Financial Performance.

Recently Pam provided her expert opinion on using supplemental labor effectively in an article by HealthLeaders Media. In the article, Hunt recommends using traveling or per diem nurses  to handle medical leaves, seasonal volume increases, or large training initiatives, rather than depending on agency nurses to cover daily demands. Hunt’s suggestion, and the article in its entirety, is pertinent for anyone seeking to reduce nurse staffing costs.

To read the full article, “3 Creative Ways to Cut Nurse Labor Costs,” click here.


HCPro Nursing Catalogue for 2012 now available online

HCPro’s 2012 catalogue for nurse leaders and staff development professionals can now be accessed online. The catalogue features information on new releases, program builders, and other educational resources.  As always, we appreciate your thoughts and feedback on our products, so please do not hesitate to comment below and let us know what you think.

The HCPro Nursing Catalogue for 2012 can be found at

Nurse donates kidney to patient

Medical News Today reports that Allison Batson, a nurse at Emory University Hospital in Atlanta, donated one of her kidneys to a patient in need.  Clay Taber was diagnosed with Goodpasture’s syndrome, a disorder that causes a patient’s immune system to attack the lungs and kidneys, and was suffering complete kidney failure. Taber was admitted to the transplant unit at Emory University Hospital and told that it could take up to five years to find a suitable donor organ.

Batson learned of Taber’s diagnosis and discovered that none of his relatives, including his mother, qualified as kidney donors. Batson said she felt a connection with Taber and ultimately came forward as an organ donor, despite only knowing Taber for a few weeks.

When asked why she chose to put herself at risk for a stranger, she responded “because I can … here was this young man in front of me who needs help—today, and I am in a position to help him—today.” Taber has commented that he will reserve a special dance for Batson at his wedding.

Source: Medical News Today

You can’t improve without knowing what’s wrong

In the healthcare quality improvement field, there has been much talk about reporting errors, about a just culture, about using occurrence reporting data to implement quality improvement initiatives, and sharing results with staff. But it seems, according the latest Office of the Inspector General (OIG) report that many of you have probably seen, that hospitals aren’t cutting it.

In summary, the report concludes:
Hospital incident reporting systems captured only an estimated 14 percent of the patient harm events experienced by Medicare beneficiaries. Hospital administrators classified the remaining events (86 percent) as either events that staff did not perceive as reportable (61 percent) or as events that staff commonly report but did not report in this case (25 percent).

So, the majority of events go unreported because staff didn’t think the event qualified for the reporting system.

A list of common events is coming (via AHRQ and CMS), and it’s sure to be helpful. Until then, hospitals should work on what Occurrence Reporting: Building a Robust Problem Identification and Resolution Process author Ken Rohde calls this a reporting threshold.

“If your staff question whether they should report something, they are asking themselves a threshold question,” says Rohde. He advises the threshold to be either low or nonexistent.

“A good way to communicate a lower threshold is to tell staff: ‘If it was important enough for you to think about it or if it disrupted your day, then report it,'” says Rohde.

Though a higher reporting volume may require a more efficient screening process, more information about adverse events is usually better.

Here’s a quick tip sheet from Rohde’s best-selling book for improving your error reporting in your system: (starred, at the bottom, free for download).

First published on Patient Safety Monitor Blog.