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Leadership in an Age-Diverse Nursing Workplace

Book excerpt from Managing the Intergenerational Nursing Team.

Your challenge is to keep all generations engaged, motivated, and satisfied in their jobs in order to increase productivity, morale, and job satisfaction. It is expensive to replace a nurse employee, so you must also find ways to decrease attrition and turnover. You are going to need to build more personal relationships with your staff nurses to increase team morale and make them feel needed and wanted.

Great leaders have a vision of the future that they can sell to others to get their buy-in. Your managerial style will benefit from having a vision of the future that your staff will support. Then you can persuade them to join as a team to bring that vision into reality. Your job is sales—selling your vision. Your job is production—giving them the tools to do the job right. And your job is cheerleader—motivating and supporting them in their efforts.

Successful and fair management of an age-diverse group begins with an open discussion of the differences between the generational cohorts while you maintain a positive attitude. Generational stereotyping can be a risky practice, so look at the needs of your diverse team in the context of their generation with caution. It would be a mistake to assume that everyone in that generation thinks the same or wants the same things. You will need to tailor your leader­ship techniques accordingly, including communication styles, conflict resolution, coaching, and motivating. Some of your staff will eagerly follow your leadership. Some of them will question and even dismiss your efforts. Knowing the preferences for each generation can provide insight to help motivate and affirm yourself during the rough times.

Generational considerations can also show you the path to solidify your work team and bring out the potential in every individual. When the team wins, you win; so set them and yourself up with every advantage to be a productive and effective work team by attending to their genera­tional needs. It will be time and energy well spent.

McCain votes no, derails “skinny repeal” in marathon session

This article appeared on Kaiser Health News on July 28, 2017.

By Michael McAuliff

WASHINGTON — Sen. John McCain (R-Ariz.), who interrupted brain cancer treatment to return to Capitol Hill and advance the health law repeal efforts, cast the dramatic and decisive “no” vote in the early morning hours that upended the Republican effort to repeal the Affordable Care Act.

The Senate struggled late into the night to craft and then vote on a “skinny repeal” of the health law, but came up empty as the bill was defeated in a 51-49 vote that prompted gasps in the chamber. McCain’s vote was unexpected and ends — for now — the Republican Party’s effort to kill Obamacare.

Sens. Lisa Murkowski (R-Alaska) and Susan Collins (R-Maine) cast the two other Republican “no” votes in a cliffhanger drama that ended just before 2:00 a.m. Friday.

Earlier, a group of Republican senators trashed the new measure, widely dubbed a “skinny repeal,” saying it would only worsen the health care system, and they demanded unprecedented promises from their House colleagues to change it.

“The skinny bill in the Senate doesn’t even come close to honoring our promises of repealing Obamacare,” said Sen. Ron Johnson (R-Wis.). “Virtually nothing we’re doing in any of these bills and proposals are addressing the challenges, the problems, the damage done [by the Affordable Care Act].”

Staff of Senate Majority Leader Mitch McConnell (R-Ky.) crafted the new bill, which was under discussion all afternoon and posted publicly late Thursday evening.

The slimmed-down version of the Senate bill — The Health Care Freedom Act, which the White House refers to as the “freedom bill” — included an end to key elements of the health law. Among them were rollbacks of the mandates for individuals and employers to buy health insurance, changes to waivers available under Section 1332 of the ACA that would give states more leeway to alter essential benefits in insurance plans, and a repeal of the medical-device tax.

It was not immediately clear how the bill achieved savings similar to $133 billion in the House’s version of repeal legislation. An equal or better level of savings is required under the arcane budgetary process that is being used to advance the bill, known as reconciliation.

Budget reconciliation allows the measure to pass the Senate on a simple majority vote, but requires that all of its provisions pass muster with the Senate parliamentarian as budget-related. The text of the bill posted publicly at 10 p.m. The CBO report on it began circulating on Twitter around midnight and the vote finally closed around 1:45 a.m. Friday.

One provision that had been restored after the parliamentarian initially struck it was an attempt to defund Planned Parenthood for a year. The new provision took in at least one additional abortion provider, and was expected to survive. The funding for Planned Parenthood was to be shifted to community health centers.

Keeping the attack on Planned Parenthood solidified Murkowski and Collins’ opposition to the vote.

This new iteration of the repeal comes after two versions failed to win over the 50 GOP senators needed. But even with all the rewriting and behind-the-scenes negotiation, four senators called a press conference to declare they will not vote for this “skinny repeal” unless House Speaker Paul Ryan (R-Wis.) promises not to merely pass the measure but send it to a conference committee between the two chambers, where it can be substantively altered.

The four senators slammed the trimmed-down compromise.

“I am not going to vote for a piece of legislation that I believe is not a replacement, that politically would be the dumbest thing in history to throw this out there,” said Sen. Lindsey Graham (R-S.C.).

He said that he, Johnson and McCain and Sen. Bill Cassidy (R-La.) would not vote for the skinny repeal until Ryan pledges to “go to conference,” where Graham can include a measure to shift current Obamacare funding into a block-grant program for states.

His fear, Graham said, is that the House might simply take up and pass the skinny repeal in order to be done with it and notch a win in their seven-year battle against Obamacare.

Graham referred to estimates that said the repeal of the ACA mandates would “collapse the individual market” and leave the GOP to “own the problem at a time when Obamacare is collapsing.”

Ryan did release a statement with a conditional promise to take the bill to conference. Initially, it did not satisfy Graham or McCain. Graham and Johnson were persuaded, however, after a phone conversation with Ryan. McCain was not.

For their part, Democrats uniformly panned the GOP’s efforts.

“We’ve had one bad bill after another. There is no bill that is a good bill,” said Sen. Dianne Feinstein (D-Calif.). “Every bill takes people off health care. Every bill makes you pay more for less. There’s a race to the bottom, so to speak.”

Sen. Chris Murphy (D-Conn.), hammered the entire process: “This is nuclear grade bonkers.”

Nurses push to prevent assault in healthcare

Healthcare professionals are four times as likely to be assaulted on the job compared to other professions, and lawmakers in Massachusetts are looking to strengthen protections for nurses and healthcare workers.

Last week, the Massachusetts Nurses Association (MNA) endorsed bill S.765/H.795, which would strengthen penalties against assaults on healthcare workers. The MNA has called the bill Elise’s Law, in honor of Elise Wilson, a nurse that was stabbed multiple times on the job last month. The bill would increase the penalty for assaulting emergency medical technicians, ambulance operators and attendees, or healthcare providers from a misdemeanor to a felony. The bill would also streamline how victims of healthcare violence can use the justice system, making it easier to seek legal recourse for their injuries.

The bill is part of a larger effort to improve prevention and response to workplace violence in healthcare. “Health care professionals are being assaulted at a rate four times greater than those working in other industries,” said Donna Kelly-Williams, RN, president of the MNA, in a press release. “Fear of violence and actual violence is rampant in Massachusetts health care facilities. An assault on a nurse is a serious action and should be taken seriously by our judicial system.”

According to the U.S. Bureau of Labor Statistics, health care workers experience the most non-fatal workplace violence compared to other professionals, and account for 70% of all non-fatal workplace assaults. A survey conducted by the MNA found that 75% of nurses reported that violence was a problem in their workplace, and the Emergency Nurses Association reports that 80% of emergency department nurses have been a victim of workplace violence.

For information on how to prepare your facility for workplace violence, check out this excerpt from Preventing Workplace Violence: Handbook for Healthcare Workers.

Clinical Nurse Leaders, partners in quality improvement

Quality within any healthcare system depends on improving patient outcomes, which rely on continual nursing professional development and overall improvements in system performance. One of your most important resources for managing such improvements is the Clinical Nurse Leader (CNL). This clinician is a Master’s prepared Advanced Generalist nurse who builds quality measures in patient care outcomes and implements evidence-based practice principles at the clinical point of care and service. These outcomes align with the facility’s goals and strategic plan and can positively impact patient care processes.

 

For example, when working with a CNL, you can align the care team with strategic performance goals. CNLs and the Quality Systems team are important resources for strategic planning for quality and performance improvement (objectives, priorities, expectations, deliverables, and timelines). Working together, you can establish an infrastructure for engaging and motivating staff and other team members to work toward achieving improved patient care outcomes within the organization’s measures of performance. CPI only happens when everyone engages to improve management of operations and care delivery.

 

As the context of healthcare environments continually evolves and changes, your role becomes more complex and demanding. However, these growing challenges offer expanding opportunities for developing partnerships with your nurse manager, CNLs, and interprofessional team members to improve quality, practice, and competency in managing unit operations and coordinating patient care. By taking of advantage of these opportunities, you can help create a unit culture of safety, quality, and practice excellence.

Source: The Effective Charge Nurse Handbook

Include cultural diversity training in orientation

Healthcare professionals have varied views about what the term cultural diversity means and the actual purpose of cultural diversity training. They may believe that such training is initiated primarily to help them avoid professional and legal problems rather than improve patient care (Nisha et al 2007). Others are genuinely concerned about being culturally sensitive when working with patients and collaborating with colleagues. NPD practitioners know that the primary purposes of cultural diversity education are to improve:

  • Healthcare professional–patient communication
  • Healthcare professional–family communication
  • Communication among healthcare professionals
  • Patient and family outcomes

Cultural diversity education is also a requirement of some accrediting agencies.  However, this is not the primary purpose of such education. Your cultural diversity programming should be practical and based on evidence that directs its design.

It is not easy to add more content to an orientation program. However, cultural awareness will help new employees to assimilate into the organization. Role play, discussion, and distance-learning techniques can all be used to provide basic information. Allow time for in-person discussion as well. Include information about how cultural differences manifest themselves in patients, visitors, and colleagues and present learners with scenarios that require them to make choices based on cultural appropriateness.

What topics should you include as part of diversity education?

It is not possible to include all aspects of multiple cultures in a diversity program. However, if cultural diversity is part of your competency program, you can regularly add material about aspects of various cultures.

The following is information to include in your initial training:

  • How do members of this culture communicate? What significance do body language, gestures, tone of voice, and eye contact have? Which family members take the lead in communicating with people outside of their culture?
  • What specific family/gender issues exist? What is the woman’s role? How are major decisions made?
  • What role does religion play?
  • How is pain expressed?
  • What are common health practices (e.g., alternative medicine, herbal medicine, home
    remedies, etc.)?
  • How do families deal with pregnancy and births?
  • Is there a standard work ethic valued in the culture? How are specific occupations viewed
    in terms of respectability, financial need, and appropriateness?
  • Are there dietary restrictions associated with this culture?
  • Are there specific political beliefs that influence people of this culture?
  • Are there specific conflicts between certain cultural groups that may surface within your organization?

Source: Staff Development Made Simple

Privacy and social media in the nursing unit

We all consider our privacy to be sacrosanct, a cocoon in which we wrap ourselves to feel safe and in control. We value our personal space and believe that others have an obligation to respect our wishes in regard to what is commonly known and what we wish to keep private.

Your role as a manager means you have become the “Privacy Police.” It is your job to protect the privacy of your staff, the hospital, your patients, and yourself. This juggling act is made more difficult by the fact that privacy is a very fragile commodity these days, and we have far less influence than we had previously thought. Large leaks of personal data in the online environment have made privacy a matter of public commentary and personal challenge.

The word “privacy” has been part of our lives back to our earliest moments of awareness, when we were told that “some things are private” or “do not talk about that at school; it is private.” However, as we swept into the 21st century, the term “privacy” began to take on a new meaning or perhaps to lose its meaning entirely. Invasive social media and the unrelenting celebrity-chasing paparazzi have somewhat neutralized the concept of privacy, making it largely a word with diminishing relevance in today’s world. Yet, on your unit, the idea of privacy remains important and fundamental to your staff and patients.

We consider privacy to be freedom from unwanted invasive scrutiny. Young people today hear about hacking and high-level release of private information, and they accept it as a natural part of life. Privacy has become relative to the degree of interest in your business and your ability to keep others out of it. Your young nurses were raised in a world calling for more transparency with decreasing value on personal privacy; these are often the values they bring to your unit when they are hired.

As a manager, you are faced with a boatload of privacy rules and regulations that fall to you for enforcement. You must ensure that your unit protocols are protecting personal health information largely driven by the Health Insurance Portability and Accountability Act of 1996 (HIPAA; U.S Department of Health and Human Services, 2015). HIPAA applies to all healthcare personnel and providers. Your manager role means you must ensure your nursing staff understands and complies with rules about documentation, photography, telephone release of information, and the media’s need to know.

You can help your staff understand release of patient information, for example, by identifying who is nonessential and who is on a “need-to-know” basis. Make sure they understand the boundaries and then ensure that they adhere.

You also need to help Boomers grasp how social media really works. Many of them get on sites in order to keep up with younger family members. They may not understand the insidious seepage of information based on the link provided by these sites. Your younger nurses might provide information to the more senior members, helping them understand the full impact of such platforms as Facebook, Twitter, and others. But do not assume that everyone just naturally knows the privacy limitations on your unit; annual review of current privacy standards is a good time to emphasize how this information helps protect the hospital as well as the individual nurse from legal repercussions.

Frank, open conversations about the right to privacy can move it from a gray area for social media followers into a priority for all activities on the unit.

Source: Managing the Intergenerational Nursing Team

Study: Nurse fatigue on the rise

A new survey indicates that fatigue affects 85 percent of nurses, and more than half of nurses have experienced burnout.

The study, conducted by Kronos Incorporated, surveyed 257 nurses currently working in U.S. hospitals. Nearly all of the respondents (98%) said their work is physically and mentally demanding, and 63 percent reported that their work caused nurse burnout. 44 percent worried that their patient care would suffer because of their exhaustion, and 41 percent considered changing hospitals in the past year because of their burnout.

Nurse fatigue has a number of causes, and can occur during any shift. An excess of fatigue without proper coping mechanism can cause burnout, an exhaustion that can cause your staff feel alienated from their work and cause diminished performance.

The best way to counter burnout in your staff is to create programs that encourage self-care and raise awareness about the symptoms of nurse fatigue. For more tips about coping with burnout, check out the following articles from the Strategies for Nurse Managers’ Reading Room:

Preventing nurse fatigue
Take Five: How renewal rooms revive stressed out nurses
Don’t underestimate damage caused by burned out nurses
Stop requiring nurses to work overtime

Challenges and Opportunities for Nurse Leaders

Looking forward, the difficulties we face include overcoming the bias that nurses are not prepared to lead, especially in interprofessional teams. This is a perception that nursing itself must change, first in the arena of self-image and then in the eyes of other powerful professional groups. If other clinical partners do not see the nurse as pivotal for ushering in change, then they are likely to use that bias to slow the rate or pace of change considerably.

For nurses to see themselves as capable of transforming healthcare, they must see themselves as equal partners at the table, able to negotiate and recommend, influence, and activate change initiatives at the local level and beyond. For some, this is an unimaginable role, but fortunately for others, this is a logical next step in fulfilling the promise of their education and preparation to lead. Stevens (2013) reminds us that there are four skills that the nurse leader must bring to this interprofessional table:

  • The redesign of healthcare systems through creativity and mastery of teamwork
  • Persistence in ensuring the education of nursing’s future workforce, with an eye focused on improving our systems of care
  • Moving beyond our current and comfortable programs of research, and learning to engage systems so that applications to larger platforms are possible
  • Inviting and ensuring multiple voices and perspectives are heard so that the transformation of healthcare is broadly focused on the needs of the larger population

It is our work not only to care for patients and to work diligently to improve the efficiencies and effectiveness of the system where we practice, but also to touch the lives of patients around the world by engaging in a readiness to move evidence-based practices into the mainstream of our thinking and our actions. To embrace change and actively implement those strategies which are best for patient outcomes will keep us focused firmly on the future and prevent us from being stuck in our past.

Source: Critical Thinking: Tools for Clinical Excellence and Leadership Effectiveness

ANA continues to oppose Senate health care bill

The American Nurses Association (ANA) weighed in last week on the potential cuts to Medicaid and Essential Health Benefits in the proposed Senate bill.

In a press conference on June 22, ANA President Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN outlined the harmful effects of eliminating the Essential Health Benefits used by millions in the U.S. The draft health care proposal from Senate GOP would make drastic cuts to Medicaid and increase the number of uninsured Americans by 22 million, according to the most recent Congressional Budget Office (CBO) estimate.

“In addition to eliminating the (essential health) benefits, the Senate Republican draft health care bill’s changes to Medicaid would be disastrous for our nation’s most vulnerable,” Cipriano said. “Medicaid is the safety net for tens of millions of children, as well as the poor and disabled. We’re nurses, and we’re here because we are very worried about our patients. We won’t stop fighting for them. We can do better and Americans truly deserve a better plan.”

The ANA has consistently spoke out against cuts to health care and Medicaid, voicing strong opposition to the American Health Care Act passed by the House of Representatives in May. ANA members, area nurses, and nursing students also participated in an “Emergency White Coat Fly-in,” and hopes to meet with Republican senators from key states that would be hurt the most by this bill and persuade them to protect health care.

Find more information on the ANA’s official website.

Nurse managers and the importance of documentation

As a nurse manager (also known as unit leader), regardless of clinical setting, it is your responsibility to assist staff in adhering to both clinical and documentation standards. It is also your responsibility to provide continuing education, ongoing feedback, and input into policy and documentation changes. It is to your advantage to fulfill these responsibilities, because if your staff is involved in a malpractice case, then your ability to manage and meet the quality and risk management standards will be called into question. You may be asked if the staff were following the standards of care based on organizational as well as accreditation or regulatory standards.

As a member of the leadership/management team, you must demonstrate that you have a commitment to providing safe quality patient care. It is your responsibility to ensure that nursing staff comply with up-to-date standards and organizational protocols/policies. The proof for this will be in the medical record. Your role is to support an efficient and effective documentation system and create an expectation that the documentation standards will be followed.

Demonstrate support for this by:

  • Developing or revising an efficient system that meets the requirements of regulatory standards.
  • Analyzing whether the documentation system allows for documentation of critical thinking and the nursing process.
  • Involving the end users in the development or analysis of the system.
  • Emphasizing the importance of documentation through written guidelines, policies, and performance evaluations.

Source: Improving Nursing Documentation and Reducing Risk