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Learning a new definition of health

Starting next week, I will be carrying two courses at a time, and I am told it can be done. I have spoken to several other classmates who have management jobs, families, etc., and some of them are actually taking a bigger course load. I don’t think I will ever go there. Just the thought makes my critical thinking skills kick in and ask, “Are you nuts?!”

The three credit course I am in the midst of is related to public health nursing, and I know what you are thinking-the same thoughts I had as I poured over the course objectives. With a bottle of Phenergan at my side, I was ready for boredom and nausea. What I found was an inspiring faculty member whose pointed questions got me thinking about healthcare and how it is delivered to the patient, the family, and the community. The course puts an emphasis on the effects of prevention on public health and assessing the health care needs of communities. Think of all the times staff approach you whining on and on about non-compliant patients. The course delves into the compliance obstacles for some of our population, such as making bad choices in their lives.

The most important questions we had to ask ourselves is to define the word health: What does it mean to each of us? Now I am asking you for your definition of health, and also your staff’s definition. Mine is printed below:

Health: A state of wellness for that individual

I anxiously await my grade for my mid-term paper, which brought back memories of why I do not work the night shift anymore. My final paper is due mid-June and no, I have not started it yet. For my final exam, I have to find a grant available for a vulnerable population we identify in our mid-term paper. Can someone please help me? I feel ischemia creeping into my brain. What was it I identified? Can Phenergan ever be used to help brain perfusion? Hmmm…..

Budgeting for orientation, education, and training

Do you get a little stressed out when it comes time to budget for orientation, education, and training? You might find it helpful running through these questions beforehand:

1. How many orientees does the hospital expect this year?
2. How long is orientation for experienced hires? For new graduates?
3. How many education days does the hospital provide for each staff member?
4. How many mandatory classes does the hospital require each employee take?
5. How many outside training classes does the hospital pay for per employee each year?
6. Does your hospital pay for staff meeting attendance for days the employee is out?

How do you plan your budgets?

Quick, effective retention tip!

Here is a quick tip I have used and found to be highly effective in promoting staff engagement, which is a huge factor in retention:

Ask your DON or VP to stop by and compliment your staff, or a staff member, on something they have accomplished. This lets them know that you have been speaking about them in a positive light to YOUR boss, who is someone they probably don’t see very often!

And here are a couple quotes to bring home the tip:

“Setting an example is not the main means of influencing others, it is the only means.”
– Albert Einstein

“I think one’s feelings waste themselves in words; they ought all to be distilled into actions which bring results.”
– Florence Nightingale

MRSA me, what are we to do?

By Sheila Gerald, RN, CIC, CLNC

The average person trembles with fear when he or she hears the word staph or MRSA, and most healthcare workers are sick of multiple drug resistant organisms (MDROs) making their daily service more challenging.

Many infection control experts will agree that MDROs have rocked our world for the past 10 years in dramatic ways. We now have to use resources for increased compliance monitoring, surveillance, and tracking. And let’s not forget about the increased need for education. How many times must we say “gel in-gel out,” “glove/gown each time,” only to get those phone calls over and over reporting it not being done?

I have a question: Why haven’t hospitals addressed this problem? Why not simply tell the public, “No, you can’t bring that child in to visit,” “No, you can’t go in the room without a gown/glove/mask,” “No, you can’t come in if you are sick,” and “No, we won’t do your surgery until you have your blood sugar under control, have lost weight, and have stopped smoking,” which all increase the risk of a poor outcome. Can you imagine the outcry from the public if we put our foot down, instead of catering to the general public’s desire to be in control?

Would we truly see some dramatic improvements if the Healthcare Infection Control Practice Advisory Committee (HICPAC) came out with stern guidelines making contact precautions the new standard precautions? After all, when you start checking for colonization you wind up putting the majority of people who are admitted under the contact precautions umbrella. How much would we save in resources if we just put all admitted patients in precautions and forego the screening? Yes, the studies have shown these people get seen less often, but what if it became the norm to gown and glove upon entry to every room and continue the hand hygiene before and after contact with the environment of care?

I think it is time to change our norm and stop whining and moaning about it. Our germ cheese has been moved and we have hemmed and hawed long enough! If we are to survive and if we expect our patients to survive this germ war, we must change the way we practice healthcare.

How do you feel about current infection control practices? What changes would you make?

Sister Nurse: The other side of the bed

By Karen L. Madsen, MSN, APRN-BC

Blog admin note: While different from most blog posts on, this is a captivating, inside look at nursing today. It is, at the same time, a look through a professor’s eyes and through a mother’s eyes. The article first appeared on and was quickly picked up by Comarow on Quality, the U.S. News & World Report blog on medical safety and quality.

I don’t like this side of the bed. No, I take that back. I loathe this side of the bed. It scares me, it makes me angry, it makes me cry. I have no control over this side of the bed, I have little identity, I don’t have much of a voice. All this and more ran through my mind as I sat at the bedside of my 15-year-old daughter recently. It had been a long time since I had been part of the patient equation of the hospital rather than the nurse. It was just as much fun as I remembered.

Our daughter, Grace, is our baby, the youngest of our four children. Grace is a typical teenage girl. She slams doors, she cries at the drop of a hat. She grazes all day rather than sitting down to a meal. She is funny and emotional and dramatic, and she is a world class champion at texting on her cell phone. All of our children have been blessedly healthy, but Grace is our emergency room child. You know, she is THAT child, the one who falls, who hits her head, who goes through a fence on a horse, the one who had more stitches by age 5 than her other three siblings had, combined, by age 20!

A few weekends ago, she came home from a school-sponsored trip on a Saturday afternoon unexpectedly pale and pouty. She can be dramatic, but is rarely pouty. I should have known then something was up or something was wrong. Her group had stopped for lunch at KFC and then she had ridden in the back of a school bus home for about 90 minutes, so I wasn’t overly surprised or alarmed when she complained of feeling nauseated. I checked her forehead with the inside of my right wrist, my trusty mother thermometer. No fever. It was Saturday afternoon and I wanted to spend some time with my husband doing something we liked to do to relax. So, I basically told her to suck it up and quit whining.

We walked around a couple of flea markets and hit the grocery store for supper supplies. Once we were home, she took a nap and woke feeling a little better. Later that night, she had several episodes of vomiting and I began to think food poisoning rather than a virus was affecting my girl. Still, she had no fever, no localized pain, certainly no pain on either side of her abdomen. “Relax,” I thought, “there are a million viruses out there right now. She’ll be better in the morning.”

And she was. Or at least I believed she was. As we had been up late the night before, both she and I slept until around noon. She woke up, ate a bite or two of breakfast, and had another nap.

It was another story when she woke about 5 p.m.

Read the rest of Karen’s two-part column.

Take a survey on the image of nursing

What is your perception of the nursing profession? How would you compare this image to the image five years ago? How about 10 years ago? Have we made any strides? If not, why?

The nurse leader is in a pivotal position that affects the image of nursing. Nurses need to mentor staff, motivating them to advocate for a true representation of nursing. These nurses should be taught the skills to mimic this in their own work environment.

In preparation for an upcoming book on the image of nursing, Shelley Cohen, RN, BS, CEN, is referencing a web link below that will direct you to a quick survey consisting of related questions. Forward it to other managers and staff so they, too, can respond with feedback on the issue. We will report on the results on the blog when they become available.

In the interim, between now and when the book publishes at the end of this year, here are some tips on how you as the manager can influence the image of the nurse:

  • Share results of the survey with your staff and work as a team to develop a specific unit plan to improve the image of your nursing staff
  • Discuss information about the Center for Nursing Advocacy with staff and encourage them to write letters and emails when they see media misrepresenting the nursing profession
  • Get involved in community projects, such as BP screenings, health fairs, and speaking at schools
  • Identify unacceptable behaviors and hold staff accountable for them
  • Dress in a professional manner at all times
  • Encourage staff to validate their nursing expertise through the documentation process

To complete the brief 10 question survey, please click below

Build an engaged team!

If asked, we’d all agree that we want to manage an enthusiastic and engaged team! That’s a tall order to fill, but it isn’t impossible. Here are a couple of quick-fire ideas to get started towards fostering engagement:

Try to identify one learning opportunity for each of your staff.
This doean’t mean that everyone has to attend an expen$ive conference. How about cross-training, one additional departmental responsibility, or a self-study project? A primary characteristic of engaged employees is the feeling of being challenged.

Offer 5 times more praise than correction.
Admittedly, this can be a challenge when considering a low achieving performer. Try to take note of any incremental progress, demonstration of positive behaviors or even a wonderful sense of humor that enables his/her peers to have a few minutes of stress relief!

What ideas do YOU use to foster engagement?

Filling the pockets of retention

By Lydia Ostermeier, RN, MSN, CHCR and Shelley Cohen, RN, BSN, CEN

When it comes to retaining staff, sometimes the hardest part is finding the dollars to drive your efforts. Too often, managers are unsure about the resources and support available to them when they budget for retention.

One of the first questions to ask yourself is, “What is my greatest resource to obtaining funds?” Whether you are determining the resource most likely to provide you with funding or the people most able to play a supportive role in validating the need for retention budgeting, the identification of these valuable sources is a key step toward monetary resources.

Here are some tips to keep in mind when working toward acquiring retention funds:

  • Always combine your budget request with ideas and plans that do not require funding, such as employee retention committees
  • Determine alternative methods of communicating retention tips, such as a monthly email sent out to managers
  • Listen to your staff to find out what things are really important to them; you don’t want to spend money on things that they do not value
  • Make a strong business case to your executive team, including the increased cost of turnover that would occur without retention efforts

If you are lucky enough to receive some specific funding for retention programs, build them in to a special general ledger in your budget so that you can keep track of your spending. And if you don’t succeed the first time, try again with a different angle. For example, it is not only important for retention of staff, but it may also help with recruitment as well; talk about the potential recruitment benefits.

If you are still not able to secure the funds that you need, take a look at your current programs, benefits, and perks. Are they all still important to your staff? Is there something that you can give up to reinvest the funds in something more worthwhile?

Many other strategies are taking place at hospitals nationwide, and communicating successful efforts is a retention strategy in itself. What have you found to be your most successful methods of gaining funding for retention efforts? How were you able to get the budgeted resources you needed to keep your nurses happy and by the bedside? To respond with questions or comments, just click on the comments link and let your voice be heard.

Who is accountable to the cost and use of patient supplies?

Are you finding yourself spending more time with a budget sheet, calculator and bottle of Tylenol these days? If you answer yes, that makes you normal as a Nurse Manager. With all your fiscal responsibilities do you ever wonder how much accountability staff should have?

Of course, their first response will be, “you make the big bucks you should take care of the money stuff. I’m here to take care of sick people and be a nurse, not an accountant”. Sound familiar to anyone? You might be wondering, where is Shelley going with this? Think about your role as a manager as it relates to sound fiscal practices in your department. With that in mind, how do you see your role as it relates to holding staff accountable from a fiscal perspective?

Have you wondered what goes on in the mind of the staff nurse when he/she reaches for supplies? You may be hoping they are calculating the cost to purchase the item vs the amount you are actually reimbursed. But, let’s be real here, after all a good professional blog prides itself on reality. When I work my prn shifts as a staff nurse and I am in need of a supply for a patient, my thoughts are (in order of priority);

Do I remember where this item is stored?

  • Will the item actually be there on the shelf?
  • What is going on with my other patients while I am in the supply closet?
  • When can I finally get to the bathroom (ok, maybe this is a number 2 priority)?
  • What time is lunch?

Can you put yourself in the position of your staff as they make selection decisions related to supply use? How can the manager educate and coach staff to lead to a more fiscally realized use of supplies? If the nurse needs one sterile 4×4 for a procedure and they have the following to choose between, how do they make their decision?

Option 1 package with 2 4×4’s
Option 2 package with 4 4×4’s

Some staff will select the item based on which one they see first. Another staff person may consider/rationalize the following;

If a liter of irrigating solution costs the same as a 250cc bottle, maybe the same applies to other supplies.

What do you think your staff consider as they make decisions about selecting supplies for their patients? How have you educated staff to details regarding costs vs reimbursement? If you had the opportunity, what would you implement that would hold staff more accountable to areas related to the costs of providing health care?

Retention tips!

Here is a quick idea that costs only about 2 minutes of time: Even though you may have thanked an employee at work for something they did “above and beyond”, take the time to call them at home after their shift to thank them again. It’s preferable for you to make the call from your home instead of your office. You may be surprised how far this small gesture can go!

When I originally sent this idea out to managers and administrators in our organization, our COO called me at home! I was not there to receive the call, but he left me a wonderful message saying how much he appreciated the retention ideas I sent out and how much he valued my position within the organization. WOW. I was floored!

If you’ve tried this idea, or are thinking about it, drop a comment on the blog and let us know how it goes!