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Lessons learned from my first class

When the Leader’s Lounge was born, I started the blog with my decision to return to school in my mid-50s. What was I thinking? It is hard to believe that my first course has already ended, and that I am preparing for the next one. Wondering how it went?

Better than I expected.

I took the one course that was only for two credits, as I knew the load would be less and I could plan from that for the other three- and four-credit course loads. I found out today I received an “A” (I never read so much in such a short time period; eat lots of carrots!) and found the overall experience was good. Getting a good grade certainly helped with that perception. I would prefer to be in a live classroom as I thrive on that interaction, but “life” gets in the way of that. Online courses can be interactive in their own way, but I miss the voices, tones, and facial expressions. Call me a product of my generation compared to the younger ones who don’t use the phone much (they text message).

I learned a great deal from my first course on Issues in Health Care Informatics. Along with the acquired knowledge of real substantial material that I can use, I learned how to study at an airport with people around you talking (shouting) into their blackberry’s, I learned how to scan articles for what I have to read, and mostly, I learned that my nursing experience, every bit of it, is relevant.

Additionally, because this was a two-credit course, it did not take nearly the time away from my home life as I thought it would. Being able to do a great deal of the work while on the road, left little time taken away once I was home.

Are you still on the edge about going back to school? What’s holding you back?

Shhh! We’re preventing medication errors here!

A creative way to prevent medication errors from the pages of our Briefings on Patient Safety newsletter:

Citizens Medical Center in Victoria, TX, took a creative approach to cut down on medication errors when it created a “no-talk zone.”

“Distractions were definitely becoming an issue with medication errors,” says Gail Martin, MBA, RN, quality analyst at Citizens Medical Center. The main problem was that two of the facility’s busiest and most critical floors had Pyxis medication dispensing machines located out in the open-next to the coffee pot and across from the nurses’ station, says Martin.

Though the obvious solution was to relocate the Pyxis machines, it was not feasible at that time, says Martin.

“That costs money. And we’re a county hospital, so it wasn’t happening,” she says. “It is in our future plans, but for the immediate future, we needed to do something.”

So, Martin’s team brainstormed different signage asking staff and hospital visitors not to disturb anyone using a Pyxis machine, especially in a busy area. They eventually settled on a simple “no-talk zone” sign much like a “no smoking” sign. The lettering is black, and the symbol is red. The sign is displayed on the floor in front of the Pyxis machine, kind of like a mat slicked on the floor, says Martin.

The “no-talk zone” has been in place for a year and has paid dividends. Since the start of 2007, five medication errors have been attributed to frequent interruptions, lighting, or noise level; this is a decrease from the entire year of 2006, in which 23 medication errors were attributed to the same causes, according to Martin.

What does your organization do to prevent medication errors? Do you think something like this “no-talk zone” would work where you are?

Quick nurse retention ideas!


In my position as Nurse Retention Coordinator, I am always on the lookout for innovative ideas I can adapt as a retention strategy. I then share these ideas with our Nurse Managers.
Employee of the Month contests tend to become popularity events; try this instead: At monthly staff meetings, draw one name out of the hat and that person becomes Employee of the Month for that month. This gives everyone an opportunity to be recognized!
Encourage your staff to write down their KUDOS about that person. Who is your creative staff member who just loves crafts, design or scrapbooking? Ask that person to compile the peer comments in any way they think is appropirate: typed on a sheet, a collage, a scrapbook page, a certificate. Be creative (or allow them to be!). No one can win twice until all staff have had one opportunity to shine!

Kick It Up A Notch: Give your creative staff a bulletin board in your unit, but not in the staff lounge. You want patients and visitors to see it too. Encourage your creative person(s) to design the board each month highlighting the Employee of the Month. This is an awesome way to provide peer recognition!
One of my staff nurses also earned a degree in Recreation Therapy – she LOVES taking time each month to design a THEME board. If you have to pay an hour or so of OT, is the recognition factor worth it?

Show your colors on National Wear Red Day

Think men are more prone to heart disease? Try again. More women than men die of heart disease each year. In fact:

  • Nearly 39% of all female deaths in the United States occur from cardiovascular disease (American Heart Association).
  • Heart attack, stroke, and related cardiovascular diseases are responsible for almost twice as many deaths among women as all forms of cancer combined (American Heart Association).
  • Coronary heart disease is the leading cause of death among U.S. women. It affects 1 in 10 women over the age of 18 (National Institute on Health).

While awareness of heart disease as the leading cause of death has increased from 30% in 1997 to 46% in 2003, only 20% of women consider it to be their own greatest health risk. National Wear Red Day, celebrated on Friday, February 1, is a day when Americans nationwide will wear red to show their support for women’s heart disease awareness and bring well-needed attention to this killer.

“Women need to realize that making even one lifestyle change reduces their risk for heart disease,” says August Stieber of Bensinger, DuPont & Associates (BDA), a national EAP firm. In fact, the risk of heart disease can be lowered by as much as 82% just by leading a healthy lifestyle, according to The National Heart, Lung and Blood Institute.

Stieber offers these lifestyle suggestions:

  • Exercise: Regular physical activity–even as simple as walking 30 minutes a day–can lead to improved blood pressure, cholesterol levels, and cardiovascular fitness.
  • Nutrition: A diet low in fat and high in fiber can help reduce the risk for heart attack by lowering cholesterol levels and blood pressure.
  • Stress Reduction: Stress management reduces heart rate, blood pressure, and cholesterol–all of which improve heart health.

National Wear Red Day was launched in partnership with The Heart Truth, a national awareness campaign for women about heart disease sponsored by the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health, U.S. Department of Health and Human Services. For more information on National Wear Red Day, click here.

Editor’s note: For additional information, Stieber can be reached at 1-800-227-8620. Courtesy of Bensinger, DuPont & Associates. Reprinted with permission.

Essential business skills for nurse managers

By Denise Danna, DNS, RN, CNAA-BC, FACHE

For a nurse manager to be successful in today’s healthcare environment, mastery of basic business skills is essential. No longer are nurse managers expected to be clinical experts but, instead, must be equipped and skillful in “running their business.” Each nursing unit is a component of a larger organization that depends on qualified nurses to manage the business and to understand the “big” picture. Nurse managers are the change agents and leaders in improving the work environment where nurses practice, so it is essential that they have the required skills.

What are the essential business skills?

As you think about business skills, the first thing that probably comes to mind is the budget or the finances, but business skills include so much more. Business skills frequently include human resources, strategic planning, and systems thinking, to name a few.

The following three categories identify several of the business skills that are essential for nurse managers:

  • Financial management
  • Human resources
  • Strategic management

For more of Denise’s article, visit our Reading Room.

Be wary of Crocs

An interesting take on Crocs from the pages of our Briefings on Infection Control newsletter:

Crocs-the popular and colorful rubber shoes-serve as convenient, comfortable clog-type footwear in healthcare settings. However, while they might make the workday go easier, Crocs also pose an infection control risk with their multiple ventilation holes and open backs, says Terry Jo Gile, MT (ASCP), MA Ed.

“That’s not allowed in a clinical lab,” she adds, noting that some hospitals had for a time allowed OR nurses to wear them.

Shoes must adequately cover the foot, must not be made of canvas, and must not be of an open or sandal design, according to National Committee on Clinical Laboratory Standards Guideline GP17-A2.

“OSHA says no, too, because you can get sprays and splashes in the holes and in the backs,” Gile says.

Her stance stems from the general provisions of the bloodborne pathogens standards, which doesn’t specifically note Crocs. However, an informal opinion from OSHA in 2006 indicated that Crocs would be inappropriate in hospital settings where one might reasonably expect drops of blood or other potentially infectious materials to land on an employee’s feet.

Moreover, Gile says, in lab environments, there’s not only the risk of infectious body fluids exposure to the feet, but a risk of chemical splashes and sharp injuries as well. Yet few labs have written dress-code policies to prohibit Crocs.

What’s your view on Crocs? Do they have a place in the healthcare setting?

Connecting technology with nursing education

By Janet M. Phillips, PhDc, RN, Associate Instructor, Indiana University School of Nursing

In February, a colleague and I will be discussing the new technology that is available for nurse educators on an audioconference.

Many of you have likely already started bringing technology into your classrooms, and you might have encountered bumps along the way. What have been some of your difficulties in using technologies in education, and how have you resolved them?

Looking to charts for a few chuckles

Documentation is a serious business. It demonstrates excellent patient care and can be your saving grace when legal issues occasionally rise to the surface. But sometimes, a chart can make you laugh. From entries as bizarre as a patient refusing an autopsy to a woman being numb from her toes down, you can find some funny stuff on a chart. A friend sent us this list of 25 gut-busters and we had to pass them along. Enjoy.

And, in case you were wondering, these were (allegedly!) taken from actual hospital charts.

1. The patient refused autopsy.
2. The patient has no previous history of suicides.
3. Patient has left white blood cells at another hospital.
4. She has no rigors or shaking chills, but her husband states she was very hot in bed last night.
5. Patient has chest pain if she lies on her left side for over a year.
6. On the second day the knee was better and on the third day it disappeared.
7. The patient is tearful and crying constantly. She also appears to be depressed.
8. The patient has been depressed since she began seeing me in 1993.
9. Discharge status: Alive but without permission.
10. Healthy appearing decrepit 69-year-old male, mentally alert but forgetful.
11. Patient had waffles for breakfast and anorexia for lunch.
12. She is numb from her toes down.
13. While in ER, she was examined, x-rated, and sent home.
14. The skin was moist and dry.
15. Occasional, constant infrequent headaches.
16. Patient was alert and unresponsive.
17. Rectal examination revealed a normal size thyroid.
18. She stated that she had been constipated for most of her life, until she got a divorce.
19. I saw your patient today, who is still under our car for physical therapy.
20. Both breasts are equal and reactive to light and accommodation.
21. Examination of genitalia reveals that he is circus sized.
22. The lab test indicated abnormal lover function.
23. Skin: somewhat pale but present.
24. The pelvic exam will be done later on the floor.
25. Patient has two teenage children, but no other abnormalities.

Are there any others you’ve stumbled upon during your time as a nurse? Feel free to add your own comment–and share the laughter.

Create a nurturing nursing environment

By Rosa Belgard, MS, RN, Presbyterian Hospital of Dallas

The challenge of retaining the best nurses at the bedside is universal in the nursing profession, so it is crucial to offer nurses an environment where they can gain new skills, contribute to improving patient care, and feel like their job makes a difference. If you offer such an environment, nurses will not only stay, they will prosper and flourish.

Choosing and developing an environment where bedside nurses are held in high esteem, receive frequent recognition, and are compensated appropriately must be an individual process every healthcare organization, and the biggest challenge is developing an environment that meets your needs.

How are you working on creating this environment for your nurses? What are your biggest challenges in developing, maintaining, and supporting a clinical ladder or career advancement program? How have you addressed these challenges?

Don’t let Dr. Jekyll turn into Mr. Hyde

Is there a physician, possibly your medical director, who has been non-supportive behind your back?

You know who these people are. At a meeting or in front of your boss, they are supportive and, at times, encouraging of your work and efforts. But once the meeting is over and everyone goes their own way, they are completely different. You would think it was a “Jekyll and Hyde” experience!

This is not to take away from all the providers we collaborate with who are ethically strong and committed to being part of a team. This hot topic is not about them; we are grateful for strong collaboratives with many providers we work with.

But believe it or not, some people are unhappy when they see your successes. Now that I spurted that out, think about it. You already knew that, but most people won’t say it. You are that multi-tasking, confident, caring, empowering nurse leader and some folks out there want to burst your bubble.

How do they burst your bubble?

  • Going behind your back and planting seeds among those who look up to you. What are they planting seeds for? They are hoping to grow their own cheerleaders and take your squad away from you.
  • Relaying misinformation about what you said or wrote
  • Discouraging staff from following policy or procedure
  • Verbally defaming your ability to perform your role
  • Identifying staff members vulnerable to getting on their bandwagon

How would you approach this professional? Or, if you have already faced a situation similar to this one, how did it go?