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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?

Give your nurses a holiday e-card

In search of a simple way to let someone know you are thinking about them this holiday season? Just want to give a quick “thank-you” for all the hard work they do?

Here’s a quick and easy way to do it: Send some fellow nurses a holiday card here.

Driving under the influence of drowsiness

It’s no secret that nursing can do a number on your health. Sore backs from lifting patients and poor eating habits because of strange schedules and lack of time, to name a couple examples, can have a detrimental effect on your health. Add driving under the influence of drowsiness to the list.

According to a new study published in the December 1 issue of SLEEP, staff nurses who work extended hours, work at night, struggle to remain awake at work, or obtain less sleep are more likely to experience a drowsy driving episode. The data was compiled during a four-week span and focused on 895 nurses, who reported, on average, one drowsy driving episode out of every four shifts worked. Additionally, 281 accidents or near car accidents were reported during the study.

Sleep restriction and sleep fragmentation are listed as the two main causes of drowsy driving. To combat the problem, the American Academy of Sleep Medicine recommends getting enough sleep, taking breaks while driving, consuming caffeine, avoiding alcohol, and avoid late-night driving.

Here is a link to the full press release with further information: Sleep Study

Every manager’s discrimination fears

Managers are forever grateful for the supportive teams they work with and all have staff they wish could be duplicated on a copy machine. Because we work with a variety of people, challenges will always be present. Our “Hot topics” will look at the reality of these challenges, helping managers by sharing their experiences. We can all benefit from those who have had success in meeting these situations of conflict.

How do you handle the employee who “everyone” knows needs to be shown the door, you have all the necessary documentation, but there is a “discrimination fear”? The employee may be obese, have a physical challenge, be from another country, or be in a recovery program for an addiction. According to the EEOC (US Equal Employment Opportunity Commission), types of discrimination include;

  • Age
  • Disability
  • Equal pay
  • National origin
  • Pregnancy
  • Race
  • Religion
  • Retaliation
  • Sex
  • Sexual harassment

Some employees may verbally threaten their manager by using the term discrimination and others use the weight of the nursing shortage as ammunition. The most recent case I was involved with was an employee who had threatened both the manager and the HR director with racial discrimination as they were walking the employee through the steps of termination.

In 2006, 75,768 individuals filed charges with the EEOC with almost 36% of them related to racial claims. gender discrimination was the next most commonly field charge at a rate of just under 31%. Of all the claims made in 2006, there were 403 suits actually filed. You can read more details about the charges, claims and outcomes of the cases at the Web site www.eeoc.gov.

What experiences have you had with this and how did you handle it? Were you surprised by the outcome? Who was your greatest resource that helped to guide you through the process? Did you find yourself in a situation where the organization was best served by “settling” the case?

Put a halt to holiday stress

Here we go again. All of a sudden, like an enormous stack of papers covering your desk on a Monday morning, the holiday season has arrived. Ugh! But hey, look at the bright side: You made it through Thanksgiving and you didn’t eat too much. Okay, maybe you did. And you weren’t one of those people who got up at 3 a.m. to shop on Black Friday. Okay, maybe you were. Either way, now is the time when shopping, eating, and stress really pick up. Here are seven tips to get you through the holidays in one piece.

Whether you’re getting ready to celebrate Christmas, Chanukah, or Kwanzaa, these tips will help you save time, money, and even the hair you want to pull out when the person in front of you at the grocery store clearly has more than 10 items in his or her plastic basket! Phew. Okay, breathe. Relax. Here we go:

Shop in spurts. Lots of people like to pick a day, get up at the crack of dawn, and plow through their holiday shopping in one, crazy 12-hour stretch. Why put yourself through it? Shop a little at a time, chip away here and there, and you’ll be done in no time.

Love to log on. A decade ago, shopping online was a bizarre idea meant for only the highest of high-tech gurus. Now, your cat can do it. If you’re sick of the long lines and your car is sick of finishing last in the parking space game, get a comfortable chair, a nice cup of tea, and shop away.

Less is more. Are you having a tough time deciding which new gaming system to get your kid? Or which cruise package to get your parents for helping you through nursing school? Here’s a thought: Don’t get any of it. Get simple, thoughtful gifts. Spend more time together during the holidays. You (and your wallet) will be happier come January.

Take some vacation. We know, we know, there’s too much going on at the end of the year to take some time off. You’ve got new projects to finish, new people to train, and new ideas to implement. Relax. Take a break. Give yourself a long weekend or take a random Wednesday afternoon off.

Treat No. 1. Guess who that is? You’ve been running around all year, catering to family, friends, and yes, patients. When do you get a break? Now. Go buy those shoes you’ve been looking at for two months. Go to a spa for a few hours.

Early resolutions. Instead of waiting until January 1 to make your New Year’s Resolution, do it now. Do you want to drop 10 pounds? Do you finally want to kick that nicotine habit? Do you want to send at least one thank-you note each week to someone in your life? Start now! You’ll feel much better about yourself through the holidays and you’ll laugh at those people who are racking their brains for a resolution next year.

Smile more. It sounds simple, doesn’t it? But have you ever consciously tried to do it? If you’re standing in a check-out line that starts and ends in two different states, smile. If your roast is drier than the Sahara Desert in the middle of summer, smile. If your shovel snaps like a twig in the middle of an ice storm, smile. It won’t make your problems go away, but it will make everything seem a lot better. Then, (gasp) maybe you can actually enjoy the holidays.

How do you get through the craziness of the holidays? Share your thoughts with your peers.