As promised last week, we’ve added a free download from Kathleen Bartholomew’s Ending Nurse-to-Nurse Hostility, Second Edition, in honor of being the only book chosen by the American Nurses Association as a recommended bullying and horizontal hostility prevention tool.
To access the download site for a tool you can use to evaluate the health of your workplace as regards bullying, lateral violence, and other undesirable behaviors, click here.
To read last week’s story the ANA position statement on workplace violence and the nursing profession, click here.
On August 31, the American Nurses Association issued a press release announcing its updated position statement on workplace bullying and violence, stating that the “nursing profession will no longer tolerate violence of any kind from any source.”
Among the interventions recommended as “primary prevention” is the HCPro classic work by Kathleen Bartholomew,
Ending Nurse-to-Nurse Hostility, Second Edition. In fact, Ending Nurse-to-Nurse Hostility has the distinction of being the only book recommended to RNs and their employers in the statement as a front line tool for preventing incivility and bullying.
We are so honored to have published Kathleen’s work, and congratulate her for this wonderful recognition of a lifetime commitment to making the nursing workplace a healthier, more collegial place. If you would like to add your best wishes, feel free to comment below!
Incidents reports are a pain to fill out, but vital for documenting what happened and for protecting yourself and your staff. This week, we’re republishing a popular post full of best practices, provided by Patricia A. Duclos-Miller, MS, RN, CNA, BC.
Yesterday we looked at the purpose of the incident report and the value of documenting facts as well as the patient’s responses to care in the nursing progress notes (see Incident Reports: Part One). Today we’ll look at eight risk reduction recommendations you should follow to limit the number of incidents you face. We’ll also give you a check list of tips for writing incident reports should adverse events occur. (I’ll make the checklist available as a PDF download in a few days, so check back for the link.)
RISK REDUCTION RECOMMENDATIONS FOR NURSE MANAGERS
- Be sure that everyone is clear as to who is managing the patient. This is especially critical in complicated cases with numerous consults. One of the major factors in adverse events is fragmentation or lack of clear communication between providers. Therefore, use the medical record as a communication tool for all providers and encourage your staff to read notes from other providers and disciplines.
- Be sure staff understand and utilize the chain of command when necessary. They are considered patient advocates and must speak on behalf of the patient to ensure quality patient care. Documentation of the chain of command process should be factual and blameless.
- Advise your staff never to create notes at home concerning the event. They should not discuss the event with other care providers without having someone from risk management present, unless the discussion is in a quality-review process or in the presence of the facility’s attorney.
- If an adverse event occurs, the staff must know that attention to patient needs is first and foremost. If a patient is injured, nursing and medical interventions take precedence over everything else.
- Follow the organization’s policy on medical-event disclosure. It is important that staff understand who is designated to inform the patient/family. Documentation should include who was present during the discussion, what information was discussed, and all of the patient/family responses.
- Ensure that the patient/family receives compassionate care and that everyone involved maintains a professional relationship.
- If an adverse event occurs, contact the risk manager. Discuss the case discretely, because conversations are not protected under a quality statute or attorney-client privilege, and therefore may be discoverable.
- Work with the risk manager. The risk manager can help you and your staff promote patient safety and proactive strategies to avoid injuries.
Incidents reports are a pain to fill out, but vital for documenting what happened and for protecting yourself and your staff. This week, we’re republishing installments of a popular post chock full of best practices, provided by Patricia A. Duclos-Miller, MS, RN, CNA, BC.
We work in high-stress, fast-paced environments. It is your responsibility as a member of the nursing management team to understand the importance of incident reports, to ensure that your staff completes them, and to investigate incidents to avoid any further occurrences. Your investigation will also provide possible defense if during your investigation you identify a system failure and take the necessary corrective action(s).
The purpose of the incident report is to refresh the memories of both the nurse manager/supervisor and the staff nurse. While the clinical record is patient-focused, the incident report is incident-focused. The benefit to you and your staff is [more]
Listening, validating and asking for a commitment
From Team-Building Handbook: Accountability Strategies for Nurses, by Eileen Lavin Dohmann, RN, MBA, NEA-BC
When working with a group, I assume that people are rational and logical.
So, if I want them to do something, I just need to explain it and they’ll do it. When I don’t get the results I am seeking, I tend to think “Oh, I must not be explaining it well. Let me try it again.”
It’s taken me a long time to realize that what I was hearing as “not understanding me” was often someone’s polite way of telling me no. So, now when I find myself explaining the same thing to someone for the third time, I stop and ask the person what he or she is hearing me request. If I can validate that the person is hearing me correctly, I ask for the commitment: yes or no.
Validating… and asking for a yes or no
We can hold ourselves accountable, but holding other people accountable can be much more difficult. Consider this nurse-physician scenario and ask yourself [more]
Nurse managers and nurse leaders are in the habit of telling people what to do and expecting them to follow through. How’s that working for you with your staff?
Maybe there is another way. Try this technique that is borrowed from executive coaching practices used in business for personal improvement. It is a powerful communication tool that can transform your approach to health behavior counseling and re-energize your work.
Instead of telling nurses what to do, coaches ask powerful questions designed to challenge thinking and action and to elicit positive behavior change. Coaching will help you guide your nurses toward rapid goal attainment, higher levels of productivity, and to reach their full potential. It also reduces your stress as a nurse manager because the accountability is on the employee, not you. [more]
I’ve posted in the past on accountability strategies, communication techniques, and building team relationships, all of which can improve the workplace. Recently I ran across the term “positive pushback”—easy to remember thanks to those alliterative “p” words—and felt that the technique might be helpful in those potential conflict situations that arise from time to time.
The promise of positive pushback is that you can communicate your concerns in an unequivocally strong and clear manner that doesn’t damage your professional relationships. No yelling and certainly no retreating to an unassertive approach.
According to Susanne Gaddis, the Communications Doctor:
A “positive pushback” is the ability to deliver an appropriately assertive response to a potentially negative and/or harmful situation. A positive pushback is executed by looking someone straight in the eye, and saying with an even, non-stressed tone what you want or need. (If you want to be really assertive include the word “I,” such as “I really need for you to stop and review this now…”)
What resources do you need to use positive pushback? Self-esteem, self-confidence, and an ability to convey urgency without “emoting” your emotions. I highly recommend that you read this blog post from Susanne Gaddis, to see if this is a tool that you can add to your collection. As with all the “soft skills,” practice makes perfect.
If you try the techniques, please post a comment here to let us know how it worked out for you!
With thanks to Susanne Gaddis, PhD, CSP and CEO of The Communications Doctor, is an acknowledged communications expert who has taught the art of effective and positive communication since 1989.
As promised, you can now download the very practical and simple tool I mentioned in last week’s post (Not My Job: The legal perspective on updating job descriptions). I’ve created a Word file of the standard job description update letter, which you’ll find here. Don’t let its simplicity fool you; this is useful tool for legal risk reduction.
About the Word file: You can customize it to include your organization’s logo, address, and such. Use it as a simple way to document that your staff members understand changes in responsibilities and duties included in their job descriptions.
When you incorporate new practices or adapt to new standards that are reflected in updated job descriptions, you’ll simply ask each staff member to sign the letter acknowledging and committing to adhere to the revised job description, and place a copy in each employee’s file.
Many thanks to Dinah Brothers for this tool…
Dinah Brothers, RN, JD, is the author of The Essential Legal Handbook for Nurses (just released), sold as a set of 10 handbooks for staff nurses, and The Nurse Manager’s Legal Companion (release: July 2015), a book offering nurse managers guidance on everything from employment law to dealing with whistleblowers and everything in between.
I learn from every book I work on, but this latest one on accountability strategies really hit home. I now realize that when I say “I’ll try” to do something by a particular date, I haven’t truly committed to being accountable for the deadline. And when I hear the same words from someone else, I no longer take “I’ll try” to mean the commitment all managers want to hear from an engaged staff: the definitive YES.
I’ll try is what I say when I don’t really see how I’ll be able to make the commitment, but don’t stop to think about what’s in the way. Do I lack the resources, the bandwidth, or (worse) the interest? Am I just allergic to saying a simple “no” when I can’t squeeze the proverbial 10 pounds of sugar into a five pound bag?
As a manager whose goal is positive outcomes from an engaged staff, you need to train your ear to “hear” the difference between words that indicate accountability and those that fall short. Your staff can do the same, and when you’re all hearing and speaking the language of accountability, good things will happen.
To find out more about building accountability in your staff, go to the web page for the team-training handbook, Team-Building Handbook: Accountability Strategies for Nurses. For ideas on how to develop a culture of accountability starting with yourself, visit the web page for Accountability in Nursing: Six Strategies to Build and Maintain a Culture of Commitment.
Both are from Eileen Lavin Dohmann, MBA, BSN, RN, NEA-BC, the Senior Vice President and Chief Nursing Officer of Mary Washington Healthcare in Fredericksburg, Virginia.
First, a couple of brief items:
Better Meetings, Better Outcomes: You can download the PDF I promised a few days ago, “What am I doing here? Tips for being accountable in meetings,” here.
Nursing Survey Ends 5/27: Our 2015 nursing survey is still open if you want to share your thoughts and (not incidentally) participate in our drawing for Team-Building Handbook: Improving Nurse-to-Nurse Relationships. Here’s the link: https://www.surveymonkey.com/s/hcpronurses2015
Next, my confession.
I’ll admit it, I peeked—I couldn’t resist the temptation to look at the results of our ongoing 2015 nursing survey to find out the biggest issues facing nurses today.
Would you be surprised if I mentioned that time (not enough of it) is as common a concern today as it was in the 2013 survey? To relieve some of your pain, I’ll share some great tips from Sharon Cox, [more]