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Ben Franklin’s advice to nurse preceptors

Tell me and I forget.
Teach me and I remember.
Involve me and I learn.

How do you provide preceptees with constructive advice Ben Franklin2
or feedback? Do you tell them what they did wrong and spell out how to correct it? Or do you encourage them to use critical-thinking skills to truly ingrain a personal understanding of ways to improve their practice?

Look at these two approaches to feedback, and see which you think would be more effective. (More examples excerpted from The Preceptor Program Builder can be found in the Reading Room.)

The preceptor observes the preceptee greeting the manager correctly, giving her name, and stating that she is a preceptee. However, she was not wearing her name tag.

Evaluative feedback
Your name tag is missing, and the manager
won’t like it!

Descriptive feedback
You greeted the manager according to the facility protocol.
Can you think of anything that would help your manager remember you?

The descriptive feedback encourages the preceptee to use critical thinking, which illustrates Ben Franklin’s timeless recommendation to “involve me, and I learn.”

If you would like to share “aha” moments and techniques for constructive feedback, please feel free to comment below…

Nurses Week giveaway: Free excerpt from Ending Nurse-To-Nurse Hostility and a chance to win a copy!

HCPro has celebrated nurses all week long with special giveaways, prizes, and promotions.

We are giving away an exclusive excerpt from the brand-new edition of Ending Nurse-to-Nurse Hostility!

In this excerpt, Kathleen Bartholomew, RN, MN, is shining a light on horizontal hostility in nursing school. Read about the effect of horizontal hostility and bullying in nursing school and the positive ways nursing students can be supported and mentored as they begin their nursing career.

Download the excerpt here.

Plus you can also enter to win a free copy of the book!

We are giving away five copies of Ending Nurse-to-Nurse Hostility. Be among the first to read the newly updated book from nursing communication expert Kathleen Bartholomew, RN, MN.

Almost 50% of former nurses cite horizontal hostility as their reason for leaving the profession. Beat the statistics! Read this groundbreaking book and discover all-new strategies and solutions to improve the nursing culture at your organization.

Enter here for your chance to win.

Poll results: Using technology to connect with patients

Last month, I posted about the ways that technology could improve patients’ communication with nurses but could also place a greater burden on nurses for round-the-clock care and feedback. To get a feel for how often nurses used technology and social media to interact with patients, we posted a poll on asking nurses and other healthcare professionals to weigh in.

Approximately three-quarters (74%) of those who participated in the poll responded that they did not use social networking sites such as Twitter, Facebook, or LinkedIn to interact with patients, while the remaining 26% replied that they do use those technologies for patient interaction.

While these results indicate that social networking sites have not become a place for healthcare communications, I still wonder whether nurses and other practitioners use other forms of technology, such as emails, listervs, or websites, to share information with patients and respond to questions about treatment plans. As mentioned previously, these resources have the potential to improve patient care, but they must be leveraged appropriately.

How do you communicate and follow up with patients outside of their scheduled appointment times? Leave a comment below!

When disrespect becomes a safety issue

A dysfunctional culture rooted in widespread disrespect is a significant barrier to patient safety, and affects everyone in a healthcare organization, according to a pair of papers published in the journal Academic Medicine earlier this year. The papers’ authors identified six broad categories of disrespectful behavior, including degrading treatment of nurses, residents, and students, passive-aggressive behavior, and dismissive treatment of patients. Other behaviors included disrespect for system-wide policies and processes, disruptive behavior, and passive disrespect. The authors concluded that such behavior prohibits teamwork and undermines morale, which in turn threatens patient safety.

Most, if not all, organizations have at least one practitioner who seems intent on making everyone else miserable. While these disruptive practitioners may only be a small percent of the people working in a hospital or other healthcare facility, their behaviors and the influence of their attitudes can have much larger implications, as the authors of the papers point out. Nurses are particularly at risk for taking the brunt of a physician’s abuse; in several recent studies, more than 90% of nurses reported experiencing verbal abuse.

The second of the two papers focuses on creating a culture of respect. The paper’s authors call on an organizations leader, specifically the CEO, to initiate changes within an organization. However, anyone in a leadership position could address the need for change and begin working towards a cultural shift. The paper recommends five major tasks: motivate and inspire, establish preconditions for a culture of respect, lead the establishment of policies regarding disrespectful behavior, facilitate frontline worker engagement, and create a learning environment for resident and students. By recognizing that there is an issue with disruptive behavior and taking steps to eliminate those behaviors from your organization, you can begin to move towards a culture that is respectful and safe.

How has your organization addressed disruptive behavior in the past? Leave a comment and let us know!

Nurses identify barriers and facilitators for clinical practice guideline use

Nurses’ adoption and use of clinical practice guidelines is largely affected by external barriers such as social and organizational factors, according to a study published in this month’s issue of American Journal of Nursing.  Clinical practice guidelines, which the Institute of Medicine defines as “systematically developed statements to assist practitioner and patient decisions about appropriate healthcare for specific clinical circumstances,” are designed to close the gap between evidence for best practice and actual patient care. Researchers chose to focus on nurses’ applications of clinical practice guidelines due to several previous studies that found that nurses were most often identified as being primarily responsible for ensuring patient safety.

Researchers examined responses to open-ended survey questions asking nurses about barriers and facilitators to using clinical practice guidelines. The top three most-identified categories for facilitating the use of guidelines were education/orientation/training, communication, and time/staffing/workload; similarly, these were also identified as categories in which there were barriers to guideline use. 44% of nurses responded that their ability to use guidelines was impeded by a lack of time and a heavy workload, while 25% cited a lack of education, orientation, and training and 22% cited poor communication as barriers. Researchers found that 91% of nurses identified at least one external barrier, or those outside of the individual nurse’s control, and 53% of nurses identified more than one external barrier.  Fewer than 10% of nurses identified internal barriers such as lack of awareness of guidelines or willingness to change practice to better adhere to guidelines.

The research suggests that social and organizational factors can be crucial in the use of clinical practice guidelines. Organization leaders should find ways to ensure that nurses receive sufficient education and adequate time to successfully implement guidelines. In addition, effective communication and cooperative teamwork should be encouraged and practiced by everyone within an organization. The study’s researchers conclude that nurses should ideally be involved in all stages of guideline development, implementation, and use.

How do your nurses respond to clinical practice guidelines? What are some ways you have found to ensure guideline use among your nurses? Share your thoughts in the comments section!

Apologies and action for famous actors only?

Hospital chief Sandra Coletta is making waves throughout the healthcare community after being frank with her audience of hundreds at the 10th annual dinner of Medically Induced Trauma Support Services (MITSS), a widely respected group that aims to support patients, families, and staffs after things go medically wrong.

She spoke about the death of James Woods’ brother in the emergency department at Kent Hospital in Warwick, RI, after orders were not carried out in a timely manner.

“Quite honestly, I did nothing other than what my mother taught me,” Coletta said of apologizing.

James Woods and the hospital settled the suit, in the process created a foundation, the Michael J. Woods Institute, in honor of his brother. The institute aims to recreate healthcare from a human factors perspective.

Similar action was taken after Dennis Quaid’s twins were put in peril because of a medication administration mistake. (According to an April 2010 USA Today story, Quaid said Cedars-Sinai hospital in LA “stepped up to the plate and spent millions of dollars on bedside bar codes.” He and his wife also created the Quaid Foundation, which has merged with the Texas Medical Institute of Technology.) Do you think these cases are addressed more swiftly, and more apologetically, because of their high-profile nature? Or do you think the tides are turning?

Of course, Sorrel King, without being famous (at least then), spurred plenty of action on her own. But are hospitals finally reacting with action and apologies, even without fame and publicity?

Source: WBUR

First published on Patient Safety Monitor Blog.

Winner of HCPro’s nurse leader best practices contest

Editor’s note: This best practice was submitted by Anjie Vickers, RN, BSN, NE-BC, Carolinas Medical Center, Charlotte, NC. Anjie won a free book. Congratulations Anjie and thanks to everyone who submitted a best practice!

I am the nurse manager of a 19-bed progressive care unit, which I have managed for almost 11 years. The culture has dramatically changed from that of the one I started with. That was one in which the nurses exhibited horizontal violence, resisted change, and lacked shared ownership. How I changed it to one that is now a healthy work environment that embraces shared decision making, learning, and engagement involved a combination of the following.

I created an expectation of peer accountability. If the employee came to me with a complaint about someone else, I set clear expectations asking if they had spoke to their peer first and foremost. Peer review and accountability has evolved over time and continues to improve even more. We have most recently adopted the practice of bedside report and have expectations that peers will communicate, mentor, and develop each other with peer-to-peer feedback and expectations of each other.

We created our unit-based council (UBC), which has grown over time to now include each of the following:

  • Quality unit-based council
  • Professional development unit-based council
  • Coordinating unit-based council

We have sub-committees off these councils that include our Sunshine Committee, Peer Interviewing team and Self-Scheduling committee. We also empower our staff to be the champions of different goals and areas, such as restraint champion, skin care liaison, and falls champion. This helps to create an engaged workforce where everyone is part of our success.

Our community liaison assists with coordinating and organizing our volunteer events such as volunteering at a men’s homeless shelter.

Areas that we have been successful include:

  • Falls champion-Quality UBC: Reduced our falls from a total of 25 in 2010 to eight in first quarter 2011, one in second quarter, and zero in third quarter
  • Skin care champion-Quality UBC: Reduced unit-based pressure ulcers from 18 and 20 in last two quarters respectively of 2009 to zero in first half of 2010
  • Professional Development Council achieved recognition of Hallmarks of a Healthy Work Environment in 2010

The feedback from patients and families speaks highly of the engagement of this department and includes many compliments.

Enter HCPro’s nurse leader best practices contest

Enter HCPro’s nurse leader contest and share best practices with your peers!

How do you deal with horizontal hostility among your employees? Do you have one staff nurse who makes the unit toxic every time he or she is on the floor? Or a clique who spreads gossip and makes others feel uncomfortable? Share your advice, best practices, and stories on this topic for the chance to win a free book.

The rules: To enter, simply share a recent success story, advice, or policy that has helped your unit become a healthy work environment. The sky is the limit—as long as your entry somehow helped implement positive change, it qualifies! If you are sending a sample policy or tool, please include a short paragraph explaining the goal of the sample.

The prize: The winner, chosen at random from all entries, will receive their choice of one of HCPro’s training resources for nurse managers:

The deadline: We will draw our winner at the end of the business day on Friday, September 16, 2011, and announce the winner in the Monday, September 26 edition of Nurse Leader Weekly.

The best entries will be posted individually on The Leaders’ Lounge Blog.

Please send contest entries to If you have any questions about the contest itself, please feel free to contact me any time.

Free webcast about ending bullying and toxic behavior in nursing

A live, free, 60-minute webcast, A Conversation with Kathleen Bartholomew: End Bullying and Toxic Behavior Once and For All, is being offered by HCPro Tuesday, October 4, 2011, 1:00-2:00 p.m. (Eastern).

Bartholomew is a visionary nurse leader who dared to ask the question: How can a profession that is based on caring include such uncaring behaviors? Her research exposes the toxic relationships and bullying behavior that cause nurse burnout and threaten patient safety.

During the presentation Bartholomew will share her experiences through true stories about the struggles she has faced and overcome and give listeners the tools and strategies to end disruptive behavior once and for all.

Click here to learn more about this program.

Due to the inspirational nature of this program, HCPro is placing no limits on who can attend. Invite your staff, friends, or colleagues. Forward information to a friend now.

Are you and your team on automatic pilot?

By Wendy Leebov, PhD

A couple of weeks ago, I was running a workshop on The Language of Caring and how to communicate in a way that builds trust and partnership with patients and families. As we worked our way through the seven skills, we reached the part where we examined what I consider to be one of the most important skills for patient-centered communication: “explaining positive intent.” This involves telling the patient (or other customer) how what you’re doing is for their sake. Often, we just engage in our activities with the patient without much explanation. We’re on automatic pilot and not thinking about how the patient or family member perceives what we’re doing. When we do explain, the explanation typically focuses on the activity: “Here’s what I’m doing.” Rarely, do we go beyond saying what we’re doing and articulate the benefit to the person with or on whom we’re doing it.

Thi [more]