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 StrategiesForNurseManagers.com 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!
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’ 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!
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?
First published on Patient Safety Monitor Blog.
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 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:
- Lead! Becoming an Effective Coach and Mentor to Your Nursing Staff
- Accountability in Nursing: Six Strategies to Build and Maintain a Culture of Commitment
- Nurse Retention Toolkit: Everyday Ways to Recognize and Reward Nurses
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 firstname.lastname@example.org. If you have any questions about the contest itself, please feel free to contact me any time.
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.
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.
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.
A new proposed rule by the Centers for Medicare & Medicaid Services (CMS) would allow the use of Medicare and private sector claims data to produce public reports that evaluate the performance of physicians, other healthcare providers, and suppliers. Organizations seeking such Medicare information would have to undergo an application process and be continually monitored by CMS.
The proposed rule requires that any reports generated from the Medicare data be shared confidentially with providers and suppliers before being released to the public in order to prevent mistakes. Publicly released reports would contain aggregated information only, meaning that no individual patient/beneficiary data.
“Performance reports that include Medicare data will result in higher quality and more cost effective care,” CMS administrator Donald M. Berwick, MD, said in a statement.
The proposed rule will be published in the Federal Register on June 8, and the CMS will accept public comments for 60 days. Until June 8 the proposed rule is available here.
For further analysis, visit HealthLeaders Media.
by Wendy Leebov, Ed.D.
“I work days and try to have everything ready when the doctors come in (labs in charts, vitals done, etc.). But they are immediately demanding everything at once, not giving me a minute to collect my thoughts and focus on the patient in question. Then, they treat me like I’m stupid when I don’t give the answers almost before they ask the question!”
Alan Rosenstein did a revealing study about nurse-physician relationships.
A few findings that struck me:
- More than 92% of nurses had witnessed disrespectful and/or disruptive behavior by physicians. The most common behaviors cited include yelling, raising the voice, condescension, berating colleagues, berating patients, and use of abusive language.
- Common generalizations about abusive behavior on the part of physicians make it seem as if most physicians are “abusive.” However, in Rosenstein’s study, nurses clarify that very few physicians are abusive. The vast majority are not. I think that’s VERY important to remember.
Still, the instances of abuse stick in the craw of not only the people on the receiving end, but also on people who witness it. So, it’s important to address this behavior, so that it doesn’t erode morale, teamwork and patient outcomes. Of course, that’s not so easy, because many caregivers feel intimidated about speaking up to stop respectful or abusive behavior because of fear of retaliation, lack of assertiveness, and/or a sense of hopelessness that the person’s behavior will ever change.
What to Do?
There’s a lot an organization can do, and should do, such as:
- Commit to and make explicit a code of conduct and link it to your vision, values and standards. Highlight the impact of teamwork, collaboration and communication on quality, patient satisfaction, risk reduction, safety, and outcomes.
- Zero tolerance. Institute and enforce a zero tolerance policy about coworker disrespect.
- Adopt a “respect” signal. Decide on something anyone can say when they witness inappropriate behavior—a signal that means “You have crossed the line.” Stopped in their tracks, many people become more aware of their behavior and more accountable for it. My favorite signals:
o “Time out.”
o “How about a cup of coffee?”
- Physician-nurse rounding. Have physicians and nurses round on patients together and provide training to support effective communication during these rounds.
- Provide personal coaches for individuals who behave in an outrageous way.
- Adopt-a-Doc: Have nurses each adopt a physician with whom they will deliberately build a positive relationship and for whom they will act as an advocate.
- Provide assertiveness training for nurses! This is critical!
- Discussion forums: Provide forums in which physicians and nurses talk to each other!
BUT, while the organization can work to reduce abusive or disrespectful behavior between nurses and physicians and among colleagues in general, in my view it is essential that the individual who perceives the behavior takes responsibility to address and handle it effectively, one situation and one person at a time.
What can the individual do?
In one of my roles years ago, I was in a position to field physician frustrations every day. My friends called me the LIVER of the organization, because so many toxins flowed through me. In my early years, in the face of a hostile physician, I would get defensive or cower. Both approaches seemed to increase the behavior I was hoping to eliminate. Then, after spending about $5 million on therapy, I learned other MUCH more effective techniques, and I have had a less stressful life ever since, because these techniques WORK.
Tips from my experience:
- Alter your own inner monologue. These are the statements you say to yourself. Look within: What do you say to yourself when someone is abusive to you? “This jerk! How awful! Poor me! I hate this! I don’t deserve this!” If your inner talk makes you angrier or more defensive, change it. You CAN decide to think something different, such as, “This is not about me,” “I deserve respect,” “I don’t have to react,” “I can stay calm and help this person,” “I can take the high road here.”
- Don’t respond in kind. It’s human nature to want to strike back when attacked. Resist. Handle the inappropriate behavior respectfully. Stay on the high road, since this will make you most effective and also enable you to feel good about yourself at the end of the day. CALMLY SAY, “What is happening is not okay.”
- Give direct feedback without anger. “I saw you do this….” or, “I don’t appreciate your tone,” “I would appreciate your keeping your voice down,” “When you belittle me in front of our patients, I resent it and it makes it hard for me to support you.”
- When someone is verbally attacking, instead of getting defensive, make explicit your positive intent. Instead of saying, “WHOA! Hold it a minute” say, “You know, I really want to help you.” Then if they persist, say that over and over in a sincere tone, “As I said, I really DO want to help you.” And then wait until they have vented enough to allow them to calm down and address the facts of the situation with you.
- Use the caring broken record. In the face of persistent disrespect, repeat your bottom line message each time with caring. “I hear how frustrated you are, and I really want to support you,” “I realize you’re under extreme pressure, and I really do want to provide the support you need,” “I’m sorry this isn’t what you wanted. I really do want to help.”
- If the abuse continues, remove yourself from the situation. “I’m hanging up now. Please call me back when you’re ready to talk with me in a respectful way about this. I really do want to help you.”
- “There you go again.” If you’ve addressed the behavior over and over and it still hasn’t changed, when it happens next, say very calmly, “There you go again. I want to discuss this with you when we can both be respectful.” And do that EVERY time it happens again.
And with your TEAM:
Talk about the elephant in the room. Work together with your team to identify great ways to respond to the disrespectful or inappropriate behavior you handle most often. I’ve provided a worksheet to guide your discussions. You can be sure you’re not alone. So, the activity will help everybody.
Healthcare environments are inherently stressful and it’s upsetting to think about the times when colleagues add to this stress instead of relieving it. To be effective and to do your part in altering an atmosphere of disrespect, it takes courage and caring — backbone and heart.
For helpful resources about handling disrespectful behavior, click here.