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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!

Celebrate a nurse through donation of roses for Nurses’ Float

Editor’s note: The following is a press release from Bare Root, Inc.

Blossoming Appreciation for Nurses: “Buy a Rose” to Decorate Inaugural “Nurses’ Float” at 2013 Tournament of Roses Parade

Funds Raised through $25 Donations to Support Nursing Programs, Scholarships and Grants

PASADENA, Calif. (July 19, 2012) – Bare Root, the nonprofit organization consisting of five California-based nurses who independently spearheaded the effort to build a float to honor 2013 Tournament of Roses president Sally Bixby, RN, and nursing professionals worldwide, announced today that they’re providing the opportunity for others to individually honor nurses by donating roses on their behalf via the foundation’s web site at

“When we decided to build a float to honor Sally, we realized that we also wanted to honor nurses everywhere.  Nurses are really the unsung heroes of healthcare and healing,” said Monica Weisbrich, RN, president of Bare Root. “So many people have approached us asking how they can honor a special nurse in their life.  We thought this would be a wonderful way to allow them to express gratitude and to share their story if they would like to.”

Visitors of the Flowers for the Float web site have the ability to access the online store and select a quantity of roses to purchase for $25 each.   During the donation process online, users have the ability to indicate the name of the nurse they are honoring and also provide a story if they would like.  These stories are being shared on the web site’s “Celebrate a Nurse” page.  The roses purchased will be labeled with the names provided and placed on the float during live decoration.

The theme of the float, “A Healing Place,” serves as a metaphor for the healing environments nurses create through the use of their qualities and skills.  “A Healing Place” is created anywhere there is a nurse and a patient – from the hospital to the battlefield; from a school to a home; from a clinic to a specialty care center.  The words that surround and support the float explain those qualities.

“There are so many people in the world who have been touched in their lives by a special nurse,” said Weisbrich. “This is just one way we can bring all of those good messages and thoughts together in a single place.”

About Bare Root and the Nurses’ Float

In 2007 five registered nurses in California formed a nonprofit organization, “Bare Root,” to raise money and build a float to honor 2013 Tournament of Roses president Sally Bixby, RN, and nursing professionals worldwide for their tireless efforts.

2013 will be the first time that a nurse will be president of the Tournament of Roses, and only the second time that a woman was named to the top role.

To date, Bare Root has raised more than $300,000. One hundred percent of funds raised supported the development of the Nurses’ Float, with continued fundraising efforts being used for scholarships and grants to qualifying organizations.

For more information about the Nurses’ float, visit or the Nurses’ Float Facebook page at



Sharon Noot
Noot Inc.


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.

Nurse leaders upbeat at Nursing Management Congress

I just returned from the annual Nursing Management Congress and it was a pleasure to meet so many nurse leaders who are committed and passionate about nursing.

The conference was held in Las Vegas and for three days the 1,000 plus attendees ignored the lure of the bright lights outside and focused on education and networking. The three topics on everyone’s lips were transforming care delivery, the changing role of nursing, and how to be a better leader.

Many of the most popular sessions focused on transformational leadership and how to find more time in your day. I particularly enjoyed one called “Why am I so tired when there’s still so much to do?” by Rhonda Lawes, RN, MS, CNE, assistant professor, University of Oklahoma College of Nursing, in Tulsa. Lawes explained the nine myths for why we’re so tired and what we can do about it. I am going to implement several of her suggestions as they were so practical and straightforward. She certainly left me invigorated and feeling like I can make some changes in my life that will make me feel like I have more time and can get more done.

The conference also covered the changing face of healthcare and provided a chance to discuss pressing issues such as value-based purchasing and nursing’s role. Attendees were buzzing about:

  • The Future of Nursing report: How to implement its recommendations and how it will change the profession
  • Value-based purchasing: How this will affect nursing and what do we need to know
  • Patient engagement: There’s more reason than ever before to pay attention to this topic, which nursing can really own
  • Quality: Preventing HAIs and all quality improvement initiatives
  • Leadership: Being a better manager, improving communication, and retaining a committed and engaged nursing staff

Keynote speaker Tim Porter-O’Grady, DM, EdD, ScD(h),FAAN, said it’s time for nursing to unbundle its work and decide what it will no longer do so that nurses are able to focus on what’s most important in the changing face of care delivery.

Click here to read a longer article on his fascinating and informative presentation and learn the strategies he shared that nurse leaders can implement now.

Rewarding near-miss reporting

By now, most of us involved in patient safety understand the importance of reporting, collecting, and analyzing near misses. More and more, healthcare providers are beginning to understand that more often than not, a systematic problem—not an individual—is behind potentially dangerous errors.

But how do you get staff to report them? No really—actually report them? Including physicians? Many healthcare providers have been working in the field for decades, and for many of those decades, mistakes were swept under the rug—especially mistakes that luckily did not reach the patient. No harm, no foul, no reporting—this was a common way of thinking for many years. When providers have learned and worked in an environment where reporting errors often meant severe individual punishment, how do get them to trust you that reporting is okay?

It’s critical to show staff the positive effects of near miss reporting. It’s also a good idea to publicly and consistently reward those who “see/experience something and say something.” A good example is one surgical suite in Johns Hopkins Hospital in Baltimore that implemented its Good Catch Awards. After 24 months, the health center provided a table of 27 good catches that shows how systems were changed in response to the catch, including one that led to a national recall of an improperly labeled drug that lead to look-alike medication errors.

Clinicians honored with an award receive public recognition with wall boards on the surgical suite. The system is not yet implemented hospital-wide, but continues at the Weinberg OR Suite at Johns Hopkins Hospital.

Do you have a near-miss reporting system? Is it used? Do staff receive public recognition for their efforts? Have you had trouble getting staff to trust that reporting is benefits all? Post your comments below.

Reference: Anesthesiology News

Source: Tami Swartz, Patient Safety Monitor Blog

Making the leap from “one of us” to “one of them”

One day you’re part of the group. Helping each other out, complaining about never having the supplies you want when you need them, and chipping in for pot luck holiday meals. The next, you’re promoted to manager and suddenly you become “one of them.”

Becoming a nurse manager is a tough transition for anyone, but it’s even harder when you become manager of the same unit where you worked as a staff nurse. Suddenly, you’re the one with the power—you can finally make the decisions you’ve always wanted to—but you also have all the responsibility.

One of the hardest issues to navigate is reconfiguring the relationships between yourself and your former peers. It’s key to acknowledge that the relationship has changed and that your new role is quite different.

Shelley Cohen, RN, MS, CEN, president of Health Resources Unlimited, and staunch nurse manager advocate, has written that the first things to do is obtain a copy of your job description and share it with staff. That was, they understand what you’re accountable for and what your priorities will be. [more]

How to get started with a nurse residency program

Want to build a nurse residency program for new graduates but not sure where to start? Kendra Varner, MSN, RN, nurse residency program coordinator for the Kettering Health Network in Dayton, OH, and contributing author to Nurse Residency Program Builder: Tools for a Successful New Graduate Program, offers the following steps to get your started.

What’s the first step?

The first step is support. You need support from above if you want to start a successful program, so make sure you have someone who understands the return on investment who can champion the cause.  

Organizational culture is also important. The culture has to support nursing, education, etc. A culture that features low morale, quality, and job dissatisfaction are significant challenges as they tend to perpetuate themselves from one generation to the next (e.g., preceptors demonstrating poor attitudes and low quality care will result in new graduate nurses with the same behaviors). These issues must be addressed by nursing leadership.

If your organization struggles with low patient satisfaction and high nurse vacancy rates, then employee morale may be poor. It’s important to have a positive culture. A good clinical working environment and a nurse residency program will make employment at your organization highly desirable among new graduate nurses in the area. It takes a village to raise a child. The residency program belongs to the entire organization and its success or failure cannot lie with the program leader alone. [more]

ANA says ACO regulations should focus more on nursing

The American Nurses Association (ANA) has recommended the Centers for Medicare and Medicaid Services’ proposed rule for Accountable Care Organizations (ACOs) to make place a greater emphasis on professional nursing’s impact on areas of leadership, patient-centered care coordination, and quality. The ANA said the suggestions would maximize patient care and create greater efficiencies and savings.

In written comments to the CMS, the ANA said that the proposed rule does not properly identify and measure nursing services or give enough incentives for care coordination, an essential part of registered nursing practice.

The ANA also expressed concerns that technical aspects of the rule involving the assignment of Medicare beneficiaries to ACOs could possibly deter patients from choosing advanced practice registered nurses as their primary care provider.

The association also encouraged the ACO to modify its rules to include nurses who demonstrate leadership in multiple roles within an organization, and said that such a change would align with recommendations in the 2010 Institute of Medicine/Robert Wood Johnson Foundation report, “The Future of Nursing: Leading Change, Advancing Health” that nurses work as full partners with other healthcare professionals in reforming the healthcare system.

Source: American Nurses Association

ANA praises Joint Commission standards for nurse-led medical homes

The American Nurses Association (ANA) issued a press release applauding The Joint Commission for implementing standards that allow nurse-led practices to qualify as primary care medical homes.

Beginning July 1, The Joint Commission will use a set of ambulatory care guidelines to accredit primary care medical homes, a decision the ANA says will give advanced practice registered nurses (APRNs) the opportunity to provide services to patients under an innovative care delivery model.

Medical homes have been encouraged by the Affordable Care Act (ACA) as a way to provide more cost-effective, high-quality, patient-centered care, as well as more choice and access to patients seeking care.

According to a statement on the Joint Commission website, the new primary care medical home (PCMH) option will focus mostly on education and self-management of the patient. Care provided by other clinicians and facilities is tracked and coordinated by a primary care clinician and an interdisciplinary team, and evidence-based treatment practices guide their care. The PCMH opportunity is also aimed at improving patient satisfaction and patient outcomes.

Applications are now being accepted from organizations ready for survey.

Click here to read the ANA news release.

Research shows simple post-surgical step reduces infections

by Matt Phillion, for the AHAP blog

According to the latest edition of the Archive of Surgery, a basic bedside technique of gently probing a surgical incision to clean the area can result in significantly reduced rates of infection, Internal Medicine News reports.

According to the report, over a three year period, researchers assessed surgical site infections in 76 adults who underwent appendectomy for perforated appendicitis at one hospital. Only 3% of the patients who received the gentle probing contracted an infection, while 19% contracted infection in the control group. In addition, those patients who received the probing technique had their length of stay reduced.

Researchers theorized that allowing for drainage of the wound was the reason behind these better results, though they were unsure the precise reason as to why this practice cut down on infections.