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Strategies for implementing evidence-based practices: Journal clubs

If you’re looking for ways to get your staff engaged and current on the latest evidence-based practices, then you should consider starting a journal club, a regular meeting of staff members to discuss articles from nursing journals. It’s a great way to improve your staff’s reading habits and critical thinking while promoting cooperation and teamwork.

To start your club, you need to choose someone to select readings. A master’s-prepared nurse specialist or educator would be an ideal candidate to lead the group, but anyone with the proper knowledge or enthusiasm would make a fine choice. They should endeavor to select readings that are informative, relevant, and accessible to encourage nurses of all levels to participate. They should start by selecting a guide to critical reading, so everyone has the tools to discuss the articles. Once they’ve selected the article, make sure the reading is easily obtainable and give plenty of advanced notice to ensure everyone has time to read it.

The biggest hurdle for starting a journal club in a healthcare environment is finding time in your staff’s busy schedule. Ideally, you want to find a time that works for everyone, perhaps during a shared break or change of shift. If this proves too daunting, you can always create a virtual journal club. You could use a hospital intranet, email list, or even a chat forum to discuss the readings.

Once you get everyone together, encourage them to think about the article critically and ask them to evaluate it. Here’s a great list of questions to start discussions and get the group thinking about the reading.

If you find that your group has lost momentum or attendance is waning over time, try providing incentives for attendees. Small perks or competitions can be a great way to encourage attendance and let your group have some fun!

Here are some helpful links to get you started!

Running an effective journal club

From the desk of Adrianne Avillion, DEd, RN

Who should facilitate journal clubs?

Help nurses critique journal articles

Do you have a journal group at your facility? We’d love to hear about your experiences in the comments below!

What to know about New Nurses: Tips for getting and keeping RNs in a rural hospital

The nursing shortage is becoming a major issue again and rural hospitals are being hit hardest. Nurses tend to stay local when possible, so rural hospitals can have a hard time attracting new nurses to move to their area without the benefits and salary of urban hospitals. Below are some suggestions on how to improve your odds of attracting (and keeping) star graduates at your rural hospital.

Moving to a rural hospital can be intimidating for a new nurse, working in relative isolation without the support system of a larger hospital. Provide mentorship and regular training programs to help ease the transition and boost the young nurse’s confidence. Schedule shifts alongside experienced RNs whenever possible to give them a sense of security.

Being a smaller hospital has some benefits as well. Emphasize the intimacy of a small hospital community and offer manageable patient-loads.

Provide leadership opportunities and a clear path for advancement. Residency programs, teaching opportunities, community wellness programs, and tuition reimbursement can be a huge draw for ambitious young nurses.

Developing a strong staff that provides outstanding care will make your hospital even more attractive to new nurses, hopefully leading to a consistent cycle of new talent into your rural facility.

For an in-depth report on the challenges facing rural nursing, check out: Healthcare in the outlands.

Rock Your Health: Tips for being a great manager

What kind of manager are you? What do others say about you? Here’s a list of qualities that I like in a manager.

M - Meets employees where they are and accepts them.

A - Assesses their attitude daily and keeps a positive attitude.

N - Notices greatness and share with others.

A - Ask questions rather than giving advice.

G - Greets everyone they see with a smile.

E - Engages employees in the decision making process.

R - Recognizes achievements and celebrates regularly.

Reminder: Nursing Peer Review Webcast

Just a few more days left until our Nursing Peer Review webcast, NPR2cloud3afeaturing nursing peer review experts Laura Harrington, RN, BSN, MHA, CPHQ, CPCQM, and Marla Smith, MHSA. These authors of the HCPro book Nursing Peer Review, Second Edition: A Practical, Nonpunitive Approach to Case Review, will pack a 90-minute webcast with answers to these questions, and more:

How do you actually do nursing case review? How do you deal
with the outcomes? And how can you use case review to monitor performance and track and trend data? And what are the core requirements for confidentiality? (See below for Don’t Disclose,
a cheat sheet of guidelines, and look for a notice soon for download instructions.)

Developing a structure to support nursing case review is just the first step. Join us on Thursday, April 16, 2015 at 1–2:30 p.m. Eastern to explore the practical requirements of implementing this important process. To register, click here.

Don't Disclose-Peer Review

 

The unofficial whistleblower flowchart for nurses

Last week, a whistleblower lawsuit was filed by Kim Cheely, a nurse manager at Georgia Regents Medical Center prior to being fired last October for “insubordination.” In this case, “insubordination” appears to mean that the trusted, 37-year veteran of GRMC dogged management to address quality-of-care concerns related to repeated staff reductions in the oncology and bone marrow transplant units.

The story in The Augusta Chronicle documents a situation where anything that could go wrong, did. Cheely took every logical step she could to affect change, and thought she would be protected from retaliation by invoking the hospital’s conflict resolution policy. This did not turn out well for Cheely, unfortunately. In fact, to be protected as a whistleblower, you must report to the state or national agency responsible for regulation of your employer.

For anyone considering blowing whistleblower flowchartthe whistle, take a look at the flowchart I created from advice offered on the ANA website. The chart, which illustrates just the bare bones, will be available for download later in the week, in case you want to share it with your colleagues.

On a related note: I’m currently reading draft chapters for an upcoming HCPro book, The Nurse Manager’s Legal Companion, by a wonderful nurse and attorney, Dinah Brothers. We’ll also have a handbook for staff nurses. Neither is available for preorder quite yet, but I’ll be sure to let you know when they are.

Injured Nurses, Part 2: OSHA has your back

Attention nurse leaders in organizations
without designated “lift teams” or assistive
devices for moving patients

Your business case for investing in a cutting-edge, osha2safe patient handling program has been made clearly and indisputably by OSHA, with the help of results from numerous case studies, research reports, and collected data. The benefits are exceptional, and the financial ROI is achievable in one to four years.

Take a quick trip to the OSHA website for wealth of tools, including a form you can use to evaluate your organization, a checklist for designing your safe patient handling program, illustrative case studies, and more.

One more note: NPR plans a fourth installment on the Injured Nurses series, so keep checking the NPR website. Here’s what they’re promising:

Part 4 will explore how the Department of Veterans Affairs implemented
a nationwide $200 million program to prevent nursing employees
from getting injured when they move and lift patients.

And, finally, I’ve uploaded the PDF of Table 18 (promised in my previous post), which you can download from our Tools Library.

Take Care of the Caretakers; Take Care of Ourselves

Nurses, the caretakers on the front line, often work shifts of 12 hours and more, and may work up to 50 or even 60 hours per week. Fatigue is a way of life, threatening the health of those nurses, as well as the quality of the care they can provide. As a nurse manager, you struggle with balancing staffing with your budget, so you know this story all too well.

Now the ANA is pushing for new limits on consecutive night shifts and shifts longer than 12 hours (see ANA press release) as a way of supporting the health of nurses, positive patient outcomes, and nursing professional standards. Until the ANA recommendations become practice, what can you, the nurse manager, do to take care of yourself and your staff today, to improve the work environment and the energy they bring to it?

(Hint, the answer comes from our latest nursing book, Essential Skills for Nurse Managers, and you will find suggestions for how to renew your energy here.)

Heading down the virtual road

An article on Advance for Nurses this week explores the dynamic between the well-informed patient and the well-educated nurse, weighing the pros and cons of patients who thoroughly research their symptoms and diagnoses prior to an appointment. On the one hand, patients who take charge of their health can be more collaborative and active in their treatment, but on the other hand these well-educated patients may challenge nurses about prescriptions and treatment options. According to the article, nurses with well-informed patients should listen carefully and establish a dialogue with patients and their families to avoid any potential aggression that might stem from disagreements about care options.

The article also points to telemedicine and the advances in technology that allow patients to communicate with nurses and other healthcare professionals easily and get quick answers to any questions they may have forgotten to ask during an appointment. It also allows nurses to monitor patients with chronic diseases more effectively.

While the internet might improve the ways in which patients can communicate with their nurses, it could also lead to increased expectations for round-the-clock care and instantaneous feedback, which might not always be possible with a hospitals’ budget and resources. Adding a virtual element to the work nurses perform daily makes for greater responsibility and accountability, especially if individual nurses are expected to maintain email communications with patients. What happens if a nurse forgets to check her email, or sees an email from a patient but does not respond quickly? Technology has the potential to improve healthcare, but it seems certain precautions should be taken when implementing telemedicine programs or when interacting with patients who have conducted extensive online research about their diagnoses.

Does your organization encourage online interaction with patients? Have you seen an increase in patient engagement in light of online communication and research? Leave us a comment below!

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]

Confusing terminology: Understanding the difference between patient satisfaction and patient experience

Everyone is talking about patient experience these days and the term is often used interchangeably with patient satisfaction. In fact, the two are different concepts. Here’s a primer:

Patient satisfaction
Patient satisfaction speaks to the quality of care. Patient satisfaction surveys are used to identify issues and spot problems as they measure what actually happened.

Patient satisfaction isn’t owned by marketing or by the c-suite. It is owned by the direct caregivers and the frontline staff who interact with patients every day.

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