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A Simple Interprofessional Accountability Technique

Listening, validating and asking for a commitment

From Team-Building Handbook: Accountability Strategies for Nurses, by Eileen Lavin Dohmann, RN, MBA, NEA-BC

accountability scenario

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]

Assessing nursing quality and patient safety

Interest in using a variety of nursing engagement surveys as a reportable quality indicator is growing.

This article, written by Cheryl Clark, appears in the June 2015 issues of HealthLeaders magazine.

Do your hospital’s nurses feel empowered? Are nurses’ relationships with physicians strong enough that nurses can call out errors or ask questions without fear? Do they think their hospital hires enough nurses with appropriate skills and provides enough resources to provide safe and timely care? Are nurses involved in making policy?

When nurses are surveyed on these and related questions, which they increasingly are, poor scores may indicate troublesome systemic issues that could, directly or indirectly, affect quality of care, even adverse events. A drop in scores can often be tracked down to a specific hospital unit, research has shown. And poor scores may correlate to “nursing sensitive” patient outcomes, such as patient falls, lengths of stay, pressure ulcers, and infections.

Simply put, this measure is asking nurses what they think about the organization for which they work and how well they trust the care they deliver in their work environments.

Read the full article here.

What am I doing here? Tips for being accountable in meetings

We’ve all been in meetings where everyone nodded and appeared to agree to something, but a few months later, nothing had changed. Why does that happen?

Because all they’ve agreed to is that they’ve come up with a good idea.

No one committed to a specific plan to make that good idea happen. The meeting organizer most likely didn’t set proper expectations and didn’t ask for specific, measurable commitments. The people attended the meeting, but didn’t have enough context to actively participate. They didn’t have the tools to make a commitment to action, and to hold themselves accountable for real results in a few weeks or a few months.

Great meetings that result in action, improvement, or resolutions are a joy to attend.

The next time you’re invited to a meeting, follow these suggestions so you’re prepared to be engaged and contribute rather than sitting for an hour as a passive participant. If the invitation didn’t explain the purpose of the meeting, if it included only a sketchy agenda, or if it didn’t include one at all, ask the organizer the questions in the following table prior to or early in the meeting.

Meeting questionsAgreeing to a good idea
just isn’t good enough.

Try using these questions to create a structure for great meetings that result in a better understanding, clarity of purpose, and positive outcomes.

 

 

 

 

Note: I’ll have the table as a download for you in a few days. Look for a link in a future blog post to share the tips with your colleagues!


Excerpted from Team-Building Handbook: Accountability Strategies for Nurses and Accountability in Nursing, both by Eileen Lavin Dohmann, RN, MBA, NEA-BC, and published by HCPro.

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

 

Nursing research: Understanding whistleblowing

Last week I promised a downloadable version of the whistle imagewhistleblower flowchart. For those who are interested, you can access the file here.

When I read about the fallout on Kim Cheely, the nurse whistle-
blower I wrote about last week, I had to ask myself:
Why do nurses risk their jobs to blow the whistle? Why speak out, when there is danger of ostracism, marginalization, and damage to one’s career? I did a bit more research on the subject, and ran across a thought-provoking study published “down under” a few years ago in the Journal of Advanced Nursing. You may find it interesting also.

Using a qualitative narrative inquiry design, the Understanding whistleblowing: Qualitative insights from nurse whistleblowers study looked into the reasons nurses decided to become whistleblowers, and gathered insights into nurses’ experiences of being whistleblowers. I doubt any nurses reading this will be surprised to learn the primary reason behind the decision to blow the whistle.

It’s simple, nurses are patient advocates. Of course there’s much more to the study, and it makes interesting reading for many reasons, not the least of which is that it used face-to-face data collection methods, and based queries on real experiences and not hypothetical scenarios.

In other words, the questions didn’t ask “what would you do” if you faced with wrongdoing. The subjects of this study had worked through the tough decisions and lived through actual whistleblowing events. You can access the report on this study here.

 

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.

Improving the image of nursing

Every nurse can play a part in elevating the public perception of the nursing profession. The table below shows you how email, evidence-based research, reasonable work schedules, a diverse workforce, preceptorships, interprofessional communication skills, and name tags can promote the professional image of nursing. This table was adapted from the HCPro book, The Image of Nursing, by Shelley Cohen, RN, MS, CEN and Kathleen Bartholomew, RN, MN.

 imageof nursing table 2

To err is human, but what can be forgiven?

Just one week after the news that nurses have once again been ranked as the most ethical and honest profession in the United States, a story has emerged in New Hampshire that has issues of trust and honesty in nursing at its core. Heather Stickney, a nursing student at NHTI in Concord, N.H., made the news recently when she was suspended for taking home scrubs she wore during her rotation at Catholic Medical Center. Her clinical advisor has accused her of stealing the scrubs and lying about it.

At first, it appears that the punishment is extreme for what could be described as a minor offense. After all, Stickney did not harm a patient or steal medications; she borrowed a set of scrubs to observe a procedure and said that she wanted to keep them as a memento. According to Stickney, she asked her clinical adviser whether she could keep the scrubs and was told to return them, but upon asking a man in the linen department the same question she was told she could keep them. The clinical adviser, noticing that the scrubs were still missing, gave Stickney an administrative failure, suspending her from the class and from the nursing program.

The issue raises the question as to whether Stickney’s actions should be interpreted as a “rookie mistake” or as a more significant character flaw, one that could lead to her lying about more serious offenses. Stickney has appealed the suspension and points to her otherwise exceptional record in the NHTI program, while nursing professors and nurse administrators indicate that nurses mist be trusted to tell the truth.

Errors happen in healthcare, and it is often how those errors are handled that makes the difference in the total impact of the incident. Nurse leaders are often told they must create an environment in which nurses feel comfortable coming forward and admitting to errors, rather than trying to hide them and potentially making the situation worse. Stickney made a mistake in disobeying her clinical adviser, but nothing in the news reports indicates that she has admitted to making a mistake or apologized for her actions. It may seem like a lot of fuss over a pair of scrubs, but it does highlight a need to instill values of honesty and ethics in nurses during training to carry over as they move into nursing careers.

Do you feel that Stickney’s suspension is an appropriate punishment for her actions? How would your organization handle a similar infraction? Leave a comment and let us know!

One of your nurses will make an error today. Will she report it?

Be prepared for errors and develop a culture where near misses are reported—and learned from—with the best practices presented in the 90-minute audio conference Learn From Errors and Near Misses with a Just Culture: Stop Punishing Nurses for Mistakes. Experts Cole Edmonson, DNP, RN, FACHE, NEA-BC, and Lucy Bird, RN, ONC, live the Just Culture experience every day and will demonstrate what to do when the worst happens to support clinicians, learn from mistakes, and build a culture of accountability and high-reliability.

Find answers to all your questions about improving patient safety and increasing nurse satisfaction by building a Just Culture in your facility.

For more information or to order, call 800/650-6787 and mention Source Code EZINEADp1 or visit the HCPro Healthcare Marketplace.

Preceptor perspectives: Reporting a near miss event

by Julie Harris, RN, MSN

Who likes to get in trouble? I know that I sure don’t! Yet, reporting a near miss event sometimes feels like that. Let’s look at a scenario that demonstrates this feeling:

One night Mason noticed a medication error from the pharmacy. They sent up the wrong dose of medication for his patient. After sending the medication back to the pharmacy, Mason filled out an occurrence form and placed it in his manager’s box. Several days later, the manager called him into a meeting with the pharmacy and other managers. They wanted him to explain the near miss event. He did and then was excused from the remainder of the meeting. Mason left feeling like he received a slap on the hand for reporting the near miss. He wondered if he should bother reporting any other near misses in the future.

This scenario is common throughout hospitals and healthcare facilities. Mason felt like he was in trouble for reporting the near miss event.

Many nurses, like Mason, do not see the “big picture” when it comes to reporting a near miss. And many times, this is due to a lack of just culture training from the hospital. Nurses are told they have to report near miss events. But, they are not told why to report such events or the outcomes of their report.

Preceptors can help solve this problem by training orientees and other staff members on the “big picture” of near miss reporting. This training should include:

  • The importance of reporting a near miss event
  • What qualifies as a near miss event
  • How to report a near miss event (i.e. how to fill out the form)
  • Where the report goes after it leaves the nurse
  • Who to contact for follow up
  • Examples of near miss events and their outcomes involving process change, patient safety, etc.

High-quality, safe patient care is the goal for all hospitals and healthcare facilities. Reporting near miss events is one avenue for nurses, especially preceptors, to take in order to achieve this goal!