March 2008 Vol. 8, No. 3 Strategies - Nurse · PDF fileAll of this improves the bottom...

IN THIS ISSUE

p. 3 Infection controlThe pros and cons of testing staff for staph infections.

Communication

Resolve conflicts between healthcare professionals

After reading this article, you will be able to:

➤ Identify how to successfully confront disputes with physicians

➤ Determine when to engage in conflict resolutions

shortens lengths of stay, improves patient compliance,

and increases the likelihood that patients will refer oth-

ers to the facility. All of this improves the bottom line,”

she says. “Collaborative work environments have also

proven to be more attractive to workers and increase re-

tention of experienced staff.”

Physician disputes

When it comes to conflict between nurses and physi-

cians, Gerardi says much depends on whether there is a

clear plan of care

for the patient. Ac-

cording to her re-

search, problems

can pile up because

physicians and

nurses tend to have

different views of

collaboration.

“Physicians tend

to think of collabo-

ration as anticipat-

ing needs and following through on what was ordered;

nurses define collaboration as joint decision-making and

respect for contribution,” Gerardi says. “Until we devel-

op some collective understanding around what collabora-

tion means, we will continue to generate conflicts resulting

from unmet needs.

“Healthcare professionals tend to be conflict avoiders.

Because of this, conflicts often fester, sometimes for years,

before they boil up into what feels like an unmanageable

situation. Developing skills for negotiating differences and

engaging in difficult conversations improves the likelihood

that people will engage with each other sooner. We must

move toward cultures of engagement rather than continue

with our tendencies toward silence and avoidance.”

“ Research repeatedly

supports the effectiveness

of a team approach to

clinical care: It improves

outcomes, shortens lengths

of stay, improves patient

compliance, and increases

the likelihood that patients

will refer others to the

facility.”

—Debra Gerardi, RN, MPH, JD

> continued on p. 2

S t r a t e g i e sMarch 2008 Vol. 8, No. 3

“Healthcare professionals have estimated that more

than 50% of their workday is spent dealing with conflict

and that the majority of that is conflict with each other,”

says Debra Gerardi, RN, MPH, JD.

The chair of the Program on Healthcare Collabora-

tion and Conflict Resolution at Creighton University in

Omaha, NE, Gerardi says that in her experience, those

conflicts affect everything from lengths of stay to staff

retention.

“Research repeatedly supports the effectiveness of a

team approach to clinical care: It improves outcomes,

p. 4 Staff participationStrategies for increasing meeting attendance.

p. 7 The Joint CommissionTroublesome National Patient Safety Goals and how to ensure your facility is meeting requirements.

p. 8 Healing treatmentsThe power of complementary therapy to reduce patients’ pain and improve their hospital experience.

p. 10 Book excerptNursing peer review promotes nurse accountability and improves patient safety.

www.StrategiesforNurseManagers.com March 2008

© 2008 HCPro, Inc.

For permission to reproduce part or all of this newsletter for external distribution or use in educational packets, contact the Copyright Clearance Center at www.copyright.com or 978/750-8400.

Resolve conflicts

“There’s a lot of avoidance,” adds Peter Moran,

RN,C, BSN, MS, CCM, president of the Case Manage-

ment Society of America and case manager at Massa-

chusetts General Hospital in Boston. “My experience

has been that people don’t like giving bad news, wheth-

er about coverage or even diagnosis. Nurses tend to be

people who want to take care of others, so confronta-

tion isn’t something we want to do.”

Engagement, not resolution

When asked for tips about ending discord, Gerardi

says that is not necessarily the answer.

“Resolution of conflict is a misnomer,” she says. “Con-

flict is often linked to tensions or polarities that have to

be balanced, such as the tension between cost and qual-

ity. There is not an end or solution to this tension, so res-

olution is not the goal. Staying engaged in conversations

< continued from p. 1

and becoming comfortable with managing polarities is a

more realistic option. Conflict is a symptom of a system

out of balance; balance is restored by improving trust

and communication with each conversation.”

When to engage

Although training can improve comfort when enter-

ing a conflict, Gerardi admits that it alone will not cut

the amount of time nurses spend dealing with conflicts.

“I think we’re already expert at conflict avoidance,”

she says. “The goal is to recognize when it is appropriate

to avoid a conflict situation, and when it is necessary to

step up and address the real issues. The steps in engage-

ment include self-reflection, open listening, acknowledg-

ment, and negotiation of differences.”

Assessing when to step into a conflict is crucial, and

Gerardi says nurses should ask themselves three ques-

tions before taking action:

1. Is this a recurring situation that is affecting patient care?

2. Does interacting with this person or situation keep me

awake at night?

3. What is my intent in wanting to resolve this situation?

Effective negotiation

When engaged, how the conflict develops (or doesn’t)

depends on your negotiation style.

“Effective negotiation requires an ability to listen

deeply and ask questions rather than to merely take

sides or stake claims,” says Gerardi. “Negotiation with

colleagues requires that we balance our assertive drive

to get all that we can with the cooperativeness necessary

for preservation of much needed working relationships.

It is important to recognize that every interaction is an

opportunity for building trust, and our choices in the

current conversation impact the next negotiation with

that person.” n

Source: Case Management Monthly, December 2007,

HCPro, Inc.

Editorial Advisory Board Strategies for Nurse Managers

Group Publisher: Emily Sheahan

Associate Editor: Jessica Baggia, [email protected],

781/639-1872, Ext. 3507

Shelley Cohen, RN, BS, CENPresident, Health Resources UnlimitedHohenwald, TN

Marie Gagnon, DM RN, B-C, MS, CADAC, LISAC, CISMDirector, Baptist Health System School of Nursing, Abrazo Health SystemsPhoenix, AZ

June Marshall, RN, MS Magnet Project Director, Medical City HospitalMedical City Children’s HospitalDallas, TX

David Moon, RN, MSDirector of Recruitment Summa Health System Akron, OH

Bob Nelson, PhDPresident, Nelson Motivation, Inc.San Diego, CA

Tim Porter-O’Grady, DM, EdD, APRN, FAAN Senior Partner, Tim Porter-O’Grady Associates, Inc.Atlanta, GA

Dennis Sherrod, EdD, RN Forsyth Medical Center Distinguished Chair of Recruitment and Retention Winston-Salem State University Winston-Salem, NC

Strategies for Nurse Managers (ISSN 1535-847X) is published monthly by HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945. Subscription rate: $129 per year. • Postmaster: Send address changes to Strategies for Nurse Managers, P.O. Box 1168, Marblehead, MA 01945. • Copyright © 2008 HCPro, Inc. All rights reserved. Printed in the USA. Except where specifically encouraged, no part of this publication may be reproduced, in any form or by any means, without prior written consent of HCPro or the Copyright Clearance Center at 978/750-8400. Please notify us immediately if you have received an unauthorized copy. • For editorial comments or questions, call 781/639-1872 or fax 781/639-2982. For renewal or subscrip-tion information, call customer service at 800/650-6787, fax 800/639-8511, or e-mail [email protected]. • Visit our Web site at www.hcpro.com. • Occasionally, we make our subscriber list available to selected companies/vendors. If you do not wish to be included on this mailing list, please write to the marketing department at the address above. • Opinions expressed are not necessarily those of Strategies for Nurse Managers. Mention of products and services does not constitute endorsement. Advice given is general, and readers should consult professional counsel for specific legal, ethical, or clinical questions. MAGNET™, MAGNET RECOGNITION PROGRAM®, and ANCC MAGNET RECOGNITION® are trademarks of the American Nurses Credentialing Center (ANCC). The products and services of HCPro, Inc., and The Greeley Company are neither sponsored nor endorsed by the ANCC. The acronym MRP is not a trademark of HCPro or its parent company.

Disclosure statement: The SNM advisory board has declared no financial/commercial stake in this activity.

March 2008 www.StrategiesforNurseManagers.com

© 2008 HCPro, Inc.


Infection control

Testing staff for staph: Some hospitals find such a proposal contentious, at best

Would staff members be more diligent about washing

their hands and following standard precautions if they

knew they were colonized with MRSA?

This is the question that has some infection con-

trol practitioners (ICP) wondering whether they might

be able to achieve better infection control (IC) compli-

ance if they test staff members for MRSA and arm them-

selves with real statistics rather than probabilities about

its prevalence.

Carol Landis, an ICP at Memorial Health System

in Abilene, KS, says she approached the administration

at her facility about testing staff members because she

thought it might help drive home IC lessons. She says

she hoped it would help people take standard precau-

tions and hand hygiene more seriously if they knew a

percentage of people they worked with were colonized.

Other facilities are mulling over the idea of similar

testing. But not everybody agrees with the idea.

Is it effective?

Although hospitals that consider testing staff members

for MRSA colonization may have the best intentions,

some experts say testing staff members for MRSA is not

something most facilities should be doing. “The answer,

as far as public health goes, is that at this time, there is

no evidence that screening healthcare workers reduces

healthcare-associated infections, so our answer would be

no, we do not recommend staff testing for MRSA,” says

Dawn Terashita, MD, MPH, medical epidemiologist of

acute communicable disease control at the Los Angeles

County Department of Public Health. However, there is

an important exception, Terashita says. Staff testing may

be appropriate in the event of an outbreak if health offi-

cials do not know what is causing it.

But widespread testing may be a lot of hassle for little

result. “Regardless of whether [staff members test] posi-

tive or negative, it’s not going to change what their actu-

al practices are,” says Jerry Zuckerman, MD, medical

director for infection prevention and control at Albert

Einstein Medical Center in Philadelphia.

How would you use the information?

Facilities wondering about the value of testing should

know what they are going to do with information about

the healthcare workers’ status once they have it, says

Zuckerman. Decolonization is not recommended in most

instances.

Terashita says that getting this type of testing autho-

rized might be difficult to get past hospital unions.

Have you considered alternatives?

That said, there are no regulations that prohibit hospi-

tals from testing staff members for MRSA, Terashita says.

But they might get more benefit by continuing their ef-

forts to encourage staff members to follow standard pre-

cautions, she says, with strategies such as:

Providing incentives

Using signs as reminders

Hiring hand-hygiene spies

Ensuring that sinks and soaps are readily available n

Source: Briefings on Infection Control, January

2008, HCPro, Inc.

➤

➤

➤

➤

After reading this article, you will be able to:

➤ Recall the pros and cons of testing your staff members for

MRSA

➤ Advise for or against testing staff members at your hospital

➤ Identify alternative strategies for dealing with staff members

who may have MRSA

Page � www.StrategiesforNurseManagers.com March 2008

© 2008 HCPro, Inc.


being a professional nurse is keeping current on things

that are changing.”

Getting to maximum capacity

So what are some ways to successfully get nurses in

those meeting rooms? Educators can try several strat-

egies to increase attendance and build their nurses’

knowledge base, ultimately improving patient care.

From the beginning, keep in mind that nurses often

employ the “What’s in it for me?” factor, says Pauly. A

journal article in Alabama Nurse advises nurses to look

for these incentives: “Before entering the meeting, iden-

tify its purpose. Ask questions such as ‘What’s in it for

me?’ and ‘By the end of this meeting, what do I expect

to know?’ ”

Thus, educators should be prepared to answer these

questions and offer fitting incentives.

“Try to give them things they want,” says Pauly. “For

example, a nurse might say, ‘I’d really like to see what

a total knee replacement looks like.’ So at the meeting,

you can show a 20-minute video.”

One strategy that Pauly has undertaken is providing

her nurses with a questionnaire concerning meetings

and what they would like them to include. (For a sample

questionnaire, see p. 6.)

“One thing I’ve heard is that nurses want education-

al opportunities,” says Pauly. “They’ll say, ‘Give us more

information to help us better do our job and better un-

derstand our patient.’ Asking them to be specific on a

questionnaire can generate ideas.”

Sometimes, says Pauly, a seemingly simple incentive

is worth a shot. For example, “if we get 80% attendance

over the next three months, we’ll have a pizza party,”

she says. “A little push could generate results.”

However, in some cases, it pays to institute a little

tough love, says Nordquist. “For meetings now, we are

going to make a policy,” she says. This policy outlines

There is always important information and interest-

ing tidbits to share at staff meetings. But when nurses

become lackluster about attendance, educators are often

left feeling helpless and frustrated.

“We’ve had very poor turnouts, even when the meet-

ings are manda-

tory,” says Danita

Pauly, RN, a clini-

cal nurse educator

at Great River Med-

ical Center in West

Burlington, IA.

“It’s a frustration

that staff don’t attend, and our experiences have been

discouraging.”

As an educator in the orthopedic unit, Pauly runs

hour-long, mandatory monthly meetings. At one of the

recent gatherings, she says, only three staff members

(out of 31) were present. “Hearing from other units, it’s

a housewide epidemic.”

Barbara Nordquist, RN, BSN, a clinical leader at

Chippewa County Montevideo (MN) Hospital, agrees

that it is extremely difficult to get nurses to participate

in meetings. This lack of participation, she says, could

eventually affect patient safety as nurses fail to be up to

speed on current best practices.

“People need to realize that in healthcare it’s always

changing, and attending regular meetings is part of their

professional responsibility,” says Nordquist. “And part of

Staff participation

Filling those empty chairsStrategies for increasing meeting attendance among your nurses

Contact Editorial Assistant Jessica Baggia

Telephone 781/639-1872, Ext. 3507

E-mail [email protected]

Questions? Comments? Ideas?

“ People need to realize that

in healthcare it’s always

changing, and attending

regular meetings is part

of their professional

responsibility.”

—Barbara Nordquist, RN, BSN


© 2008 HCPro, Inc.


that nurses must attend 80% of meetings; otherwise,

they will receive a verbal warning. After three warnings,

says Nordquist, the nurse could be terminated.

Additionally, says Nordquist, facilities that are not

union hospitals should consider tying meeting atten-

dance to nurses’ wages.

“When it impacts people’s pocketbooks, they start to

listen,” she says. “They know there’s no meat in ‘manda-

tory.’ And that’s going to change. People have to be held

accountable.”

Barriers to cross

When you work to increase meeting participation,

there are a few potential roadblocks to keep in mind.

One of those, says Nordquist, is the road itself.

“You really need to take into consideration the dis-

tance people are driving,” she says. “We have people

who live 30-something miles away, but we feel it’s im-

portant to have them come to keep them up to speed.”

Pauly agrees that this is a major barrier. “Comments I

get from my nurses include ‘I’m not going to drive in on

my day off’ or ‘I have small children and I’d need to find

day care.’ For some of them, it is a big inconvenience.”

A possible solution to the commuting hurdle, says

Nordquist, is having the meetings during working hours

(for example, having an eight-hour education day rather

than shorter, more frequent meetings during off-hours).

This is an initiative that Montevideo is beginning to adopt,

she says.

“While it’s kind of costly to do that, it’s the way you

can get people to come,” she says. “It’s much more diffi-

cult to get them to come on days off.”

Another barrier may relate to scheduling. If the hur-

dle of getting everyone in the same room at the same

time is just not going away, realize that there are other

effective means of getting across vital information to staff

members.

For example, try developing a bulletin board for each

unit or sending out informative e-mails.

“If it’s in their in-box, they can go back to it and look

it up later,” says Nordquist.

And don’t let nurses tell you they shy away from

computers, adds Nordquist.

“One of my nurses said to an administrator, ‘I don’t

read my e-mail.’ His response was ‘Why not?’ This is the

age of technology, and nurses need to realize that.”

The ultimate goals, says Nordquist, are to ensure com-

petency and improve patient safety. “You’re a nurse, and

you have to know what you’re doing,” she says. “Pa-

tients trust that we make you competent, and we have a

lot of things to cover. We’re trying to make sure nurses

get the right education.” n

ReferenceGaddis, S. (2004). “Preventing meeting burn-out: How to make the most of every meeting minute.” Alabama Nurse 31(1): 24.

Source: The Staff Educator, January 2008, HCPro, Inc.

Save the date!

September 24–26, Chicago

HCPro, Inc., seminars

Shared Governance Symposium

Join us on September 24 in Chicago at the Hyatt Regency to

hear practical strategies from Tim Porter-O’Grady, DM,

EdD, APRN, FAAN, senior partner at Tim Porter-O’Grady

Associates, and Kim Hitchings, RN, MSN, manager of the

Center for Professional Excellence at Lehigh Valley Hospital in

Allentown, PA, about building a culture that supports shared

governance. The seminar will teach you how to implement

a model of shared governance, as well as valuable tips and

strategies to sustain it over time.

Nursing Leadership Summit

Stay in Chicago September 25 and 26 for our Nursing Lead-

ership Summit, which will provide nurse managers with

proven, practical solutions to the biggest leadership and

management challenges they face. Hear from renowned

industry experts about topics such as professional nursing

environments, leadership, education, communication, and

quality improvement.

To register or for more information, call 800/801-6661

or visit www.greeley.com.


© 2008 HCPro, Inc.


Staff meetings: Sample questionnaire for nurses

1. What keeps you from attending meetings? ______________________________________________________________________

________________________________________________________________________________________________________________

________________________________________________________________________________________________________________

________________________________________________________________________________________________________________

________________________________________________________________________________________________________________

________________________________________________________________________________________________________________

2. What kind of information would you like to hear at meetings? ______________________________________________________

________________________________________________________________________________________________________________

________________________________________________________________________________________________________________

________________________________________________________________________________________________________________

________________________________________________________________________________________________________________

________________________________________________________________________________________________________________

3. What could be done to resolve the problem of poor meeting attendance? ___________________________________________

________________________________________________________________________________________________________________

________________________________________________________________________________________________________________

________________________________________________________________________________________________________________

________________________________________________________________________________________________________________

________________________________________________________________________________________________________________

�. If attending meetings does not work, what do you see as a possible alternative? ______________________________________

________________________________________________________________________________________________________________

________________________________________________________________________________________________________________

________________________________________________________________________________________________________________

________________________________________________________________________________________________________________

________________________________________________________________________________________________________________

5. What meeting format (hour-long, etc.) would you prefer? __________________________________________________________

________________________________________________________________________________________________________________

________________________________________________________________________________________________________________

________________________________________________________________________________________________________________

________________________________________________________________________________________________________________

________________________________________________________________________________________________________________

Source: Pauly, D., Great River Medical Center, West Burlington, IA. Adapted with permission.


© 2008 HCPro, Inc.


The Joint Commission

Are you meeting your compliance goals?Despite current discussion of the 2009 NPSGs, 2007 NPSGs are still challenging facilities

Although The Joint Commission’s (formerly JCAHO)

2008 National Patient Safety Goals (NPSG) are now in

effect, many facilities still struggle with adequately im-

plementing some of last year’s NPSGs. Specifically, Goal

#8, medication reconciliation, and Goal #2A, reporting of

critical test results, have been a challenge.

“Why are these still challenging? Because the goals are

fluid, there’s always a minor change,” says Elizabeth Di

Giacomo-Geffers, RN, MPH, CNAA, BC, a healthcare

consultant in Trabuco Canyon, CA. “You can’t just write a

goal and expect a complete culture change immediately.”

The medication reconciliation goal, introduced in 2005,

with full implementation required in 2006, continues to

plague hospitals throughout the country. For 2007, the

medication reconciliation requirements were changed to

state that facilities had to provide the discharged patient

with a list of his or her medications. However, many hos-

pitals were already having a tough time complying with

the goal, and this addition just complicated things.

Avoid reliance on med rec form

According to Marion Martin, RN, MSN, MBA, pa-

tient safety officer and director of infection control and ac-

creditation for Moses Cone Health System in Greensboro,

NC, physician pushback is one obstacle to fully implement-

ing the medication reconciliation process. Another is the

reliance on a form.

The need to provide patients with a list of medica-

tions upon discharge was already in place in most fa-

cilities, says Di Giacomo-Geffers. This step works a lot

easier in facilities that use an electronic records system

because all the medications a patient has received are al-

ready in one spot. The hardest part of reconciling medi-

cations at discharge, however, is still providing that list

to the next provider(s) of care, says Di Giacomo-Geffers.

She recommends looking at The Joint Commission’s

Web site for its medication reconciliation flow chart.

Improve critical test results process

Accurately communicating critical test results has puz-

zled facilities since 2003. Both Di Giacomo-Geffers and

Martin agree that being in compliance with this goal is a

process issue.

Most facilities define what needs to occur when a crit-

ical test result is called in, but the process for carrying

this out just isn’t occurring.

“It still goes back to the process,” says Martin. “I think

we may make it too complicated; staff need to be able

to describe the process.” She adds that instead of creat-

ing new forms to facilitate the process, reeducating staff

members about the critical test reporting process will

provide the most value.

Sometimes, the problem is that some hospital staff

members move from facility to facility.

“Some of your staff are agency or contracted [work-

ers], so then how do you orient them to how [the

process] functions in your hospital?” asks Di Giacomo-

Geffers. “Maybe you should have a one-page handout

when they sign in that says, ‘These are our safety goals,

and these are our hospital policies.’ “

Tips to comply with most challenging NPSGs

Develop ways to check up on staff members and see

whether they are following the facility’s policy around

the NPSGs. Martin says Moses Cone has developed NPSG

report cards that grade staff members on their compli-

ance with the goals.

Use a dashboard to report to leadership how well

the facility is doing regarding NPSG compliance, says Di

Giacomo-Geffers. If there are specific goals with which

your facility is struggling, drill down to the root cause to

find out why they are problematic. n

Source: Adapted from Briefings on Patient Safety, De-

cember 2007, HCPro, Inc.


© 2008 HCPro, Inc.


Patients in pain can benefit from additional methods,

beyond pain medication, to help them relax or ease their

discomfort, so the pain committee at Grant Medical Cen-

ter in Columbus, OH, formed a subcommittee to imple-

ment a complementary therapies program to help meet

its patients’ emotional and physical needs at the bedside.

“By encouraging the use of complementary therapies,

staff nurses are able to meet the spiritual and emotional

needs of each patient while enhancing their individual-

ized care,” says Paula Kobelt, MSN, RN, a pain man-

agement nurse.

Grant Medical Center’s complementary therapy pro-

gram has been so successful that Kobelt submitted an ab-

stract about the project to the ANCC, which was accepted

as a poster presentation for the 2007 11th Annual ANCC

Magnet Recognition Program® (MRP) Conference in At-

lanta. At the conference, Kobelt presented how the orga-

nization’s therapies improve patient care at the bedside.

“The fact that the poster won the evidence-based

practice award at the ANCC conference this year really

speaks volumes on how this isn’t just what the patients

are demanding,” says Kim Boggs, Grant’s MRP coordi-

nator, “but it’s a best practice, and the evidence shows

that it helps patients during their hospital stay.”

The pain committee chose five different therapies to of-

fer: drumming, guided imagery, healing touch, massage,

and animal-assisted activity. The pain committee want-

ed to provide cost-effective therapy options to as many

patients as possible. To do so, it evaluated therapy pro-

grams that were already taking place within Grant and re-

searched how complementary therapies help treat pain

and enhance relaxation.

Announcing the complementary therapies

Wanting to get the word out to all staff members and

patients about the healing treatment therapies, Kobelt

held several sessions in Grant’s auditorium during which

the guided imagery music was played and staff members

could receive a massage or healing touch.

“The more the staff can experience these programs,

the better,” says Kobelt. “Staff nurses were able to feel the

benefits and, therefore, are more apt to recommend one

of the programs for a patient.”

Patients and families are notified about the comple-

mentary therapy programs via posters displayed on

every nursing unit describe the therapies and how to

receive them.

Relaxing to the beat of a drum

Drumming is perhaps the most surprising of the com-

plementary therapies at first glance—as it may not sound

relaxing. But drumming has been shown to increase cir-

culation, reduce tension, improve mood, and boost the

immune system in patients, says Kobelt.

Patients, and even their families, are welcome to try

drumming if they are interested, and are usually smiling

and laughing after drumming, says Kobelt.

Massaging the pain away

Massage therapy first started as a relaxation treat-

ment for cancer patients, but the pain committee want-

ed to extend this service to all patients in the facility, so

Kobelt asked the massage therapist to extend her servic-

es to all units.

“Our massage therapist does not perform full body

massages with our patients,” says Kobelt. “She focuses

on shoulders, hands, or feet.”

A physician order is required before a patient can re-

ceive massage, to ensure the patient is fit to do so and no

harm will be caused.

Barking at the bedside

One of the most visible complementary therapies of-

fered is animal-assisted activity. The hospital worked with

Healing treatments

The power of complementary therapyNurses meet patients’ emotional and physical needs

the Delta Society Pet Partners program to recruit volun-

teers who would bring specially trained and groomed dogs

to visit patients, families, visitors, and staff members. The

Welcome Waggin’ therapy program now includes 13 dogs

of different sizes and breeds.

“Dogs give people a common ground or something to

talk about,” says Boggs. “People just seem happier after

they have been around a dog.”

To help the dogs and volunteers stand out in the facil-

ity, the dogs wear lime green T-shirts and the volunteers

wear purple T-shirts, both embroidered with the Wel-

come Waggin’ logo. When staff members see the dogs in

their colorful shirts, they know these are dogs that are

allowed in the facility, says Kobelt, along with seeing eye

dogs and those needed for other special situations.

The pet therapy program was rolled out on one unit

at a time so there was time to iron out any problems.

It was determined that the best times for dog visits are

nonmeal hours, so visiting hours are from 1 p.m. to 3

p.m. and 6:30 p.m. to 8:30 p.m. Before the dogs visit,

they are meticulously bathed and groomed. Staff nurs-

es and volunteers are provided with information about

which patients can receive dog visits and what the vol-

unteers will do when they arrive.

“As I’m walking around the hospital, you just can’t

underestimate the value of these dogs and their partners

because they are not just seeing patients—they are see-

ing families and visitors and even staff,” says Boggs. “Ev-

erybody walks around with a lighter heart after either

petting a dog or talking to people about the dogs.”

Healing touch

Another therapy was implemented after Kobelt no-

ticed that staff nurses were taking classes outside the

hospital on healing touch—a therapy that works by us-

ing your body’s energy field to support its natural ability

to heal. Before implementing a program, Kobelt sought

physician approval for healing touch.

“A few physicians had actually experienced nurses us-

ing healing touch before on patients in the intensive care

unit and had seen the benefits of it,” says Kobelt. “Both

nurses and physicians noticed after patients received

healing touch [that] the patients didn’t have as much

pain and their heart rates went down. Therefore, the

physicians were very supportive for nurses to use heal-

ing touch.”

Kobelt began offering healing touch classes at Grant

for staff nurses to learn the healing treatment, which as-

sists in balancing patients’ physical, mental, emotional,

and spiritual well-being.

Listening to music and viewing imagery

The final complementary therapy is offered around

the clock as calming music and imagery stories on two

TV channels available in patients’ rooms. The TV chan-

nels offer inspiring words, natural scenery, guided imag-

ery stories, and calming music for patients to use when

they are having trouble sleeping, or just to create a re-

laxing environment when they are receiving a massage

or healing touch.

Surveying patient outcomes

To obtain feedback about how patients are benefiting

from the complementary therapies, staff nurses give pa-

tients a purple note card where they can keep track of

which therapy service they received and how their pain

and relaxation was before and after treatment.

Kobelt says that the difference has been impressive.

On a 0–10 scale, patients have reported average pain re-

ductions of 4 points from healing touch, and average re-

ductions of up to 6 points for massage. Patients also say

their relaxation increased between 4 and 8 points. n

Source: HCPro’s Advisor to the ANCC Magnet Recog-

nition Program®, January 2008, HCPro, Inc.


© 2008 HCPro, Inc.


MAGNET™, MAGNET RECOGNITION PROGRAM®,

and ANCC MAGNET RECOGNITION® are trademarks

of the American Nurses Credentialing Center (ANCC).

The products and services of HCPro, Inc., and The Gree-

ley Company are neither sponsored nor endorsed by

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© 2008 HCPro, Inc.


Upcoming eventMarch 27—Retention in Nursing: Top solutions to keep

RNs at the bedside (SKU N031008)

Learn how to develop effective retention strategies to focus

employee engagement and reduce turnover with speakers

Shelley Cohen, RN, BS, CEN, and Lydia Ostermeier

MSN, RN, CHCR.

For more information, call HCPro’s customer service

representatives at 800/650-6787 or visit

www.hcmarketplace.com.

Book excerpt

The benefits of peer reviewHow formal incident review promotes nurse autonomy and accountability

Historically speaking, nurses have long conducted

some level of peer review. Since the first nurse conferred

with another about caring for a patient, some form of

peer review has been in place.

Yet when nurses are considering whether to imple-

ment a formal peer review process, or if the organization

has already started down that road, many may wonder

about the benefits of conducting peer review and ask

questions such as “Why now?”

Time is of the essence. Medical staffs have been peer

reviewing their cases for years, and as fellow profession-

als, we must hold ourselves to the same high standards.

Nurses are professionals who must hold each other ac-

countable and evaluate patient care so we can eliminate

system and human errors.

The major reason for implementing a peer review

process is to improve patient care. If nothing else, it is

the right thing to do to protect the patient from potential

harm. The goals and benefits of peer review include:

Improving the quality of care provided by individual

nurses

➤

Monitoring the performance of nurses

Identifying opportunities for performance

improvement

Identifying systemwide issues

Achieving outstanding results

If the process of peer review is to be effective, then a

formal structure must be created to allow for the track-

ing and trending of information and the identification of

potential system or human failures. Case review is use-

ful because it presents opportunities to identify failures

through investigation. Think of each essential respon-

sibility a nurse leader must carry out to ensure opti-

mal performance as a layer in the performance pyramid

model; the more time leaders spend on the base layers,

the less time they will have to spend on the upper layers.

The six layers of the pyramid and the role of each in im-

proving nurse performance are discussed in detail next.

Appoint excellent nurses

If you start by bringing people into the hospital who

are well qualified and competent, you improve your

ability to reach the level of excellence you desire.

Carefully selecting nurses requires solid screening

systems. When a nurse first applies for a staff position,

his or her professional credentials (e.g., licensure, edu-

cation, experience, current competence) must be veri-

fied in accordance with policy and procedure, state and

federal regulations, and accreditation standards (e.g.,

The Joint Commission [formerly JCAHO] or the Nation-

al Committee for Quality Assurance).

But don’t stop here. This is the point at which it is cru-

cial to go beyond minimum requirements. Create and

maintain the highest possible standard for nursing.

Set and communicate expectations

Few organizations take the time to define and explain

➤

➤

➤

in one document what is expected of a nurse on staff in

the organization.

The nursing department should tell every new nurse,

in writing, what is expected of him or her to achieve ex-

cellence. This is your opportunity to establish expectations

for the type of nursing culture you want. In a one-page

document, define the routines and protocols that are used

and acceptable in the organization. Consider it a statement

of the culture of the nursing staff, including information

about how the staff does things at your facility.

Measure performance against expectations

After a hospital has established expectations and com-

municated them to the nursing staff, it must measure

each nurse’s performance against those expectations.

The foundation of any successful quality program is

the basic premise that measuring something drives im-

provement. How often do we monitor nursing docu-

mentation for key elements in the medical record?

Continuously. And the results are always the same: We

always have deficiencies. But who has the deficiencies

and why?

More often than not, we monitor nurses using only

one percentage to evaluate nursing care. For example,

we find that there is a 45% deficiency in completing the

nursing assessment within 24 hours of admission. This is

our statistic. But using just one percentage penalizes the

nurses who always meet our expectations and allows the

other nurses to slip through the cracks and not be no-

ticed. We assume nurses need more training and further

reiteration of the policy, when actually it may only be a

few nurses who are bringing the percentage down.

Therefore, once nursing indicators are established,

take your quality program to the next level by identify-

ing individuals’ performance.

Provide periodic feedback

Nobody really knows whether they are meeting ex-

pectations unless they receive periodic feedback about

their performance. Annual feedback is not enough.

Nurses cannot hope to improve if they only receive

information about how they can improve on a yearly

basis. Feedback should be frequent and targeted. On-

going feedback to nurses about their performance is es-

sential and reinforces the expectations established by

the organization. When nurses receive feedback in a

timely and easy-to-follow manner, they will use it for

self-improvement.

In addition, it is important for nurses to receive feed-

back and appreciation when they perform well, not just

when they perform poorly. Remember, the goal is not to

weed out the bad apples but rather to give all nurses ev-

ery opportunity to improve.

Manage poor performance

Nursing leaders should not wait until the annual re-

view process to address performance issues. Discuss

such issues with the particular nurse as soon as concerns

arise. For example, if a feedback report shows that a

nurse is not meeting performance expectations, and the

nurse does not self-correct, appropriate leaders or men-

tors should meet with the nurse to discuss improvement

strategies. Leaders and mentors can help motivate the

nurse to change or eliminate unacceptable performance,

provide useful advice and direction for doing so, and

should monitor the nurse’s progress.

Take corrective action

Nursing leadership must act when all of the steps out-

lined in this chapter have been taken but a nurse fails to

self-improve and her or his poor performance threatens

quality of patient care. Such action is known as correc-

tive action and is a formal process that involves pro-

gressive discipline, with the possibility of termination.

Nursing leaders must consult HR or the appropriate au-

thority before corrective action is taken. n

Source: This excerpt is adapted from HCPro’s new book Nurs-

ing Peer Review: A Practical Approach to Promoting Pro-

fessional Nursing Accountability, by Laura Harrington, RN,

MHA, CPHQ, CHCQM, and Marla Smith, MHSA. For more in-

formation or to order a copy, visit www.hcmarketplace.com.


© 2008 HCPro, Inc.



© 2008 HCPro, Inc.


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“Is there a physician, possibly your medical director, who has been nonsupportive

behind your back? You know who these people are. At a meeting or in front of your boss, they

are supportive . . . but once the meeting is over and everyone goes their own way, they are completely different.

You would think it was a ‘Jekyll and Hyde’ experience!”

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Tip of the month

The business of healthcareSuccess secrets for every nurse manager

Are you ready to redefine your leadership role? Are

you in need of some quick and useful leadership tips?

Successful leadership is dependent on one’s ability to:

Inspire confidence

Show personal interest

Produce results and quality outcomes

Inspire, gather, and use employees’ ideas

Lead rather than boss

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Foster teamwork and a sense of community

Coach staff members to reach their potential

I recommend this Web site as a wonderful resource

for all your leadership needs: www.businesssuccesscoach.net.

Sign up now for the free success sessions that will help

every manager, whether new or seasoned. The sessions

are led by John McKee, who is nationally known for his

work in helping leaders develop new levels of greatness.

Healthcare is a business, and sometimes nurse manag-

ers need guidance from the business world to help them

achieve their goals. McKee’s first Success Secret is all

about recognizing where you sit in the organization-

al chart and working out how to balance meeting the

needs of both your boss and your staff. n

Source: Shelley Cohen, RN, BS, CEN, Health Resources Un-

limited, www.hru.net. Adapted with permission.

➤

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Continuing Education Exam January–March 2008

Accreditation statement:HCPro, Inc., is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. This educational activity for three nursing contact hours is provided by HCPro.

Directions:Fill out your contact information in the space provided.

Complete the exam by circling the letter that corresponds to the correct choice for each question. The questions are based directly on content from the January–March issues of SNM, and you may refer to them as you take the exam.

Return all four pages of the exam to us by April 1. To qualify for three nursing contact hours, you must answer at least 80% of the questions correctly—that’s 24 correct answers out of the 30 questions. Upon successful completion of the exam, we’ll e-mail you a certificate that you may use for display and documentation of three continuing education (CE) credits toward your nursing certification.

Name: _______________________________________ Facility: _____________________________________________

Address (city, state, ZIP): _____________________________________ Nursing license number: _______________

Telephone: ____________________________________ Fax: ________________________________________________

E-mail: ____________________________________________________________________________________________

A service of Strategies for Nurse Managers

January 2008

1. According to Karen Siroky, RN, MSN, senior director of education for San Diego–based AMN Healthcare, Inc., what is important to consider when hiring international nurses?

a. They do not have the same work ethic as U.S. nursesb. Healthcare systems are different in other parts in the worldc. They require less pay than U.S. nursesd. They do not have the proper formal training to practice in the United States

2. Why do foreign-born nurses immigrate to the United States?a. They prefer U.S. healthcare systemsb. They have trouble finding work at homec. They seek first-rate working conditionsd. They do not receive adequate nursing education at home

3. Which of the following is not a benefit of adding international nurses to the workplace?a. They have better communication skillsb. They bring professionalism to the practice settingc. They add diversityd. They bring a new nursing perspective

4. According to Bette Case Di Leonardi, PhD, RN-BC, what is the first step for educators following the hiring of a foreign-born nurse?a. Learn about the nurse’s cultural background b. Nurse assessmentc. Provide an orientation program d. Preceptor training

Strategies for Nurse Managers Continuing Education Exam—January–March 2008Page 2

5. According to Mary D. Brandt, MBA, RHIA, CHE, what should your first priority be when you receive notification from OCR about a patient complaint?

a. Speak with the patient directlyb. File the complaintc. Contact your facility’s senior executives d. Launch an internal investigation

6. Whom does Brandt recommend assigning the complaint to within the facility? a. Nurse managerb. Privacy officerc. Staff nursed. Risk manager

7. According to Marjorie Chavez, BS, RN, how can educators help to foster positive nurse-physician relationships?a. Hold the nurses accountable for breaks in communicationb. Establish a zero-tolerance policy for bad communicationc. Require the physicians to help new nurses use their critical thinking skillsd. Use incentive programs

8. What is the 30-minute guarantee of sister hospitals St. Mary’s Medical Center in Blue Springs, MO, and St. Joseph Medical Center in Kansas City, MO?

a. If you’re not seen by a doctor within 30 minutes of walk-in, you get a coupon for free pizzab. If your case is noncritical, you will be discharged within 30 minutesc. If you’re not seen by a doctor within 30 minutes of walk-in, you get two free movie passesd. If you have waited more than 30 minutes to see a doctor, you will immediately be seen by a nurse practitioner

9. Due to the 30-minute guarantee policy, wait times have improved by ______.a. one hourb. 40 minutesc. 30 minutesd. 25 minutes

10. St. Mary’s modeled its program after which Ascension Health hospital?a. Borgess-Pipp Hospitalb. St. Mary’s of Michigan c. Seton Centerd. Lourdes Hospital

February 2008

1. According to Nancy Knecht, RN, staff development specialist in the ICU at Mercy Hospital in Iowa City, IA, a charge nurse should _________.

a. rely on his or her staff nursesb. be extremely detail orientedc. serve as a resource for his or her coworkersd. foster excellent critical thinking skills

2. According to current research reported by MedSurg Nursing, why is the charge nurse role critical to the nursing profession?a. Staff nurses need encouragement to be focused and committedb. Charge nurses coordinate care due to the increasing use of agency and foreign-born nursesc. Nurses are not natural-born leadersd. Nurses prefer having a leader so they are not required to be accountable

3. According to a study in the Journal of the American Medical Association, MRSA may be responsible for ________ potentially deadly infections every year.

a. 90,000b. 20,000c. 5,000d. 120,000

4. What does MDRO stand for?a. Medical drug record optionalb. Multidrug radical onsetc. Medical drug-related organismd. Multidrug resistant organism

5. Why does Emily Rhinehart, a vice president at AIG Consultants, Inc., believe hospitals need to increase their vigilance against MDROs?a. The cost of lawsuitsb. The Centers for Medicare & Medicaid Services’ new ruling on limited reimbursement for preventable infectionsc. The number of deaths caused by MRSAd. The increasing bad publicity hospitals have received due to infection-related deaths

Strategies for Nurse Managers Continuing Education Exam—January–March 2008 Page 3

6. Why are lawsuits related to infection control issues particularly appealing to attorneys?a. They are often large scale with the opportunity for a greater payoffb. Infection control is the current hot topic issue in lawc. Cases based around medical complications are easier for attorneys to argue in courtd. Judges usually side with the plaintiff in these types of cases

7. Rhinehart says it is critical to document everything you do within your infection control program. Which of the following is not necessary?

a. Hand hygieneb. Surveillancec. Nurses’ hoursd. Committee meetings

8. How can a facility provide its staff members with the proper infection control training?a. Develop incentive programs to encourage staff participationb. Prepare an outline and take regular attendance at training sessionsc. Mandate a zero-tolerance policyd. Shadow staff members

9. According to Jackie Smith-Helmenstine, quality resources analyst and regulation and accreditation coordinator for the University of Wisconsin Hospital and Clinics (UWHC), what is one simple way to alleviate survey stress?

a. Require mandatory survey preparation trainingb. Help staff members become comfortable when conversing with surveyorsc. Offer incentives for good survey performancesd. Tell staff members to speak with the surveyors as little as possible

10. When being interviewed by a surveyor, Smith-Helmenstine says you should not ________________.a. use specific examples from workb. ask the surveyor to reword the questionc. make up an answer to a question you don’t knowd. answer the question as simply as possible

March 2008

1. Research supports the effectiveness of a team approach to clinical care by proving that it _________________.a. is best choice for providing quality healthcareb. improves the staff retention ratec. helps nurses with their critical thinking skillsd. increases the potential for miscommunication

2. According to Debra Gerardi, RN, MPH, JD, nurse-physician disputes often result from what?a. Nurses do not respect physicians’ authorityb. Physicians do not value nurses’ opinionsc. Their differing views of collaborationd. Their inability to understand one another

3. Another common problem that often results in miscommunication is that healthcare providers __________________.a. tend to avoid conflictb. often have trouble getting along in a professional settingc. are not patient with one anotherd. only listen to their managers

4. Why does Gerardi believe resolution is not the answer?a. There is no way to handle conflicts among healthcare professionalsb. Conflict is ongoing, and one must find a balance, not a permanent solutionc. Nurses will never be able to get along with physiciansd. Physicians consider themselves to be more important than nurses

5. According to Gerardi, which of the following is not a necessary step of conflict engagement?a. Self-reflectionb. Open listeningc. Acknowledgmentd. Avoidance

6. According to Carol Landis, an ICP at Memorial Health System in Abilene, KS, testing staff members for MRSA would help ____________.

a. prevent future MRSA outbreaks at the facilityb. staff members take infection control precautions more seriouslyc. senior executives recognize the MRSA threatd. patients protect themselves from MRSA outbreaks

Strategies for Nurse Managers Continuing Education Exam—January–March 2008Page 4

7. Why do many facilities see no point in testing staff members for MRSA colonization?a. Staff members are not willing to be testedb. It is too expensivec. Facilities do not see MRSA as a serious threat to the communityd. There is no evidence linking the screening of healthcare providers with infection outbreaks

8. Why does Jerry Zuckerman, MD, think widespread staff testing is an unnecessary hassle?a. Negative results will have little effect on the culture changeb. Positive results will generate confusion and conflict among staff membersc. Neither result (positive or negative) will result in a change of infection control practiced. MRSA is not a serious healthcare risk or concern

9. What is the problem with attempting decolonization?a. It is difficult to get it approved by hospital unionsb. Nurses, in particular, are opposed to itc. It could pose serious risks to the healthcare providersd. The process is too expensive

10. Which of the following does Dawn Terashita, MD, MPH, not recommend for encouraging hand hygiene and infection control compliance?

a. Provide incentivesb. Use signs as remindersc. Institute hand-hygiene educationd. Hire hand-hygiene spies

Evaluation

1. Did this CE activity relate to its stated learning objectives? _______________________________________________________

2. Was the format of this CE activity easy to use? _________________________________________________________________

3. Did we avoid commercial bias in the presentation of our content? _________________________________________________

4. Will this activity enhance your professional development? _________________________________________________________

5. How long did it take you to complete this activity (including reading, exam, and evaluation)? __________________________

______________________________________________________________________________________________________________

HCPro, Inc., is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s

Commission on Accreditation. The SNM editorial advisory board has signed a vested interest form declaring no

commercial/financial stake in this activity.

If you have any questions or concerns, please contact customer service at 800/650-6787. Fax or mail your exam and evaluation

by April 1 to Strategies for Nurse Managers, CE Exam, P.O. Box 1168, Marblehead, MA 01945. Fax: 781/639-2982, Attn: Kerry

Betsold, CE Coordinator.

March 2008 Vol. 8, No. 3 Strategies - Nurse · PDF fileAll of this improves the bottom...

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