Family-centered work environments help nurses thrive

Transcription

1 Vol. 4 No. 10 October 2004 INSIDE Interdisciplinary care corner Brush up on essential communication skills for effective interdisciplinary collaboration on p. 4. Communication Become more assertive: Follow the model on p. 6 for more effective communication skills. JCAHO Read 10 ways to comply with the 2005 National Patient Safety Goals on p. 8. Leadership Learn how one New Jersey hospital used transformational leadership to attain magnet recognition on p. 10. Motivation Staff in a slump? Read how to motivate them before they bring everyone down on p 12. Sign up for the Nurse Manager talk group and network with your peers! Receive helpful advice from your colleagues on the HCPro Strategies for Nurse Managers talk group, a free benefit to all newsletter subscribers. To start talking today, Buy more and save! Call 800/ to learn how you can save more than $100 per subscriptions when you order multiple copies of Strategies for Nurse Managers. Nurse retention Family-centered work environments help nurses thrive By Rene Jackson, RN, BSN Work-life balance has emerged as a top priority in the workplace for nurses. The right balance can have a positive effect not only on the family, but also on the organization where they are employed. To help nurses achieve this balance nurse managers must be flexible in scheduling giving their employees a chance to work when they work best. Along with flexibility, such support as childcare, eldercare, financial and legal help, employee assistance, parenting seminars, and education and training have given way to increased productivity, lower turnover, and deepened commitment. A nonprofit organization that studies labor recently conducted a survey of unionized employees and found that 68% of employees felt that allowing the option of parttime work would raise morale, reduce absenteeism, and help employees balance work and life. Susan Seitel, president of Work & Family Connection, says informal flexibility and the right to request flexible work arrangements are number one on the priority list for every employee. A family-friendly workplace Pitt County Memorial Hospital (PCMH), a 745-bed hospital in Greenville, NC, was named in 2003 as one of the nation s top 100 corporations for working moms by Working Mother magazine and was also recently awarded the coveted Magnet designation by the American Nurses Credentialing Center. PCMH was one of only eight healthcare organizations to make the Working Mother list. Familyfriendly attributes such as onsite day care, children s programs at its wellness center, flex time, and educational assistance are just a few of their focused efforts to create a positive work environment for all employees including special support programs for working parents. PCMH currently offers 16 different scheduling options, which include 32- and 36-hour work weeks for which employees receive full time pay. PCMH tries very hard to be flexible with the scheduling of nurses. Most units do self-scheduling, and nurses are given many options, said Barbara A. > p. 2

2 Nurse retention Family < p. 1 Butterworth, RN, MSN, a neonatal nurse practitioner (NNP) at PCMH. Butterworth took advantage of PCMH s close collaboration with East Carolina University School of Nursing and other community colleges. She made the most of PCMH s flexible scheduling and staffing options to obtain her NNP certification. Rewards to help balance work and family Children s Healthcare in Atlanta has a program called Total Rewards that supports its work-life initiative. Some of the benefits that help nurses achieve work-life balance include educational assistance, which provides up to $5000 to employees pursuing degrees toward critical need positions, free concierge services, childcare, and financial assistance that provides up to $10,000 in reimbursement for expenses associated with adoption and infertility treatment. According to Donna Nazary, director of the Total Rewards program, her facility requires that hospital managers both facilitate balance for their staff and also demonstrate that balance in their own lives. Source: AMN Healthcare, Inc. This article was reprinted with the permission of RN.com. Go to www. rn.com for more information. Competencies Surviving JCAHO scrutiny: An Army nurse s advice for fixing your competency program Editor s note: The following article is excerpted from the new HCPro newsletter, Competency Management Advisor. To subscribe, please call our Customer Service Department at 800/ or go to Would your competency program stand up to JCAHO scrutiny? Kimberly K. Armstrong, RN, MSN, lieutenant colonel, U.S. Army Nurse Corps in Fort Sam Houston, TX, explains how she whipped her organization s competency program into shape. The assignment In May 2002, a mock JCAHO survey performed on Brooke Army Medical Center (BAMC) in Fort Sam Houston, TX, revealed shortcomings in the areas of human resources and competency assessments. As a result, the facility selected Armstrong to head the clean up efforts for the organization s competency program. Her first task was to identify the problem. Know your enemy Don t confuse orientation and competency. Orienting a new person to his or her job or unit is not sufficient to satisfy a facility s competency requirements. Just because you have oriented them and they know where the supply room is, where the lunchroom is, and they know how to answer the phone does not mean that they are safe to do the job and that is where the competency piece comes in, explains Armstrong. Previously, BAMC assessed noncredentialed staff competence with skills checklists and other similar tools, which she felt didn t meet the facility s or the JCAHO s exact needs. Therefore, Armstrong decided to build her own Page HCPro, Inc.

3 Competencies Nursing retention JCAHO scrutiny < p. 1 competency tools. With the help of department supervisors and staff, Armstrong created an intranet of over 350 unit-specific clinical and administrative competency assessment tools targeting staff s technical or clinical abilities, critical thinking, and interpersonal skills. Mass education Following the implementation of BAMC s centralized competency program, Armstrong and her team were charged with bringing 450 supervisors and key employees up to speed before the next JCAHO visit, which was only 10 months away. Their action goals included setting up monthly, four-hour training sessions, which are now offered for new supervisors. Sessions accomplished the following goals: 1. Discussion on orientation v. competency assessment approximately minutes. 2. Explanation on how to organize competency folders approximately minutes. 3. Reorganization of 10 staff competency folders, brought by each supervisor the remaining two hours. The competency folder serves as a portfolio, says Armstrong. She advises folders contain the following: Cover sheets for consistency in presentation Job description Evidence of health and safety training Proof of facility or department-level orientation Unit-specific orientation checklist Unit-specific competency tool Evidence of ongoing competency validation Proof of current basic life support card and valid license Continuing education certificates and list of inservice training attended Mission accomplished Armstrong s competency folders were a success during BAMC s JCAHO survey. After reviewing only a handful of staff folders which were all organized the same way, complete with the competency tools that answered much of surveyors usual questions surveyors quickly finished their search and moved on to the next leg of the survey. Competencies The right time to evaluate competency Kimberly K. Armstrong, RN, MSN, lieutenant colonel, U.S. Army Nurse Corps in Fort Sam Houston, TX, offers the following advice for the best times to evaluate staff competency: 1.During the hiring process. Ask yourself whether the applicant is qualified to do the job? 2. During the preceptor program. Does the person have the skill sets to perform the job independently? Remember that it takes six months to one year to completely understand an organization s system. 3. On a daily basis. Never stop evaluating competency. It is an ongoing process. 4. On an annual basis. In each competency folder include a one-page statement with summarized information from the annual evaluation. By doing this, you eliminate unnecessary competency assessments. Instead, revalidate staff on risky, low-volume skill sets high-risk, high-volume skill sets changes in practice (i.e., equipment or regulations) required competency (i.e., age-specific care) 2004 HCPro, Inc. Page 3

4 Interdisciplinary care corner Get along with other caregivers: Essential skills for interdisciplinary collaboration Your organization s interdisciplinary patient care process may require you and the other care team members to meet, review, and revise the priority order of treatment goals. There should also be a process for evaluating the patient s progress toward goals and for making revisions to the plan of care. These decisions must reflect the interdisciplinary makeup of the process, and they will rely on the care team s collective communication skills. Specifically, the care team must understand and become familiar with techniques for effective group decisionmaking and conflict resolution. Group decision-making Decision-making is challenging within a team especially where the different clinical disciplines involved have diverse skills and knowledge. Effective group decision-making relies on a clearly established procedure. The design of this procedure needs to promote openness, support, and trust, and it must account for confrontation and conflict. Within the group decisionmaking process, there are certain principles that will help encourage interdisciplinary collaboration. These principles include the following: Decisions need to be made by the entire team, not just those with the highest level of education. Team members must listen to all options on the table before making a final decision. Try to make decisions unanimously; no one member should feel pressured into supporting the majority just to get it off the table. Always establish who is responsible for carrying out the decision and who needs to be informed of the new information. If conducted appropriately, group decision-making discussions can be an opportunity for your staff to learn about other disciplines in the facility. Conflict resolution Conflict is often inevitable in any team environment. Bringing together people of different education, training, values, and beliefs is likely to result in disagreements but it can also lead to worthwhile discussions that can conclude effectively. Being able to resolve a conflict in a healthy manner is essential for ensuring effective interdisciplinary communication. The following are tips for conflict resolution: Discussions should always be professional personal attacks only hinder the process. Misunderstanding of roles within the group is often a cause of conflict. Team members must avoid ganging up on each other. Evaluate ideas based on their merits, not on the care provider who made the contribution. This will help eliminate the emotional component. Ensure that everyone understands the conflict often the two parties are not talking about the same issue. If two different approaches to the same problem are suggested, consider the pros and cons of each. Start by agreeing that there is no such thing as a bad idea; then use your discussion to agree as a team on the best choice. Brainstorm every possible solution. Resolving conflict in a healthy and efficient manner leads to improved future communications across the disciplines and helps to avoid delays in patients progress toward goals. Source: Working in Interdisciplinary Teams to Improve Patient Care: A Staff Training Handbook, by Brenda Gail Summers, MBA/MHA, RN, CNAA, HCPro, Inc. Page HCPro, Inc.

5 Recruitment and retention How an Illinois hospital develops new nurse leaders while boosting retention Nurse managers were overwhelmed at Edward Hospital, a 236-bed community hospital in Naperville, IL. A hospitalwide survey showed that after spending time on their retention and recruitment responsibilities, they felt as if they had little time to manage the daily operations of their units, which fostered dissatisfaction among staff and managers. The overall nursing turnover was 20.3%, says Lynn Wagner, MS, RN, administrative director of critical care and medical/surgical services. Hospital leaders decided to create the new position of clinical leader to allow nurse managers to devote more of their time to nurse retention. A committee of nursing leaders developed the new role. The group divided the clinical leader s responsibilities as follows: 60% of work hours acting as charge nurse 40% of work hours for administrative duties The committee set a goal to fill one to two clinical leader vacancies in each nursing area of the hospital as soon as possible. In January 2002, 28 positions were filled all of which were internal promotions. The clinical leader curriculum consisted of a 12- week mentoring program. A director and manager instructed the program, which covered topics such as leadership, role transition, negotiation skills, conducting effective meetings, recruiting and interviewing staff, and a patient satisfaction overview. Overall, the creation of the new position has had a positive effect on the organization. The managers were relieved of some of their duties, and it really helped ease their stress, explains Wagner. Nurse turnover also decreased to less than 10%. Press Ganey survey results indicated that nurse satisfaction increased from the 51st percentile to the 83rd percentile. Nurse manager turnover fell to 7% well below national trends. One clinical leader resigned, indicating a 3.4% turnover among the new leaders, which proved to Wagner and her colleagues that this system has been a tremendous success. Source: Mentoring New Leaders for Success, presented during the American Organization for Nursing Executives 2004 Annual Meeting & Exposition. Reprinted with permission. SNM Subscriber Services Coupon Start my subscription to SNM immediately. Options: No. of issues Cost Shipping Total Print 12 issues $179 (SFNMP) $18.00 Electronic 12 issues $179 (SFNME) N/A Print & Electronic 12 issues of each $224 (SFNMPE) $18.00 Order online at and save 10% Be sure to enter source code N0001 at checkout! Sales tax (see tax information below)* Grand total For discount bulk rates, call toll-free at 866/GO-HCPRO. *Tax Information Please include applicable sales tax. Electronic subscriptions are exempt. States that tax products and shipping and handling: CA, IL, MA, MD, NJ, VA, VT, FL, CT, GA, IN, MI, NC, NY, OH, PA, SC, TX, WI. States that tax products only: AZ, TN. Please include $21.95 for shipping to AK, HI, or PR. Your source code: N0001 Name Title Organization Address City State ZIP Phone Fax address (Required for electronic subscriptions) Payment enclosed. Please bill me. Please bill my organization using PO # Charge my: AmEx MasterCard VISA Signature (Required for authorization) Card # (Your credit card bill will reflect a charge to HCPro, the publisher of SNM.) Expires Mail to: HCPro, P.O. Box 1168, Marblehead, MA Tel: 800/ Fax: 800/ customerservice@hcpro.com Web: HCPro, Inc. Page 5

6 Communication Become more assertive: Follow this model to develop more effective communication skills Editor s note: The following is an excerpt from the book, Core Skills for Nurse Managers: A Training Toolkit, by Shelley Cohen, RN, BS, CEN, Sharon H. Cox, MSN, RN, CNAA, Beth Klitch, BA, FACHCA, and Sandra Kay Webb, RN, BS, published by HCPro, Inc. By nature, nurses tend to be people-pleasers and often communicate indirectly. It is not uncommon to hear a people-pleaser say something such as, It s not a big deal, but if you could just try and see if maybe you could... These are weasel words they water down what you re trying to say so much that the point is lost. One key management skill is the ability to be straightforward, direct, and honest. Follow the DESC model to become more assertive when communicating with a staff member who has behaved in an inappropriate manner: D Describe the behavior. Don t attack the person and try to give clear specific examples. E Explain the effects of the behavior (e.g., feelings and actions). S State clearly and briefly what you would rather have. C Consequences: Follow through to get their attention. For example, say, When you come in late [behavior] it is frustrating [impact] and puts us behind [impact] because we have to redo the assignments. That feeling of frustration gets us started on a negative note, which we don t need [impact]. We need for you to routinely be here when the shift starts [what you would rather have] so we can all get started with the shift and attend to patients needs. Quite often, the DES part of this model is all that is needed to see a behavior change because when a person realizes the effects of his or her behavior, he or she quickly changes. However, sometimes a change in behavior doesn t last or comes and goes over time. The last step in the model focuses on consequences. That word often conjures up a sense of punishment, which is not the intention in this model. The intent is to get the person s attention so they change their behavior. To maintain credibility with the staff and your own personal sense of integrity, it is essential that you follow through on requests for behavior change. The following is an example of a follow-through conversation: We have talked about your tardiness, and although things improved, it has not lasted. For the past month, it appears that you are back in the old pattern, and I need you to know that this is unacceptable. I need to know what it is going to take to get your attention so the behavior change we need to see is sustained over time. If you choose to use this DESC model, you may find it useful to practice at home and in comfortable situations before taking on a difficult situation at work. Also take the time to role play this model with another manager or the person to whom you report so the conversation will not be too emotionally charged. This will make you feel more confident when you deal with your staff member. Call for authors Are you a nursing author? Are you interested in writing or contributing to HCPro nursing books? If so, we d like to hear from you! Contact Executive Editor Emily Sheahan by phone at 781/ , Ext or by at esheahan@hcpro.com. Page HCPro, Inc.

7 Patient safety Tailor your fall prevention program to fit patients with dementia Reducing falls for patients with cognitive impairments involves a different approach than you take with other patients on your unit. No two people fall for exactly the same reason, and no prescribed set of interventions will work for every patient. A study conducted by Fiona E. Shaw published in the July/August 2003 Geriatrics & Aging estimates that the annual incidence of falls for seniors with dementia to be about 70% 80% almost double the incidence of falls for elderly people without dementia. There are some risk factors specific to patients with cognitive impairment, as well as risk factors shared with other older adults that have greater significance for those with dementia. Some risk factors to pay close attention to include the following: Wandering Agitation Perceptual difficulties, including difficulty perceiving three-dimensional objects Lack of fear or caution/poor judgment Balance impairments Gait impairments, such as a slower walking speed, reduced step frequency, and shorter step length Risk factors for elderly patients without dementia have particular significance for those with dementia, including medications, especially psychotropics environmental fall hazards visual impairment Consider a broad range of fall causes. Someone with dementia may not be able to give a reliable account of a fall, and witnesses to falls may be unavailable. In the absence of hard facts, it is important to consider all the possible causes of a fall. Assess cognitively impaired patients to determine the direction in which they are most likely to fall. This will help you determine the body parts that they are most likely to injure, and fit the patient with protective padded clothing. Those with dementia tend to develop distinctive fall patterns, depending on the areas of the brain that are damaged and on muscular responses particular to the individual. Try soft, flexible moccasins or socks without shoes. This type of footwear enables cognitivelyimpaired patients to feel the floor and compensate for declining depth perception, thereby reducing falls. Small interventions can make big improvements in mobility. Trying a different walking aid or wearing more suitable shoes may make a big difference. Editor s note: This passage was adapted from HCPro s Long-Term Care Risk Management: Resident Falls A Guide to Prevention, Assessment, and Response, by Carole Eldridge, MSN, RN, CNAA, BC. Call 800/ or visit for more information. Questions? Comments? Ideas? Contact Associate Editor Rebecca Delaney Effective interventions Train your staff to use different fall prevention techniques for patients with dementia, including the following: Telephone: 781/ , Ext rdelaney@ hcpro.com 2004 HCPro, Inc. Page 7

8 JCAHO How to comply with the 2005 JCAHO National Patient Safety Goals: Tips from healthcare colleagues By now you ve heard about the JCAHO s new National Patient Safety Goals for 2005, but do you know what you need to do to comply with them? Don t reinvent the wheel. Heed these tips from colleagues who have already done the work. Patient identification: The JCAHO wants your staff to use at least two patient identifiers. This is not only when they administer medications, blood products, or take blood samples, but also when they take other specimens for clinical testing, or provide any other treatments or procedures. This is a logical continuation of a safety measure that many hospitals already practice. Be prepared to show the JCAHO how you monitor your staff s adherence to this measure. Tip: Ensure that two identifiers are readily available and clearly legible for staff to use for verification, according to the Institute for Safe Medication Practices. Tip: Label cardiac monitors that display multiple patients rhythms and patient names using a standardized verification process involving two individuals on your unit. Medication reconciliation: By January 2006, you have to reconcile a patient s medications across the continuum of care by developing a method to obtain and document a complete list of each patient s current medications upon admission. Tip: Get into the habit of calling your patients providers, caregivers, pharmacists, family members, and others who may be familiar with their medications. Critical test results: The JCAHO now requires you to assess the timeliness of reporting critical test results to licensed caregivers and make improvements in your process as necessary. Tip: Once your organization defines which test results are critical, identify who should receive the results, suggests the Massachusetts Coalition for the Prevention of Medical Errors. Make sure the receiver is someone who can take immediate action, rather than an intermediary staff member. When this person is unavailable, consider creating a call schedule or system to identify to whom the results should go. Tip: Define acceptable notification time parameters for communicating the results such as within an hour, within the shift, or within three days, depending upon the test result, the coalition suggests. Patient falls: Prepare to assess and reassess each patient s risk for falling, including how their medications affect this risk, and take the appropriate steps to prevent falls. Tip: Require staff to do toilet checks on highrisk patients every hour or two, suggests Sharon Eddy, MSN, director of nursing for Natchez Regional (MI) Medical Center. We go in and offer to help them to the bathroom before the patient really feels the urge, says Eddy, who instituted the program in June. This reduces the likelihood that the patient will try to get to the bathroom without asking for help. About 80% of our falls are associated with the bathroom in some way, so my gut feeling is that our fall rate will go down, she says. Source: Briefings on Patient Safety, September 2004, HCPro, Inc. Page HCPro, Inc.

9 Nursing in the news Beneficial or unfair? Nurses try to make sense of new overtime rule New overtime regulations have many U.S. workers, including nurses, scratching their heads. This new federal law passed in August redefines who is eligible for overtime pay, and many nurses wondering how they will be affected. This is an assault on nurses working conditions, says David Schildmeier, spokesperson for the Massachusetts Nursing Association. It gives hospitals the incentive to pay nurses on a salary basis to cut overtime, which would be devastating to patient care. Under the new rule, workers paid less than $23,660 or $455 per week will automatically receive overtime pay regardless of their title or job description. Nurses who are paid hourly will continue to receive overtime. Under this law LPNs will also receive overtime because they are not considered exempt learned professionals. Despite the continuation of their overtime benefits, many nurses fear that the new regulation will encourage hospitals to pay nurses a salary instead of an hourly rate to cut costs. Union nurses overtime benefits are protected under collective-bargaining agreements with hospital administration, but Schildmeier says nonunion nurses are left vulnerable if hospitals decide to pay them salaries a notion that Karen Moore, RN, MS, CHE, president of Massachusetts Organization of Nurse Executives, disputes. There s no evidence that any hospital is considering such a change, she says. It just doesn t make sense. Nursing in the news More than $15 million awarded to expand and diversify nursing work force Nursing programs across the country recently received a huge boost in the form of more than $15 million in funds for training more nurses and promoting diversity within the field. The funding, awarded by the Department of Health and Human Services (HHS), filters to 62 universities, colleges, nursing schools, medical centers, and other healthcare institutions from New York City to Compton, CA, to expand the supply of qualified nurses. More than $10 million of the funding will support grants under the Nurse Education, Practice and Retention program which is designed to increase enrollment in baccalaureate nursing programs develop internship and residency programs promote cultural competency among nurses boost nurse retention rates The remaining funds will go to the Nursing Workforce Diversity Program to support student scholarships, stipends, and nursing retention efforts for nursing students with disadvantaged backgrounds. The national nursing shortage threatens the quality of America s healthcare, said HHS Secretary Tommy Thompson in a statement. These grants will help us meet the future demand for the essential healthcare services that nurses provide HCPro, Inc. Page 9

10 Leadership Transformational leadership: The key to one hospital s magnet achievement When Barbara O Brien, RN, MSN, ANCC, started her job as vice president for patient care services at St. Joseph s Regional Medical Center in Paterson, NJ, the nursing department was in crisis. Staff turnover was high and the hospital had countless vacancies in its critical care units. Despite these dire circumstances, O Brien challenged the facility to achieve the highest standard for nursing excellence magnet recognition. I decided to use the magnet standards to redesign my organization, she says. A lofty goal to be sure, but after three years of hard work O Brien and her staff achieved magnet recognition from the American Nurses Credentialing Center. How did St. Joseph s realize such a dramatic turnaround? The magnet award begins with leadership, she says. O Brien credits transformational leadership as the key to her success. Transformational leadership, a term coined by Bernard Bass, a leadership and management expert, focuses on the following principles: Charisma Individual consideration Inspiration Intellectual stimulation The tenets of this leadership model match well with the 14 forces of magnetism, says O Brien, who is now founder and president of Magnetic HealthCare Strategies, a consulting practice in New Jersey. The forces emphasize strong nursing leaders who are knowledgeable risk-takers who advocate for their staff. According to the forces of magnetism, nurse managers are regularly visible to staff and continually participate in day-to-day unit activities. Managers also solicit and incorporate feedback from all levels of staff. To illustrate transformational leadership, O Brien described some well-known and highly successful business leaders who practice this form of management, such as Jack Welch, former CEO of General Electric, Rudy Giuliani, former mayor of New York City, and Microsoft chair Bill Gates. These leaders walked around their organizations a lot, and they always knew what was going on, says O Brien. They monitored their organizations down to the smallest paperclip. They measured the outcomes and provided feedback to their staff. Source: Magnet Status: Steps to Achieving Nursing Excellence, HCPro audioconference. To order a tape of this presentation, call our Customer Service Department at 800/650/6787. OCT./NOV. Audioconferences: Upcoming events 10/21/2004 Peer Review in Nursing: Effectively Utilizing Staff to Assess Competencies 10/27/2004 Appropriate End-of-Life Care: Case Studies and Cost Efficiencies to Help You Move Your Patients to the Next Level 11/4/2004 Training Nurses to Improve Documentation Skills Call Customer Service at to register. Page HCPro, Inc.

11 Medication safety Got stickers? How one PA hospital uses labels to reduce medication errors Color-coded stickers helped one Pennsylvania hospital significantly reduce high-alert medication errors. Albert Einstein Medical Center in Philadelphia began placing color-coded labels on high-alert medication IV bags and IV tubing in late 2003 after a task force determined that investing a few thousand dollars on labels and dispensers could reduce the possibility of medication administration errors, says pharmacy director Deborah Hauser, RPh. Even though we have all of these double-checks, you could still make a mistake, Hauser says. It s very confusing with all these tubes twisted up like spaghetti. In the heat of the moment, you could grab the wrong pressor or the wrong drug. The hospital received the Delaware Valley Healthcare Council 2003 Medication Safety Award for the program after reducing the average number of highalert medication errors to fewer than one per month. No severe errors have reached a patient since the program began, Hauser says. Using this process can also help ensure JCAHO compliance. National Patient Safety Goal #3 requires hospitals to improve the safety of using medications. JCAHO medication standard MM.5.10 requires organizations to safely and accurately administer medications. Pick your medications Hospital staff label IV bags and tubing for 20 highalert medications, Hauser says. The hospital selected the medications from the Institute for Safe Medication Practices high-alert medication list. Nurses also made suggestions about which medications they thought should have color-coded labels, Hauser says. The medications the hospital chose included insulin, heparin, and neuromuscular agents. The idea grew out of a practice commonly used in the OR, where staff label syringes with color-coded stickers. Each label color refers to drug classes or an adverse effect, Hauser says. For example, neuromuscular agents have red labels because a patient could stop breathing as a result of receiving those drugs. Label each high-alert medication Pharmacy staff place labels on IV bags when filling high-alert medication orders. Nurses label the IV tubing on the floors, Hauser says. Nurses label the tubing instead of pharmacy because tubes usually hang for more than 24 hours at a time, whereas pharmacy prepares IV bags every day, she says. Each of the 48 critical-care unit rooms where staff use the majority of high-alert medications has a dispenser with labels in it. Nurses told Hauser that placing label dispensers in each room would remind them to label IV tubing each time they change them, she says. The labels are right there in the room to make it as easy and convenient as possible for nursing staff, Hauser says. There s no reason not to do it. The labels also include tall-man lettering using capital letters to distinguish similar spellings to help staff distinguish between look-alike and sound-alike drugs, something that the JCAHO now requires under National Patient Safety Goal #3. One example includes DOPamine and DOBUTamine, Hauser says. Source: Hospital Pharmacy Regulation Report, September 2004, HCPro, Inc HCPro, Inc. Page 11

12 Motivation Motivate staff before they bring down the whole unit One staff member has started complaining loudly and often. Your most productive nurse is suddenly the least productive. If your staff struggle with motivation, address the situation promptly. Do not ignore it, says Terri Levine, a mastercertified business coach in North Wales, PA. If you don t address this behavior, it can rise up to become a big monster later. Follow these tips for approaching and motivating a staff member not performing at the level you d like: Comment only on the employee s work don t judge the employee s character. Saying something like You just aren t the same kind of a worker you used to be destroys a person s self esteem, Levine says. Instead, praise how their behavior used to be and point out how it s changed. Acknowledge the person in a truthful way. For example, if he or she has done exemplary work, make that known, but also explain how you think job performance has changed. You might say, You ve been on the unit for five years and you have done great work. I m thrilled to have you as part of the staff, but I m noticing that you don t interact with the patients the way that you used to. Request a change. Tell the employee that you d like to see a return to the previous work style and ask him or her to help you find ways to foster that improvement, Levine says. When an employee becomes defensive, remain neutral, Levine says. Let the employee say what he or she needs to and then acknowledge him or her again. Tell them, I can really hear that this is sensitive for you, and I just want you to know that you re a great worker. I really do care about you and value you, and I want to assist you, Levine says. Source: Private Practice Success, August 2004, HCPro, Inc. Strategies for Nurse Managers Editorial Advisory Board Shelley Cohen, RN, BS, CEN President Health Resources Unlimited Hohenwald, TN Sue Fitzsimons Senior Vice President Patient Services Yale-New Haven Hospital New Haven, CT David Moon Executive Vice President Modern Management, Inc. Lake Bluff, IL Bob Nelson, PhD President Nelson Motivation, Inc. San Diego, CA Tim Porter-O Grady, EdD, RN, CS, CNAA, FAAN Senior Partner Tim Porter-O Grady Associates, Inc. Otto, North Carolina Dennis Sherrod, EdD, RN Forsyth Medical Center Distinguished Chair of Recruitment and Retention Winston-Salem State University Winston-Salem, North Carolina We want to hear from you For news and story ideas: Contact Associate Editor Rebecca Delaney Phone: 781/ , Ext Mail: 200 Hoods Lane, Marblehead, MA rdelaney@hcpro.com Fax: 781/ Publisher/Vice President: Suzanne Perney Group publisher: Kathryn Levesque Executive Editor: Emily Sheahan Online resources: Web site: Visit HCPro s Nursing site at Subscriber services and back issues: New subscriptions, renewals, changes of address, back issues, billing questions, or permission to reproduce any part of Strategies for Nurse Managers, please call our Customer Service Department at 800/ Strategies for Nurse Managers (ISSN X) is published monthly by HCPro, Inc., 200 Hoods Lane, Marblehead, MA Subscription rate: $179 per year. Postmaster: Send address changes to Strategies for Nurse Managers, P.O. Box 1168, Marblehead, MA Copyright 2004 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/ Please notify us immediately if you have received an unauthorized copy. For editorial comments or questions, call 781/ or fax 781/ For renewal or subscription information, call customer service at 800/ , fax 800/ , or customerservice@hcpro.com. Visit our Web site at 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. Page HCPro, Inc.