How to improve physician-nurse relations to increase retention

Transcription

1 Vol. 4 No. 11 November 2004 INSIDE Nurse-physician relations Learn how to get nurses and physicians on the same page with a communication model on p. 2. Interdisciplinary care corner Three interdisciplinary methods to reconcile medications on p. 4. Patient safety Test your patient safety know-how with a word search on p. 7. Communications Twelve tips to facilitate an effective and enjoyable meeting on p. 9. Staff management Need a vacation from dealing with time-off requests? How to develop fair guidelines 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 subscription when you order multiple copies of Strategies for Nurse Managers. Recruitment and retention How to improve physician-nurse relations to increase retention Five years ago, a staff survey at the Colorado Permanente Medical Group (CPMG) in Denver showed that 68% agreed when asked whether physicians in their unit treated them with respect today that number has jumped to 78% and continues to climb thanks to an initiative spurred by the medical director to curb workplace abuse and improve the nurses work environment to increase recruitment and retention. Physicians are part of the problem, but how do we become part of the solution? asked Jack Cochran, MD, FACS, CPMG s executive medical director, during the September JCAHO symposium for nurse executives held in Washington, DC. In 1997, Cochran teamed up with CPMG s CNO and director of human resources to develop a zerotolerance program for workplace violence. Next, in an effort to educate physicians on the importance of working together with nurses to provide quality care, Cochran began the CPMG Preferred Clinical Partner Program. The program s key components include the following: Physician-nurse partner expectations. From day one when a physician is hired, we set the standard for how they are expected to treat nurses, he says. Mentoring and scholarships to encourage enrollment in an area-accelerated nursing program. Training laboratories to assist in the education of accelerated nursing students. Physician performance management. If a physician is abusive, we meet with them, give them a work improvement plan, and, if they still don t improve, we fire them, explains Cochran. The effort appears to be paying off. Last year, CMPG was listed among the top 10 accredited organizations in effectiveness of care by the Health Plan Employer Data and Information Set. We got some tangible results, says Cochran. Our clinical quality speaks to our investment in people, he says. Source: Healer, Leader, Partner: Physicians Opting In on the Nursing Shortage, presented by Jack Cochran, MD, FACS, during the JCAHO s September symposium Critical Linkages: Patient Safety, Nurse Staffing, and Leadership Solutions for Tomorrow in Washington, DC.

2 Nurse-physician relations Get nurses and physicians on the same page Nurses and physicians are trained to communicate differently hindering interdisciplinary teamwork and endangering patients, says Michael Leonard, MD, director of patient safety at the Colorado Permanente Medical Group in Denver. Communication was the number one root cause for sentinel events between 1995 and 2003 according to the JCAHO. Nurses are trained to be narrative and descriptive when discussing a patient, whereas physicians are taught to be problem solvers; they just want the headlines, what s important, and what the nurse wants them to do, Leonard said during his presentation, The Human Factor: Effective Teamwork and Communication in Safe Care, at the JCAHO symposium for nurse leaders in Washington, DC, in September. Leonard s suggests using the SBAR model to bridge this communication gap. SBAR, which stands for situation, background, assessment, and recommendation, is a structured way to communicate to make sure everyone s on the same page, he says. The following is an example of a nurse communicating with a physician using the SBAR model: Situation: Dr. Jones, I m Paul, the nurse on unit four West taking care of Mrs. Smith. I was told to get help if I was worried about a patient, and Mrs. Smith is in serious respiratory distress. Background: Mrs. Smith was admitted for her severe chronic obstructive pulmonary disease and lately began going downhill and has suddenly become much worse. Assessment: Her breath sounds are way down on the right side. I think she has pneumothorax and needs a chest tube immediately before she stops breathing. Recommendation: I would like you to come to the unit and see Mrs. Smith. She s in trouble and needs your help. Facilities that adopt the SBAR model make it clear that when nurses ask physicians to see a patient they are worried about, the physicians must respond, says Leonard. Source: The Human Factor: Effective Teamwork and Communication in Safe Care, by Michael Leonard, MD. Presented during the JCAHO s September symposium Critical Linkages: Patient Safety, Nurse Staffing, and Leadership Solutions for Tomorrow in Washington, DC. 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: Page HCPro, Inc.

3 Management Do you dread disciplining staff? Tips for making the conversation constructive and effective Editor s Note: The following is an excerpt from the book, Core Skills for Nurse Managers: A training toolkit, written 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. Managers often dread taking disciplinary actions, due in part to the mindset that discipline equals punishment. The first step in dealing effectively with disciplinary issues is to reframe your thinking and consider discipline as an opportunity for solving a situation with a staff member. Role of the manager Remembering the responsibility you have to patients and staff can often remove any reluctance you have to dealing with a disciplinary issue. It s also important to respect the staff member involved in the disciplinary issue by focusing the discussion on the behavior, not the person listening to the staff member s perspective abiding by the HR-established guidelines for fair and equitable treatment discussing the issues in a clear, honest, and direct manner being consistent and following through on agreements As disciplinary issues arise, make a point of working in close contact with your facility s employee relations manager. Use this colleague as a coach, and discuss any past history, related events, and reserva- tions or concerns you might have about talking with the staff member involved. Also, familiarize yourself with the policies, guidelines, and forms that the employee relations manager offers. This is important in ensuring that your actions are thought out, fair, and legally defensible. Preparation is paramount To prepare yourself for dealing with a disciplinary issue, answer the following questions: Can I explain the gap between expected and observed behaviors? Do I have examples that allow me to be specific rather than generalize? Am I clear about why this behavior is a problem and needs to change? What logical consequences will occur if the behaviors are unchanged? What action is needed on my part to deal with this issue? (A comment, or coaching? A private face-to-face meeting? A written warning for the employee s file?) Do I have the written guidelines that reflect the validation for this disciplinary process (e.g., employee handbook, job description, etc.)? Take time to consider the answers to these questions and take notes. Your answers will show you where you may need to collect additional data, review guidelines from human resources, or discuss your thoughts with another manager or your supervisor so you feel clear and organized prior to the one-on-one meeting with your staff member HCPro, Inc. Page 3

4 Interdisciplinary care corner Three methods to reconcile medications Not sure where to begin when it comes to meeting the JCAHO s new National Patient Safety Goal on reconciling medications across the continuum of care? Relax. An interdisciplinary group of clinicians have already done the work for you. The group, sponsored by the Massachusetts Coalition for the Prevention of Medical Errors and the Massachusetts Hospital Association, has worked for the past two years to identify the most effective ways to reduce medication errors by reconciling medications. The group includes representatives from hospitals across the state, including clinicians from such key areas as nursing, pharmacy, case management, and medical staff. What is medication reconciliation anyway? Before it could identify a set of best practices, however, the group first had to agree on exactly what medication reconciliation means. The group agreed that medication reconciliation is the process of obtaining a list of each patient s current home medications and comparing it against the physician s admission and transfer/discharge orders. The true reconciliation happens when staff alert the physician to any discrepancies, the physician makes any necessary changes, and the physician and/or nursing staff document the changes in the patient s medical record, says Paula Griswold, MS, the Massachusetts coalition s executive director. The JCAHO s National Patient Safety Goal for 2005 includes a similar definition. The JCAHO will allow hospitals until January 2006 to fully comply with the goal, although it will require hospitals by January 1, 2005, to communicate a complete list of each patient s medications to the patient s next provider of service. Three best practices for reconciling medications After trying different approaches in their own hospitals for two years, the healthcare professionals in the Massachusetts group developed the following best practices for reconciling medications: 1. Assign the primary reconciling duties to a staff member who has sufficient expertise and accountability. The floor, triaging, or admission nurse tended to be the best candidate, although some hospitals found that the pharmacist was the best choice. Other hospitals felt that it was only necessary to require pharmacist involvement for special situations, such as for high-risk patients (e.g., patients who take high-risk medications or elderly patients who take more than five different types of drugs). Tip: Be sure to document your reconciliation activities by requiring the reconciler to initial an entry in the patient s chart, says Griswold. Tip: Create a standardized medication reconciliation form and consistently place it in a visible location in the patient s chart. Consider turning the form into a medication order sheet. The form should include the dosage and frequency of each medication the date/time of the last dose information about the patient s compliance with prescribed dosages and frequency information about allergies a space for the verifier s initials a signature line for the physician People [in the group] agonized over how to get that gold-standard, perfect list, says Griswold. But don t let the quest for the perfect list be the enemy of the good list. Just get the best information you can about the home medications that patients are taking. 2. Reconcile patient medications within specified time frames. Establish time frames for this to take place, based on each patient s time of admission and medication risk. Some hospitals required the reconciliation to take place before the patient s next therapeutically prescribed dose. Others required it before morning rounds. When managing high-risk patients or high-risk Page HCPro, Inc.

5 Interdisciplinary care corner medications, many hospitals required reconciliation within four hours of admission. High-risk medications that triggered the four-hour reconciliation requirement included insulin, antiseizure medications, eye medications, and pain medications. Tip: Develop a fail-safe backup plan to ensure that staff can reach a pharmacist 24/7, such as a pharmacist hotline or a satellite pharmacy. Tip: Specify conditions that require a consult, such as when the patient takes more than five medications, cannot provide a complete list of home medications, or reports taking abnormal dosages. 3. Develop clear policies and procedures for the steps in the reconciling process. The hospitals agreed that the policies should address how to obtain each patient s home medication list and compare it to physician orders contact the physician to review discrepancies and the steps to take if the ordering physician is unavailable pass off nonreconciled medication lists at a nursing shift change to ensure follow-up by the oncoming shift identify high-risk situations that require involvement from a pharmacist, case manager, or special consultant prohibit blanket orders, such as continue home meds or resume all meds Source: Briefings on Patient Safety, October 2004, HCPro, Inc. Patient safety Spark staff excitement: Four ways to win staff support for medication reconciliation Although it s not easy to get staff buy-in for an initiative that will clearly result in more work, you may have luck if you can show staff how your new process will reduce medication errors and readmissions. If all else fails, you can always remind staff that it s now a JCAHO requirement. The following are four tips for winning staff support: Collect examples of errors or near-misses that have occurred at your facility as a result of poor medication reconciliation and show them to staff, says Andy Kosseff, MD, physician director of quality improvement at St. Mary s Hospital Medical Center in Madison, WI. If people don t feel the effort is worth it and don t use it, you haven t made an advance, says Kosseff. Measure your success regularly and share the data with staff. Show them how their efforts are decreasing medication errors and increasing efficiency. This will help support and motivate their improvement efforts. Make sure your reconciliation processes are truly interdisciplinary. Some hospitals initially tried to assign all the duties to pharmacy, but found that they had better results when they also included nurses and physicians, says Paula Griswold, MS, the executive director for the Massachusetts Coalition for the Prevention of Medical Errors. Start off small. Test your new approach by confining it to one unit or even one patient. See what you can change and do better, Griswold says. Don t try to spread it beyond a pilot unit until you ve tested it and it works. Source: Briefings on Patient Safety, October 2004, HCPro, Inc HCPro, Inc. Page 5

6 Technology training Get with the program: One ME hospital s experience with EMR Imagine looking up critical patient information with the click of a button instead of leafing through a bulky chart. Think it s unrealistic? Think again. After the Bush administration announced its 10-year plan for widespread adoption of electronic medical records (EMR), hospitals nationwide are gearing up to adopt the tool that experts say is the most significant way to reduce medical errors, improve patient safety, and save more than $140 billion a year in healthcare spending. In light of this objective, organizations should get a jump start on planning and a critical focus area is nurse training. Some healthcare organizations have already started incorporating the new technology into their programs and determined that an EMR system affects more than the facility s patient care. Nurses in Eastern Maine (Bangor) Medical Center s rehabilitation unit recently pilot tested an EMR system and gained a new outlook on information technology. The nurses have used the computer system since May, though development began 10 years ago. Pat Patry, director of clinical information systems at Eastern Maine, told the Bangor Daily News that training nurses on the new system triggered mixed results, with younger nurses learning faster than older ones. When Terri-Lee Brown, RN, first demonstrated the system s capabilities to the rehab nurses, the pilot had to be postponed because a slow system hampered patient care and nurse morale. After working out the kinks, the system was reinstated and the rehab nurses have approached it more enthusiastically, the newspaper reported. Over time, the EMR grew popular because of its speed, efficiency, and error-reducing ability. For example, the EMR reminds nurses to check a patient s comfort level after administering medication, and it also persistently reminds him or her to record the patient s response. Nurses appreciate its positive effect on their work. A lot of times I might ask [if a patient is comfortable], but then I get too busy to write it down, Brown explained to the Daily News. It s not a question of whether I do the assessment; it s a question of documenting that I did. Nurses also rely on the EMR for quick access to patient information, programmed reminders for medication and treatment, and its accurate documentation check-off system. Despite its price tag $5 million to $20 million per site Eastern Maine Medical Center hospital officials predict widespread use of EMR because of its effect on patient safety and quality of care. They plan to adopt this bedside technology throughout all units in the hospital by the end of 2004, according to the Bangor Daily News. When implementing EMR in your facility, keep in mind some nurses will meet the change with resistance simply because it is a different method than what they re used to. Make the transition a smooth one: Ensure that nurses receive training on a system that has been debugged, and emphasize the short- and long-term benefits for the nurses and their patients. Have you had to train your staff nurses on new technology? If so, we d love to hear your story! Contact Associate Editor Rebecca Delaney at 781/ , Ext or rdelaney@hcpro.com. Page HCPro, Inc.

7 Patient safety Patient safety word search Help keep patient safety fresh in the minds of your staff by challenging them to this clever word search. Tip: Consider offering a prize to the first five employees who complete the puzzle correctly, or enter completed puzzles into a random drawing for a staff appreciation prize. The reader who designed this puzzle staples it to staff paychecks each month and awards prizes to the first few employees who correctly complete it. Directions: Each of the words listed below is located in the puzzle above. Each word appears only once, either diagonally, horizontally, or vertically. Some words are spelled backwards. Circle the words as you find them. The solution appears on p. 10. Abbreviations Fire Patient identification Sharps Alarms Handwashing Power failure Slips Communication Infection Prevention Speak up Disaster Injury Read back Time out Drill Legibility Restraints Trip hazard Equipment Medications Risk Two identifiers Error reporting National Patient Safety Goal Security Verbal orders Fall Needlestick Site Marking Wrong-site surgery 2004 HCPro, Inc. Page 7

8 Diversity in nursing Nursing still lacks minority professionals: How two facilities are working to bridge the gap Minorities remain underrepresented in healthcare professions, and the disparities continue to grow. According to a report recently released by the Sullivan Commission on Diversity in the Healthcare Workforce, blacks, Hispanics, and American Indians account for more than 25% of the U.S. population but only 9% of the country s nurses. The report also says minorities constitute less than 10% of baccalaureate nursing faculty members. Some work forces mirror area demographics, accounting for the lack of representation. Vermont is not a very culturally diverse state, says Katherine Riley, BSN, RN, director, integrated clinical services, and Magnet coordinator at Southwestern Vermont Medical Center in Bennington, VT. Bennington county, where Southwestern Vermont Medical Center is located, is 97.3% caucasian. The other 2.7% is a mixture of various cultures, but no predominant culture. Our work force is reflective of this, says Riley. Because of such incongruities within the work force, the Sullivan Commission, chaired by former U.S. Department of Health and Human Services (HHS) Secretary Louis Sullivan, MD, plans to address the lack of diversity by developing new mentoring programs, analyzing admissions criteria nationwide, eliminating the burden of student debt by making more scholarships available, and pushing for considerable increases in federal funding for diversity programs. RN, MS, Magnet coordinator for the hospital. The hospital also awards a minority scholarship for nursing students and is involved in international recruiting in the Philippines. At Fox Chase Cancer Center in Philadelphia, the nursing recruiter targets nursing colleges with higher minority populations, says Anne Jadwin, RN, MSN, AOCN, CNA, director of nursing. We also send minority nurses out into local schools in the Philadelphia area to talk about careers in nursing, says Jadwin. And we ve developed a clinical ladder program for our certified nursing assistants, the majority of [whom] are African American, to promote career advancement. One boost to diversity comes from funding recently awarded by HHS specifically designated for training more nurses and promoting diversity within the field. Five million dollars of the $15 million grant goes to the Nursing Workforce Diversity Program, which supports student scholarships, stipends, and nursing retention efforts for nursing students with disadvantaged backgrounds. Questions? Comments? Ideas? Contact Associate Editor Rebecca Delaney The commission urges healthcare facilities to combat the emerging crisis, and many organizations are taking steps to address the lack of minorities in various healthcare fields. Miami Valley Hospital in Dayton, OH, has a vicepresident who oversees diversity, says Janice Mains, Telephone: 781/ , Ext rdelaney@ hcpro.com Page HCPro, Inc.

9 Communication Try these tips for productive, enjoyable meetings Although meetings are a necessary evil for most nurse leaders, there are ways to make them a more pleasant experience. From heading off the dominating egoist to energizing sleepy-eyed attendees, consider the following tips from executive coach Francine R. Gaillour, MD, president of the Gaillour Group and executive director of Creative Strategies in Physician Leadership, in Bellevue, WA: 1. Arrive early to troubleshoot. A malfunctioning PowerPoint presentation can disrupt a meeting before it begins. Allow time before your presentation to ensure that the room is still available and adequately arranged and equipped. Doublecheck that projectors, laptops, speaker phones, and other equipment are functioning properly. 2. Put the meeting in perspective. Keep your opening remarks brief. Your first agenda item should highlight the meeting s objective. 3. Acknowledge attendees. Recognize the importance of the attendees by emphasizing why you invited them. For example, say, The reason you re here is because we can t [achieve this goal] without everyone having some input. 4. Define your objectives and set ground rules to stay focused. If you have someone else speak during the meeting and they go off on tangents, ask them to postpone that topic until later in the meeting or during a separate meeting. People will get frustrated if a facilitator doesn t keep the [meeting] focused, she says. Keep a list of all tabled issues and acknowledge them at the end of the meeting. 5. Take mini stretch breaks. Rather than waiting for the break s scheduled time, take a break when you notice people fading. Consider frequent five-minute breaks rather than occasional 15-minute breaks. 6. Begin the meeting on time. Don t make prompt people wait for those who are late. Encourage punctuality by announcing that snacks will be served to the early birds. 7. Wrap up with a quick review of the facts. End the meeting by reviewing what was covered, how it relates to the meeting s initial objectives, and all of the items that require follow-up action. Handling hecklers Here s how to handle some common hurdles to smooth meetings: 1. Every meeting includes talkers, people who are the first to speak on every topic. Quiet them down by encouraging others to participate, such as by saying, Let s hear from other people who may have been thinking about this topic and who might be ready to speak. 2. If two people are talking to each other and disrupting the meeting, move closer to them. It s a very respectful way to say, I m noticing you, Gaillour says. What we don t want to do is embarrass anybody. 3. Your meeting may also include intimidators who are disrespectful while others are talking, either by using aggressive language or by interrupting. If somebody is being really verbally out of line, a facilitator may actually say Whoa, where did that come from? or Ouch, acknowledging that that was a barb, says Gaillour. 4. If you think someone is likely to monopolize the conversation or intimidate other attendees, ask that person for input on the agenda ahead of time. This will give him or her a chance to vent about the issue beforehand. 5. Follow up with attendees. Consider distributing an evaluation at the end. If you think an evaluation would be overkill, wait a couple of days and ask a few attendees about how they feel the meeting went, whether they think it was useful, and how it could be improved. But make sure to wait a couple of days, says Gaillour. People need a little time to percolate. Source: Briefings on Quality Improvement and Data Reporting, April 2004, HCPro, Inc HCPro, Inc. Page 9

10 Leadership Are you a socially competent leader? Check out three traits of effective and successful leaders As a nurse manager, you likely monitor your staff s clinical competence to ensure that they deliver highquality patient care. But have you ever given any consideration to your social competence and how it affects your leadership effectiveness? Social competence is the ability to communicate and negotiate effectively, decrease conflict, and form strong personal bonds with team members all of which can help you become a stronger leader for your unit. The following are some characteristics of socially competent leaders. Empathetic Empathy is the ability to recognize and respond appropriately to the emotions of others. It involves tuning into verbal as well as nonverbal cues to discern your team members moods, emotions, and feelings, and then modifying your approach accordingly. To become more empathetic with your staff, try the following: Practice active listening. When you actively listen to someone, you not only hear the words they re saying, but you also notice what they re not saying. Restate what you heard in your own words, capturing not only the words but also the feelings that accompany them. For example, saying What I hear you saying is that you don t like me disagreeing with you because it makes you upset. This is a powerful anger management technique to use if confronted with an irate staff member or patient. Any time you interact with a team member visualize the following words on his or her forehead: Make me feel important. Then act accordingly. Honest Various studies have shown that most people lie at one time or another. We inflate our resumes, fudge our accomplishments, and exaggerate inconsequential events. When you lie, you diminish your staff s hard-earned trust. There is no good excuse for lying or exaggerating. Only by getting in the habit of always telling the truth especially if it is at your own expense will you be able to talk from the heart, which in turn will enhance your leadership skills. People follow people whom they can trust. Humble Ego has probably destroyed more organizations than any other human emotion. Eliminate your ego by integrating the following five phrases into your everyday discussions with staff nurses, senior hospital administration, or anyone else you come in contact with throughout your day: You are right about that. I ve made a mistake. I changed my mind. I don t know. Let s agree to disagree. Source: Rinke, W. J. Don t Oil the Squeaky Wheel and 19 Other Contrarian Ways to Improve Your Leadership Effectiveness. McGraw-Hill, New York, Page HCPro, Inc.

11 Nursing in the news Vacancy rate dips in Massachusetts hospitals The vacancy rate for RN positions fell slightly in Massachusetts over the past year, according to a survey released by the Massachusetts Hospital Association (MHA) and the Massachusetts Organization of Nurse Executives (MONE). The survey showed that in January 2004 the vacancy rate was 6.8%, a decrease from the 8.5% rate reported in Despite these gains the two organizations called for an increase in space and faculty in nursing schools to widen the pipeline of future nurses. Today s nurses have greater authority in the delivery of care to patients. Students are showing new interest in a nursing field that is both personally and intellectually rewarding. We are doing what we can to cultivate that interest but we must expand enrollment at nursing schools, says Karen Moore, RN, MONE president. The Massachusetts Nurses Association (MNA) discredited the survey, saying it did not show the turnover rate for these newly hired nurses and that without legislated nurse-patient ratios, the nursing crisis will continue. Julie Pinkham, RN, executive director of the MNA, says there is no shortage of nurses in Massachusetts. What we have is a shortage of nurses willing to work under the conditions created by the hospital industry. The fact is that our state has more nurses per capita than any state in the nation. The number one problem we face is one of retention, says Pinkham. Puzzle solution Below is the solution to the patient safety word search puzzle on p. 7. S Y I R P A T I E N T I D E N T I F I C A T I O N H A R T E N O I T C E F N I E H T L O T G H M I K E K W K R H B R G W R O N E E D L E S T I C K S A S A S S R G N I H S A W D N A H S T P A T U G S T N A T I O N A L P A T I E N T S A F E T Y G O A L O T O T R O L C R P I T B C Z T B I A R A R W L S I M P E R V I L E R M G E A E R B R K I Q U R A I T Q U M E Y E T A D E A R N P A R E U P C S V R N A U A A P R Q R D N O N U I D P E Q P H O R P M T C A S R O T U E B M U B L R L T V U H A M E E S E I L T K R S I N A A T T I Y S L I P S Z M I L A S D I P I T C P O C I L L A K W Y A R L A U F K T M E T M N I L M A K N L O F C R A T E L R N I A Y R M Y R G N T E U C J G P R O O N I V P D I T T L P B P H I G C N A M U H S E D P R O E R I C N Y I L R W A N E M T S Y R P T W H E M N N T P A E M P A P T S E C U R I T Y O R O N T R S T O A T D I S T O H B R I N T R I Q U S P R A H S I R T I I L L I Y R E G R U S E T I S G N O R W E O P S O O P M O S L E G I B I L I T Y P I N Q U S N M T N W O S N A R E T S A S I D W A C G R E S T N I A R T S E R NOV./DEC. Audioconferences: Upcoming events 11/4/2004 Training Nurses to Improve Documentation Skills 11/18/2004 Complex Cases for Case Managers 12/1/2004 Reducing Delay Days To register call customer service at 800/ HCPro, Inc. Page 11

12 Staff management Need a vacation from dealing with time-off requests? How to develop fair and appropriate guidelines With the holidays quickly approaching and staff starting to request time off, now is a good time to review the effectiveness of your staffing plan. When staff request vacation time, how do you cover the department? Are staff automatically given their request without regard to patient needs? Do you allow more than one person to take vacation time at the same time? For some managers, the thought of listening to staff complain when they don t receive their time-off request is so unpleasant that they grant the requests and put off thinking about the necessary coverage for their units. Take time to reflect on the following questions which will help shape the ground rules you should set for your department: What is my priority enough staff to provide patient care or time off for staff? How do I determine who gets time off? Is it first come first serve, or should I use other criteria? Should seniority be considered when granting requests for time off? Should staff not be allowed to take time off during peak periods on the unit? Should ground rules related to time requests be in writing and posted on the unit? Should staff develop these ground rules or should the nurse manager be primarily responsible for drafting the guidelines? Once you consider your views on these questions, present them to staff for further discussion and consider developing a policy as a team that instructs how time off is granted. Working together brings greater commitment to the guidelines, which makes staff more accountable and will minimize their complaints. Source: Adapted with permission from the Manager Tip of the Month by Shelley Cohen, RN, BS, CEN, Health Resources Unlimited, 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.