S t r a t e g i e s. Labeling meds an issue outside of the OR. Patient safety. Immediate administration

Transcription

1 September 2007 Vol. 7, No. 9 S t r a t e g i e s Patient safety Labeling meds an issue outside of the OR Continuing Education Learning Objectives After reading this article, you will be able to: List the settings in which labeling medications and solutions must take place Describe the one instance in which medication containers do not have to be labeled After the largest decline in compliance of any National Patient Safety Goal (NPSG) from 2006 to the first quarter of 2007, the question has to be asked: What are hospitals doing wrong regarding NPSG #3D, the goal concerning medication error avoidance? The drop from 91.1% compliance of labeling medication and solution containers in 2006 to 84.8% in January March could mean that The Joint Commission surveyors were looking more closely at this goal, but more likely it was due to confusion about In this issue p. 3 Communication strategies What s the best way to improve nurse-patient communication? Communication expert Kathleen Bartholomew offers some insight. p. 6 Phone etiquette Ensuring that staff members make good impressions on the telephone is crucial to patient satisfaction. Learn the best strategies to improve phone etiquette. p. 7 Retention Changes in your hospital s culture can help recruit and retain nurses. A study about retention brings intriguing insight. p. 9 Infection control What s the best way to handle pets and animal visitors at your facility? Take a look at the measures that your hospital should take in this key area of infection control. the settings to which the goal applied. The confusion arose because the early renditions of the goal mentioned only perioperative settings. But The Joint Commission s FAQs, released earlier this year, point out that this goal really applies to all settings in which procedures take place and medications and solutions are drawn, according to John Rosing, MHA, FACHE, practice director of accreditation and regulatory services for The Greeley Company, a division of HCPro, Inc., in Marblehead, MA. The questions about what settings NPSG #3D applied to led other hospital settings to be a If I had to guess the one area that is causing most little slow to adapt, of the noncompliance, especially because it would be that staff labeling is not as members are prelabeling common in many of containers. the other settings to John Rosing, MHA, FACHE which it applies. The operating room tends to be more regimented about labeling and attending to such things as counting sponges and instruments, Rosing says. Some of these other areas may go several days between using a solution that would require labeling, and when things aren t habitual, sometimes they get overlooked. Immediate administration Last year s FAQs addressing NPSG #3D stated that the one exception to the requirement for labeling all medications and solutions drawn from their original containers was cases in which the medication or solution was immediately administered to the patient. This led to questions about how immediate was defined. If there are any interruptions whatsoever that break the chain from withdrawal to administration, you have to label it, says Rosing. A nurse can t withdraw a medication into a syringe > continued on p. 2

2 Page 2 September 2007 Patient safety < continued from p. 1 and then put that syringe down to prep the patient. That prep time would be considered a break in the chain, so a label would be required even if no one else touches the syringe, he says. The Joint Commission addressed a similar problem in a new FAQ asking whether staff members needed to label syringes if they were drawing up two medications in two separate syringes right before administering. The FAQ says this would not be allowed, because the time taken to draw up the second medication would constitute another activity and thus mean that there is no immediacy. In this instance, you would have to draw up one medication, administer it, and then do the same for the second if you wanted to avoid labeling. One issue that is causing fits for some hospitals is Editorial Advisory Board Strategies for Nurse Managers Shelley Cohen, RN, BS, CEN President, Health Resources Unlimited Hohenwald, TN Marie Gagnon, DM RN, B-C, MS, CADAC, LISAC, CISM Director, Baptist Health System School of Nursing, Abrazo Health Systems Phoenix, AZ June Marshall, RN, MS Magnet Project Director, Medical City Hospital Medical City Children s Hospital Dallas, TX David Moon, RN, MS Director of Recruitment Summa Health System Akron, OH Group Publisher: Emily Sheahan Associate Editor: Lindsey Cardarelli, lcardarelli@hcpro.com, 781/ , Ext 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, NC Dennis Sherrod, EdD, RN Forsyth Medical Center Distinguished Chair of Recruitment and Retention Winston-Salem State University Winston-Salem, NC Disclosure statement: The SNM advisory board has declared no financial/commercial stake in this activity. Strategies for Nurse Managers (ISSN X) is published monthly by HCPro, Inc., 200 Hoods Lane, Marblehead, MA Subscription rate: $199 per year. Postmaster: Send address changes to Strategies for Nurse Managers, P.O. Box 1168, Marblehead, MA Copyright 2007 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. 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. prelabeling syringes and containers. If I had to guess the one area that is causing most of the noncompliance, it would be that staff members are prelabeling containers, Rosing says. It s commonly done to save time, but it s an error-prone practice and an easy catch for surveyors. The new FAQs specifically state that prelabeling is not allowed, except for when manufacturers provide prelabeled, prefilled containers. If a staff member prelabels a container with plans to fill it later, there s a risk of someone filling it with a different solution than what is labeled. It s too easy to grab the wrong container. The problem is the news doesn t filter down to everyone in the organization, and some staff are of the opinion that prelabeling carries a low risk of causing an error, and whatever risk exists is outweighed by the efficiency such practice brings, Rosing adds. It s a matter of getting out the message from nursing to anesthesiologists that this practice is potentially dangerous and fails to conform to NPSG #3D. Container storage An additional tricky part of goal #3D may be Implementation Expectation #7, which requires original medication containers to be available for reference after a procedure. This poses a problem because many syringes are immediately tossed into sharps containers, and other solutions are discarded throughout the procedure to keep the procedure area clear and organized, and to reduce the risk of spills. The Joint Commission s new FAQ states that using sharps containers and other safe disposal methods is still allowed during procedures, because if the need arises, it is still possible to access these containers. n Source: Briefings on The Joint Commission, July 2007, HCPro, Inc.

3 September Page Book excerpt Aiming for the heart Showing your patients that you care Editor s note: The following is adapted from HCPro s new book Stressed Out About Communication Skills, by Kathleen Bartholomew, RN, MN. For more information about this book or any other from our library, visit www. hcmarketplace.com. In my role as nurse manager, I have visited more than a thousand patient rooms asking questions about patient care: Did your care meet your expectations? Is there something we could have done to make your stay better? It is the thousand answers to these questions that have taught me the most about nurse-patient communication. Quite simply put, patients either like their nurses or they don t. Lukewarm responses are rare. After listening to countless stories, it all comes down to only one thing: Patients respond to the nurse who shows them that he or she cares. Proficient as an android Consider the following scenario. Mary had been on our unit for almost a year. She did well clinically and was always on top of her patients plan of care, consistently using critical thinking to advocate for her patients needs. Yet not once in the entire year did the manager ever receive a patient compliment about her nursing. Curious, the manager visited a few of Mary s patients prior to her performance evaluation. She discovered that Mary was as proficient as an android. According to patients, she went through the steps of nursing like a robot who memorized a dance routine. The patients perception was that Mary just doesn t care, or as one patient put it, I didn t know that you could be a nurse and not care. When the manager shared the patients feedback, Mary was perplexed. She struggled to understand what was missing and, when she could not find the caring inside, signed up for counseling. Mary couldn t give what she didn t have. Often, even though most nurses do care very much, the patients perception is that their nurses do not care. This usually happens when patients perceive that a nurse is in a hurry and when there is little eye contact, touching, or small talk. Forcing yourself to slow down for just five minutes to connect with your patient will have a noticeable effect on the entire shift. To love the world, you must first love yourself For communication to be therapeutic, you must have a deep sense of compassion and love for yourself. It is this well of empathy that is most healing to patients. Knowing that someone is willing to be with them in their time of need, anger, fear, or loss can make all of the difference. The quality of It all comes down to your relationship only one thing: Patients with your patient respond to the nurse who is directly related shows them that he or to the relationship you have Kathleen Bartholomew, she cares. with yourself. For RN, MN example, if you have ever lost a child, that can resonate profoundly with another mother who has also lost a child your patient feels this instinctively. If you find yourself criticizing and judging a patient, there is a good chance that you don t forgive yourself for a similar mistake. Compassion and criticism can t exist in the same space. So if you find yourself being critical, stop and rewind. Is there an association between this patient s situation and a past event in your life? Look at this moment as an opportunity for your growth and healing. The last thing you need in communicating with patients is words. It s like having a cell phone that s not connected to any service: If you don t have a signal, it really doesn t matter what you say. Every time you walk into a patient s > continued on p. 4

4 Page September 2007 Book excerpt < continued from p. 3 room, your very presence sends off a vibration. Be aware of the nonverbal signals you are sending; if you are not, the patient will react, but you won t have any idea what he or she is reacting to. You are transparent. Even though you might not say the words out loud, the vibration comes through loud and clear. Here are some tips for staying present when you walk into a patient s room: Try to jot down as much as you possibly can in your notes. Don t try to keep a to-do list in your head. Trying to remember everything will take your attention away from everyone. Stop at the doorway and take two or three long, deep breaths before entering the room. Be keenly aware. The most important communication happens within the first minute of walking into the room regardless of whether anyone speaks. Focus in on the particular patient not room 542, not the pneumonia patient. Pay attention to the surroundings. Is the room messy or neat? Are there any flowers or candy? What does the environment say? What is it like to be in this room? You cannot define or interpret an experience for someone else. You can t always make things better. However, what you can do is stay and sometimes that is the hardest part. The feelings that patients experience are intense and unfamiliar. But when someone is willing to stay with them, to stand witness to their unique experience, it is more than enough. Presence is the ultimate service. Questions? Comments? Ideas? Contact Associate Editor Lindsey Cardarelli Telephone 781/ , Ext lcardarelli@hcpro.com Keep an open mind Patients will pick up on your fears and prejudices faster than you are even aware of them. Your body does not lie. Your patients are a mirror. Their intuition immediately interprets your subtly raised eyebrow or the few extra inches you create between you and them. No less compassion and understanding is required of a nurse than if he or she were a rabbi or minister. So what can you do? As soon as you read a diagnosis or hear something about a patient that produces an ugh or yuck within, take some extra time before you go into the room and: Search. Scan your past like a recorder on rewind for any personal history. Just being aware of a past experience will help tremendously. Personalize. Always call the patient by his or her name, and ask the patient what he or she would like to be called. Imagine. Put yourself in the patient s place. What must it feel like to be this patient under these circumstances? Be curious. What is this patient s unique story? Sometimes you may have to do some searching. What is something you both have in common? Remember. Your value system is just that yours. Still uncomfortable? Imagine that this patient is a family member. It stretches the heart open a little farther and helps you empathize. When you have time, write a small paragraph about what it must feel like to be this particular patient. Remember, judgmental, derogatory comments about a patient go against the basic tenet of nursing practice: respect for all individuals despite their situation or diagnosis. Have you ever noticed how one derogatory comment acts like an open invitation for other comments? Bad comments are contagious; don t tolerate derogatory comments about a patient from anyone. n

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6 Page 6 September 2007 Patient satisfaction Seize your one chance to make an impression Study shows that if operators can t handle calls, consumers will look elsewhere for care Your marketers have got all the advertisements in place. Direct mail pieces are ready to go out. Your hospital s new marketing plan is ready to go. But is your organization equipped to handle the swell of responses that your marketing will bring? Are your staff members skilled in phone etiquette? You d better hope so. A new white paper from Bedford, TX based research firm The Beryl Institute shows that 75% of consumers calling your hospital will give it one chance to meet their needs. That means if the phone rings and rings, if they re put into an endless circle of voice mail recordings, or if the person answering the phone can t answer their question, consumers will disregard everything they ve just heard, and instead, take their business elsewhere. If their concerns aren t addressed effectively, they re not going to call back, says Kristin Baird, president of Baird Consulting, Inc., in Fort Atkinson, WI. For some reason, hospitals and practices believe that they have this loyal following, but that s not the case. Developing phone etiquette One way to make sure that your customers are getting the best experience when they first attempt to contact your hospital is to employ mystery shoppers. Posing as real patients, shoppers call your organization at various times of the day or night and pose questions that could be asked by potential patients the ones that should be easy to answer, Baird says. During her years in the healthcare business, Baird has seen her share of telephone techniques that are sure to make potential customers run the other way. She s been at hospitals where operators don t know how to use the phone, or don t know about the newest, most exciting initiatives at the hospital, and others where employees are just rude. How often have you called somewhere, asked for a department, and before you know it, you re on hold with the phone ringing? It s poor manners to transfer someone without telling them. It s like abruptly walking away from someone at a cocktail party in the middle of a conversation, Baird says. They should ask, I d like to transfer you to that department, where someone can help you. Is it OK to transfer you? You always have to make sure you re being courteous and respectful. Some other things to keep in mind: Have empathy. Look at how your [operators] portray empathy in their voice, she says. People who answer the phone have only one means of communication their voice. Actively listen. People call our organizations with emotional information. The last thing they want is to reach someone who sounds like they ve just tuned you out, Baird says. Many times, listening involves asking more in-depth questions to make sure they can give the customer exactly what they re looking for. Know how to use the telephone. It sounds so basic, but this organization I mystery shopped for had just built a multimillion-dollar senior housing project, she says. I called and said I wanted to speak to someone about senior housing. A friendly person answered the phone, but acknowledged that she didn t know how to transfer the call without disconnecting. If I m in a market where I m checking out two or three different campuses for my parents, I m thinking, If they can t answer the phone, how are they going to handle the care of my dad with memory problems? Teach operators to think critically. Sometimes, all it takes to make a customer feel satisfied is to make them believe that you truly want to help them, even if you can t grant their original request. n Source: Healthcare Marketing Advisor, August 2007, HCPro, Inc.

7 September Page 7 Retention The right culture change can keep staff members around Many skilled managers suspect that their staff turnover is due to employees finding better pay and benefits elsewhere. However, a 20-year program studying retention indicates that monetary perks rank third or fourth on lists of reasons why people leave their jobs, indicating that low pay is not often the driving factor when it comes to turnover. Staff [members] want the nontangibles respect, meaningful work, input in decisions and a voice in the organization, open communication, and to know what to do in their job and why they are doing it, said Susan Gilster, PhD, NHA, a fellow of the Alois Alzheimer Center in Cincinnati. That s not to say money doesn t fit into the equation. The study that Gilster worked on with Jennifer Dalessandro, BS, NHA, at the Alois Alzheimer Center found that the facilities they studied spent $350,000 $600,000 per year on turnover. If facilities make a point Save the date! September 6 7, Chicago An HCPro, Inc., Seminar HCPro s Workshop for the ANCC Magnet Recognition Program Join us at the Drake Hotel to learn practical strategies to successfully achieve ANCC Magnet Recognition Program designation. Topics include assessing organizational readiness, the 14 Forces of Magnetism; the role of the project coordinator; document organization; evidence-based practice; implementing shared governance, and preparing for the site visit. To register or for more information, call 800/ or visit to cut back on these costs by increasing retention rates, they could put the savings into offering more competitive wages. According to the study, there are several techniques that managers can use to help improve retention at their facility. Revisit your vision and mission Most organizations develop a vision, mission, or credo by which to live. But how often do you review yours? Use your vision constantly, Gilster said. Ask, Why are we here, what does our work mean, and what difference do we make? Additionally, ask those questions not just of yourself and others on the management team; involve your entire organization. For example, if you don t already conduct exit interviews, start doing so. Ask staff why they are leaving, and do something with the information, Gilster said. If employees say they are leaving because their manager didn t respect them, ask them for examples. Consider hosting leadership training for all of your supervisors to help reeducate them in their roles. It is also important to survey your staff members satisfaction during their employment as well. Make sure you do not to wait until they have quit to identify problems. Also, give employees ownership of their processes. For example, at one facility in the study, too many employees were calling in sick during the weekends. The administration gathered staff members together and asked them whether they thought that this behavior was consistent with the facility s vision. The staff members said that it was not consistent, so the administration asked them what they could do to bring the actions back in line with the vision. The staff members decided that if an employee called in sick on a weekend, that person would have to work the next weekend shift. > continued on p. 8

8 Page 8 September 2007 Retention < continued from p. 7 Allowing the employees to find a solution to the problem instilled pride and accountability in their work as a team, Gilster said. Stimulate and motivate Understand that work is only a part of your staff members lives. Make efforts to connect with them on a more holistic level. Foster an environment that focuses on staff members staff [members] want the successes in their nontangibles respect, jobs, as well as the meaningful work, input other important in decisions and a voice areas of their lives, in the organization, open Dalessandro said. communication, and to Try some of know what to do in their these efforts at job and why they are your facility to doing it. Susan Gilster, PhD, NHA keep work life exciting: Celebrate accomplishments. Make a big deal out of it when a staff member finishes a school program or job-related training. Make success personal. If an employee goes above and beyond at work, send a note to his or her home praising the person for it. Go national. Nominate staff members for national awards. Many people think that they can t compete with an entire country of contenders, but the truth is that many of the awards take time to apply to, so the candidate pools tend to be small, increasing your chances, Dalessandro said. Honor your differences. Consider hosting an ethnic appreciation day for staff members. You may be surprised at the number of countries represented by your staff. Taking time to celebrate their heritage ensures that staff members become stars of the day. Seize every opportunity to educate. Offering continuing education seems obvious, but what does continuing really mean? Continuing means seizing opportunities at every opportunity. At one facility that Gilster and Dalessandro studied, the facility accepted a patient from a nearby hospital. Shortly after admitting the patient, the facility received a phone call from the hospital alerting them that the hospital had a Norovirus outbreak. Administrators used this timely and vital case as a chance to educate staff members about Norovirus and remind them of the importance of hand hygiene and other relevant topics. Survey staff members about topics that they are interested in. In addition to ongoing education relevant to their jobs, staff members might also enjoy and benefit from workshops about how to change a tire, financial planning, or health and wellness, among other interesting topics. Start off on the right foot Make sure that you keep your employees around long enough to engage in all of the great ideas mentioned above by adequately orienting your staff members to their new jobs. Gilster provided the following tips for excellent orientation practices: Don t skimp on the pay. Pay the orientation attendee a full day s salary, not a training rate. Don t shortchange new employees. Provide orientation periods that are long enough to adequately orient new staff. Take buddy programs to the next level. Having a senior employee mentor a new employee is a huge help for the recent employee. Bring incentives to your mentor programs. Pay your preceptors or mentors extra per hour for helping out. Also, make sure they are properly trained before they start precepting or mentoring new employees. n Source: Briefings on Long-Term Care, July 2007, HCPro, Inc.

9 September Page 9 Infection control Don t let IC standards go to the dogs when pets visit Continuing Education Learning Objectives After reading this article, you will be able to: List the three categories of animals that are most commonly found in healthcare facilities Recall three questions that you must answer when you consider approving a patient for pet visits Evaluate your organization s pet policy based on specific criteria Not all visitors to healthcare facilities walk upright from time to time you may find yourself having to accommodate four-legged guests and the noise, excitement, and potential infection risks that come with them. Although pets and service animals can play an important role in healthcare, they can also be a threat to patient safety if proper precautions are not taken, says Kathy Aureden, an epidemiology coordinator at Sherman Hospital in Elgin, IL, and a member of a Practice Guidance team at the Association for Professionals in Infection Control (APIC), which is participating in animal visit guideline development. There are a host of diseases (e.g., rabies) that can make the jump between animals and humans, not to mention the risk of animals soiling the facility, licking a patient with an invasive device, or scratching a patient and causing an infection. In recent years there have also been numerous cases of MRSA in animals. Such cases involved both colonizations and infections in dogs, cats, and pigs, among other species, says Aureden. But these risks can be minimized if your facility takes the time to develop appropriate policies and procedures to successfully navigate these visits. Types of visits According to Aureden, the animals that most healthcare facilities encounter fall into the following three categories: 1. Service animals: These animals are defined as any animal individually trained to do work or perform tasks for the benefit of a person with a disability. These animals include guide dogs, hearing or signal dogs, and seizurealert cats. Because of the important role that they play, the Americans with Disabilities Act of 1990 (ADA) protects these animals, and you cannot exclude them from your facility unless they would force a fundamental alteration to your practices or are a direct safety threat, according to the APIC report The Implications of Service Animals in Healthcare Settings. 2. Patient-owned pets: Often, healthcare facilities receive requests from patients who are hospitalized with a serious or terminal illness to allow a visit from a beloved pet. 3. Therapy animals: These animals are generally classified as pets and differ from service animals because of the nature of the services they provide. The ADA does not cover such pets, although some states do afford them protections under the law. Addressing the issues Your facility should take the time to create policies and procedures related to each category of animals. Aureden recommends that you consider the following tips when developing your policies: Understand your limitations under the law. We have to be careful of laws when we put together a program to ensure that we don t allow something that is legislated against in either federal or state regulations, says Aureden. Different states have different rules, so it s important to take the time to research your local regulations. This is particularly true when working with service animals, which federal ADA regulations protect. The law requires your facility to permit these animals to carry out their duties in assisting patients. With this in mind, you should plan to accommodate each animal on a case-by-case basis. Some questions to ask when planning those accommodations are: Why has the patient been admitted? > continued on p. 10

10 Page 10 September 2007 Infection control < continued from p. 9 What kind of illness does the patient have? What type of service animal is he or she using? It s important to focus on the specifics of the animal s toileting needs and, whenever possible, assign a private room for the patient that is close to an exit. It s also important to find ways to limit the animal s contact with other patients. For example, you may want to avoid letting the animal use the main elevator, which transports a lot of visitors, and plan for the patient and animal to use an alternative route. It s also a good idea to assign the patient to a room that can easily be observed by the nurses. The nurses should be looking to avert potential problems with the animal, but also to see whether the animal is alerting them to a problem with the patient. Require a physician order for pet visits. Most facilities require a physician to write such an order that states in the medical record that he or she thinks the visit is medically necessary. Encourage proper hand hygiene. Once again, proper hand hygiene is a critical tool in reducing the risk of infection, particularly when an animal is present. Patients should wash their hands prior to and after any contact with a pet. Providing trainers with alcohol-based hand sanitizers and teaching them to encourage hand hygiene can also help increase compliance. Regulate the pet s visit closely. The pet should not be permitted to visit anybody other than the patient or patients approved for the visit. Ensure that the animals that visit are healthy. There are several animal diseases that can be transmitted to humans that you need to be aware of (for a list of common zoonotic diseases, see p. 11). Rabies, campylobacter, and Leptospirosis are a few of these zoonotic diseases. To ensure the health of the visiting animals, it s critical to bar from your facility any pet that has had a fever, cough, or diarrhea-type illness in the past week, says Aureden. Your facility should also require certification of a rabies shot. Require flu shots for all handlers. People can be contagious with the flu for 24 hours before they even have symptoms. Thus, you must consider both the pet and the handler when forming your policy. Consider barring animals that have an accident in your facility. If the animal voids or defecates in the facility, it might indicate that it is not appropriate to allow that animal back in the future. Work with known service organizations. A credible organization will be aware of the inherent risks involved with pet visits to a healthcare facility and should take steps to ensure that the individuals and animals it sends to the facility are appropriate. Require temperament testing. It is imperative to ensure that animals are well-trained and well-mannered enough to ensure that they can safely interact with patients. React quickly to incidents. Animal scratches or bites are always a serious problem, particularly in the healthcare setting. Pet nails can break fragile skin and cause an infection in an immunocompromised patient. Put patients on isolation precautions off-limits to animal visits. Animals can transmit infections to patients, but the opposite is also possible. For this reason, it s important not to allow animals to visit patients who are on contact precautions. Log all visits. If you do have an outbreak that might be pet-related, you must be able to trace it back to where the pet has been. Develop an alliance with a local veterinarian to help address animal-related issues and concerns. Taking measures to incorporate these steps into your policies and procedures can help ensure that pets and infection control standards are in harmony with one another. n Source: Briefings on Infection Control, August 2007, HCPro, Inc.

11 September Page 11 Possible zoonotic risks among dogs, cats, and nonhuman primates *Indicates few challenge studies available to definitively assess efficacy of vaccine. Source: APIC report The Implications of Service Animals in Healthcare Settings. Reprinted with permission.

12 Page 12 September 2007 Tip of the month How to sell your lemonade In some of my leadership development courses, I cover the topic of how to sell staff members on the processes and ideas with which you want them to align, an obviously difficult process. We can compare this process to a person who sets up a lemonade stand that is near another lemonade vendor. What makes people buy your lemonade instead of someone else s? Whether you realize it or not, part of your job is selling. That s right you are in the business of sales. Sales is convincing people that your product or service is worthy of their time, effort, and/or money. And as a manager, you are often in the position of persuading others to buy into your point of view. One of the most well-known and respected sales gurus is Jeffrey Gitomer, author of the Little Red Book of Sales Answers. Here are a few of his tips to help you sell your lemonade. Understanding the following tips also helps answer the questions Why do so many staff want to work for a particular manager? and How are they selling their lemonade to attract more buyers? : Create an atmosphere in which people want to buy into what you are selling. A positive environment will often breed positive responses. Know your customer s needs before you try to sell them anything. It s crucial to know your buyers. Find one thing on which you can all agree. This will give you common ground and an important starting point. Ask staff members questions that inspire conversation and help to identify their needs. Not only will this show you what your staff members want, but also showing you care will create a bond of trust. n Source: Shelley Cohen, RN, BS, CEN, Health Resources Unlimited, Adapted with permission. Upcoming events September 24 Shared Governance in Practice: Strategies to build a staff-driven model of decision and action (SKU N092407) For more information, visit and click on the Nursing tab, or call customer service at 800/ SNM Subscriber Services Coupon q Start my membership to immediately. Options: No. of issues Cost Shipping Total q Print & Electronic 12 issues of each $129 (SFNMPE) $24.00 q Electronic 12 issues $99 (SFNME) N/A Order online at 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 888/ *Tax Information Please include applicable sales tax. Electronic subscriptions are exempt. States that tax products and shipping and handling: CA, CO, CT, FL, GA, IL, IN, KY, LA, MA, MD, ME, MI, MN, MO, NC, NJ, NM, NY, OH, OK, PA, RI, SC, TN, TX, VA, VT, WA, WI, WV. State that taxes products only: AZ. Please include $27.00 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) q Payment enclosed. q Please bill me. q Please bill my organization using PO # q Charge my: q AmEx q MasterCard q 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:

13 Continuing Education Exam July September 2007 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 July September issues of SNM, and you may refer to them as you take the exam. Return all four pages of the exam to us by October 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 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: July According to Lori Lupe, RN, MSN, CCRN, director of critical care at HealthPark Medical Center in Fort Myers, FL, what is one reason in particular that nurses often have problems with communication? a. Their lack of respect for staff members b. Their full workload c. They do not understand the importance of communication d. They do not interact with other staff members enough 2. What is one way to increase assertiveness in communication? a. Role-playing b. Speaking without an action plan c. Not concentrating on what could have been said differently in a past conversation d. Making judgments 3. To stay organized on the job, staff nurses must determine a technique that works for them, such as: a. Always doing the smallest or easiest tasks first b. Keeping a detailed written agenda c. Asking other staff members to help with the seemingly less important tasks d. Saving the most important things to do last 4. According to Fran London, MS, RN, health education specialist at Phoenix Children s Hospital, what is the problem with many time management issues? a. Procrastination b. Lack of organization c. Delegation d. Lack of motivation A service of Strategies for Nurse Managers

14 5. What element did Marge Battista, RN, at Riverside Regional Medical Center in Newport News, VA, add to PowerPoint training presentations? a. Sentimental testimonials from patients b. Humor c. Personal anecdotes d. Planned breaks 6. What is one of the key benefits to using humor in training presentations? a. It keeps the content fresh while captivating the audience b. Staff members do not take the material seriously c. The meetings are well-attended d. Staff members remember the humor after the presentation ends 7. What is one way to use humor in the workplace? a. With physicians b. With patient families c. In training presentations d. In meetings 8. Leadership effectiveness is based on which of the following? a. Formal education b. Real-life experience c. Rigorous reading d. Executive decisions 9. Which of the following educational tools does a mentor offer that an individual cannot normally get directly from his or her supervisor? a. New skills, pay raises, and more time off b. Broader experience, new skills, and more time off c. A more well-rounded view of the organization, broader experience, and discipline d. Broader experience, organizational perspective, and a more well-rounded view of the organization 10. To promote patient safety and implement changes in the clinical process, adoption of which of the following is necessary? a. Formal mentoring programs only b. Informal mentoring programs only c. Formal and informal mentoring programs d. Electronic health records August Gloves must be used when there is reasonable anticipation of employee hand contact with any of the following EXCEPT: a. Blood b. Mucous membranes c. Hair d. Nonintact skin 2. According to Francine Kidd, people get a false sense of security with gloves because they are focused on: a. Protecting themselves b. Providing care c. Meeting Joint Commission standards d. Impressing other staff members 3. One way to change staff members behavior regarding glove use is to: a. Threaten punishment b. Install cameras in hallways c. Use demonstrations during training d. Ignore the problem 4. Gloves are not always safe because they can: a. Change consistency b. Develop tears c. Melt in high heat d. Toughen skin 5. What can burnout potentially lead to? a. Drug addiction b. Monetary loss c. Stomachaches d. Diabetes Page 2 Strategies for Nurse Managers Continuing Education Exam July September 2007

15 6. One stay-well strategy to protect against burnout is to: a. Exercise b. Take time out c. Eat healthy food d. Work harder 7. A critical thinking program that provides a high level of support can retain up to % of new nurses. a. 30% b. 40% c. 50% d. 60% 8. According to Shelley Cohen, nurses who partake in critical thinking programs will: a. Feel confident in their delivery of nursing care b. Be more likely to make errors c. Feel inadequate d. Be deserving of more money 9. During an HCPro audioconference, of listeners indicated that their facility used a method to assess the critical thinking capabilities of their new staff members. a. 74% b. 36% c. 19% d. 44% 10. A nurse that has grasped critical thinking skills will have a(n): a. Relative sense of urgency b. Desire to explore nursing literature c. Increased risk of experiencing burnout d. Harder time with prioritizing September Compliance of labeling medication and solution dropped from 91.1% in 2006 to % in January March. a. 89.4% b. 90.2% c. 70.3% d. 84.8% 2. According to John Rosing, what area within labeling meds is causing the most noncompliance? a. Containers that are prelabeled b. Broken containers c. Wrong-size containers d. Missing containers 3. Prelabeling is only allowed when: a. Manufacturers provide prelabeled, prefilled containers b. Nurse managers give staff members written permission c. The drug company signs an agreement d. The patient gives his or her consent 4. The one exception to the requirement for labeling all medications and solutions drawn for their original containers was in cases when: a. The medication had been prescribed within the last 24 hours b. The medication was immediately administered to the patient c. The patient was intraoperative d. The patient was comatose 5. All of the following are categories of animals commonly found in healthcare facilities EXCEPT: a. Service animals b. Therapy animals c. Purebred animals d. Patient-owned pets 6. Pets in a hospital can pose a threat to patient safety by: a. Soiling the facility b. Making patients overemotional c. Frightening staff members d. Potentially running away Strategies for Nurse Managers Continuing Education Exam July September 2007 Page 3

16 7. When planning to accommodate an animal at your facility, what should you ask? a. How are other hospitals accommodating animals? b. How do other patients feel about the animal? c. How long will the pet be present? d. What kind of illness does the patient have? 8. When a patient has an animal, it is important to limit the animal s contact with: a. Staff members b. Other patients c. Other animals d. The outdoors 9. You should consider barring an animal from your facility if it: a. Has an accident b. Starts making noise c. Is too large d. Sheds 10. All animal handlers should receive flu shots because people can be contagious with the flu for hours before they have symptoms. a. 6 b. 12 c. 24 d. 36 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/ Fax or mail your exam and evaluation by October 1 to Strategies for Nurse Managers, CE Exam, P.O. Box 1168, Marblehead, MA Fax: 781/ , Attn: Kerry Betsold, CE Coordinator. Page 4 Strategies for Nurse Managers Continuing Education Exam July September 2007

17 200 Hoods Lane, P.O. Box 1168, Marblehead, MA Dear Strategies for Nurse Managers subscriber, We are pleased to announce the launch of our brand-new online resource center, www. StrategiesforNurseManagers.com. Developed exclusively for nurse managers like you, this new Web site cuts straight through the virtual clutter to put practical tools, proven advice, and peer support right at your fingertips. As a Strategies for Nurse Managers subscriber, you are now enrolled as a member of this new online resource at no extra charge. In addition to receiving your monthly newsletter, you can now log on to www. StrategiesforNurseManagers.com for: Sample tools to measure staff performance and competence Advice from recognized experts Evidence-based practices and sample tools Discussion board forums for trading strategies with peers Nursing continuing education activities Benchmarking reports about the nursing environment A searchable database of archived content to save you time Exclusive member savings on other HCPro resources, including books, videos, newsletters, and audioconferences To log in to the site, please use your current Strategies for Nurse Managers username and password. If you don t already have a username, you must verify your address with HCPro to set up a username and password. Please call our customer service team at 800/ to ensure that you are set up properly. If you have any questions about this valuable new member benefit, please don t hesitate to contact me. Sincerely, Lindsey Cardarelli Associate Editor Phone: 781/ , Ext lcardarelli@hcpro.com