Confidence and Truthfulness

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This blog is the first in a new series,
Nurses on Boards: Building a Healthier America. Wolters Kluwer is a Founding Strategic Partner of the Nurses on Boards Coalition.
 

Your presence on a board warrants confidence and truthfulness. In our turbulent health care environment, we are faced with old issues and new challenges that require immediate solutions and planning.  In the words of Helen Keller, “optimism is the faith that leads to achievement. Nothing can be done without hope and confidence.” That being said, your role on a board places you in a position of influence. Your ideas, positions, and nursing experiences, provides you with a solid foundation to influence, empowered by confidence and truthfulness.
 

How can you be confident?

  1. Learn from setbacks, failures, and success.
  2. Become well versed on the topic of discussion.
  3. Be aware of your body language.
  4. Assert views in non-threatening, non-judgmental ways.
  5. Be articulate and concise when making your points.
Your nursing perspective is valuable to inform stakeholders about the realities of the issue, evidence-based information, new research, and stories. What we communicate may have an impact on colleagues, families, communities, or society. The information and perspective you share may be the foundation for an issue that may have political, economic, and social implications both in the short term and long-term.
 

How can you be truthful?

  1. Convey authenticity through openness, humility, and transparency.
  2. Be diligent in exercising your fiduciary responsibility.
  3. Represent nursing and other disciplines at board meetings.
  4. Communicate in a way as to maintain credibility and build relationships.
  5. When you don’t completely understand an issue, ask for clarification to gain full understanding.
According to Mary Beth Kingston, Executive Vice President and Chief Nursing Officer, Aurora Health Care, Milwaukee Wisconsin, and past AONE Board of Directors, "It is important to do 'due diligence', specific preparation prior to board service by learning about the organization, it's work or product and values.”
 

Call to Action

As you serve or aspire to be on a board, remember it calls for confidence and truthfulness. We hope our column serves as a reflective tool to strengthen your influence when serving on boards.

Reference
American Organization of Nurse Executives. (2015). Nurse executive competencies. Chicago, IL:
Author. Retrieved from http://www.aone.org/resources/nurse-executive-competencies.pdf
 
M. Lindell Joseph, PhD, RN, AONE Board of Directors and The University of Iowa College of Nursing
Laurie Benson, BSN, Executive Director, Nurses on Board Coalition
 
Posted: 5/30/2017 7:14:12 AM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Leadership


Surgeon General, RN

Sylvia_Trent-Adams_Official_Portrait.jpgIt is an exciting time for nursing! On Friday, April 21, 2017, Rear Adm. Sylvia Trent-Adams, became one of the first nurses to serve as Surgeon General of the United States.

Trent-Adams was a nurse officer in the Army and also served as a cancer research nurse at the University of Maryland. In 1992, she joined the Commissioned Corps of the Public Health Service and was the deputy associate administrator for the HIV/AIDS bureau of the Health Resources and Services Administration. In November of 2013, Trent-Adams joined the office of the Surgeon General as   the 10th chief nurse officer of the U.S. Public Health Service (USPHS).

I look forward to seeing Trent-Adams’ impact on public health. Based on what I’m learning from her biography and her quotes in the articles below, I believe her nursing background will positively influence her decisions and actions.

In a 2014 Profile in American Journal of Nursing, Trent-Adams is quoted as stating:

“Nurses bring common sense to solving problems, which has not been recognized enough,” she said. “Nurses spend more time with the patient than any other health care provider.”
 
In 2015, American Journal of Nursing profiled Monrovia Medical Unit (MMU) Team 1, a group who spent 60 days in Liberia operating a 25-bed Ebola unit outside the capital city, with the specific intention to treat health care workers.

Rear Admiral Sylvia Trent-Adams, chief nurse officer of the USPHS, went to Monrovia with the team as commanding officer of the Commissioned Corps Ebola Response. She said the team "did an outstanding job." They provided "high quality care and treatment services, which were often described by our international partners as the best available care in the country," she said. "Each day we strive to 'protect, promote, and advance the health and safety of our nation,' and this mission was no different."
 
I am proud to see a nurse assume this leadership position. It is an exciting time for nursing, indeed!
   
 
Posted: 4/25/2017 3:30:24 PM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Leadership


Nurses – Get on board!

I must admit, when discussions about nurses on boards transpired here in our office, I wasn’t exactly sure what that meant. Nurses provide patient care – it’s what we study, it’s the work we do, and for many, it’s our passion. When I heard the term “nurses on boards,” I immediately thought of managers and administrators. Serving on a board wasn’t something for all nurses to consider, or was it?

Leadership-competencies-for-nurses-300x750.pngA little history
According to the 2014 American Hospital Association governance data, nurses hold only 5% of board seats in health-related organizations and corporations. Shouldn’t we be involved in the decisions that affect our health care system, our organizations, our profession, our patients, and ourselves? One of the key messages of The Future of Nursing: Leading Change, Advancing Health report is “Nurses should be full partners, with physicians and other health care professionals, in redesigning health care in the United States.” As a result of our minimal representation on governing boards and the Future of Nursing report recommendations, the Future of Nursing: Campaign for Action set a goal to get an additional 10,000 nurses on governing boards by 2020.
 
Why nurses need to “get on board”
Earlier this month, Susan Reinhard, RN, PhD, FAAN, chief strategist for the Center to Champion Nursing in America and senior vice president and director of AARP’s Public Policy Institute wrote an excellent piece, Getting nurses on board, for Trustee magazine. In her article, Reinhard addresses the gender gap and other barriers to nurses serving on boards. She also shares her path to the boardroom and the real life stories of other nurses serving on boards and how their service made an impact. For example:

“The late Connie Curran, R.N., told the story of listening as her 100-bed community hospital proposed saving money by eliminating weekend hours at its in-house pharmacy. Medication orders could be filled Friday evenings, the thinking went. The other board members, she noted, were not being negligent. But she was the only person whose experience working nights and weekends led to a few unasked questions, such as, ‘What about newly admitted patients?’ The pharmacy stayed open.”

Can you imagine working where the hospital pharmacy is closed on the weekends? This is exactly why nurses are instrumental to serving on committees, commissions, and boards where health care decisions are made. This example illustrates our unique experience and the need for us to be present where decisions are being made at the organizational level and beyond.

Overcoming barriers
As nurses, we know about overcoming barriers. We face obstacles in our day-to-day practice that force us to speak up and advocate for those in our care. In 2009, Prybil identified three barriers to nurses serving on boards:
  1. Gender – 90% of RNs in the U.S. are women and women are underrepresented on boards
  2. Belief that nurses aren’t able to weigh in on safety and quality issues
  3. Potential conflict of interest related to placing an employee in a voting capacity
How can we remove barriers and foster collaboration? Let’s focus on what we know about ourselves and our profession. First, nurses represent the largest segment of the health care workforce; there are 3.6 million of us in the United States. We are a female-dominated profession, and that should not affect our representation among the decision makers. We need to work hard to have our voices heard, and remember that we are skilled communicators and problem-solvers.

We also know the issues, especially when it comes to safety and quality care. We face these issues every day. We use the nursing process repeatedly in the clinical setting to assess, diagnose, plan, implement, and evaluate. This framework can be applied for strategically tackling any hospital-wide, local, national, or global issue. Nurses are knowledgeable and skilled and need to have a “seat at the table.”
Additionally, people trust us – that’s been proven time and again. We are on the frontlines, not only in the hospitals, clinics, and offices, but also in schools, the community, and so many other settings. And remember, we are all leaders, no matter the setting or role of our work.

The Nurses on Boards Coalition (NOBC)
The Nurses on Boards Coalition was developed to help ensure that the goal of at least 10,000 nurses are on boards by 2020 is reached. It’s a national partnership of organizations committed to this endeavor.

nobc-logo-300.png“Our goal is to improve the health of communities and the nation through the service of nurses on boards and other bodies. All boards benefit from the unique perspective of nurses to achieve the goals of improved health and efficient and effective health care systems at the local, state, and national levels.”

Visit the NOBC website to be counted if you already serve on a board, or to learn more about this initiative and board membership.
 
Wolters Kluwer is proud to be a Healthcare Leadership Organization Strategic Partner of the NOBC.
 
Improving health and wellness of U.S. citizens by placing more nurse leaders on boards
Watch this video of Chief Nurse, Dr. Anne Dabrow Woods, to learn about improving care of communities so we can improve care and outcomes for individuals. Nurses must have a voice where health care decisions are made; our unique perspective is essential to achieve optimum wellness for our patients.
This video was created for A Community Thrives (ACT), part of the USA Today Network nationwide program that provides the resources necessary for philanthropic missions in our communities to succeed.
Please consider casting your vote for this submission. You may vote once daily through May 12, 2017.
 
More Information
Nurses on Boards Coalition
Future of Nursing: Campaign for Action
American Nurses Foundation: Nurses and Board Leadership
American Nurses Association: Policy and Advocacy
References
Huston, C. (2008). Preparing nurse leaders for 2020. Journal of Nursing Management, 16(8).
Prybil, L. (2009). Engaging nurses in governing hospitals and health systems. Journal of Nursing Care Quality, 24(1).
 
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Posted: 4/12/2017 10:47:31 AM by Lisa Bonsall, MSN, RN, CRNP | with 1 comments

Categories: Leadership


All Nurses Are Leaders

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As we get deeper into 2017, let’s remember that we are all leaders, no matter where we work, the patient populations that we care for, or our role in nursing. As nurses, we lead every day – some of us at the bedside or in the clinic, some of us in the classroom, some of us in patients’ homes, some of us in the boardroom – there are too many places to list! For 2017, I’d like to focus on you – as a leader in nursing – no matter where you are. Hopefully, you already realize that you are a leader every day, but if you do need a little convincing, through the course of this year we’ll make it clear to you.
 
So how are you a leader? Ask yourself the following questions…
 
1. Are you an expert? Think of the things that your colleagues come to you for repeatedly. Maybe it’s a question about a certain diagnosis or patient population. Perhaps you’re the go-to person for placing I.V.s when there is a patient who is a difficult stick.

2. Are you an educator? Do you teach students? Do you ever precept new or new-to-your-unit nurses? Do you teach colleagues from other disciplines about the unit where you work? What about patient education? (We all do this one!)

3. Are you an advocate? Do you speak up for your patients and their families? How about for yourself? Your colleagues? The nursing profession?

4. Are you a role model? Do you take on the charge nurse role? Are you a team player? Are you a nurse that others strive to be like? Do you model healthy behaviors for patients and the public?

5. Are you a voice for our profession? Are you educated about the global issues affecting nursing and health care? Are you a committee member at your institution? Are you a member of a professional nursing organization? Are you involved in local, state, or national boards?

6. Are you a nurse? We know we are trusted by the public – in fact, we’ve been voted the most trusted of all professions for the past 15 years in a row! How often do family members and friends come to you with a health-related question or advice? The title ‘nurse’ signifies leadership to those around us.
 
If you answered yes to any of the above, then you are a leader!
 
Stay tuned as we dig deeper into each of these areas throughout the year. We’ll share resources, advice, and personal stories, and some helpful strategies as you continue to develop the nurse leader within.
 
Have a great year!
 
Posted: 2/10/2017 4:33:27 AM by Lisa Bonsall, MSN, RN, CRNP | with 2 comments

Categories: Leadership


Nurse On the Move: Lori Mayer [Podcast]

Nurse On the Move: Lori Mayer [Podcast]For this special edition of Nurse On the Move, we are featuring Lori Mayer, DNP, MSN, RN, MSCN, an MS-certified nurse and editorial board member of LiveWiseMS.org. LiveWiseMS launched in December of 2016, and is a site dedicated to supporting patients with MS, their caregivers, and health care providers. 

Our own senior editor, Kim Fryling-Resare, joined LiveWiseMS to offer her technical skills as their web editor, but also as the voice and face of the site. She was diagnosed with multiple sclerosis in 2003 and has dedicated part of her life to supporting patients like herself. She recommended that I speak with Mayer, who holds a Doctor of Nursing Practice degree and is the director of Medical Research Services for Central Texas Neurology Consultants/Multiple Sclerosis (MS) Clinic of Central Texas, as well as a chair for the IOMSN Research Committee, and member of the editorial board of the International Journal of MS Care. 

Listen to our conversation to learn more about what an MS nurse is, how to create a nursing care plan for an MS patient, and to discover what LiveWiseMS.org is all about. 

Listen for the whole interview…
Nurse On the Move Lori Mayer Podcast
 
Be sure to check out LiveWiseMS.org and recommend it to your colleagues or patients. 
 
Posted: 1/25/2017 9:10:59 AM by Cara Deming | with 0 comments

Categories: Leadership Nurse On the Move


Nursing Management Congress (NMC) 2016

Nursing-Management-Congress-program.jpgNurse leaders + Las Vegas + a Presidential election = a busy conference week! Whew…it certainly was an eventful week as nurse leaders from around the world got together in Las Vegas for Nursing Management Congress 2016!

Preconference workshops

For two days, preconference workshops were in action. The New Manager Intensive provided fundamentals for success for those new to the role, including calculations – staffing, supplies, and equipment – to effectively and safely run a unit. In addition, new managers brushed up on relationship and communication skills, as well as handling the pressures of leadership through a period of health care reform. The Experienced Nurse Leader Intensive covered topics related to the business of health care, such as aligning with organizational goals, team development, and improving performance. Other sessions during these two days included a Certification Prep Course, Creating a World-Class Culture, and Improving the Patient Experience.

An opening session to remember

This was my first real exposure to Zubin Damania, MD, aka ZDoggMD, and I am now a big fan! His humor, talent, and passion for improving the patient experience were inspiring. He encouraged us to “reshuffle our deck” and embrace a new era of health care – Health 3.0 – re-personalized medicine with a focus on building relationships.  Here’s a brief video clip from his keynote address:
 

You can find ZDoggMD on YouTube, Facebook, and twitter. His “membership-based primary care and wellness ecosystem”, Turntable Health, is truly breaking down barriers.

So much learning

While I’ve never held a role in nursing management, the knowledge and advice from the experts at NMC are beneficial to all nurses. Here are some of the pearls and tips I learned:
“To be a successful leader, you must be flexible and move quickly in decision making.’”
Opening Session
Jeffrey Doucette, DNP, RN, FACHE, CENP, LNHA
 
“Until you change people’s minds about their work habits, they’re not going to change their work habits.”
Changing the Culture of Fatigue: A Nurse AND Patient Safety Problem
Mary Lawson Carney, DNP, RN-BC, CCRN, CNE
 
“Understanding quality across the continuum will lead to improved outcomes across the continuum.”
Reducing Readmissions Across the Care Continuum
Leonard L. Parisi, RN, MA, CPHG, FNAHQ
 
“Nurses should prepare for the future by keeping their eyes on how nursing care helps patients become and stay healthy and allows the health care system to work smoothly.”
Nursing Workforce Predictions: What’s Really Happening?
Sean Clarke, PhD, RN, FAAN
 
“It’s the simple solutions that get us where we need to be.”
Getting the Most from People Around You
Andrea Mazzoccoli, MSN, MBA, PhD, FAAN
 
“The curse of knowledge…We forget what it was like to not know what we know now.”
Talkin’ Bout My Generation: Generations in the Workplace should be Your GREATEST Strength, Not Your Biggest Headache!
Libby Spears

As next year’s planning gets underway, we invite you to look at our 2016 NMC photo album, see social media highlights, and submit an abstract!
 
See you next year!
#NMCongress

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Posted: 11/25/2016 6:47:52 AM by Lisa Bonsall, MSN, RN, CRNP | with 1 comments

Categories: Continuing EducationLeadership Inspiration


Nurse On the Move: Ann Marie Marks

nurse-on-the-move-ann-marie-marksIn honor of National Case Management Week, which takes place October 9th – 15th, we are featuring a stellar Nurse On the Move, Ann Marie Marks RN, BSN, CCM. Marks has over 36 years of nursing experience. She started in the critical care field and eventually segued into case management at a time when this field was being developed.

Marks helped pave the way for the role of the case manager, including creating content for the first Certified Case Manager (CCM) exam in 1990. She’s helped define what case management entails and continues to serve as an advocate for patients by coordinating care across a large, interdisciplinary health care system.

Today, she serves as an RN case manager consultant and speaker; she presents at the Thomas Jefferson College of Health Population Health Academy, and was the #1 ranked speaker at NAHQ’s 2016 National Quality Summit. She recently served as the Director of Care Coordination at the Delaware Valley Accountable Care Organization where she continues to consult on post-acute services.  She was previously Director of Commercial Case Management for Humana, Inc., in Louisville, Ky., and as the National Director of Integrated Care Management for Aetna’s Medicaid division. In 1999, Marks was appointed by the governor of Kentucky to serve as Deputy Secretary of Health, with oversight of Commonwealth’s Primary Care Case Management Program (KenPAC), and programs within the Department of Medicaid Services, CCSHCN, and Office of Aging.

I was fortunate enough to sit down with Marks in our Philadelphia office to discuss what case management is, what it was, and how it’s evolved, including why it’s so important in today’s world of health care.

Read on to discover the vital role that case managers play and for more case management news:
  • Subscribe to Professional Case Management , the Official journal of the Case Management Society of America (CMSA).  Marks is a CMSA member and a long-time subscriber to the journal and says, “Over the years, this journal has been the source for evidenced-based studies and peer-reviewed literature for case management. It’s the most often cited and is often a source of reading materials for classes on case management. For me, this journal is one of my go-to spots when I’m attesting to the value of case management or saying a program hasn’t proved valuable.”
 
Professional Case Management

  • Check out these books on case management from Wolters Kluwer.
 CMSA Core Curriculum for Case Management, COLLABORATE® for Professional Case Management, Case Management

CMSA Core Curriculum for Case ManagementCOLLABORATE(R) for Professional Case ManagementCase Management












The interview:

Q: You’ve been a registered nurse for nearly 40 years and specialized in critical care. What made you decide to become a nurse?
A:
When I was 15 my father was in a horrible auto accident. He was taken to a larger city hospital about 70 miles from our small town.  His jaw was wired and he had a chest tube, a feeding tube, and many injuries.  He could not be left alone, and my mother needed to return to her position as a teacher.  Somehow I was nominated to “stay” with him. I slept on a cot in his room and within a day the nurses and doctors started teaching me to care for him. I learned so well that they allowed me to take him home three weeks earlier than anticipated! Three years later, I was awarded a college scholarship to a college that had a Bachelor's in Nursing and knew I wanted that. But having the experience of living in a hospital for eight weeks and caring for a complex patient, my dad, certainly influenced my choice to be a nurse. It was the confidence those nurses instilled in a teenage girl.

Q: How did you enter into the case management field?
A:
It seemed like years before what I did was called case management. When I entered in the early 1980’s, we were referred to as rehabilitation nurses.  It was my encounter of a “rehab nurse” when I was working in ICU that inspired me to explore the field. A nurse arrived in our hospital to discuss a patient who had been in a catastrophic industrial accident. She was very business-like and wore a suit! I found it intriguing that she was a nurse, not providing direct medical care (treatments, medications, etc.,) but was coordinating the care. I came to learn that she was working for a company that provided services to large self-insured employers and insurance carriers. Eventually, I was able to get my foot in the door there. The president, Mary Gambosh, hired me part-time, and challenged me with expanding her business in Kentucky.

But more importantly she trained me about the principles of good case management, and shared everything she knew. Mary assigned me to a large account in the coal fields of eastern Kentucky. That was the beginning of a great career in case management and the expansion of nursing for me and a mentorship under one of the legends in this field, Mary Gambosh, RN.

Q: Can you define what a case manager is and speak to why the name, “case manager,” has changed over time from patient navigators to care coordinators, etc.?
A:
I think the word “case” was always there because the insurance companies would “refer you a case;” I first started to hear the term “case manager” in various states’ Departments of Insurance.  As long as I have known about case management, I have associated it with advocacy, care coordination, and resource management. Even when I entered the field as a ‘rehab nurse,’ I knew that the profession of case manager was evolving, and there was a need to distinguish the education and experience of the professional who did this work. In the late 1980’s, talk started to ensue among the rehabilitation nurses, the certifying agencies, and other professions with great debate about who would qualify to sit for an exam to be a ‘case manager.’ Simultaneously to this, we started to see case manager roles expand inside the hospitals, among payers, and self-insured employers themselves. Components of utilization management, hospital bill auditing, and care coordination became requests of those in this field.  I have seen the new titles of care coordinators and navigators, and I am pleased when I see the job descriptions that often state, “CCM preferred.” The certification attests that you meet a certain competency and experience level to sit for the exam. We do help patients and families navigate complex systems. We do coordinate care. Case management is about making things happen!

Q: How are case managers patient advocates? What is vital about this role in the health care system?
A:
In addition to their clinical experience, the case managers have training in the benefit systems and reimbursement systems that pay for the services. Helping patients access their benefits and manage those benefits effectively is often critical to the outcome. Advocating for quality care, access to care, and even evidence-based care, is part of the advocacy. Sometimes it’s as simple as getting people involved in the patient’s care to listen—to take a pause and think about what the patient is trying to say or wants.  In a world that is stressing value-based care and quality performance measures, the case manager role becomes more vital. We are vital to driving quality health care, helping manage benefits at the right place, right time, etc., and ultimately to the cost management of large populations.

Q: Can you describe an important case you’ve worked on?
A:
One that always stands out in my mind was a victim of a mass shooting known as the Standard Gravure Shooting in Louisville, Ky., in 1989.  It’s important to me because gun violence and violence in the work place has become a weekly headline.  But this event drew national publicity.  Within hours of the shooting, I was being called to be the case manager for some of the victims. One was a gentleman who had worked in the plant over 40 years. This wasn’t just a patient with serious physical wounds, but one with emotional trauma. I remained a part of his case until the day he returned to work, which was his personal goal. I followed him the first year in his new job.  But this patient, this case, changed my awareness of the importance of integrating physical and behavioral health into care planning. 

Q: What is the biggest challenge related to case management?
A:
Establishing trust with patients.  Today we talk about “patient experience” and “patient engagement” and this applies to case managers as well. Many patients or families initially see you as the person who is coming to take something away. It takes skill to help a patient with complex issues to understand that you are there to assess the situation and can actually help. There are also challenges in health reform itself and the demand for quality case managers. 

Q: I understand you helped write t sample test questions to become a certified case manager in the 1980’s. How has this specialty evolved since then?
A:
Back when case management started, it was very episodic. Up until the early 1990’s, you would take one case, then another, and we thought that receiving a case referral six months after a diagnosis or three months after an injury was “early.” It used to be based on the idea that something had to have already happened. Now, I’m looking out across the population with predictive analytics information on a subset of that people in a community and trying to identify where I could best place a case manager.

An additional change is the growing numbers of certified case managers. The recognition of case managers in the continuum of health care has been part of the evolution. They are valued as key members of the team, in whatever setting. Case managers have started to be identified as part of the preventive services, not just a referral after a catastrophic event.

Q: Why should nurses in other practice areas pay attention to National Case Management Week and what are some ways nurses can celebrate?
A:
National Case Management Week, like other specialty recognition weeks, affords an opportunity to learn about nurses and other professionals who are part of an integrated care team. Gaining insight into the training, the various job roles, and what a case manager can “make happen” could help other nurses collaborate with this key person on the team.  It might even help nurses who are interested in the specialty of case management find an open door.

Q: What do you see for the future of nurses and case managers?
I see that the role of nurses in general has really come back to that primary care model. We want to coordinate end-to-end care for the patient, and I think the future holds more case managers taking the lead coordinating for the patient across the entire continuum of care. I see unlimited possibilities, but I certainly see an increased demand not just for nurses, but for case managers. Technology will also continue to play a big role. The skill sets have changed and over the years I’ve hired 2,000 case managers in a variety of settings, and I can tell you that the skill sets to do this work require so much knowledge about the software for the documentation and for the reporting. Plus, many of our case managers are virtual, so the settings will continue to change. A person needs to survive in a virtual workforce.
 
Posted: 9/23/2016 9:47:00 AM by Cara Deming | with 1 comments

Categories: Leadership Nurse On the Move


Working Around Work-Arounds

nursing-workarounds.pngWe’ve all experienced it over the years…the frustration of having some piece of equipment, computer program, patient care process, person, or policy get in the way of getting the job done. Sometimes it’s because the thing or situation that’s standing in our way is broken. Other times it’s because there’s no rule in the playbook that addresses exactly an unusual circumstance. The end result is often the creation of a work-around…and nurses can be extremely creative!
 
Work-arounds circumvent established procedures, policies, and processes. In some cases, they truly may be needed to get an essential task accomplished because the current system has not yet caught up to the realities of clinical practice. The work-around may ultimately indeed be the right way, but just continuing to do it informally may be viewed as a much quicker and easier path to travel than the journey to making it a permanent solution. Depending on the nature of the issue and the organizational change process that’s needed, there may be tedious processes to follow, forms to fill out, a chain of command to invoke, a business case to make, committees to form, places to go, and people to see. 
 
In other words, the real solution can appear a far-off, daunting task that requires considerable expenditure of time and energy and quite possibly a measure of stretching way beyond a personal comfort zone into organizational bureaucracy. There’s a very real chance that the proverbial “squeaky wheel” that brings the matter to light could wind up the owner of the issue and be expected to be part of the solution. However, if the work-around makes things look like everything is working just fine, there’s no obvious burning platform as the catalyst for necessary change. The problem may remain invisible to the larger system and go unsolved. If leadership is unaware, there’s no opportunity to submit requests for maintenance or budget for new equipment, system upgrades, or even necessary material or human resources.
 
Another category encompasses the work-arounds that may simplify the job or allow it to be accomplished faster, but bypass safety measures put into place to reduce risk. Ignoring established safety practices that are perceived as cumbersome is an example. Staff may become so good at these that the work-around escapes detection. These types of work-arounds can evolve to become the usual practice or even the cultural norm.  They may be passed along to new staff members as tips or tricks to be more efficient to the point that staff stops seeing the strategy as a work-around at all. Direct observation might be the only way to spot this situation. Nurses who follow the rules can experience considerable moral distress when they discover that co-workers are using such work-arounds inappropriately. They are then placed into the very difficult position of either turning a blind eye (which has significant ethical and even professional regulatory implications), or acting as a whistle blower to management.
 
My advice is that if a work-around is felt to be necessary, there’s a problem with the current system that must be addressed. That includes those situations where the work-around is done to make the job easier or faster but bypasses safety measures. Perhaps the safety measures could be maintained and risks reduced if the system was re-designed in a way to make it easier to do the right thing while still meeting all of the standards and regulations. Our knee-jerk in healthcare often involves creating a new form to fill-out or coming up with a new tedious process that gives the illusion of a safety improvement, but instead just adds another barrier that people look for ways to overcome. We need to think broadly and be truly innovative. Strategies include researching current best practices, connecting with staff at other organizations to learn how they manage similar issues, and even investigating if there are applicable innovative solutions in industries outside of healthcare. 
 
We do need to make processes associated with nursing practice and healthcare in general safer, easier, more efficient, and more effective. The appearance of a work-around is a red flag for an improvement opportunity.  Rather than allow it to persist or remain obscure, bring the situation to light and be an advocate for necessary change.  Keep in mind the old adage: if you always do what you’ve always done, you will always get what you’ve always got. When confronted with a work-around, take on the challenge and demonstrate individual leadership, advocacy, and the courage to engage in true problem resolution. 
 
Happy Nurses Week!
 
Linda Laskowski-Jones, APRN, MS, ACNS-BC, CEN, FAWM, FAAN
Editor-in-Chief, Nursing2016
Vice President: Emergency & Trauma Services
Christiana Care Health System – Wilmington, Delaware


 
Posted: 5/8/2016 6:09:52 AM by Lisa Bonsall, MSN, RN, CRNP | with 1 comments

Categories: Leadership Patient Safety


Safety in the Healthcare Workplace: How Safe Do You Feel?

workplace-safety.PNGSafety is something we think about constantly in our daily lives. We look both ways when we cross the street, we buckle our seatbelts when we get into the car, and we put on helmets when we participate in outdoor activities, such as biking, skateboarding and skiing. For many, safety is not an all-consuming concern at work. As health care providers, however, we are exposed to a multitude of dangers every day. According to the United States Department of Labor, Occupational Safety & Health Administration (OSHA), a hospital is one of the most hazardous places to work.1 Health care workers experience some of the highest rates of nonfatal illness and injury – surpassing both the construction and manufacturing industries.2 In 2011, U.S. hospitals recorded 253,700 work-related injuries and illnesses, a rate of 6.8 work-related injuries for every 100 full-time employees.1

At work, I regularly lift, turn and transfer patients with limited mobility, strength and balance. I often encounter confused and combative patients who pose a great risk to themselves and the clinical staff. The threat of a needle stick injury and the possible exposure to infectious diseases are two dangers that are perpetually at the forefront of my mind. In nursing school, we were taught basic ergonomic techniques to protect our backs. We were instructed on procedures to prevent unintended exposure to blood borne pathogens. But in the fast-paced world of health care, where patient loads are high, many of these safety strategies fall by the wayside. By nature, nurses often put their own health and safety at risk for the benefit of the patient.3 So, how safe do we really feel at work and what are hospital administrators doing to protect their employees?

In 1979, Congress passed the Occupational Safety and Health Act, which resulted in the creation of the OSHA. OSHA is the government body responsible for ensuring a safe and healthy working environment for employees by setting and enforcing standards and by providing training, outreach, education and assistance.3 When I began working in the intensive care unit many years ago, I remember having to complete my first annual competency checklist, which incorporated mandatory lectures developed by OSHA. Topics included blood borne pathogens, fire hazards, fall prevention and methicillin resistant staphylococcus aureus (MRSA). Today, those topics have expanded to include latex allergy, equipment hazards, workplace violence, and workplace stress.4 These topics are just a subset of the hospital-wide OSHA standards spanning every department from dietary to central supply to housekeeping.

One area of hospital workplace safety that has received great attention in the media in recent years is the use of Personal Protective Equipment (PPE). This issue was highlighted in the news when the first laboratory-confirmed case of Ebola was diagnosed in the U.S. in September 2014.5 Controversy surrounded this story, which began when a man, who arrived from Liberia initially without symptoms, walked into a Texas emergency room complaining of fever and other flu-like symptoms. After being discharged, he was readmitted several days later and diagnosed with the Ebola virus. Personal Protective Equipment was provided to the staff assigned to the infected patient. Despite these safeguards, however, two clinicians were exposed and ultimately contracted the deadly virus. Thankfully, both nurses survived, but fingers pointed to the hospital administrators, placing blame on their inability to properly educate and ensure the safety of their staff.  Were they at fault or just inadequately prepared with minimal resources to deal with this seemingly rare occurrence?

Ebola is an extreme example that emphasized the importance of hospital workplace safety and one that forced hospital administrators across the country to evaluate current policies and procedures. All workers, regardless of the industry, have a right to a safe work environment. Have you noticed any areas of your hospital where improvements could be made to increase overall safety? Do you have recommendations or a success story to share? We would love to hear from you – please leave your comments below.

Resources
Occupational Safety & Health Administration (OSHA): Worker Safety in Hospitals 
Occupational Safety & Health Administration (OSHA): Hospital eTools
Improving Patient and Worker Safety: Opportunities for Synergy, Collaboration and Innovation (Joint Commission)
References
1. U.S. Department of Labor: Occupational Safety & Health Administration. (2016) Worker Safety in Hospitals: Caring for Our Caregivers. Retrieved from: https://www.osha.gov/dsg/hospitals/index.html

2. The Joint Commission: Improving Patient and Worker Safety. Retrieved from: http://www.jointcommission.org/assets/1/18/tjc-improvingpatientandworkersafety-monograph.pdf

3. U.S. Department of Labor: Occupational Safety & Health Administration. (2016) About OSHA. Retrieved from: https://www.osha.gov/about.html

4. U.S. Department of Labor: Occupational Safety & Health Administration. (2016) Hospital eTools: Intensive Care Units. Https://www.osha.gov/SLTC/etools/hospital/icu/icu.html

5. Centers for Disease Control and Prevention (2016). Cases of Ebola Diagnosed in the United States. http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/united-states-imported-case.html

Myrna B. Schnur, RN, MSN


 
Posted: 5/7/2016 5:56:22 AM by Lisa Bonsall, MSN, RN, CRNP | with 1 comments

Categories: Leadership Patient Safety


Every Day in Every Way

As health care professionals, there are few things more agonizing than listening to a grief stricken mother describe how her young daughter, bravely fighting cancer, died during a hospital stay as a result of delays and failed communication. Looking at the audience at the Patient Safety Seminar that day, you could see that all of us felt her pain. After all, we got into the medical field to help people, to heal the sick and care for the most vulnerable, but in this case, we failed. Sadly, I have heard versions of that mom’s story many times throughout the years. The specifics change, but the result is the same -- the loss of life or permanent injury as the result of a medical error.
 
We aren’t perfect, I tell myself, as I hear those excruciating stories. We are human beings and sometimes, despite our best efforts, we come up short. But inevitably, as I let their brave messages sink in, I use those heartbreaking stories to motivate me -- to dig deeper and try harder and to become a more determined advocate for improving patient safety.    
 
Culture-of-Safety-NNW-logo.png

The American Nurses Associations (ANA) theme for National Nurses Week this year is Culture of Safety – It Starts with you. Since the landmark Institute of Medicine (IOM) report, To Err is Human: Building a Safer Health System was released in 1999, creating a culture of safety has been a major focus in our profession. The notion that medical errors resulting in patient harm are largely preventable and a result of system failures provided the platform for health care culture reform. 
 
The IOM report provided clear recommendations to address medical errors. The government, professional organizations, and health care organizations have all worked towards reducing preventable medical errors. There is a plethora of information on culture of safety, including webinars, how to guides, frameworks, guidelines, etc. While we have made progress, preventable harm occurs in hospitals every day. 
 
So what is a culture of safety? A culture of safety is an environment in which patient care is safe and effective, and patients are free from preventable harm. The complexity of systems in which health care is provided makes this challenging, but not impossible.
 
So, how can every nurse take a leadership role in creating and sustaining a high reliability culture of safety?
  • Actively engage patients and their family as partners in care.
  • Approach care delivery with interprofessional collaboration and teamwork.
  • Promote a culture of blame-free reporting of adverse events and near misses; analyze and learn from them.
  • Implement evidence-based best practices; remove barriers to ongoing sustainment.
  • Maximize the use of technology as intended.
  • Improve hand-off communication and transitions of care.
  • Maintain a high level of situational awareness in your work area to anticipate problems ie., rounding, huddles.
  • Speak-up if you witness or identify unsafe behavior or safety hazards and hold each other accountable to safe practices.
  • Establish goals, measure outcomes and promote transparency of data.
During Nurses Week this year, let us all make a commitment to ourselves, our teammates and those we care for, that we will become better patient advocates. Let us learn from those heartbreaking stories of loss and take whatever steps are needed to create and sustain an environment founded in a culture of safety -- every day and in every way.
 
Susan Mascioli MS, BSN, RN, NEA-BC, CPHQ, LSSBB
Director, Nursing Quality and Safety
Christiana Care Health System


 
Posted: 5/6/2016 7:31:48 AM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Leadership Patient Safety


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