1. Doucette, Jeffrey N. DNP, RN, CEN, NEA-BC, FACHE

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Is staff text messaging bad news?

Q I've noticed a recent trend of my staff members using their personal cell phones to communicate with providers via text message. Are there rules and regulations about this practice?


This isn't a good practice and it's something that should be immediately addressed. There are several problems and pitfalls with this approach to communication. The Joint Commission has clearly stated that texting isn't an appropriate way for clinicians to communicate orders about patient care issues because there's no way to record the original order or to verify that the order is, in fact, coming from the person to whom the sending number belongs.

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There are also significant concerns about patient privacy in this scenario. Even if a text messaging service is HIPAA compliant, there continues to be the issue of identity verification. Furthermore, there are potential issues with labor relations by requiring staff members to give out their personal contact information and/or to use personal devices for company business without compensation.


All in all, this is a practice wrought with problems and not one the prudent nurse leader should allow or endorse.


SWOT + gap analysis = positive change

Q I've been asked to help write a business plan for a new idea I'd like to implement. My organization requires both a SWOT and gap analysis. What's the difference?


SWOT is an acronym for strengths, weaknesses, opportunities, and threats. This method of assessment is widely used in healthcare to evaluate the current state of a particular issue or challenge. The strengths and weaknesses can be found in the organization's functional areas or they may be a consequence of interactions between different functional areas. Strengths and weaknesses of a particular issue or challenge should be evaluated at multiple levels (individual, unit, department, and organization) to produce a meaningful SWOT analysis. Opportunities and threats are generally focused on environmental factors-both internal and external-that may have an impact on the issue at hand.


In contrast to the SWOT analysis, the gap analysis is a tool used to determine what's needed to get an organization, team, or unit from its current state to a desired future state. This approach starts with the desired state and then works backward to the current state, identifying measurable milestones that need to be met to achieve the future goal. The leader then develops the action steps needed to move from the current to the desired state. This tool can also assist in accelerating organizational decision making. The outcome of the gap analysis is to identify where "gaps" exist between the organization's descriptions of practices and the desired state.


The combination of the SWOT analysis to assess readiness and the gap analysis to determine the path forward is a powerful management tool that you can use to understand the change process.