1. Section Editor(s): Raso, Rosanne MS, RN, NEA-BC

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As managers-and as leaders-we're expected to deliver outcomes. Some are short-term: Is your quality improvement report done? Some are intermediate: Are your salary expenses back to budget by next month? And others are long-term: Have you improved your nurse communication HCAHPS results by three points year to year? Without a clear strategy and expectations of yourself and your staff, none of these goals will happen. At times, we get lost in the day-to-day and leave our expected outcomes to chance, hope, and possibly even prayer. This isn't the path to success.

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Often, although not always, the data and/or evidence lead us to a strategy and we find our way. Perhaps you, your colleagues, and/or your staff members are part of a work group that develops a project plan to follow. Maybe your bosses are crystal clear about specific expectations. We're not talking about endpoints; rather, how to get to the endpoint. It's so much easier when you have a path, you know the steps, and the expectations are defined. You also have to know the "why"-when there's purpose and meaning behind what we're doing, there's a much greater chance of favorable outcomes.


Your staff members need the same surety. Do you expect everyone to be on time and participate in bedside shift report? Are you anticipating respectful interactions at all times? Call bells answered within 1 minute? Three minutes? What about regular patient rounds, chlorhexidine bathing for patients with central lines, or teach-back with patient and family education? You must make your expectations clear to everyone responsible-both the why and the how. And there must be follow-up, either by you or via a peer model. Acknowledge those who do and coach those who don't-immediately. The rules of engagement must be defined, understood, and doable.


Be crystal clear on what you want and why you want it. If not, you won't see it happen and your outcomes will suffer. This isn't a power move; it's leadership and should be done collaboratively with staff. Your expectations may need a workout to make sure the necessary steps are achievable and resources are available. Whatever shared governance or participative management model your organization employs, use it to develop an action plan for your unit or department that will actually work.


Look. Ask. Listen. When there's a specific process to be followed, you shouldn't wait for failure and then go back. You want a dynamic, high-reliability environment in which the expectations are lived and everyone has a sense of purpose. Feedback is essential or else it won't stick, positive or negative. Does this sound like an accountability model? Yes. Does it sound culture changing? Yes!


As we know, there's more to positive outcomes than the paragraphs on this page. It should be so easy. Foundationally, these elements are the key to positioning you and your staff for success. Clarity of expectations-with a purpose and a goal-is a basic element on the path to results. Are we clear?



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