1. Hader, Richard RN, CHE, CPHQ, NE-BC, PhD, FAAN

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There's never enough time!! The passing of hours quickly turns to days, weeks, and months; before you've realized it, another year is gone. Have you achieved what you wanted to in the last 12 months? If you're like most of us, chances are your list of accomplishments is far shorter than the goals you set out to tackle. We typically rationalize our lack of success by stating that there wasn't enough time to attain our stated objectives. The repetitive lack of achieving goals begs the question: Are we spending our time doing the right things?

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As leaders, many of our days are spent attending meetings, preparing reports, and coordinating department activities. We're in constant motion, causing physical and mental exhaustion by the end of the day. We initially believe that we've accomplished a huge amount, considering our enormous workload, until we reflect on our actual achievements and realize that we've, in fact, worked in a circular rather than a longitudinal motion. We spend a significant amount of time repeatedly doing the same things and accomplishing very little.


New regulatory requirements, de jour initiatives, and crisis situations tend to require new systems and processes that translate into additional work for ourselves and our staff. We tend to pile on requirements without spending the time to remove activities irrelevant to achieving success. Instead of heading in a straight line to achieve objectives, we run in circles. I call this phenomenon the "circular time trap."


One strategy to mitigate the chance that you'll fall into this management quagmire is to carefully analyze the work you're currently doing and make a determination of whether or not your efforts are yielding the desired outcomes before adding more work. For instance, if you're spending time monitoring if nurses are documenting the correct information for patients in restraints and the results aren't improving, yet there have been no changes in the process, you need to reevaluate your implementation strategies and make adjustments that may yield different results before continuing to monitor. By consistently surveying the same process that produces the same poor results, you're wasting time!!


Nurses tend to perform in a certain manner because they've been educated to do so. Many of the procedures we learned in school are based on historical performance and ritual and aren't proven to produce better outcomes. Implementing evidence-based care and protocols may decrease the amount of time you or staff members have to spend on implementation and evaluation. One such clinical performance change is the required frequency of I.V. site changes. Before research on this topic, nurses were changing I.V. sites every day; it was eventually determined that these invasive catheters could remain in place for many days with no greater risk of infection for the patient. This change in practice saved a considerable amount of time for the bedside caregiver while providing greater comfort for the patient.


When additional work is added it's important to make an objective assessment of whether this change will indeed help improve performance. If performance isn't positively impacted, you must work with your staff to head onward and upward...Avoid those dizzying circles!!


Richard Hader

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