Remembering the Simple Truths June 19, 2007
Posted by manthey in Relationship-Based Care, Staffing.Tags: delegation, morale, partnering, reengineering, skill mix, trust
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John Nelson — nurse researcher, president of Healthcare Environments and CHCM adjunct faculty — frequently shares data with us about the outcomes of our work with our clients. One hospital implementing Relationship-Based Care found that a richer skill mix decreased the dollars per Adjusted Patient Day, decreased ventilator-associated pneumonia and decreased patient falls with injury. John would hasten to add that this is a statistical correlation that does not indicate causality, but only a relationship between variables. I think the more we learn how to interpret and correctly discuss this kind of statistic, the better able we are to explain the importance of adequate staffing.
After the “reengineering” of nursing in the nineties (which had nothing to do with nursing, and everything to do with saving money), we lost sight of simple truths and replaced our authentic experience with “grids” which supposedly save money but which in reality wreak havoc with common sense.
Some truths we need to reclaim are:
- Skill mix should be related to acuity not to a financial goal.
- Changes in patient census should drive changes in total FTEs.
- Continuity of assignment increases productivity (having the same patients two days in a row increase productivity by approximately 25%).
- Use of support staff improves when delegation is based on trust. Working together builds trust, so pairing and partnering leads to the best use of NAs and LPNs.
- Staff should only be ‘pulled’ off their home unit when not to do so will have DIRE consequences. It should never be done just “balance the numbers”.
- Morale of the staff determines quality of care. Morale is a function of how staff members treat each other.
Introducing Relationship-based Care is an excellent way to re-introduce these simple truths and return our profession to “common sense management”.
Building Professionalism: Trust and Risk Taking August 14, 2006
Posted by manthey in Leadership, Professional Practice.Tags: professionalism, tools, trust
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M. B., a nurse from Alberta emailed me with some comments about professionalism:
I highly value the principles of professionalism but find in some workplaces and amongst some nursing colleagues that this has varying connotations and meanings. I have put this question to various professionals in health care and some exclaim that it does not truly exist. The more I search I have come to realize that professionalism in an institution is largely dependent on leadership’s belief and value of professionalism.
The extent of the leadership’s belief is reflected in how professionalism is exercised and maintained in culture of that work environment. If this belief is low, then any kind of behavior is acceptable in that work environment. If it is high, then that the culture will be of mutual respect and high trust. This indeed would be the ideal workplace but I am afraid I have been exposed to both in my life time career, thus far. The first is “hell”, the second is “heaven”.
I was very confused about the meaning of “professionalism” for a long time as well. Then I was taught about the definition used by sociologists, particularly the professionals use of autonomous decision making. I think our lack of clarity about what decisions we can rightly make (despite the clarity of language in the license) leads to the ambiguity that exists at all levels
So, first of all, there is the matter of professional practice. And then the matter of professional behavior. I find it useful to concentrate on the first: professional practice. This is where, as my friend from Alberta notes, leadership is critical. If the CEO, COO, CNO, CFO — the top leaders of the hospital — do not accept the notion that nursing is a profession with decision-making authority, they will not trust nurses.
This lack of trust creates a workplace environment that is antithetical to the normal risk-taking of decision-making. This lack of trust in employees sets up structures and behaviors that result in negative interpersonal relations. Nevertheless, I have seen many examples of creative and courageous leaders (below the level of the “Os”) who have been able to create healthy unit or departmental level cultures in spite of a lack of support from the highest level.
I know these statements are a simplification of highly complex factors, but trust is one of the major reasons some hospitals are heaven for employees, while others are hell. Couldn’t agree more. Like many of us, M. B. is looking for ways to build up professional nursing:
I am looking for more tools, any works that are currently out there to share with others to move nursing in this direction.
Creative Health Care Management has some 3-day programs that can transform nurses and their practice. One is called Leading an Empowered Organization and is for unit and departmental leaders and managers. The other two are Leadership at the Point of Care and Reigniting the Spirit of Caring, both for clinical care-givers. All three are set up so we can ‘train-the trainers’ and license the programs for use by associations, large systems, and individual hospitals
M. B. speaks for so many of us when she ends with:
I believe nursing is an honored and privileged profession/family to belong to.
