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Strategic Problem Solving at the Staff Nurse Level December 13, 2005

Posted by manthey in History, Leadership, Professional Practice.
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What is Wrong with this Picture?

Several times a week, in hospitals all over, system or another breaks down requiring a staff nurse to “fix” the problem so a “patient” won’t “suffer” from the breakdown. Maybe it’s pharmacy sending the wrong drug, or not sending it on time, or a late tray that never arrives for a hungry patient, or the transporter arriving without a wheelchair to take a patient for a test. You know the situations.

Time after time, nurses stop what they are doing to “fix” the problem. Eventually their frustration mounts to the point they tell their nurse manager that something needs to be done.

What would Nightingale do?

She would assess the pockets of power, align herself with strong allies, and convince people that a solution to the problem will be found. She had an extraordinary knack for letting some things go until they had to be fixed. I’m reminded of the story that when she arrived in Crimea the British Military Surgeons refused to let her enter the hospital. They did not want to deal with a “do-gooder” … and a lady at that. The fact that she arrived with a ship fully loaded with medical supplies, dressings, bedding, food, clothing, etc. gave her the leverage she needed. She responded to their refusal to let her enter the hospital by refusing to allow the ship to be unloaded. For some days it sat in the harbor with desperately needed medicine, equipment and supplies, until the surgeons changed their minds and invited her and her nurses to come work in the hospital. It seems clear to me that during those days the ship was in the harbor, there were patients who “suffered” because they didn’t have the food and medicine on the ship.

The lesson I take from this is that the strategy of letting a failing system fail might be better than the situation-by-situation “fixes” nurses engage in, which take them away from the patient.   Strategy is important. Over the next few weeks, I’ll share some examples of potential strategies I’ve either seen work, or would like to see someone try. Meanwhile, please share strategies you’ve used or heard of to get failing hospital systems to work better.


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