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Changing the Staffing Mindset

I orgininally delivered this speech in July 2000 at a national conference presented by The Forum on Health Care Leadership. A version of it is featured in Creative Health Care Management’s Staffing: Changing the Way We Think, a collection of essays, interviews and speeches examining the staffing problem in hospitals.

I’ve been in nursing over forty years, from staff nurse to Vice President to President of a consulting company. Woven through every single bit of experience I have, including the experience our consultants have today in the thirty or forty hospitals we visit every year, is staffing. Staffing is always, always the issue. Staffing is an inexorable pressure. It never ever ever goes away. You can have all your budgeted positions filled, you can have everybody back from a leave of absence, you can have everything just perfect and — bam! something happens to knock a hole in it. You can do the perfect job of management and — bam! –something happens. There you are, back in the mess again. Unfortunately, that’s the nature of our business. We are a twenty-four hour a day, seven day a week operation. We deal with people. It would be very nice if there was some way that line position could lighten up so that wasn’t always under pressure, but there is no way. No matter how good a manager you are, no matter how many years of experience you have, no matter how good your system is, you can have the most effective computerize predictive cyclical staffing and — bam! — something knocks a hole in it.

Let’s take that as a given — nothing can be done about it. But that doesn’t excuse not having effective systems in place. A lot of the problems that we have right now, that we’ve always had with staffing, are ineffective systems. Systems that have been designed to do the wrong thing, in the wrong way, for the wrong reasons. We put them in place in order to recruit, live with them for ten years, and they create havoc for care delivery and individual schedules. So, it’s important to keep improving the systems, to keep on making them rational and beneficial to patients and staff. But I want to talk about a staffing mind set that is, I believe, universal in this profession and has been for a great many years. I can’t remember a time, ever, when a staff nurse said, “We had enough help for the work to do today.” We have a scarcity mind set in this profession. As a result, every staff nurse every day drives to work saying to herself: “There’s not going to be enough help today. I know there’s not going to be enough help today and I’m not going to be able to get everything done today. I hope I don’t screw up too badly today.” Every day, when that shift is over and that nurse is driving home she’s saying, “Oh, I didn’t do this. Oh, I forgot to do that. I didn’t do everything I should have done. My patients didn’t get the kind of care they should have gotten and I’m angry about it.” We have a population of staff nurses going to work fearful and coming home angry. Every study on nursing satisfaction ends up with the same conclusion: Nurses love to take care of patients; they hate their jobs.I want to change the way you think about patient care. The mindset we got when we went to school was based on assessment of patient care needs: our grade was linked to the number of needs we were able to find. “What, you only got three needs? That’s a C.” “Fifteen needs? That’s an A.” Find the needs, find the needs, find the needs. The more needs, the better the grade. At no point was the issue of resources to meet the needs attached to the assessment of needs. We could assess the needs, but decision making about which needs would be met and which ones would not was not ever part of the process.

I’ve been involved in primary nursing ever since the mid-seventies. Primary nursing has been a link to resource mindset issues. When I was doing a seminar in a large New York City Hospital, some the staff weren’t too happy that the Vice President had me there talking about primary nursing. One person raised her hand and said, “Ms. Manthey, just how many patients is a primary nurse going to have to take?”

I said, “Well, that really depends on how many nurses and how many patients you have got. The best way to figure that out is to count up the number of nurses on the left hand side of your time sheet who are working full time and who are available to be primaries.”

Someone poked her and said, “You’ve got your time sheet right here. Why don’t you count them up.”

So we waited while she counted and she said “Twenty-two”.

I said, “Full time and part time?”

“No, just full-time

“Is this an ICU

“No, Med. Surg.”

“How many patients have you got

“Forty-four.”

She had twenty-two RNs for forty-four patients and the notion, just the notion of having nurses develop a relationship with patients was so overwhelming that she assumed she was going to need more nurses.

The reengineering of the last ten or fifteen years ought not to have happened the way it did. As a nursing profession we could have handled cost reductions in a much more professional way; with empowerment of staff, with much less pain and struggle. But we didn’t. The scarcity mindset is so overwhelming that we have nurses running around doing tasks all day long, never lifting their heads to look at a patient and say, “Who is this person that I’m taking care of?” We have slipped back through the reengineering process into task based work organization. This is preventing us from making the kind of decisions we need to make.

Carol Lindemen, former Dean of the School of Nursing at University of Oregon, has a solid understanding of practice issues. Four years ago, as president of the NLN she gave a speech that knocked my socks off. It was absolutely the most on target speech I have ever heard in my life. She said the current nursing curriculum and baccalaureate programs are not at all preparing nurses for the future. This is a woman who has been a baccalaureate educator all her life. She understands perfectly what is going on in education, as well as what’s going on in health care delivery systems.

She identified five skills that we need to have. They provide a fantastic foundation for our future. The first skill is critical thinking. She doesn’t talk about critical thinking skills from a theoretical framework. She talks about being able to make decisions in the real world and explain your rationale to others, even those who don’t agree with you. What we need to be doing is to be making decisions about the care we’re going to give and not give and be prepared to explain our rationale, even to those who don’t agree with us.

The second skill is establishing a therapeutic relationship with patients. We needs to establish relationships with patients that are effective and therapeutic, to balance care provider and care manager responsibilities. That means making decisions about how you’re going to use your resources.

Next, we need to become experts in nursing resource utilization. That means your own time and energy as a staff nurse. What are we going to do today and what are we not going to do. That’s the professional judgment that we’re being asked to make: How to utilize the resources of care available in a given period of time. That includes your own resources. It means a staff nurse has to own her own time. Own it. Not give control of it to somebody else.

Fourth, every nurse should have a community population focus.

The fifth skill is every nurse always being a primary care giver, which means always focusing on the future health of your current patients. Those are the five skills, critical thinking, relationship based practice, balancing care managing and care providing, a community population focus and primary care as the basis of every nursing activity. Every nursing department ought to focus its
continuing education in those directions. These are the skills we need to be giving staff. We need to stop dealing with resource utilization as though resources are always scarce.

I want to talk about workload and staffing and bring some realism into what I consider to be unrealistic and unhealthy mind sets. A unit is not four walls, a med room, a utility room, a desk area, lounge and so on. It’s really two groups of people: patients and staff. Patients have needs, staff have abilities, skills, licenses, and job descriptions. The care delivery system is how you get these two together

Let’s look at the issue of work load control. How much control does nursing have over its workload? None. Zero. That’s one of the characteristics of this profession. Let’s suppose that on a given day you’ve got X number of patients with needs that take Y amount of time. Let’s pretend that you could get a bar code wand and go over the bed of each patient before the day shift. It goes chingchingching and adds up all the time it’s going to take to provide this group of patients with the care needs they have. This patient acuity system is absolutely foolproof — bar-coded. And let’s assume that over here you have exactly the right amount of staff to meet those needs at exactly the right level of skills in exactly the right combination of personnel. Everything is just perfect. You’ve got exactly the right amount of staff to take care of those patients.

What can you do to keep it that way? Nothing. Workload is driven by two things, doctor’s orders and types and numbers of patients. At no point in time can you say, “Attention all surgeons, attention all surgeons. We have exactly the right amount of staff for the care requirements of patients on 5-C, therefore there’s a moratorium on orders. We will not accept any new orders for the next eight hours, thank you.” Can’t be done. The other thing you can never say is, “Attention all patients, attention all patients. We have exactly the right amount of staff for the amount of work that is required for your care today, therefore you may not get any better or any worse. Please maintain your current acuity level.” Can’t be done.

So you’ve got this perfect match. According to the bar codes you’ve got the exact amount of help. But you know what is going to happen at ten o’clock — boom — three patients are going to go bad. All of a sudden the patients require eleven, twelve hours worth of work in this eight hour period of time. All of a sudden there’s more hours of work to be done than there’s staff available. So you call the nursing office: “Gotta have some help. Things are falling apart up here. Three went bad. Gotta have some help right now. I don’t care if the pool is empty.” See everybody thinks there’s a pool down there. This misconception has been going on for over twenty years. I can tell you, it’s at least 25 years since we eliminated all the pools.

And the nursing office says “I don’t have anybody.”

“Well you’ve got to send somebody. We can’t go on this way. I don’t care where you get ’em; you’ve gotta get us some help. It’s desperate up here.”

And so the nursing office says, “All right, I’ll look around and see if I can find anybody.”

Now this is the situation our nurse knew about when she was driving in this morning: “If we have enough help they’re going to pool.”

Sure enough they get the call: “We need to pool somebody.”

“We can’t spare anybody, we’re just getting along today, everything is just fine, you know you always do this to us. We’re getting sick and tired of it.”

“I know but they’re desperate. They’ve gotta have some help.”

“We’ve got to get our cares finished. We absolutely can’t send anybody until we’re finished with morning cares.”

“Okay, fine send somebody as soon as they’re finished with morning cares.”

“They’re going to send somebody as soon as they can.”

“Well, we need them right now.”

“As soon as they can they’ll send somebody.”

Three hours later, someone shows up: “I was pooled to come over here.” And then at three o’clock it starts up again. The evening charge nurse comes on, looks around and says “Oh my God what’s been going on around here. This place is a mess!” Looks at the time sheet and says, “Who are they going to send? Did you call? Did you tell them how bad it is?”

“Yeah, but they haven’t got anybody down there.”

“I don’t care if they haven’t got anybody. They’d better start calling. We’ve got to get some help here. This can’t go on.”

We’ve got a mind set that says when the workload goes up we’ve got to have more resources. And in point of fact we don’t always “got to have more resources”. Now nursing is a very busy profession. There’s always more work to do than time available. When things go bad that becomes even worse. But even on the best day, when everything was perfect, nurses will say there was more work to do than time available.

Do you ever finish with a patient? Do you ever say to yourself “I’m done. All the care I’m going to give that patient they’ve had. My 2.6 hours…pft….done.” Nursing work is never done. We never sign off until this patient goes home. So when the work load goes up we expect the resources to come.

We have a sacred covenant with society. Part of the covenant we have with society is trust. They trust us so much with their lives and with their bodies that we are allowed to break society’s taboo about touching another person’s body. Society expects us to make decisions about their care that are better than the decisions than Joe Blow off the street would make in the same situation. They expect us to make decisions based on our knowledge and our experience. When we pass state boards they give us the license to do that. That’s what that license is about. We get to make decisions about the care of those patients.

We have to become a lot more comfortable with prioritizing. Now, you know, every time that workload goes up and the nursing office can’t send any help, they say, “Well you better prioritize.” When most nurses talk about prioritizing they mean putting the work in the order of importance. They never understand the reality of prioritizing. Prioritizing always involves drawing a line, the bottom line so to speak, under which things are not going to be done. What do we do when we prioritize in nursing? Nurses say what’s the most important thing, what’s the next more important, what’s the next more important. They do that all day long, next most important thing, next most important thing, next most important thing, next most important thing, and they believe if they prioritize right they’ll get everything done. Nonsense. If there’s 11 hours worth of work to do and you’ve got 8 hours of work time to do it you can only do eight hours worth of work.What we have to learn how to do is to decide what NOT TO DO.

We need to work with administration. We need to work with physicians. We need to get the courage to say “I’ve decided not to do that.” I know you’re going to say what about doctor’s orders and law suits, but I maintain that we need to bring common sense back into decisions about what we do and what we don’t do. If you have an effective relationship with a patient, and you change his dressing three times instead of four in a 24 hour period, that patient is not going to sue you.

You need to look at the sacred cows in your practice. You need to look at things like the timing of activities. Who sets the time the medications are going to be administered? The pharmacy, probably according to the delivery system. If it’s a QID what does that mean? It means to give it four times a day, right? Am I speaking a different language? Is this not true? And we actually act as if it’s an error if it was given at 10:00 instead of 9:00. But 9:00, that’s an arbitrary time that was set. If you do it at 10:00, 2:00, 6:00 and 10:00 it’s the same as 9:00, 1:00, 5:00 and 9:00. We need to gain control over the use of our resources by using common sense about what we will do and what we will not do and the way in which we will do the things that we do.

Who owns a staff nurse’s time? I look at our history a lot and I’ve looked at the impact of doctor’s orders and the meaning of doctor’s orders. This is the way I think about doctors orders now. I grew up in an era when thinking about what symptoms meant and what was supposed to be done about them was a forbidden thought process, reserved for the doctor. You’re supposed to have a lobotomy done on your brain. Just report it, don’t think about it. So I’ve had to change my mind set in a big way. I hope that some of you can see ways to change your thinking what you were taught. I think we were taught wrong.

A physician is given privileges and the privilege of the physician is to admit a patient to a bed in the hospital. Which means he now has the right to decide which of all the hospital’s resources are going to be used in the care, the diagnoses and the treatment of his patient. Here sits the laboratory with thousands of potential tests and the physician orders the diagnostic tests that are appropriate for that patient. There’s the kitchen with zillions of different diets and potential opportunities for feeding and the physician writes requisitions the appropriate diet for that patient. The physician requisitions from the pharmacy the specific medications to be used. All these departments sit here with all of these resources and the physician uses privilege to decide which resources are going to be utilized in the care of that patient. So instead of looking at what the doctor writes as an order, treat it as a requisition. If the physician requisitions more resources from nursing than it has, nursing must decide which of those requisitions are going to be honored and which ones aren’t.

It’s a very unusual situation, this business of doctor’s order. Orders come from the two foundations of healthcare: the military and the religious systems. Think about what orders mean in the army — failure to obey an order can result in court marshal and death. In a context of religion failure to obey an order after you’ve taken a vow of obedience results in excommunication and loss of your soul. We have put some stuff on that word “orders” that we must take off. Courts hold that nurses are supposed to obey doctor’s orders unless they are wrong. We are the ones that get to say whether this order is okay or not. If we follow an order that’s wrong we’re liable. When you’ve got eight hours to do eleven hours of work, the decision about what to do and what not to do needs to be made on the basis of what’s best for this patient.

When you make that judgment not everybody is going to agree with you. Not everybody has your point of view, not everybody sees the situation as you see it. Not everybody has the same understanding of your workload that day that you have. You may need to explain your decision, and you may need to explain it to people who don’t agree with you. That’s tough. Part of being a professional is deciding how to utilize the resource of yourself in the care of the patient. When there is more work to do than time available you need to prioritize and prioritizing means making decisions about what to do and not what to do. Instead of going home at night saying, “Oh I didn’t do that. Oh, I didn’t do this.” I would like you to go home at saying, “Boy, I’m I glad I decided to do this instead of that. Boy, am I glad I decided to give that patient a bath and spent fifteen minutes talking to them instead of something else.”

Years ago I studied the management theory of Jay Hall, who talked about competencies in a whole different way than is used right now. He said most of our organizations are organized around the theory that people are incompetent and need to be controlled. Most of the structures in organizational life (job description, rules, regulations, policies procedures) are there to control people and stop them from doing the wrong thing. He thought that was wrong. He thought we ought to be organized around the basic belief that people are generally competent. I loved his theory. I thought about it and I used it and I’ve brought into my work in a number of different ways. One of the things that I know is that we don’t spend enough time thinking about the good that we do. We don’t spend enough time experiencing the intrinsic rewards of competence.

I want to talk a little about energy use and competence. A lot of what we see in hospitals today is the reality of toxic cultures that are dysfunctional and people that are disheartened, dispirited, and depressed. There is wonderful book named Sacred Space written by an English nurse friend of mine. It is written for nurses. It’s about maintaining a sense of balance in yourself as you work in systems that due to the chaos and complexity of the changes in health care are often times toxic and dysfunctional. I encourage you to be thinking along these lines as you look at your work in your relationship to your work. If you are a leader or a manager, I encourage you to spend some quality thinking about how to bring these ideas into the reality of the experience of your staff nurses on your unit. Energy is a precious commodity. I’m sure you have experienced talking to some individual and you walk away and pfff — “Boy…huh… I felt pretty good before I talked to her and now I feel just awful.” Some people just pfff — it’s like they pull the plug and all the air goes out. When you interact with other people there’s always a breeze, you’re always up, feeling good, things are fine. If you have any degree of freedom over how you use your time, consciously and deliberately spend more time with people who energize you and less time with the people who de-energize you. Take some control over who you spend time with and who you don’t.

Beyond that, you can energize your own work by paying attention to the intrinsic rewards of competence. It drives me crazy when I ask nurses how they know if they’ve done a good job and 9 times out of 10 the answers are: “The physician said so,” “The head nurse told me,” “The patient said ‘thank you’.” Jay Hall says competence is it’s own reward. If you play softball and hit the ball just perfectly, you know at the moment of impact it’s a home run. In tennis or golf, it’s that perfect swing. You know the feeling that goes through you inside? You can have that same feeling when something works out really well in patient care.

If you are a manager, as you set goals for your unit and as you begin to achieve those goals, take the time to experience the intrinsic reward of competence. Teach your staff to make choices about how to use their time, then teach them how to acknowledge for themselves the importance of what they do.

Nurses in other counties cannot conceive that American nurses would ever feel that they don’t have enough help. In Germany they have eleven nurses total FTE, no other auxiliary help, for a 36 to 40 bed unit. They have two nurses on days and maybe an aide. Their average work load will be between 12 to 18 patients per RN. So they look at those ratios and then they come over here or they read our books and they think you are living in the lap of luxury. They have 10, 15, 18 patients per nurse on a day shift. They’re no busier than you are with 4 patients in an acute care, because the kind of patients that they have are much different. They’ll have patients that are in for 3 weeks being stabilized on a hypotensive medication. They see things that we never even see in the hospital any more. Their average length of stay is ten days and they have a lot of patients who are just in for long periods of time up walking the halls, sitting in the dining room having their meals.

It’s a significantly different situation but the mind set is the same. They think they have the worst staffing in the world. Every country I’ve been in, England, Australia, Canada, Brazil, Israel, Germany, they have exactly the same mind set that we do in this country:”There’s never enough help. We never have the right amount of staff. When anything goes wrong we need more help”.

Think about nursing as being resource driven rather than needs driven. Think about the resources that you have in a given day and distribute those resources in a way that makes sense to accomplish the outcomes needed. Then maybe we can unhook ourselves from the anger of not being able to meet patient care needs. That anger is devastating, and you know who’s being hurt: Nurses. Our anger over staffing issues is eroding our spirit.

I don’t know that this anger really helps increase staffing. Maybe it does. I do know it erodes the spirit. Nobody stays awake at 2 AM with heartburn about staffing issues outside of the nursing profession. I can guarantee you that. The ones who wake up with heartburn about staffing issues are the nurses who are angry. We need to find a way to deal with resource and staffing and outcomes and needs from a different mind set.

One of the things a nurse can do is ask the patient first thing in the morning, “What is the most important thing I can do for you today?” Asking that question in the morning allows you to make the right kind of decisions for that patient. You have the confidence of knowing that you’re making decisions that make the most sense for the patient. Resource driven, outcome focused, care decisions about resource utilization is absolutely the mind set that we need to have.

I don’t know how many of you have ever experienced not having enough resources for something you wanted in your life, but I have. I had two children, and I could never afford to send my kids to Harvard or Yale. My kids went to the state universities, they worked part time and I helped them with tuition. I didn’t have the resources to give my family absolutely everything they wanted throughout their life. Have any of you experienced that kind of resource deficiency in your life? Some people develop permanent anger about that kind of situation in their personal lives, but most of us learn to get over it, most of us learn how to accept the fact that we don’t have as much of something as we would like to have in this world.

If nurses own their resources, and use those resources in the best way possible to achieve outcomes that are important both for patient and nurse, we gain control over our profession. With the scarcity mindset, every new idea that comes down the path is met with “We don’t have enough.” If we live by learn Carol Lineman’s five principles, if we can learn how to rethink the way we look at our work and our resources, we can open ourselves up to some real logical delegation making the best use of the RN’s intelligence, education, experience, and license. Then, instead of being reactive to everything that’s happening in health care, instead of always saying, “We can’t do any more — I don’t want to do that — I can’t do that — I’ve got enough to do,” we can say, “Hey that’s something nursing can do.”

The RN needs to be in charge of the amount, degree and kind of care the patient is going to get. She needs to do enough care to know her patient and to understand what that human being needs, but she does not need to give all the care. I have been involved in primary nursing since day one and I have thought very long and hard about the RN role. I have worked my entire career to strengthen the role of the RN at the bedside. I’m not in any way suggesting that we step back from hands on care: That is how we get to know our people best. We have the right to intimate knowledge about human beings who are ill and the best way to gain that knowledge is through giving some care. But, as Carol Lindeman, says “we have to balance care management with care provision.” The utilization of auxiliary personel needs to be done in a partnership or a paired system, then we don’t have people running around doing a lot of tasks, but rather we incorporate them into a holistic perspective of care for a group of patients under the direction of a knowledgeable RN.

The angst in the nursing profession right now is a serious problem. I’m going to ask you to focus your attention on the historic, ancient, and ever present values of the nursing profession. I am going to ask you to provide leadership and energy and inspiration. The absolute best thing you can do for the nursing profession and for the care of people who are sick right now is to inspire your staff to find meaning in their work. Give people hope for the future and appreciation of the incredible values that have always been at the bedrock of the nursing profession.

Most of us came into this nursing profession because we believe that of all forms of human interaction, one human being helping another has the highest value. We live in a very materialistic world today that values competition, that values aggressiveness, that condones violence. We live in a world that says winners are better than losers. We nurses are goody two shoes saying “Oh no, it is far better to help another human being than to compete with them.” We’re out of step, and sometimes we feel disrespected and under appreciated.

I love the work of Viktor Frankl, the Jewish psychiatrist who wrote Man’s Search for Meaning after four and a half years of torture in Nazi concentration camps. The single message he gave me in that book is: No matter how oppressive a system is no one can take away a person’s right to define a meaning of his/her life. I insist that no matter how materialistically oriented, financially driven or business focused the health care delivery system is, no one can take away nursing’s right to define the meaning of our profession. No one can take it away, but we can give it away and we can throw it away. We have to make a conscious and deliberate effort to understand that every time a nurse goes into a patient’s room and interacts with that person in a way that alleviates pain and increases their comfort she’s engaging in an act full of nobility and dignity.

Nightingale said, “It is a dignified profession but it is up to you nurses to give it dignity.” When I first read that sentence, I thought she spoke improper English.It didn’t sound like a good sentence. But the more I’ve thought about it, the more I think it is absolutely beautiful, absolutely beautiful.

Leaders, give the staff permission to decide what not to do if there is more work than time available. If you have nurses who are making bad judgments, you need to improve their decision making ability. Managers, develop your staff. If you’re bogged down with other work, delegate as much as you can to somebody and pay attention to developing the staff. Develop their clinical competence, but, most of all, their esprit de corps. Find ways to help staff develop healthy interpersonal relationships. Find ways to use your staff meetings to inspire your staff. Make the goal of every staff meeting to have people walk out feeling more dignified than when they walked in. Use your staff meeting to inspire, motivate, and challenge your nurses to be as good to each other as they are to the patients. There’s a wonderful book called Between the Heartbeats. It’s a book of poetry and prose written by nurses. If you’re ever looking for something to use at a staff meeting, pick out one of those poems and just read it out loud. It will encapsulate the true meaning of nursing for your staff.

So change the mind set about staffing. Understand that every time the workload increases, resources are not going to increase. Sometimes, it is far better to work short staffed than to pool. Some hospitals change the floating policy to “No one will be pooled from another unit unless not to do so would have dire consequences for patients.” Don’t pull the balance numbers, because you disrupt two staffs; staff relationships are incredibly important to morale, to energy and to the spirit of nursing.

We have a wonderful profession. We should never feel uncomfortable about our values. We should never feel out of step. I believe instead that if society would adapt our values this would be a much more civilized world.

Comments»

1. Michelle Webb - February 17, 2010

Amen.

2. Jeanie Aloia - March 4, 2010

Marie,
What a fantastic way to start my day!
I live in Traverse City, Michigan and will be hosting a nursing salon on Sunday March 7 in my home. Have spent a lot of time gathering all different sorts of nurses, and am so excited to see what evolves.

Reading this validates what I try to do each day, and it is good to hear the voice of a kindred soul. I am going to be thinking of” Nursings Natural Resources” as I go about my day. I have ALWAYS enlightened people when they ask me, “where did you get your training?” I always respond–“I was educated at the University of Evansville” It is a good time to be a nurse. THANK YOU

mariemanthey - March 16, 2010

I heard your Salon was a great experience. Good for you for doing it. Are you thinking of making it a regular thing? I’m really impressed with Nursing in your community. Tell us about your Salon

3. Joseph D. Stafford, RN - November 14, 2010

I am a nurse currently studying Community Health Nursing and Practice at the RN to BSN program of Rutgers University in Camden, NJ. I stumbled on your blog after receiving an APN writing tool from a nurse in Minneapolis.

Currently I am assigned to a clinical post in a High Performance, Accountable Care, Medical Home. A not for profit DOCTORS OFFICE ON STEROIDS. Eventually, the disruption of not for profit primary care in communities with crowded emergency rooms, will revolutionize how chronic care is delivered in a community, it will be nurse managed.

I have only just glanced at some entries, but this one was the one that completely captivated me. Especially:

” …Fourth, every nurse should have a community population focus.

The fifth skill is every nurse always being a primary care giver, which means always focusing on the future health of your current patients. Those are the five skills, critical thinking, relationship based practice, balancing care managing and care providing, a community population focus and primary care as the basis of every nursing activity. Every nursing department ought to focus its
continuing education in those directions. These are the skills we need to be giving staff. We need to stop dealing with resource utilization as though resources are always scarce. ”

Thanks very much for writing and getting others to write and say the things that many new nurses are thinking about.

Joe

mariemanthey - November 26, 2010

Thanks for the comment Joe. I have to believe that discussions like this on the internet will eventually influence our practice in ways we can only imagine now. Keep reading and commenting. Share the blog with classmates and faculty. And please, pay attention to all the stuff about Salons. This is my great hope for the future. Hope you had a great Thanksgiving.

4. Joseph D. Stafford, RN - November 26, 2010

As with most things Nursing…Marie…I have to tell you that skepticism runs deep among BSN students as well as their professors. I’ll keep at it and I’ll be back for more of what you have written here. It’s refreshing.


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