Roberta Abrams: The Patient has turned the corner

[NRSKarenRN, BSN, RN]

THE PATIENT HAS TURNED THE CORNER

By Roberta B. Abrams, RNC, MA, LCCE, for HealthLeaders.com

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http://www.healthleaders.com/news/print.php?contentid=37876

The patient is nursing.There are signs of nascent recovery. This is a good time to review those signs and to focus on the problems that remain and could still doom the patient. But there is reason for hope.

Groups across the nation have been working on the problems of nurse retention and recruitment. Nursing leaders are working to solve the issues that have driven nurses out of nursing. Mandatory overtime, for one, was a major offense. It has been eliminated in many facilities and is in process of elimination in others.

Staffing levels are a major focus in most healthcare facilities. The multi-focused solutions being implemented include:

*Recruitment bonuses

*Use of professional staffing agencies

*In-house "float" pools

*Flexible scheduling programs

*Legislation mandating staffing levels for disparate types of units

While some of these solutions are valid both for short and long- term use, others, including the recruitment bonuses, have significant downsides and should only be considered as temporary patches for the current crisis in nursing. It is also appropriate to note that recruiting new staff is an exercise in futility if the institution does not also address the issues involved in retention. Nursing administrators whose leadership styles demonstrated lack of requisite knowledge and skill are being helped to either become leaders or to find new career opportunities. (Yes, I am aware that there are still many more "opportunities for improvement" in this area.)

Pathways offered to facilitate leadership development include:

*Courses in leadership offered as part of advanced education programs at colleges and universities

*Workshops that focus on leadership skills

*Mentoring of new leaders by those whose abilities to lead are attested to by retention levels or by achievements including *Magnet Hospital designation.

Leaders deserving of that title are working to demonstrate the value they place on the staff. They empower their staff by sharing the governance of the facility. Representatives of nursing staff from all areas in the hospital convene on a regular basis with nursing leaders to discuss matters involved in patient care within the facility. Their jurisdiction includes:

*Staffing levels and staffing patterns derived from trends in unit census and acuity

*Supplies for the unit, including reviews of new equipment and materials

*Practice patterns on the unit, including review of protocols, policies, and procedures.

*Collaborative practice committees to improve communications among caregivers, including physicians

Another way nursing leaders and hospital administration demonstrate the high regard in which they hold the staff is by investing in its continued professional grow at all levels. Forward-looking hospitals have a system of career ladders to guide and support non-professional staff toward professional careers in healthcare. Forward-looking hospitals allow professional staff to continue their growth by allowing the time and funds for them to pursue advanced degrees or professional continuing education programs.

At a recent professional nursing conference, I was appalled to discover the number of nurses who had to use vacation time to attend the conference and to pay all conference expenses out of their own pockets. Failure to support activities such as attendance at national nursing conferences certainly sends a message to that staff and to their colleagues about the value system of their managers. The good news was that there were a number of nurses who, despite the failures of their managers, demonstrated enough professional pride to attend regardless of time constraints or fiscal challenges.

In another vital part of the healing process for nursing, leaders from nursing administration and nursing education are meeting together to build bridges across the longtime chasms that have harmed each of them. Together they are examining trends in healthcare delivery systems to ensure that students' education is truly preparation for practice. They are finding new ways to provide clinical experiences for students and growth opportunities for professional staff. All are major strides in the renaissance of nursing. They need to be nurtured, and carefully monitored to ensure that progress continues.

There are areas remaining, however, where progress has been slow or non-existent. One of these is the absence of significant numbers of clinical nurses in recruiting and retention efforts. It is vital to have the nurses who are directly responsible for patient care in the middle school and high school classrooms telling stories about the excitement of nursing. We need to see those nurses - and the advanced practice nurses - initiating and participating in future nurses' clubs to recruit our share of the best and brightest of today's youth into nursing.

We need to attract not only the youth, but also the adults who are seeking new careers. We need to include more of those for whom nursing has not traditionally been a career choice. Men, for example. We need to broaden the cultural scope of nurses so that nursing becomes more reflective of the population in which we live.

We need to improve the ways in which we, as nurses, treat each other, and the ways in which we nurture our young. When student nurses rotate through your facility, is the staff welcoming? Does that staff seek out the students and offer them stimulating experiences? Or do the nurses regard these students as another incursion on their already overloaded work schedule?

Do they offer statements like, "why would you want to be a nurse?" I've overheard those conversations while precepting students. When I speak with the naysayer, I usually get comments such as, "Well, you know what a mess nursing is in. I'm trying to see if she has the guts to make it."

Yes, nursing is in trouble, but that certainly is not the way to fix it. And the naysayers usually refuse to involve themselves in the process of repair. These are the victims of "burnout." They need to get help themselves before they can become helpers.

We also need to review the way in which we greet new staff. All too often, new staff are expected to "prove themselves" before they are accepted on the unit. Nursing units traditionally are wonderful about farewell parties for departing staff, bringing gifts, food and tears to the person who will never again assist them. We need to be equally cordial to the new recruit. Incoming staff should have a welcome party, where members of the staff greet the new member and offer to help to make her or him feel at home in the new environment.

We need to use the staff ACE nurses as mentors for new employees on the unit. An ACE is:

*Accessible to the new employee, with their schedules matched for the orientation period

*A skilled Communicator who is able both to communicate requisite knowledge for the new employee and to collaborate with other staff to ensure the "newbie's" comfort level

Enthusiastic and proud of the nursing profession.

New employee orientation is a major key in staff retention. The new employee and the mentor should establish goals and timelines for orientation predicated on the new member's education and experience. They should meet regularly to evaluate progress in orientation to ensure the "fit" of the new employee for the selected unit.

It is helpful to use the new staff member's previous experience as a new set of eyes for the unit. What new ideas does she bring that can improve patient care or make the workload easier? It is important to involve new staff in unit governance. It facilitates their adaptationand increases communication. So be welcoming. The work you save may be your own.

The patient is nursing. The patient is getting better. Each of us has a role to play to ensure the patient's return to optimal health. Be aware that the results of your efforts will be commensurate with the energy and commitment that you bring to the job. Do your best.

[oramar]

Even though "the patient is getting better" is kinda premature, I too think I have seen some positive signs. That is why I hate to discourage people who are just beginning to think about going into nursing. If you are 5 years away from taking boards things could be very different by the time you graduate. One thing that discourages me is when I hear experienced nurses say that their manager told them to look for another job when they expressed concerns about patient safety stemming from staffing and other problems.

[sjoe]

Rumors of the patient's improvement are exaggerated and inaccurate.

[caliotter3]

management speak

[911fltrn]

I've been wrong before, but in my humble opinion I believe the patient is dying. With substantial $, better environment, and some rear end smooching for all the bad times the patient MIGHT survive.