Changing a unit's culture?

Published

Specializes in Professional Development Specialist.

I started in LTC/subacute 6 months ago as a new grad. Fast forward to today and I am now unit manager of a different unit. 60 beds of subacute patients with a crew that doesn't work like my old team did. I'm at a loss. My old unit worked together out of mutual respect for each other and our patients. This team seems burned out and they know going the extra mile today means that an extra 2 miles will be expected tomorrow. I have no idea what to do to turn this all around. The pt complaints are innumerable. I somehow need to change the culture to a group effort like my old unit but I really don't know how. On my previous unit things worked smoothly before I ever started. I "led" by example. My CNA's knew I had their back so they always went the extra mile. When call lights were going off I answered them. But that's a tricky road since some will just take advantage.

I'd really appreciate some practical advice. What makes you, or your nurse manager, effective? How can I support my team without being ridden into the ground? In my previous careers I led well because people respected me. I was usually promoted from within and my coworkers knew that I knew what I was doing. They knew I wasn't asking them anything I wouldn't do myself if I could. They knew I'd stay late and work hard to make their lives a little easier and they knew I respected them and their strengths from the bottom of my heart. I haven't had the opportunity to work with these people like that so they only know me as the "favorite child" who kicked out their buddy. :(

Before we start, management knows my lack of experience. They know the challenges and still think I can do this despite my spoken misgivings and the petition from the unit to keep their previous manager. OTOH everyone in the building including myself would follow the administrator to hell and back (and many have in the last 10+ years.) I respect that individual enough to push myself. I also had no choice in the move other than get a job somewhere else. In this economy I'd be better off winning the lottery. Any constructive input is appreciated.

Up Vote Up Vote ×
Specializes in ICU, Education.

This is a great question and one that is very real whether speaking of hospital, unit, rehab, LTC, or even McDonalds.... I truly wish I knew the answer, because i have seen really great units go to pot when just a couple bad apples infiltrate the culture.... "There goes the neighborhood" so to speak, and that is the honest truth... Try rewarding and recognizing the high performers, and disciplining and recognizing the poor performers... Maybe you need to figure out who the bad apples are and get rid of them. You sound like a person with the right motive and intent... good goals for your unit and a great work ethic... Let that shine, but don't hesitate to be a bad ass too.

Up Vote Up Vote ×

Thank you for caring enough to even want to make things better. Here are a few thoughts.

Notice the good stuff. Catch people doing things right. Do this with both employees and residents.

Ask people privately to think about what would make things better and get back to you on low cost ways to improve morale. Do this not only with your "good" employees, but pick some that are less than stellar. Get them invested in group success.

Get to know your staff--what are their concerns? What motivates them, matters to them, gets them going or gets them down? What kinds of incentives would they value? And what might they be willing to do to help provide for this?

Highlight a staff member or resident each week to be profiled (with their permission, of course). Put up their picture (both now and in their youth for residents), tell their story, share their hopes and dreams, hobbies, favorite music, best recipes, etc. This kind of attention can do wonders for someone (again, staff or resident) who ordinarily fades into the woodwork. Or someone who is a perennial crabby pants. :D

Promote interest in local sports teams. Have football Sundays where team colors rule. Divided loyalties can make for interesting times.

Visit on PMs and nights. Show them they register on your radar, too. Bring treats and they'll look at you differently.

Unite behind a common cause. Pick one family (from the community or with a connection to the facility if that seems okay) to receive a Christmas blessing from your facility. Between now and the middle of December, collect dollar bills, canned goods, simple toys, mittens, socks, hats, art supplies, whatever this family needs. Get everyone in on it. Residents who are able can write down or dictate stories they remember--both fairy tales and real life reminiscences. Others might be able to illustrate. Everyone can participate in making cards, even if they only make a thumbprint signature.

Make a group recipe book as a fund raiser for extra fun supplies. Staff and residents and family members can all participate. There are so many ways that this can have a positive impact.

You have to be careful with this, but give hugs, hold hands, touch respectfully when you can. One of my daughters worked in LTC for years before returning to school. In all of her jobs she made it a habit to give almost every resident a hug or a peck on the cheek or do something to say she cared and they mattered to her. In all of her jobs, the residents cried when she had to leave because so many rarely had anyone else touch them with affection. :heartbeat Many residents lose the opportunity to hug or connect in this utterly human fashion and a part of them withers.

See about acquiring a therapy pet or having therapy pets brought in. You can Google this and find all kinds of information about the best ways to do make it happen. Some of the more able residents might be interested in helping to pursue this.

You'll notice that I suggest including both staff and residents (and family members) whenever possible. This can foster a sense of solidarity and connection and reduce and "us vs. them" mentality.

The biggest things to communicate to your staff and your residents? I see you. You're a part of this group. You belong. You matter.

They are fortunate, indeed, to have a leader who cares. :up:

Up Vote Up Vote ×
Specializes in ER, ICU.

Changing culture means things have to change. You have to lay out what you expect and be prepared to fire employees who will fight you at every turn. This will take a lot of backbone but if you don't you will probably end up leaving instead. It's not a matter of making things "they way you want", it's about standards, quality, and integrity. You have to exhibit the changes you want to make, then hold the others accountable to meet your standard. Communicate with your staff. Make the changes a group project, take suggestions and listen to their input. You are the referee of ideas. Expect some buy in and some resistance. The more input the employees have the more likely they are to buy in. Identify and focus on your key employees, the "keepers" or high performers. Encourage them, support them, and they will become the standard. Best of luck!

Up Vote Up Vote ×
Specializes in Professional Development Specialist.

Wow, thanks so much for the amazing advice everyone!! Some of my ideas were mentioned and it's good to know I'm on the right track. The new ideas are fantastic. It's going to be a long few months while I settle in and get to know everyone but I think the bones are there for a great change.

Up Vote Up Vote ×

Sometimes (and I'm not saying in this case) there is a miserable person who is setting a bad vibe, and "infecting" the others. Most people want to change and work in a pleasant, mutually respectful environment, but there is always one who is miserable, no matter what you do.

Up Vote Up Vote ×

In my LTC facility we have 2 units both hosting 60 residents each. My unit, I couldn't ask for more from my crew, the other unit, you couldn't double my pay for me to work there...

My crew is a good mix, of old and new careers.. yes we are usually short staffed as most LTCs are, but we work with it and are greatful for each other.

Some of the things that I/we do that I think helps is

1. I treat everyone as an equal, no matter what letters follow the name, or dept you work in.. EVERY job in LTC is important, and that means, housekeeping, laundry, diatary, CNAs, LPNs, RNs, No one could do their job without the other.

2. Everyone knows what is included in their job, ie: Don't bother housekeeping over a cup of spilt water, Don't bother a CNA to get a Resident a cup of water. EVERYONE can answer any call light, Redirect a Resident, answer the phone.

3. I don't schedule breaks, lunches, or halls, they are adults and can work it out themselves. I feel that that helps them learn to respect and communicate with each other, and enables them to work as a team. (They know if I see that it is causing problems that I can say "you go here, and you go here") I have never had a problem. It usually works out that the same CNA has the same Residents 5 nights a week. This works out to not only give the Residents comfort and a feeling of security, but also helps out the nursing staff because that CNA is more apt to notice changes in condition, skin, appitite etc. we rarely have in house wounds on my unit.

4. I will back and defend my staff to the bone, and they know it, but if they screw up, I will call them out on it in private, and try to make it a learning experience. They know this too.

5. acknowledge the individual good stuff, show appreciation, accept that the lady in laundry that has been there 20 years, knows the Residents better then you do, and the CNA that has yrs of experience, is truly a bedside nurse, without the degree. Let them know that you trust their judgement, and respect their knowledge. Everyone will start seeing you in a different light in no time.

Up Vote Up Vote ×
Specializes in NICU.

all the suggestions so far are really great.

i can only add that you might try putting together a positive culture committee (or a sunshine committee or a patient/staff satisfaction committee). ask for volunteers, from all shifts, that want to help make your facility the best place to work. then ask them for suggestions on projects they can do to make a difference in the culture and let them implement an idea for a month then come back and evaluate how it is going. they can then decide if they want to keep the original project, make changes to it, or get ride of it. once that decision is made they can look at another project they can try. change takes time for people to buy into. be patient and keep moving forward - it will happen.

Up Vote Up Vote ×
Specializes in Neuro/NSGY, critical care, med/stroke/tele.

Hi! You're awesome for being invested enough to make the effort of posting for advice.

I'm not in nursing (yet - completing prereqs and applying right now) but I am a program manager for a day habilitation program (we provide nursing, PT, OT, SLP and help people build skills and independence). I've only been a manager for about 7 months, and it's been a steep learning curve, but I did have one idea that hasn't been mentioned yet as I was reading through here -- what about a team training/team building day/session? I ran one of these because there were some - *ahem* interpersonal differences...! - amongst the staff here. So we did an afternoon of discussion (why it's important we work together, examples of when we've done that well, when could it have been done better...), trust exercises, team building games (there are a whole load online or I can email you some from the book I use if you'd like), and then we went out for dinner as a group afterwards. It really helped to break the ice and just gavepeople the opportunity to voice whatever issues/frustrations had come up but hadn't been voiced. It definitely cleared the air and was a really positive experience (though challenging being the one running it instead of just participating!).

Other than that, I'd just say as much as possible make sure you have time set aside for regular supervisions/check-ins with anyone appropriate. With persistence and consistency they'll realize they'll always be able to fall back on you and that they'll be able to rely on you and get your ear when they really need it.

Up Vote Up Vote ×

Most of the suggestions I listed were "carrots." A few others mention weeding out bad apples and letting folks know that those who don't pull their weight will be out the door. That's the "stick."

It's a good idea to let staff know that you have both approaches available, and their behavior determines which one gets used on them.

It's also a good idea to have some new hires waiting in the wings (prescreened and interviewed) so that you aren't hamstrung if you have to fire people.

Do let us know what happens.

Up Vote Up Vote ×
Specializes in Professional Development Specialist.
Most of the suggestions I listed were "carrots." A few others mention weeding out bad apples and letting folks know that those who don't pull their weight will be out the door. That's the "stick."

Part of the challenge is that there really is no "stick." Write ups continued with no real threat of job loss under the DON (now on her way out, by her choice.) Sometimes the write ups were valid, and sometimes they were based more on the mood of the DON than the actual infraction. When we finally fired an under performing nurse on my previous unit, she had dozens of serious write ups. The one that ended her employment wasn't any more critical (although it was a SERIOUS error.) With no consistency it's hard to make real change as no one takes disciplinary action seriously. I'm left to run by other motivators. OTOH the DON is leaving soon and the administrator is always willing to listen.

I have enjoyed getting to know my fellow employees, and with the exception of a few there is a real sense of community and a team attitude. I really hope it will be okay. I'll update as time goes by if anyone is interested. Maybe our journey will help others.

Up Vote Up Vote ×
+ Join the Discussion