Quality Management/ performance improvement ADVICE PLEASE!!!

[caeRn]

I posted this last week. thanks to all who replied. I just am very frustrated lil history on subject read my last post and then i will explain:

This is last week post

"I have a question? Here is a little history. I am an RN BSN. I started my career in ICU. I worked ICU for 3 years and then went to Float pool. I floated to all clinical areas of hospital for 3 years. I have just accepted a new position in Quality Management. I was approached to take this position by administraion and medical director. It is new to me but i enjoy my role so far. I work on all patient concerns/greivances, set.events, RCAs, quality assurance and performance improvement. I have really got a taste of the other side, behind the scenes kind of nursing. Anyway my question is to all the nurses working patient care, (I was one for 6yrs) Why do I get such an attitude and defence/resistance from all when asking questions about an event or patient concern. We are not there to get you in trouble. We are there to help improve quality of care and improve performance. Why is there such a resistance from the staff nurses? I am not being smart when I ask do many of you even know there is a Quality/PI Office in your hospital??? I have found from my hospital, staff doesnt know what Quality or PI is. "

I have made it a point to compliment the staff on all the positive observations I make. I have typed up notes on specific positive incidents i have witnessed and praised the staff.. I hang them in break room ofcourse without any patient identification. I also personally give the involved staff a copy and the manager. Today I go to a floor to discuss what happened when a patient left AMA. When I go to interview the staff, I make it a point to tell them I am not here to get them in trouble i am here to clear up what happened. I talked to three nurses involved in the case. Just trying to get the entire picture. They all 3 gave me a BIG old ATTITUDE!!! I am so frustrated. I am a nice person. I do not approach staff with attitude and i always reasure them I am here to help. I keep getting the same comment from staff..."You are one of them now"... I reply no i am one of you, a nurse, a nurse who worked along side of all of you, I wanted a change and got the opportunity to see nursing from the other side. I am still one of you!

arghhhhhhh!!! I do know the last person in my position wasnt very nice and always talked about the bad and didnt talk to the staff as a peer but as if she was police. I am not the darn nursing police!!! frustrated.........

sorry for typos too frustrated to check!!!

[dishes, BSN, RN]

There was a negative attitude about quality assurance in my workplace about 8 years ago and it had a lot to do with management talking too much and not listening enough. The ability for staff to express their opinion about quality assurance is important in creating a positive climate. Most of the staff did not want to discuss incidents and quality assurance. Some feared it would be held against them if they filled out incident reports. The staff were given the option to complete regular, anonymous, employee satisfaction surveys. The surveys included a number questions that allow the employee to rate their employers response to their concerns about patient safety, staffing levels, equipment needs, beliefs about completing incident reports, managements response to staffs safety concerns and response to incident reports. The staff received feedback about the overall ratings from the satisfaction surveys and our employer implemented changes based on the survey results. Over the years that we have been doing these surveys there has been a gradual shift in attitudes and there is more cooperation on both sides.

regards

dishes

[gtoko]

Maybe you could try your approach a little different. Instead of saying "I am not here to get you in trouble, etc...." A little softer approach??? ,wont make the nurses feel as defensive?

[zahryia, LPN]

It's going to take time. Shifts in attitude don't happen overnight. And as much as you want nurses to know you're not the police, you don't want to get too chummy either

You need to own your position. I'm curious. What type of clothes do you wear to work. You'd be surprised how that makes a difference.

For example, do you wear ultra corporate clothes? Is it basic business casual? Are you in scrubs?

Basically, what I'm saying is that you need to convey an image of a charge nurse-so to speak. Someone in authority that the nurses can relate to.

Again, this will take time. It would be an interesting project to assess attitudes now and attitudes a year from now. Make it a challenge. Do your own performance improvement process on your department.

Good luck!

[David13, MSN, RN]

In my experience, the Quality department has always had an ambiguous connotation. No one in management seemed to want to clarify the Quality Manger's duties, so she could basically do whatever she wanted in terms of "policing" the staff. She also had the option of doing basically nothing and, because her position was so ill defined, that was okay, too.

This type of ambiguity created a great deal of animosity from the staff nurses whose job duties were VERY well defined and who did not have the option of coming and going as they pleased, or really any autonomy at all.

That is just my experience. Perhaps the nurses at your facility have that same animosity toward you because they don't know precisely what it is you do, and also because you appear to have a great deal more autonomy than they do. Maybe a clarification of your job description and duties provided to the staff nurses would help. This is just a thought. The situation at your facility may be completely different.

Good luck. It appears that you are trying to do the right thing.

[inshallamiami]

1. all management is concerned about is money

2. quality would improve if staffing improved

3. your position is window dressing

sorry, you seem like a nice person, but naive.

[caeRn]

I do wear business clothes. As float staff which was my previous job, I made friends in every unit. I got alone very well with my peers. I am trying to change the attitudes and make a difference. My position is important. I am not naive. As for this comment :

1. all management is concerned about is money

2. quality would improve if staffing improved

3. your position is window dressing

sorry, you seem like a nice person, but naive.

You obviously dont know about Quality or PI or how important it is to a hospital and staff. It is not window shopping. I was asking for advice not rude comments! The last thing I care about is money. The only thing I care about is my staff and patients!!! Is it so hard to believe that someone in management cares???

[caeRn]

To everyone else thanks for the advice i appreciate it.

[canoehead, BSN, RN]

Is it so hard to believe that someone in management cares???

Yes it is that hard, because so many pretend to care and end up just toeing the company line. Start with a PI project that will prove they need more resources. Don't start your job with a project that proves nurses should do more with less. Good luck.

[inshallamiami]

Yes it is hard to believe management cares. Maybe that explains the attitude. WE (myself and the other nurses with "attitude") are cynical, YOU are naive.

[casper1]

For Years Nurses have seen quality improvement as punitive in Nature. The Nurse was always to blame for whatever went wrong. Insufficient staffing, lack of equipment, difficult families, demanding doctors were not excuses for errors. Nurses were where the "Buck stopped" and that was where the blame is placed. It's no wonder Nurses are apprehensive and defensive when a problem is investigated.

Perhaps a generic approuch would be helpful. Word questions like " What can the facility do to support you in your practice ?"

[casper1]

I have had patienys leave AMA. for a wide variety of reasons. They did not have a babysitter, they had unattended pets at home, they were worried about a ill spouse at home. Sometimes they don't have insurance and they are afraid of the cost, their given meds start to feel better amd decide they don't need to stay.

Sometime they are not happy with what the MD's have to say. Their mad because they can't get the pain meds they want. They have a Drug or alcohol history and are suffering from withdrawal that is not being adequately treated. Many times they a psych. patients who have been admitted with a medical problem. The MD's who are treating the medical condition neglect to address the psych issues, and do not order the medications to help the patient stay in control and make the right decisions. I have seen Nurses blamed for a patients disruptive behavior, when it is clearly documented to the chart that this patient has a extensive psych history and has been on medications. Now here they are under stress from their condition and no one has addressed the fact that this patient need their meds.