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.........
OP, disregard the negative nellies. Obviously, they're going through something right now that you have NOTHING to do with.
Something has worked for me is to focus on the process and not on the people. I've found that the majority of time, there's a flaw in the process and when the process is sound, there's a flaw in the training. And when the training is sound, only then is there a flaw in the performance.
Can you set up a multidisciplinary committee for each unit? Offer food or knickknacks-whatever you need to get them in the door.
And be careful about reading 'evidence based practice'. What's good for one unit or hospital may not be appropriate for all. Don't be afraid to customize the EBM to your workforce, hospital resources and patient demographic.
What else? Get patients involved. Do you guys have a patient committee? Do you have a patient's relations coordinator you can involve?
If you continue to have problems with the frontline staff, you might have to disengage them and have management do your 'dirty work' for you. It always sucks when it comes down to this, but you gotta do what you gotta do.
On the other hand, I have to agree with some of what the "negative nellies" have to say.
IMHO, I think it's important to at least be aware of history that occurred before you took over the job ... staff has probably experienced being thrown under the bus by "suits" and do not yet have enough experience with you to be able to trust that you won't do the same.
You may be paying the price for a management culture that protects itself by finding someone to blame, so that person can be disciplined to show that management is doing its job and the underlying systemic problems continue to be ignored. The excessive defensiveness you describes suggests this might be so ... hit someone often enough, and eventually they'll flinch at the mere sight of you.
On the one hand, you definitely need to address quality-of-care issues regardless of whether the staff likes what you do ... it's your job and it's the right thing to do. You have the right and the responsibility to ask the questions you do and to get straight answers.
On the other hand, it may be a bit unrealistic to expect an enthusiastic buy-in for your efforts on the part of the staff being questioned. If their main experience has been one of having to catch the feces rolling downhill, without so much as a spare shovel from management, then it's going to take some time to counteract the initial instinct to cover their heads.
It may be simple misunderstanding of your objectives, but if the management culture really is a punitive one, you might be stuck with it unless you can start to change that culture ... a beast of a job.
A patient leaving AMA does not trigger me to be involved the reason i was involved was because they called in and filed a complaint. I address these issues with the staff to come up with ways to improve our process. Actually 9 times out of 10 the staff did nothing wrong and i always assure the staff they can talk with me at anytime. I am a RN. I have had patients leave AMA. I realize the staff just doesnt know what CMS and JC require a facility to do with a complaint or greievance. They are categorized in high/low risk major and minor. THEY HAVE TO BE INVESTIGATAED! I think I will do an education session to explain the process of patient concerns. I really appreciate those whp have given me advice.
As for you this comment:
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.
YOU have no right to judge me. I am doing my best to change things. Whatever experiences you have had would have been great to hear about but for you to state i am niave and be so negative... I will just say a prayer for you!
I have made it a priority to compliment the staff and assure them they did the best they could do. I would not like to be blamed for something I didnt do. I understand because I have been in their shoes for six years. I know how hard it is the poor nurse/patient ratios all of it. It is very stressful. I love bedside nursing. I love being a nurse. Part of me really loves this new job because I have the opportunity to make a difference. If i can change old ways and improve the quality of care and performance of staff. That to me is amazing! I do miss patient care. I have suffered an injury that has not allowed me to go back to patient care... I am a nurse as caring as the rest of you. I want ratios /stafing to be suffcient. I want change I want nursing to have a support system and be heard. I am doing all I can to change this!
I am not sure that you are being honest because you do not know me. I am not juding you so i would appreciate it if you have nothing to say other than smart comments you just dont reply at all. With such a judgement that my job is basically "window shopping" you were being rude.
ok look, you obviously are a decent, caring person. I take back "naive" because it offends you, and I really dont want to do that. I do stand by my other comments, but maybe you will be the exception to the rule and good for you if you are. lets not fight, lets work together toimprove things.
Open yourself to comments that are critical of quality assurance and management, you will learn more from probing this point of view than you will by dismissing this opinion as uninformed. If you respond as defensiely to staff as you did to inshallamiami you will only alienate the staff. inshallamiami and canoehead are bright articulate posters and I am quite sure they understand patient safety standards and quality assurance.
I am not fighting with you. I am calling out to my peers for help advice. Ways I can change this. I am pro nursing. I am dedicated to my profession and making sure patients recieve the best care they should as a nurse should be. I have had some awful experiences as a patient myself where I recieved horrble care. I want what is best for both sides. Not all nurses are created equal, there is unnacceptable behavior that will not be tolerated, but most of the time there is behavior that needs to be praised. I do not think staff is used to compliments. I know they come far and few between, but are due daily.
I am open to comments and personal expereinces but i do not feel like I should be judged as I was. I do not approach my staff defensivly at all. Like I said 9 times out of 10 the staff was not in the wrong and maybe they were blamed in the past, but not while i have this position. No way no how. I can put myself in their shoes. Education and understanding is key. I really want to make a difference and yes be a support for the nursing staff.
Make a point of making your first project one that proves the nurses need more staff, or better equipment, or something positive. What do they WANT? Then find a way to get it, even if you have to start a conspiracy with the manager so that your PI work is better accepted. Go to every staff meeting and listen to their concerns. Maybe state some of your own about wanting to help and needing their input and support in order to do that. You sound like our heart is in the right place, but so is theirs. I know after being burned a few times I just want to be left alone. Do something positive for them and make sure they hear about it.
Your feelings of being judged interfered with your ability to probe inshallahmiamis initial comment. If you can eliminate your personal feelings from the equation and listen carefully, you may win the respect of the staff. If staff believe you have the authority to implement change and are not just window dressing or the safety police, you may actual be instrumental in mending the communication gap between the staff and administration. To be effective in your new position you have to remember it is not about you and how committed you are to QA, its about understanding the problems that are going on from the staffs point of view.
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zahryia, LPN
537 Posts
OP, disregard the negative nellies. Obviously, they're going through something right now that you have NOTHING to do with.
Something has worked for me is to focus on the process and not on the people. I've found that the majority of time, there's a flaw in the process and when the process is sound, there's a flaw in the training. And when the training is sound, only then is there a flaw in the performance.
Can you set up a multidisciplinary committee for each unit? Offer food or knickknacks-whatever you need to get them in the door.
And be careful about reading 'evidence based practice'. What's good for one unit or hospital may not be appropriate for all. Don't be afraid to customize the EBM to your workforce, hospital resources and patient demographic.
What else? Get patients involved. Do you guys have a patient committee? Do you have a patient's relations coordinator you can involve?
If you continue to have problems with the frontline staff, you might have to disengage them and have management do your 'dirty work' for you. It always sucks when it comes down to this, but you gotta do what you gotta do.