Quality Management/ performance improvement ADVICE PLEASE!!!

Nurses General Nursing

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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. :confused: "

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!!!

i dont want praise or compliments. i don't want pizza or cute little notes in the break room ( that i rarely have a break in.) i want adequate staffing so i can do my job and not kill anyone (thats a sentinel event to you.) do you have any say in staffing? can you change my ratio from 8:1 on days (tele) or 3:1 (icu). are you working to change that? if you are good for you, hows it working so far?

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This too will pass.

I had several nurses ask me how I was able to get "that job". I regularly looked at openings, applied, interviewed, and then got hired.

There was some jealousy.

There is some old baggage from that other nurse. You will need to prove yourself to NOT be like that other person.

It stinks, but time will be needed to heal their wounds and separate yourself from the other person.

otessa

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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???

I agree with you wholeheartedly. When I worked in PI there were many positive changes for nurses and for patients that was improved because there WAS a nurse in PI. I'm a very realistic and optimistic person-we CAN bring about change.

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yeah that's it. I am just jealous of you PI people.

fyi I currently work FT in Interventional Radiology, a dream job with a ratio of 1:1. But I still work per diem in ICU and telemetry, where my heart is.

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Specializes in ICU, Float RN , Quality & PI.

Thanks everyone for repling. I will do my best to change it for the best believe it or not.

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From the scuttlebutt I have heard, a combo of dressing/being still "one of us" might be more important than it seems at first. Posts on Allnurses about admin talk about the sound "click, click, click of high heels" coming down the hall. Looking put together and not a hint of the sweaty/frazzled that the nurses on the floor feel they radiate. Seeing admin seems to cause an auto bad taste in the collective mouth.

I also think that being an advocate for making things better as Canoe has said, and being a good all around listener are things that really there is no one else to provide. If you have this gift to offer, you will become someone who is wanted.

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Specializes in ICU, Float RN , Quality & PI.

thank you 2ndwind. I appreciate the advice. I am an advocate for staff as well as patients. I truly feel that if i can make a change in the quality of care or improving the gaps between what the staff needs and administraion that would be incredible. There were many times i thought while on floor "omg i can not do this any more" the stress the unsafe ratios etcetc.

I did not take this position because i thought it would be easy. I debated over it for a while. I suffered an injury that has left me on sedentary work as of now. I have been for the past year. I have struggled and cried with the doctors who have told me going back to the unit may not ever be an option. I didnt have much of a choice in that. This is not where I thought I would be at this time in my nursing career, maybe in like 20 years, but it is now so i am doing my best. I truly do like it for the many reasons i have already expressed.

I went to school to be a nurse to care for others. I unfortunately may not get to do that again. If I can change the stress and frustrations of my peers that too would be rewarding!

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Specializes in ICU, Float RN , Quality & PI.

oh yeah and the clicking of the heels... it bothers me too, so i see what you are saying. Those clicks will not come from me. Can only wear flats since my injury. :)

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Sounds like you really want to make this something of your own. Then do it. Be an entrepreneur with this position. Don't look to how others have done it in the past. Politely ignore co-admin who do things differently. Build your own trust. :up:

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oh yeah and the clicking of the heels... it bothers me too, so i see what you are saying. Those clicks will not come from me. Can only wear flats since my injury. :)

I'm all about comfortable shoes. The only time I would put on my "click, click " shoes was when I was meeting with the CEO and CFO (both women). I'd go back to my office afterwards and change into my real shoes, aaahhh.

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Specializes in Critical Care, Education.

WOW - strong feelings. It is easy to see that a lot of folks must have had bad experiences that probably generate this type of reaction.

I think the OP is caught up in an organizational 'black hole'. It's difficult to be positive in a culture that is so adversarial. Her role seems to be that of 'internal affairs' and investigations. Sheesh. Hope she's got a flak jacket under that lab coat.

We have a different sort of approach. Anything that is associated with a potential 'loss' (like lawsuits, falls, equipment failure, employee injuries, etc) is handled by Risk Management. Our QI folks focus only on QI. I think that this provides a much better distinction. We have also been pretty successful in establishing a 'just culture' in which we focus on trying to identify and fix process breakdowns rather than figuring out who is to blame.

We have great systems for reporting 'near misses' and 'unexpected' events like AMAs. The RM folks follow up to get details of the situation. Staff who report them are acknowledged (by their managers & supervisors) for contributing to a safer and better workplace.

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Specializes in Health Information Management.
WOW - strong feelings. It is easy to see that a lot of folks must have had bad experiences that probably generate this type of reaction.

I think the OP is caught up in an organizational 'black hole'. It's difficult to be positive in a culture that is so adversarial. Her role seems to be that of 'internal affairs' and investigations. Sheesh. Hope she's got a flak jacket under that lab coat.

We have a different sort of approach. Anything that is associated with a potential 'loss' (like lawsuits, falls, equipment failure, employee injuries, etc) is handled by Risk Management. Our QI folks focus only on QI. I think that this provides a much better distinction. We have also been pretty successful in establishing a 'just culture' in which we focus on trying to identify and fix process breakdowns rather than figuring out who is to blame.

We have great systems for reporting 'near misses' and 'unexpected' events like AMAs. The RM folks follow up to get details of the situation. Staff who report them are acknowledged (by their managers & supervisors) for contributing to a safer and better workplace.

Sounds like a good system. Now, how long did it took to reach that state? It sounds as though the OP is running smack into a brick wall of longstanding institutional culture. Changes in a situation like that just don't come quickly or easily. They require an enormous, long-term investment of time and effort.

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