Quality/ Performance Improvement

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Specializes in ICU, Float RN , Quality & PI.

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:

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Specializes in LTC, Hospice, Case Management.

Read any thread about staff vs management. It will give you some insight to this ongoing difficulty. I agree, it is enlightening to actually see both sides of the fence, but many just automatically think of management as the "dark side".

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Specializes in ICU, Float RN , Quality & PI.

I agree with you, but I really thought it would be different for me. Not that I think im better than anyone. I say that because i worked in float pool had great relationships with staff in every unit. I have only been in this new job for three weeks. I feel like they forget I worked with them. I am not a random hire they know me, so i am having a hard time understanding the resistance. Everyone still treats me nice until i need their patients chart or need to discuss something with them.

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Specializes in PICU, NICU, L&D, Public Health, Hospice.

Perhaps there is some history you are unaware of?

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Specializes in home health, neuro, palliative care.

I think you nailed it when you said staff doesn't understand your role. How can you change that? What can you do to show staff that QI is about improving quality for everyone, patients and staff, and fixing system errors, not about blaming and punishing individuals?

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Specializes in Med/Surg, L&D.

In addition to what everyone else said about not understanding your role and the tension between admin/floor nursing, I have to say that there is a component of resentment. These nurses have been working along side of you and now they perceive that your job is to judge them (even though it is not your job). They resent that someone who used to be one of them is now raised above them. I have seen similar things happen when CNAs graduate nursing school and become RNs on the same floor where they were CNAs, when floor nurses become charge nurses/educators/managers on the floor. There is this natural struggle with people being "raised above you." Maybe try using contrasting in conversations with them like "I get the impression that you think I am trying to get you in trouble or that I think you are not doing a good job. This is not my intention at all. I think you provide excellent care. What I am trying to do is improve the quality of our hospital and address patient concerns." Then they can see what you are and are not intending when you come into their unit.

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Specializes in LTC, Memory loss, PDN.

How many times does quality management approach floor nurses with a positive, a non-complaint, a praise, etc? I'm not talking about your hospital (I obviously don't know your situation), but in general. Usually it's a lot more negatives than positives and some of the positives are followed by "but...". And, of course, what Nascar nurse said. It's an us vs. them arena and these days you're on the "them" side. Now, that, the us vs. them, would be a marvelous project to work on for any quality control officer.

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Specializes in L&D, QI, Public Health.

I've worked quality for years and the quality folks are seen as the police. I think risk management staff and quality staff should be seen as different departments. Therefore you have risk management doing the police/investigagtion work and you have quality doing the 'fun' improvement activities. These quality activities should empower the frontline staff to suggest and implement the activities and measure them as well.

You definitely want to educate the staff and get buy-in before you start any activities. Try to target at least one well respected staff member from each unit to get the staff buy-in. See if you can get money to have them travel with you to quality improvment conferences or point out quality improvement sessions within their speciality conferences to try to get them more educated and involved.

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Specializes in ICU, Float RN , Quality & PI.

Thank you to all who replied. I have tried to approach things in a different manner than the person who previously had my job. I have gone to the floors and observed. I have been giving compliments to the staff. I know they think im like internal affairs or the police, but i am definatley not there to get them in trouble. I have taken the time to reassure the staff I am only there to help improve. If i am there for an unfortunate situation, I need there help to put the peices together to educate us on gaps so these things do not happen again. Thanks again!!!

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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 was you 5 years ago- when RNs on the floor gave me attitude-I had worked side by side with them in the float pool for years, they said you are one of "them" now. I would say-who would you rather have in this position, someone who really HAD been in the trenches or someone else---it got less and less over time.

good luck.

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