strategies for change

[ainz]

Shortages of nurses are getting worse and is also occurring outside of the USA. Recruitment of foreign nurses may not be an option for the US healthcare system in the future. Conditions are materializing in a way that healthcare organizations will probably increase their efforts to replace nurses with less qualified and less expensive personnel, in part because of the shortage, and the shortage will be used as a legitimate reason for "de-skilling" the direct patient care staff.

I am a fervent advocate of advancing the nursing profession to a true professional status. The issues facing nursing are many and there is no quick fix. To advance our profession will take time, commitment, and must start at a "grass roots" level in the local hospitals and other organizations that employ nurses.

THIS POST IS PRIMARILY DIRECTED TOWARD NURSE MANAGERS.

Here are some facts, like them or not. Administrators, corporate executives, and doctors have the power in healthcare. For nursing to advance and conditions to improve, these are the people we will have to convince, primarily healthcare executives. As you should be aware, the primary motivator for executives is making money. This is not necessarily a bad thing, it is what they are hired to do.

When the hospital is performing well financially, administrators are happy, when it is not, administrators are not happy and begin to look for ways to cut costs. Since nurses are the most visible employee to the hospital's customers, nurses are in position to GREATLY INFLUENCE the success of the hospital. As a matter of fact, NURSES ARE PROBABLY THE GREATEST SINGLE INFLUENCE ON THE SUCCESS OF THE HOSPITAL.

Make no mistake, DOCTORS ARE THE PRIMARY CUSTOMER, NOT THE PATIENT. Doctors are the only ones that can order things that make money for the hospital, so administration holds them in high esteem and bends over backwards to accommodate them. Doctors judge a hospital, to a large degree, on the quality of the nursing staff. They look for professionalism, skill, knowledge, assistance in getting their diagnostic information, they want reports on how their patients are doing. These are their primary interests so they can GET IN, MAKE ROUNDS, AND GET OUT QUICKLY.

We know that employees are more productive and perform best when they are satisfied with their jobs. IT IS A PRIMARY RESPONSIBILITY OF THE NURSE MANAGER TO SHAPE AND INFLUENCE THE SATISFACTION AND MORALE OF THEIR NURSING STAFF. There are many ways to do this. One primary way is to "screen out" the negativity from upper level management. Not saying to hide or withhold information, but how you relay negative information will greatly influence your staff's morale. The nurse manager should work hard to keep things positive for their staff. Some suggestions:

-be visible, available, a resource, willing to pitch in and help

-stay out of your office as much as possible

-stand up for your staff, defend them, bragg on them

-point out to your staff good things they are doing

-look for reasons to praise your staff

-honor requests for days off, go out of your way to do this

-show up and take report early in the morning along with staff

-if things are bad on the unit, don't leave early

Remember this: YOUR SUCCESS DEPENDS ON THE SUCCESS OF EACH OF YOUR STAFF NURSES. IF THEY ARE NOT SUCCESSFUL, YOU WILL NOT BE SUCCESSFUL. Therefore, your number one job is to find ways to make your staff successful, so, support them, help them, nurture them.

-give your staff room to be themselves

-recognize their professional autonomy

-do not create an oppressive, hostile atmosphere where everyone is afraid of getting reprimanded

-give them freedom to take educated risks, and if their ideas don't work, do not reprimand them.

Doctors, administrators, patients, and your co-workers all prefer a positive, upbeat, motivated atmosphere to one of negativity and complaining--you are the first line in helping create this, it is your responsibility.

[ainz]

Second Strategy:

Keeping in mind that administrators are the first people you will have to convince of the value of nursing, the following will help advance the profession.

One of administration's primary jobs is to grow the business, to look for ways to increase volume (number of admissions, ER visits, surgeries, outpatient procedures, etc). They are challenged with coming up with strategies to do this.

Nurse managers, along with their staff, are in an excellent position to know what works and what doesn't. Look for ways to build your business. Treat your unit like it was your own small business and not just a part of the bigger organization. Take ownership of your unit from a business standpoint. Try to think of ideas that will increase your admissions and procedures that generate revenue and make money for the hospital.

By doing this, you and your unit will be viewed as willing and able to help the hospital, not a cost center that is always complaining about something. This will help you win favor with administration. Since administration has the power, it is good to be in their favor. Then you have a much better chance of getting what you want for your unit. You will be viewed as someone who is smart, aggressive, on board with the hospital, and helping them manage their business and grow their business.

[ainz]

Third Strategy:

Doctors are the primary customer of administration. If an administrator can recruit new doctors and win the favor of existing doctors, they have a better chance of the doctor sending his/her patients to your hospital rather than your competitor's.

Nurses are a primary factor in a doctor determining which hospital they want to use for their patients. Surveys show that patients still go where their doctor says for them to go, this is changing, but is still the primary reason patients end up in your hospital.

Doctors are always in a hurry. When they make rounds they want their charts, their diagnostic information, and the nurse assigned to their patients to be able to give them a clinical report. As a nurse manager, work to create an efficient system so that your doctors are taken care of when they make rounds. Having a good system, holding staff accountable for all of this, and creating a positive atmosphere will make a huge impression on the doctor. This can all be done in a professional way without being the doctor's handmaiden.

As an administrator, hearing a doctor brag about a particular nurse manager, nursing unit, or group of nurses CARRIES A LOT OF WEIGHT. It really makes a difference and administration will tend to be much much more supportive of a nurse manager, a nursing unit, and a group of nurses when they are all positive, supportive of the hospital, supportive of the doctors, take care of their business professionally and efficiently, and have good patient outcomes.

Again, like it or not, administrators and doctors have the power. These are the first people we must convince that nursing is not their enemy but their ally.

[iliel]

You have very good points here! As a student, who may end up a manager, this is good advice.

Ainz, have you started a website?

I will say this, I think students need to be addressed by you as well. I think they will respect what you say. We are idealistic and what to make nursing our life long career so we are willing to do the thing that are important to make changes.

[dosamigos76, RN]

Thank you, thank you, thank you! Awesome post. I am learning a lot reading your threads.

Cheryl

[ainz]

Fourth Strategy:

Start gathering objective, data driven information about the effectiveness of your unit and your nursing staff.

You can work with your Quality management department or performance improvement department. JCAHO requires this, HR needs the info for staffing effectiveness indicators etc.

You can initiate PI projects on your unit. I suggest starting with staffin effectiveness and another project you can come up with that demonstrates improvement in patient outcomes.

Staffing effectiveness, for example, look at your staffing levels, skill mix, numbers of patients, acuity of patients, put this together in an organized way. Then look at patient outcome indicators that are clinical in nature, things like falls, nosocomial infections, length stay, readmissions within 24 to 48 hours, IV restarts, vital signs trends on appropriate patients, number of cardiopulmonary arrests or events, and whatever else is applicable. Take this information and relate it to staffing trends, analyze the data and look for correlations. Get some financial information and tie it in to demonstrate:

good outcomes with good length of stay generated x revenue for the hospital. Take credit for your unit and nurses in making money for the hospital through providing good nursing care.

bad outcomes with long length of stay cost the hospital money. Look for reasons related to staffing and skill mix and correlate the two. Show how much money poor staffing and/or skill mix cost the hospital.

If you have good data that is objective that ties nursing care to patient outcomes to financial performance--you will get the attention of administration, they will be more supportive of you, they will view you as more professional, intelligent, and a good manager. All of this will help you get what you want for your unit and nurses and improve administration's perception of nursing.

You will also create some good things to document your quality for whomever is interested and the JCAHO. Also, Medicare et al are moving toward reimbursing hospitals based more on quality ratings. Therefore, in the future, nursing will be even more important to the hospital's bottom line and if administration has some objective data to show quality and what it takes to achieve that quality in nursing, they will be more supportive of it. Things like adequate staffing, good skill mix, better working conditions, things to improve nurses' job satisfaction and so on.

[ainz]

PRINCIPLE TO REMEMBER:

YOU CAN GET EVERYTHING YOU WANT IF YOU HELP ENOUGH OTHER PEOPLE GET WHAT THEY WANT. (Zig Ziegler)

Zig Z. is one of my favorite motivational speakers, he is awesome in my opinion. He is getting old now. I have found the saying to be true over and over and over again.

People want to feel good about themselves, they want to achieve their goals and realize their dreams. If you approach your dealings with people in a way to find out what motivates them and help them succeed, you will be viewed as someone that is successful yourself and others will be willing to return the favor. This principle is especially important to the nurse managers. If you help your staff get what they want, they will work for you and help you get what you want. The same goes for administration. If you help administration get what they want, they will help you get what you want, and so on.

[ainz]

Management and Leadership are really about helping other people succeed and achieve their goals. By doing this, you will gain support for your initiatives and achieving your goals. In the end, everybody can win and you can create a positive, upbeat, motivated, professional atmosphere. Applied to nursing, this will help advance our profession by helping us shake off the image that we are complaining, negative, stressed-out, and only focused on what we want.

Nurses claim many things in the name of patient care, but, when you examine closely what nurses complain about and how the complaints are presented, it seems to tie back into what the nurse wants--ie, better working conditions, more staff, better pay, etc., etc.

As far as being a nurse manager, you must not go down the path of wanting your authority and power to be recognized. During my first job as a nurse manager I made some common novice mistakes. One of those was thinking that my expertise, skill, leadership abilities and so on had finally been recognized by my bosses. Next I was to gain this recognition from my staff. I ended up creating a negative and oppressive atmosphere on my unit. Everyone had to know I was in charge. I also created a dependency on me among the staff, nothing could be done without my approval and it had to be done my way. Obviously, this did not work for long.

I have learned that gaining the support of your staff will ensure your success as a manager. By ensuring your staff's success, you ensure your own. GIVE THEM SOME BREATHING ROOM.

All managers have objectives and goals they must meet, many are not their own and some you don't like, still others you may not agree with. However, supporting your staff will help you achieve your objectives and win favor and respect with your bosses. Once you establish this, then you can go about the business of getting some things you want done.

In the end, the image of nursing will be improved and the advancement of the profession can begin. There is still much much more to be done in other areas, this is only a start at the grass roots level.

This thread will probably generate some differing opinions, or may not generate much response at all, but, we have got to start somewhere and the first place I recommend is having the leadership of our profession looking in the mirror.

Nurse managers and directors of nursing: YOU REPRESENT US ALL TO ADMINISTRATION, MUCH OF THEIR VIEW OF US DEPENDS ON YOU AND HOW YOU PRESENT YOURSELF. PLEASE DO NOT LET US DOWN.

[ceecel.dee, MSN, RN]

I am printing this for our DON to read. Thanks for sharing your insight. I think you are right on!

[renerian, BSN, RN]

I beg to differ on one thought. I have done management in health care a long time and let me tell you I made alot less than many of the nurses doing patient care. I was salaried and worked like a dog. I worked no less than 60 hours per week sometimes over 70. My main thought was to provide a great place to work for the staff, all and not money or heck I would have done an hourly job with potential for over time.

Just a thought from the peanut gallery,

renerian

[1 Leg Lance]

Well ainz I gotta tell you I registered here after lurking for months just because of the chord your post struck with me.

I am currently a NA (new) at a hospital here in Phx and I should enter a local RN program in Jan.

As someone in his 30's, male, an amputee and former biz owner I come to this profession with some different viewpts than some of my co-workers. I was shocked at how little of the biz most of my co-workers understood and how strong the "way it has always been" feeling is held. I agree about the need to communicate with management in thier own language and moving others by getting them to move themselves. Nothing happens without the "why" well answered by someone :)

I am really looking for ways to get RNing to a higher professional level. I like your comments and would value any imput on how I as a NA can start improving the world :)

Thanks for your post and keep'em coming!

1 leg lance

[live4today, RN]

Ainz.........thumbs up! I like the way you think here. I emailed this page to my Nurse Manager. Thank you for posting it! :kiss