July • August 2014
Compiled by | Jacqulyn Robison, BSN, RN, GRN Contact | Jacqulyn Robison BSN, RN, GRN P 308.630.1450 E Jacqulyn.Robison@rwmc.net 4021 Avenue B Scottsbluff NE 69361
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Table of Contents A Note From m the Editor
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A Messa age From Shirley
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Safety Sense e
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Professio onall Development
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Nurse Re esidency and
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Cliniical Coach Programs Breakfasst with Shirley
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Shared Gove ernance Updates
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The summer months are upon us and we are deep into expectations of picnics, family time, and my favorite, sun tea. Time will fly by and school will be in the near future. As a child, the best part of summer for me was going swimming almost every day. This luxury was possible because I had an incredible mother who worked nights as a nurse on a Telemetry Unit. She would come home and sleep until noon and once she was awake, her four children, including me, would dart at her asking, “When are we leaving?” because we could not contain our excitement.
Jacqulyn Robison Jacqulyn Robison, BSN, RN, GRN Survey Preparedness/Magnet Coordinator
That is one of the perks to working as a nurse – being able to have time to spend with your family. Working as a shift nurse has many perks. Being able to schedule shifts at the beginning of one week and the end of another allows for nurses to take a short vacation somewhere without having to use vacation time. When it is summertime and your children are home from school, you’re able to take them swimming, to the library, or get creative with the quality time you give them. If you have no children and still enjoy sleeping in, it feels like being a kid again when you have no responsibilities and can sleep in until your body tells you to wake up. Other perks of being a nurse include the flexible scheduling, being able to run errands during the work week when it is not so hectic, and still make a decent living. If you want to take a class or
join a weekly study group, you’re able to accommodate for those instances. In fact, 10 very good perks of being a nurse include: 1. Getting to influence others and save a life! 2. Flexible schedules. 3. Ability to travel: You can work almost anywhere in the world. 4. Physical work: Nursing helps you stay in shape. 5. Variety: Diverse nursing jobs are available. 6. Job security: With illness and the promotion of health and wellness. 7. Challenge: We are never bored! 8. Respectable pay: Sometimes it feels as though nurses are underpaid with the type of work we do, but we do get fair compensation. 9. Scrubs: It’s like getting to wear pajamas to work. 10. Food: People love to bring food/treats to nurses. The many perks or advantages of being a nurse should outweigh the disadvantages – in fact I am surprised more people do not want to go to nursing school and become a life saver! Respectfully,
Jacqulyn Robison
“Far and away the best prize that life has to offer is the chance to work hard at work worth doing.” —Theodore Roosevelt
Shirley Knodel SHIRLE Y KNODEL, MS, RN Chief Nursing Officer Vice President, Patient Care
What brings you joy at work? Is it mentoring someone who needs help doing something he or she hasn’t done before? Is it helping someone lost in the hallway by walking them to their destination? Teaching someone about a new medication? Helping a family cope with a sudden life change? We often underestimate how much these things mean to other people. This week a tearful woman who had just lost her mother stopped to say that one of our nurses made a very difficult time in her life bearable by the love and kindness shown to her mother and to her. Talk about having a powerful impact! A local businessman took time out of his day last week to write a letter of thanks for the great care his family received. During rounding, patients sing the praises of our staff on a regular basis.
Reflecting on this, I began to wonder how one complaint reverberates loudly in the organization while a compliment seems to come in a whisper. The difference seems to lie in how we react to a compliment versus a complaint. A compliment is an affirmation that what we are doing is viewed positively and it makes us feel good. A complaint is a criticism of something we did or did not do, so it stings. It’s easy to take the complaint personally. If, instead of personalizing the complaint, we view a complaint as an opportunity to improve our interaction with a person, it has the potential to become a positive. This takes a conscious effort on our part to reframe our thoughts. Reframing our thoughts will change our reaction. One thing is certain, people who master the ability to connect with others and see complaints as opportunities to seek more information and improve the situation, are people who find more joy in their work.
Summer is such a great time! Sunshine, warm weather, ball games, vacations, swimming… My summer has been great and has gone way too fast. How has your summer been? What have you been doing during these months of play? If you’ve played any sports or gone to watch your kids play sports you know that in order to do well they need a good coach who can pull them together as a team. What about at work? Do you work with others on a day-to-day basis? How dependent is your working relationship with your leader and co-workers to getting the job done and done well? That’s right – very important! WE don’t work in a silo, we work in teams, lots of different teams. The product of our work is a reflection of how well we work together as a team. So how do I work effectively in a team to produce excellent work? An example of this comes from military aviation with the “Wingman” concept.
Susan Backer SUSAN BACKER, MSN, APRN-CNS, ACNS-BC Patient Safety Officer/Clinical Nurse Specialist
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“A wingman is a pilot who supports another in a potentially dangerous flying environment. Wingman was originally a term referring to the plane flying beside and slightly behind the lead plane in an aircraft formation. The traditional military definition of a “Wingman” refers to the pattern in which fighter jets fly. There is always a lead aircraft and another which flies off the right wing of and behind the lead. This second pilot is called the “Wingman” because he/she primarily protects the lead by
‘watching his back.’ Among the Wingman’s primary responsibilities are remaining close to the leader of the aerial formation and warning the leader of any immediate threats at the cost of losing mutual protection.” (Retrieved from http://en.wikipedia.org/wiki/ Wingman on 7/30/2014) So how does this play out in our work at Regional West? We all work in teams so we each need to be a Wingman and have a Wingman, or many Wingmen. No matter if we are a leader, a middle manager, a direct care provider, or support those who provide direct care – we all need each other. We need each other to: •Warn of impending dangers – such as proper use of personal protective equipment when caring for patients in isolation or cleaning up a chemical spill, or putting up the yellow sign to warn of a wet floor. •Remind each other to do the right thing. •Coach others when they are struggling or need extra encouragement and support. •Educate others. •Think together to come up with the best solution to a problem.
•Gain an awareness of what’s going on in the unit and the organization that would affect patient and staff safety (the daily Huddle). •Communicate clearly so we are all on the same page. •Treat each team member with value and respect so he or she isn’t afraid to speak up when something is not right.
Jacqulyn Robison Jacqulyn Robison, BSN, RN, GRN Survey Preparedness/Magnet Coordinator
•Interact cooperatively within the team to accomplish a common goal. •Be unified in our purpose to provide safe, quality care. I have to ask myself – do I do this? Do I work within a team to make the team better? Do I speak up when someone is about to do something that could harm them or someone else? Do I receive this feedback gratefully or become defensive and irritated? Am I a good Wingman? Do I have someone who is a good Wingman to me? I like this quote from an article I found on the Internet written by Senior Airman Chase Connolly on Feb. 27, 2012: “The wingman concept is a simple but critical idea that can be used every day, in many situations. It fosters an environment of collaboration and accountability. It helps us head off bad decisions by catching mistakes early, so we can take the best course of action soonest.” Who’s your Wingman? This fall you will have the opportunity to honor your Wingman publicly. Look for details on the Campus Homepage and posters distributed throughout the organization. Let us know who has your back!
The background Understanding the need for pursuing professional development and furthering education can be frustrating. However, research has shown that pursuing further education is beneficial and important to focusing on patient safety and health. Understanding that when one becomes a nurse, continuing to be a lifelong learner is the most important and humble lesson to learn when accepting this role. Why go on? When taking on more education and leadership, the nurse promotes a culture of ambition, good work ethic, and competence. The nurse who
pursues a higher level of education or certification will also benefit from increased self-esteem as well as career advancement opportunities. Going on for further education promotes the confidence that the nurse has in himself or herself while giving the best possible care to the patient. This will also create an environment of teamwork within the unit, department, and/or the organization. With that, I am hoping that all nursing staff are encouraged to go on and pursue educational opportunities for not only the patients but also for themselves.
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Kim Meininger Kim Meininger, BSN, RN Nurse Education Coordinator
Nurse Residency and Clinical Coach Programs The Nurse Residency program for 2014-2015 will begin October 1. This program is designed to support newly licensed nurses and nurses changing an area of specialty in their transition to practice. The Nurse Residency program curriculum will include six separate modules: 1. Patient Centered Care 2. Communication and Teamwork 3. Evidenced-Based Practice 4. Quality Improvement 5. Informatics 6. Professional Development These six areas related to health care are considered the core competencies that each nurse demonstrates in an acute care setting to provide safe and competent care. These transition modules are supported by the National council of State Board of Nursing (NCSBN), the Institute of Medicine (IOM), and the Quality and Safety for
Nursing Education (QSEN) competencies. Content within these modules includes information related to delegation and supervision, role socialization, utilization of research, prioritizing/organizing, conflict management, clinical reasoning, interpersonal communication, and unit specific simulation labs. The classroom structure for interactive learning will occur on the first Wednesday of each month beginning October 1, and then unit specific simulation labs will be conducted once a month. In the simulation labs, nurse residents will be able to apply the concepts taught in the classroom while incorporating this information in patient specific population scenarios. This includes the nursing process with assessment, nursing diagnosis, planning/interventions, implementation, and evaluation. Along with the Nurse Residency program will be continued support of our clinical coaches. The success of the transition to practice for newly licensed nurses is highly dependent on a strong
clinical preceptorship. The didactic classroom interactive learning and unit specific simulation labs are open to all nursing staff members who are striving for professional growth and are committed to lifelong learning. This is an ideal opportunity for clinical coaches to apply their mentoring skills with newly licensed nurses and promote their own continued professional growth. Past evidence has shown that Nurse Residency programs show a decrease in nurse turnover rates in their first year of practice. The program effectiveness for our Nurse Residency program will be measured by monitoring job stress/job satisfaction, nurse retention, and self-efficacy with clinical competency by utilizing the CaseyFink graduate Nurse Experience survey. The department-specific simulation labs will be monthly for each unit involved in the Nurse Residency program. Clinical coaches, clinical coordinators, and other expert staff will be participating in these simulation labs to provide expert clinical knowledge in their specific patient
population. These simulation labs are open to any staff member who would like to participate in the learning experience (with prior approval from your manager and/or director). The following is the Sim lab schedule: DATE
TIME
DEPARTMENT
2nd Wednesday of each month
10 a.m. to noon
Operating Room
2nd Wednesday of each month
1 to 3 p.m.
ICU/PCU/PACU, Emergency Department
3rd Wednesday of each month
8 to 10 a.m.
Medical-Oncology
3rd Wednesday of each month
1 to 3 p.m.
Medical-Surgical 2nd East, 2nd West, Outpatient Surgery
4th Wednesday of each month
8 to 10 a.m.
Birth and Infant Care Unit, Pediatrics
4th Wednesday of each month
1 to 3 p.m.
Float Pool
Location for each classroom setting will be conducted in the basement of the current Apria building (also known as the 211 building). Each Sim lab location will vary from month-to- month depending on the type of simulation that will be conducted. More information regarding these Sim labs and classroom topics will be sent to all nurse managers and clinical coordinators,
August 26 During “Breakfast with Shirley,” the main focus was on nurse retention, which has been a common theme throughout this issue of Magnetic Times. With that fact, it is also important to recognize that as nurses, we must remember to be empathic and open-minded in accepting the “newbies” of the organization. That ranges from nurses who come in from other regions/ organizations to new grads who are fresh out of nursing school.
No matter how many leadership books we read, the same message is loud and clear: that leadership is the number one success in making an organization grow and be sustainable. Then there are the leaders who might behave in a negative sense and it seems as though they are rewarded because of who they know or their seniority. Hopefully the ‘newbies’ will overcome these types of leaders and continue to trek on their own trail of success and positive patient care outcomes. Never let fear control the bullies of the workplace. In fact, show them their wrongdoing when they say you cannot do something. Kill them with kindness; rise above.
It is difficult to overcome some of the bullies who might be humiliating or intimidating, but that does not mean it can’t be done. This is one of the consistent behaviors seen nationwide. The best thing to do when encountering bullies is to look at the situation; see if there is something they lack with their own emotional behaviors, do what is in the best interest of the patient, and continue to do the right thing in serving the patient. The other thing each one of us can do is to reflect on our own actions and see if we are the so-called “bully of the workplace.” If we are, there is still hope for us as we can change and turn that bullying into leadership.
To tie bullying in with the workplace and nurse retention, the main focus is that if we do not accept our new nurses, we will lose them. This will affect our workload, our patients, and our happiness. If we are open and accepting, we can be true leaders who build positive relationships and keep our nurses within our organization. With that, we might not only find a co-worker to depend on, but also find a friend we can trust. Jacqulyn Robinson
Shared Governance Update Coordinating Council The Coordinating Council is getting ready to transition and have new roles within this council. As the year rolls around, the chair and chair-elect for each Shared Governance Council will see fresh leadership and hopefully retain the wisdom of the current leadership. The Coordinating Council has taken a new approach to incorporate an educational topic to promote learning and discussion. This has been taking place at every other meeting starting with June 2014. Fair and Just culture was the first topic of discussion. The second topic was on nurse retention. Liz Ossian did a lot of research and nicely presented how there are three generations of nurses currently in the workforce. These include the “Baby-Boomers,” the “Generation Y’ers,” and the “Generation X’ers.” Despite the differences in age, skills, and beliefs, the common incentives for staying in their current job included reasonable workload and manageable nurse-patient ratios. The discussion was interesting and there were other incentives versus disincentives shared throughout the group. Out of these discussions, came recommendations to utilize the Pathway to Excellence model as a general guide toward higher RN retention. We are also working on ensuring that nurse workloads are reasonable and that nurse-patient ratios are manageable. We have adopted that teamwork helps make this possible while leadership continues to support the frontline nurses. If we begin manager development early on, empower staff nurse councils, and keep the focus on safety, we are on the right track. Last, adopting the “life-cycle” approach to benefit design and build a culture of positive aging will be the final key component in making nurse retention a success. Quality & Safety Council Quality & Safety has been working on the Nurse Fatigue Project, which can tie in with the nurse retention topic that has been discussed with the Coordinating Council. With the results of this project’s survey, the outcomes have led council members to start brainstorming ways to reduce nurse fatigue. They have become creative with discussions in what the next steps will be after Leadership has reviewed and approved such ideas. Examples of the creativity would include taking a break at work after you have given the appropriate handoff report, good sleep habits, and having a
wingman at work who has your back when it comes to your safety/assertiveness on fatigue. Professional Practice Council The Professional Practice Council has been wrapping up details with the Fall Health Care Celebration Day that will be held in October. This is an exciting opportunity for all staff to relax and enjoy a humorous speaker. They will be having a work day to discuss changes in the Nursing Ladder. They have been researching what other organizations are doing to revamp this ladder. One suggestion that has been discussed is the PRISM (Professional Recognition of Initiative, Skill, and Merit) Professional Clinical Ladder for Nursing from Chester County Medicine in Pennsylvania. This model, based on Shared Governance values, really rewards the nurses who are trying to be successful in their work and strive for outcomes based care. Care & Practice Council Care and Practice has been tackling the challenge of document intakes and outputs as well as entering daily weights accurately into the patient’s chart. This is a crucial part of nursing because it is relayed to physicians and can affect the type of orders they write. It can also affect the patient’s safety. The nurses here care about safety first and are trying to find a universal way to approach this documentation process. During meetings it has been suggested the campus homepage have links under the Nurse’s Resources tab that store job aids. These job aids will educate staff on the proper way and process to weigh a patient. Having a reference sheet that converts the ounces into milliliters will also help nursing staff remember how to document any liquids the patient consumed. Nurse Finance Council The Nurse/Finance Council has initiated their IV Tray project to cut down on waste in IV supplies. This will hopefully cut down costs and save time for the nurses in finding supplies while starting an intravenous access line for a patient. Remember, if you have some ideas on ways to reduce costs, please visit the Intranet site and submit them! You can also contact Vicki Schmall or Tami Bokelman with any ideas. During the council meetings, they discuss all submissions to see if they can be pursued. It is important to remember we are each accountable to be good stewards of our time, resources, and keeping our areas clean.
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