INSIDE Conduct ‘honeymooners’ quiz to reduce employee turnover · view their new work...

INSIDE

Vol. 5 No. 6June 2005

Safety trainingDiscover three training techniquesto keep nurses safe in the ED on p. 3.

Interdisciplinary care cornerLearn how staff from multiple disciplines conducted sneakyhandwashing compliance auditson p. 4.

CommunicationUse the tips on p. 5 to enhancecommunication with your nightnurses.

LeadershipRead about the concept of elitenursing and the four motivatingfactors behind employee retentionon p. 6.

Operations managementIf patient flow is a problem on your obstetrics unit, readstrategies for easing it on p. 7.

work and again on the 90-daymark. This form of support helpsretain new nurses because itshows that you are willing to offercontinuous guidance and that youvalue nurses’ input.

Conduct the ‘Honeymoon Quiz’ Studer and his team of leadershiptrainers at the Studer Group inGulf Breeze, FL, created the quizafter conducting extensive inter-views with healthcare leadersabout the troublesome topic ofemployee turnover. The result isthe following six all-purpose ques-tions to ask your employees:

Question #1: How do we com-pare to what we said we’d belike? This is what Studer calls thevalue question. “Basically, it offersnew employees a chance to tellemployers whether or not they arewhat they promised to be,” Studersays. Make new hires comfortableto ask about elements of their jobsthat differ from what they expect-ed. “[You’ll] learn a lot, and you’llusually be able to reassure an em-ployee that the problem they’reworried about is probably onlyshort-term,” he says.

Question #2: What do you likeabout the job? What’s goingwell? Taking a moment to let newhires discuss the positives

Learning objectives: After readingthis article, you will be able to1. explain how ongoing orientation

for new staff helps reduce employeeturnover

2. identify six questions to ask newhires as part of an ongoing orienta-tion program

When a nurse manager hires anemployee to fill a vacancy, allthat’s left to do is train that newnurse and start him or her on thepath to becoming a productivemember of the unit. Right?

Wrong. Orienting new staff, espe-cially new graduates, is an ongoingprocess. Often, new employees aredisenchanted when the realities ofthe new job (e.g., workload orworkplace atmosphere) don’t meetthe expectations that the new em-ployees set.

Managers miss the boat if theydon’t sit down with these employ-ees during the first few months oftheir tenures, when new employeesview their new work environmentsin a positive light, to conduct what’sbeen dubbed the “HoneymoonQuiz” by Florida-based corporatecoach and former hospital adminis-trator Quint Studer.

Studer suggests conducting thequiz 30 days after new hires start

Employee orientation

Conduct ‘honeymooners’ quiz to reduce employee turnover

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Ongoing interviews

rather than the negatives of their new jobs can go along way toward making employees feel welcome.This question can help employees who have been onthe job for a short time realize that their adjustmentsmay not be as trying or awkward as they originallythought, Studer says.

Question #3: Which employees have been help-ful to you? Studer sees this question as a chance tofind out about your seasoned employees. Ask thisquestion to find out “who really is a good peer andwho’s really not good at bringing on new staff,” saysStuder. And although most of what you discuss withnew hires during these meetings will likely remainconfidential, this is one instance in which Studer rec-ommends spreading the good news on your unit.

Question #4: Are there duties you performed at your last job that might help us? The medicalprofession is notorious for not being very receptiveto suggestions from employees about performingeveryday tasks or improving operations.

“By asking this question, you are telling your em-ployees that you value their suggestions,” Studersays. And the fact that you ask these employees inprivate often gives them the confidence to say some-thing they never have before, he adds. Also, if youhold the interview early on, you may get some origi-nal ideas before new employees become too accus-tomed to doing work your way.

Question #5: Is there anything here that couldmake you want to leave? It’s a question that mostemployers loathe asking their employees—particular-ly new employees, who employers hope haven’tfound anything to dislike about a new position orworkplace.

But “the truth is, there could be something wrongon your unit that you’re not aware of, and it couldbe something wrong enough to make a person wantto leave a job,” says Studer, offering hypothetical ex-amples such as bullying by another employee or

even sexual harassment.

The answer to the question will generally be no, inwhich case, there’s no harm to your unit and youlook all the better for having the attentiveness toask.

The consequences of burying your head in the sandto avoid hearing anything negative could result inthe loss of a promising new hire and, even worse,risk patient safety.

Question #6: Do you know anyone who mightadd value to our team? When a unit recruits astrong, competent new member from another hospi-tal, it stands to reason that others from that samehospital might share the employee’s high level ofskills—and may also be interested in finding a newsetting.

The best way to find these potential jewels is to askyour new hires if they know any candidates. Butknowing when to ask them is crucial, Studer says.

When people first start at new jobs, “they might notfeel confident enough to recommend a friend,” saysStuder. “By the time they are ready, they may havelost touch with the friends from their old [employer].”That’s why Studer suggests that employers ask aboutpotential new hires within the first few months.

A real team effort As for who should conduct these meetings, Studersays the quick answer is “whoever does the staffevaluations.” It’s also possible to split the responsi-bility between nurse managers and preceptors byincorporating Studer’s Honeymoon Quiz into anexisting preceptor program.

Editor’s note: Studer’s Honeymoon Quiz and otherstrategies for managing and sustaining healthcare facil-ities can be found in his book Hardwiring Excellence:Purpose, Worthwhile Work and Making a Difference.Visit www.studergroup.com for more information.

Employee orientation (cont.)

< p. 1

Strategies for Nurse Managers—June 2005 © 2005 HCPro, Inc.

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Safety training

Make the ED a safer place for nursesTrain nurses to respond to violence in the workplace

Learning objectives: After reading this article, you willbe able to1. list three security training methods to increase nurses’

safety in the ED

In a healthcare setting as unpredictable as an ED,staff—especially nurses—must be prepared to han-dle violent situations.

The results of a recent HCPro, Inc., survey aboutsecurity efforts in the ED echo the concerns of hos-pital security experts who stress the need for appro-priate staff training.

Nurses are top targets Respondents revealed that nurses are the most likely(87%) targets of violence in the ED as the frontlinestaff who interact with patients through the durationof their stay. To address this issue, consider thesethree techniques to enhance training for nurses sothey are prepared to handle violent patients, familymembers, and visitors:

1. Train nurses in aggressive/violent behavioralmanagement. If a patient becomes violent, nursesneed to know how to respond immediately and inthe least disruptive manner to keep other patientssafe, says Fredrick Roll, CHPA-F, CPP, president of

Roll Enterprises, Inc., a healthcare security consultingfirm in Morrison, CO. Although all nurses shouldreceive basic training to recognize violent behavior,consider extensive training for at least one personon every shift in the ED.

2. Don’t allow nurses to be alone with patients.Establish a system in the ED in which nurses arenever left alone with patients. If it’s impossible tohave another nurse or physician enter the ED withthe patient, try to establish a way that nurses can beheard and seen without violating a patient’s privacy.For example, some ED rooms contain large glasswindows that allow others in the ED to see inside.

3. Train nurses in deescalation techniques. If pa-tients become irritable, nurses must be able to calmthem down with words and a soothing tone of voice.If patients yell, nurses should know not to yell backbut instead ask how they can assist. It’s important tounderstand patients’ frustrations and empathize withtheir situations, Roll says. “If someone starts being ex-tremely aggressive, back away and tell the person tostop,” Roll says. “Wait for additional resources to ar-rive before you take it any further.”

Source: Briefings on Hospital Safety, April 2005,HCPro, Inc.

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Interdisciplinary care corner

Stealth staff conduct handwashing compliance audits behind the scenes

Learning objective: After reading this article, you will beable to1. demonstrate how to conduct a multidisciplinary hand-

washing compliance audit to increase adherence to theJCAHO’s National Patient Safety Goal (NPSG) on handhygiene

Infection control (IC) staff at Lanier Health Servicesin Valley, AL, recruit workers to help conduct hand-washing compliance audits under cover.

Random audits using IC staff did not work, saysDebra Hudmon, BSN, RN, Lanier’s manager of per-formance improvement and patient safety. “Wewould walk in, and [employees’] normal behaviorwould change,” she says.

Now case managers or social service workers con-duct the compliance audits during their daily roundsand report their findings to the IC department.

Before they went undercover, these helpers under-went training to understand exactly what to look forand how to record their findings in an audit form.

The JCAHO’s NPSG #7 requires handwashing com-pliance to reduce the risk of healthcare-acquiredinfections.

To demonstrate compliance with Goal #7, the ICdepartment uses an audit form, which it adaptedfrom a document used by the U.S. Veterans Adminis-tration, Hudmon says.

The form includes places to note whether employeeswash their hands at the appropriate opportunities, thelength of time they spend washing, and whether alco-hol-based hand gel is available. The audit identifies aspecific person by title, not by name.

Staff who conduct the audits don’t use the actualform during rounds. Instead, they take notes and

then enter the appropriate information into the form.

The IC department targets certain groups of employ-ees on certain days for surveillance, including thelarge population of nursing students who work atLanier.

If you can’t recruit other healthcare professionals toaudit IC compliance, Terri Rebmann, RN, MSN,CIC, infectious disease specialist at Saint Louis Uni-versity School of Public Health, recommends an al-ternative. Have IC staff observe handwashing fromnurses’ stations while acting as though they were fill-ing out charts, she says.

See the lightThe challenge of meeting Goal #7 is to change staffbehaviors, particularly those of older physicians whomay not recognize the need for proper handwashing,Hudmon says. To convey the goal’s importance tonurses and physicians, IC staff shine an ultraviolet lighton employees’ hands after they have washed to seewhether their hands were properly cleaned, she says.

“We were able to get great compliance from ournursing staff after we showed them what showed upunder the light,” Hudmon notes.

Tip: It’s not just getting staff to wash their hands thatleads to proper cleaning. The length of time theyscrub is just as critical, Hudmon says. At Lanier, staffwere taught to use the trick of singing a jingle for10–15 seconds to ensure that they spent an appro-priate amount of time washing.

Demonstrations with the ultraviolet light and follow-ing up on results of the audits have contributed to a40% increase in staff compliance with handwashing,Hudmon says.

Source: Briefings on Infection Control, April2005, HCPro, Inc.


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Communication

Night shift nurses: Bridge the communication gapStrategies to include night nurses in your daytime events

Learning objective: After reading this article, you will beable to1. discuss the communication barriers between night-shift

nurses and their units, departments, and organization2. identify at least six ways to include night nurses in

committees and staff meetings

Editor’s note: In the first of this two-part series, weexplore strategies to keep night-shift nurses connectedto programs and events that are part of their organ-ization’s daily culture. In the next issue of SNM, we’llgive you methods to convey important policy/proce-dural changes to night nurses and ideas to includethem in training initiatives.

Meeting the needs of night-shift nurses presentsunique challenges for nurse managers. Night nursesmay require more managerial, departmental, andorganizational support because their shift time mightcreate feelings of isolation. To maintain teamworkand morale, make an effort to include this group inhospital committees and staff meetings.

Because night nurses are unable to participate incommittees and attend meetings held during theday, coordinate your schedules to increase your facetime with staff. “Our unit clinical managers flex theirhours to be visible on all the shifts,” says Anne Jadwin, RN, MSN, AOCN, CNA, director of nursingat Fox Chase Cancer Center (FCCC) in Philadelphia.

FCCC uses departmental newsletters, an internalnursing Web site, and posts departmental minutesfrom council meetings to keep staff connected, saysJadwin. Many of FCCC’s nurses work 12-hour shifts,so they visit the hospital for shared governance meet-ings, inservices, and on-site conferences during theirtime off. Staff also videotape many daytime inservicesso the night-shift supervisor can show them to staff.

FCCC also fosters communication using unit-basedlog books where staff write reminders and updatesabout policies and procedures. In addition, it holds

certain staff meetings and all nursing forums duringall three shifts.

At Medical City Dallas Hospital, staff meetings occurduring day and night shifts, sometimes at 2 a.m., saysCole Edmonson, MS, RN, CHE, CNAA,BC, associateadministrator of patient care services at Medical CityDallas Hospital and Medical City Children’s.

To schedule meetings that include all staff, the exec-utive team hosts quarterly update meetings called“city forums.” The meetings are scheduled in one-hour time slots throughout one week and start asearly as 7:30 a.m. and end as late as 6 p.m. to allowall 2,400 staff to attend at various times. The facilitysupports meeting attendance by compensating staffwho come in for the meetings prior to or after theirshifts or on their days off.

Because all staff cannot be present at all meetingsdue to time conflicts, Medical City Dallas Hospital en-courages the involvement of all staff nurses throughits participative leadership model, in which every unithas a council composed of RNs from different shiftsthat meets monthly.

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Leadership

The Elite Nursing Pyramid Framework supports staff nurse commitment

By Gordon Barnhart, president, Compass Group inInc., Cincinnati

Leadership objectives: After reading this article, you willbe able to1. explain the four elements of commitment in nursing lead-

ership that compose the Elite Nursing Pyramid

Hospitals are desperate for nurses—some throwmoney, signing bonuses, and even free cars atpotential candidates. But administra-tors are still searching for the holygrail—the factors that truly moti-vate a nurse to commit to onefacility.

The Compass Group, a companythat helps healthcare organizationsoptimize operational performance,developed the concept of elitenursing to create a sustainablesolution to the nursing crisis.

The Elite Nursing Pyramid (see p. 7) is a key ele-ment to the approach and provides a clear picture ofthe factors that motivate nurses to personally investthemselves in an organization.

The pyramid provides both a management map and aframework for productive dialogue with staff nurses.It helps managers create high-commitment environ-ments, supports individual staff nurses in self-manage-ment, and influences their work environment.

The elements of commitmentThe major factors that combine to create a person’swillingness to invest himself or herself in an organ-ization are

� feeling safe� gaining success� seeing a clear personal financial return on invest-

ment (ROI)

� seeing a clear psychological return for the invest-ment of self

Not surprisingly, the interplay of safety and successalong with a desirable ROI are the same factors thatpeople consider when making financial investments.Nursing is just a different type of investment. Formanagers, the question is, “How well am I doing tobuild these elements into a strong foundation forcommitment for our people?”

Following is a detailed explanationof the factors that drive personalinvestment:

1. Safety and success. These factors(listed in the chart on p. 7) indicatehow well people understand theirwork environment and navigatetheir way through it to be successful.

When these factors are in place, peo-ple can take responsibility for themselves

and manage their work experience. When these fac-tors are missing, people are much more vulnerable tothe vagaries of the workplace and are handicapped intheir ability to manage their experience.

For example, imagine having clarity of mission, ex-pectations, group norms, career possibilities support,and feedback combined with the knowledge, rela-tionships, processes, and staffing necessary for suc-cess. Then imagine not having those factors in place.You would make very different decisions aboutinvesting yourself in a job.

2. Material returns. Of the four main categories,material returns are rarely the primary influence onpeople’s willingness to invest. However, managersoften focus the most on them. Material returns are amajor disincentive when they fall below a certainlevel, but they are rarely a significant sustainableincentive.

The opportunity to grow and have

enriching relationshipsis often at the heart of nurses’ willingnessto invest themselves

in a workplace.


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Operations management

Smooth patient flow helps increase patient satisfaction, unit efficiency

Learning objective: After reading this article, you will beable to1. discuss the theory behind variability methodology and

recognize three of the positive outcomes that Elliot Hos-pital achieved through this concept

Nurses are on the verge of quitting, pregnant patientsare angry and sent away daily, and the unit clerkwants to tear her hair out.

Two years ago, this was a typical day in the eight-bedobstetrics unit at Elliot Hospital in Manchester, NH.

However, without expanding or hiring additionalstaff, maternity center director Susan Leavitt Gullo,RN, MS, turned the unit around in less than a yearwith a seemingly counterintuitive method and thehelp of her nursing leaders. Her move increasednurse retention and facilitated recruitment. Patient

satisfaction soared as the ward began to accommo-date its patients. It has cancelled fewer than 10patients’ scheduled inductions since January 2004,compared to almost daily cancellations before then.

Understand variability and patient flow During an audioconference in fall 2003, Gullo listen-ed to patient-flow expert Eugene Litvak, PhD, pro-fessor of healthcare and operations management atBoston University and director of the Program forManagement of Variability in Health Care Delivery,explain his variability methodology and how it worksin hospitals.

Litvak and Michael Long, MD, wrote “Cost and quali-ty under managed care: Irreconcilable differences?”The article, published in the March 2000 AmericanJournal of Managed Care—explains that many pa-tient-flow bottlenecks are created by different

Leadership (cont.)

Financial strategies are usually default strategies.They are employed when management doesn’tknow what else to do or doesn’t believe that ithas time to build more substantive approaches.

3. Psychological returns. For many nurses, thepsychological returns are often the most importantfactors in the Elite Nursing Pyramid. Having asense of contribution, meaning, place, respect,value, and worthy identity along with the opportu-nity to grow and have enriching relationships isoften at the heart of nurses’ willingness to investthemselves in a workplace.

The other factors are important, but the psycholog-ical returns are often transcendent for nurses.

Editor’s note: Discover strategies to apply the EliteNursing Pyramid in practice with the second partof this series, “How to Use the Pyramid as a Tool,”in the July SNM.

> p. 8

Source: ©2001 Compass Group, Inc. Reprinted with permission.


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patient categories competing for the same hospitalresources, such as beds and radiology services.Scheduled and unscheduled patients are the two cat-egories that compete most often.

To maximize resources, your goal is to schedule pa-tients back-to-back, Litvak says. For unscheduled pa-tients, your goal is to make sure that resources arealways available for them. You must leave slots openfor these patients, but that impedes your goal ofscheduling patients back-to-back. Litvak’s theory ofvariability states that when two flows have differentgoals, you must separate them so they don’t com-pete for the same resources, he explains.

Improving patient flow and the hospital’s overallsuccess hinge on operations management and lead-ership buy-in. “Patient flow can be screwed up sobadly that quality goes down,” Litvak says. “Youcan’t provide quality care without quality operationsmanagement.”

Obstacles in obstetrics While listening to Litvak discuss OR operations man-agement, Gullo realized that the same technique forthe OR could work in obstetrics because both havescheduled and unscheduled patients. Unlike the OR,the duration of scheduled procedures in obstetrics isoften unknown, and inductions can last up to 24hours, Gullo says.

Most patients favor scheduled inductions, Gullosays. Physicians like to schedule them at 7 a.m.because the average induction lasts 12–24 hours.Physicians would tell their patients to arrive at thehospital at 5:30 a.m. to guarantee a slot because ofthe high volume of scheduled patients and the un-predictability of unscheduled patients. However, theward simply could not accommodate all of its pa-tients, and the clerk often sent home those who ar-rived early for their appointments. Even scheduledpatient inductions were cancelled daily upon arrivalof unscheduled patients. Staggering patients’ induc-tion times didn’t help either because of the length

of labor.

Smoothing out the flow During the first six months of putting Litvak’s theoryin place, Gullo and Litvak focused on smoothing theflow and making sure patients arrived at 7 a.m. forinductions. Patient volume remained the same. Theyexamined data from fall 2003 in the following areasto determine the ward’s needs:

• Number of scheduled patients • Number of unscheduled patients • Time of patient arrival • Length of stay • Pattern of demand

The length of time you spend collecting data dependson what data are available, Litvak says, and the moredata, the more accurate the result.

Use data to form a strategy Based on the data analysis and modeling of patientflow in the unit, Gullo and Litvak chose to set asidefour beds—half of the beds in the ward—for sched-uled procedures Monday–Friday. Although four bedsworked at Elliot, Litvak encourages each hospital toanalyze its own data to determine its needs.

To get nurses on board, Gullo spent two weeks show-ing them evidence and data proving that the processworks. Nurses felt that nothing could make the unitmore chaotic and were willing to give it a shot, shesays. Each day, staff highlight which beds are set asideon a white board. Staff then contact patients sched-uled for the next day to ensure that they will arrive at7 a.m. If the ward appears to have heavy volume overthe next 24 hours, Gullo makes sure enough nursesare working and puts nurses on call if needed.

Editor’s note: To read the paper, visit www.ajmc.com/files/articlefiles/AJMC2000MarLitvak 305.312.pdf. Thisarticle was adapted from Briefings on Quality In-formation and Data Reporting, March 2005,HCPro, Inc.

Patient flow < p. 7

Operations management (cont.)


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Coaching

Coach your way toward a championship team

Although you are in healthcare and your team mem-bers are not in the business of scoring points, effec-tive coaching skills will improve your success as aleader.

A manager who uses coaching skills effectively helpseveryone understand their roles and provides direc-tion to the team, which ultimately leads to betterperformance.

Coaching is also mentoring, encouraging, motivating,and setting the work ethic for staff. Once the manag-er becomes more adept at coaching, he or she willrealize

� improved ability to motivate staff� improved consistency in the delivery of patient

care� mutual respect and trust between manager and

staff� pride in team members� staff being more willing to participate in problem

solving

As a coach, you are the teacher, motivator, resourceexpert, negotiator, role model, and much more.

In order for you to be all of these things, make sureyour staff understand your

� ethical and moral convictions related to patientcare� expectations of the team and what you will not

tolerate� commitment to your job description� commitment to the skill level for which you are

licensed/certified � willingness to demonstrate daily self-discipline,

which allows you to follow the mission/vision ofthe organization

FeedbackIf there’s a lack of feedback between the staff andtheir coach, the coach is unable to perform his or her

role, and staff lose their desire to actively participateon the team. A lack of feedback implies staff input isunimportant in the eyes of the coach.

Feedback in your department should be

� easy and require little paperwork� ongoing, and not only when the manager hands

out a survey� regular, given by the manager in the form of

praise and recognition� nondefensive, and it should leave staff feel-

ing comfortable to give feedback to their manager� clear, in a message that shows staff you not only

care about patient care, but also about them

Part of coaching is telling staff when their behavioris not appropriate or when an employee’s skills do not meet the requirements of his or her jobdescription.

Don’t let the following get in your way of coachingemployees to improve their job performance:

� Your perception of a lack of time to coach them� Feelings of intimidation between yourself and

them� Fear of losing a staff member� Your dislike of confronting people

With the right approach and perspectives related tocoaching, your interaction can be the best thing foryou, the employee, and the department.

Seek out a mentor who is successful at coaching hisor her staff and adapt his or her coaching style toyour unit.

Source: The above excerpt is from the book Core Skillsfor Nurse Managers: A training toolkit, written byShelley Cohen, RN, BS, CEN; Sharon H. Cox, MSN,RN, CNAA; Beth Klitch, BA, FACHCA; and SandraKay Webb, RN, BS. Published by HCPro, Inc.


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JCAHO

Comply with the JCAHO’s requirements for primary stroke center certification

Learning objectives: After reading this article, you willbe able to1. discuss two practices that are critical to the success of

earning the JCAHO’s primary stroke center certification2. describe two strategies to comply with the JCAHO’s data-

tracking requirement to achieve primary stroke centercertification

Earning JCAHO certification as a primary stroke cen-ter requires hospitals to comply with 11 recommen-dations of the Brain Attack Coalition (BAC) and theAmerican Stroke Association (ASA).

Organizations need to establish efficient data collec-tion methods and obtain support from frontline staffto successfully earn this certification. Here, two hos-pitals share advice on meeting a couple of these rec-ommendations through data collection, networking,and staff buy-in.

Collect and analyze data The JCAHO requires that primary stroke centers trackin a database or registry the number and type ofstroke patients seen, their treatments, the treatments’timeline, and the measurement of patient outcome.

Brackenridge Hospital in Austin, TX, was certified asa primary stroke center in October 2004. LaurenBrandt, RN, MSN, CNS, clinical director of neuro-sciences for the brain and science center at Bracken-ridge, developed the all-encompassing data tool onp. 11 to improve efficiency and facilitate data collec-tion. “We had to fine-tune the quality improvementprocess to make sure we were collecting and analyz-ing data,” she says.

Consider sharing data with other hospitals Caritas St. Elizabeth’s Medical Center in Boston hasworked with 17 hospitals nationwide for the pastfive years to collect and compare data on perform-ance measures, including seven that the JCAHO’scertification requires. The hospital, which is now

pilot-testing a tracking method for all 10 JCAHO per-formance measures, has become efficient at collect-ing and sharing information.

The hospital uses a Web-based data collection sys-tem that allows for comparison with other hospitals.Sharing data is valuable in determining why process-es go wrong or desired outcomes aren’t achieved,says Judith Hinchey, MD, director of the strokecenter at Caritas St. Elizabeth’s.

For example, by analyzing these data, Hinchey hasfound that hospitals that use preprinted order formshave higher rates of adherence to performance meas-ures, including preventing deep vein thrombosis.

Each hospital can create its own template for a pre-printed order form by visiting the BAC’s Web site atwww.brainattackcoalition.org.

Creating a template is free, says Hinchey, and userscan view forms that other hospitals have created andadapt them to meet their needs.

Gain both the support and enthusiasm of your frontline staff to succeed Providing the top-notch care required of primarystroke centers falls mainly on staff’s shoulders. There-fore, staff enthusiasm is critical to success, says Brandt.“You need staff, especially at the bedside, who arecommitted and adequately trained.”

To generate enthusiasm and promote education, staffreceived free t-shirts when they attended educationalsessions on stroke, says Brandt. The hospital formeda Brain Attack Team with a bat theme and rewardedstaff contributions with bat t-shirts or stuffed bats. Staff appreciated the recognition and it helped in-spire them to become involved, says Brandt.

Source: Briefings on JCAHO, April 2005, HCPro,Inc.


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Stroke tool

Site

MR # _______________ Category status change?

Admit date _______________

Onset of symptoms _______________ Transferred from another hospital/acute-care facility? nn Y nn N

Arrival time _______________ (triage/exam room)

MD assess time _______________ (ED MD)

CT done _______________

CT read _______________ (document both dictation time and ED MD time)

Sample stroke data collection tool

Source: Brain & Spine Center, Brackenridge Hospital, Austin, TX. Reprinted with permission.

Additional notes:

nn Stroke: Ischemic HemorrhagicNIHSS score documented? Y Nt-PA considered? Y N DK N/At-PA received? Y N

ED stroke protocol? Y N

Swallow eval prior to liquid or food? Y N DK N/A

DVT prophylaxis by day two if nonambulatory? Y N DK N/AAntithrombotic at discharge?

Y N DK N/AAntithrombotic for A Fib?

Y N DK N/APatient education:

Disposition:Home rehab LTAC NF Death

nn TIAPresenting symptoms:Time symptoms resolvedCarotid u/s Y N

Antithrombotic during stay? Y N N/A

Swallow eval prior to liquid or food? Y NDK N/ADVT prophylaxis by day two if nonambulatory? Y N DK N/APatient education:


nn Subarachnoid hemorrhageHunt-Hess score documented? Y NCircle: Clipped Coiled NeitherEVD insertion date________EVD dates of use:Shunt Y N

Swallow eval prior to liquid or food? Y N DK N/ADVT prophylaxis by day two if nonambulatory? Y N DK N/AVasospasm? Y NIf yes, Angioplasty? Y NIf yes, Intraarterial intervention? Y NIf IAI, initial date: __________Hyponatremia: Y NIf yes, Na+ low: __________If yes, 3% NS? Y NIf 3% NS, initial date: __________Last CT date ___________Infarct? Y NIf yes, location _____________



www.hcpro.com

Tip of the month

Five hints to strengthen your delegation tactics

Despite nurse managers’ overwhelming workload,many struggle with delegating tasks to their staff.

If you need help in the art of delegation, try toreshape your assumptions about this skill by review-ing the following tips:

� Remember, each time you choose not to delegateto staff, you send a message implying that

- you don’t trust them- you can do it all by yourself- you can do it better than them- they do not have skills that meet your

expectations

�Remind yourself that the more often you delegate,the more comfortable you will become with it� Learn to identify who is best suited for the taskyou want to delegate�Make time to follow up with the person to whomyou’ve delegated work

� Give staff permission to make errors the first timeon the task and delegate responsibility to themagain to show that you have faith in their ability

Source: Shelley Cohen, RN, BS, CEN, Health ResourcesUnlimited. Adapted with permission.

Strategies for Nurse Managers

Editorial Advisory BoardShelley Cohen, RN, BS, CENPresident Health Resources UnlimitedHohenwald, TN

Sue FitzsimonsSenior Vice PresidentPatient ServicesYale-New Haven HospitalNew Haven, CT

David MoonExecutive Vice PresidentModern Management, Inc.Lake Bluff, IL

Bob Nelson, PhDPresidentNelson Motivation, Inc.San Diego, CA

Tim Porter-O’Grady, EdD, RN, CS, CNAA, FAANSenior PartnerTim Porter-O’Grady Associates, Inc.Otto, North Carolina

Dennis Sherrod, EdD, RN Forsyth Medical Center Distinguished Chair of Recruitment and Retention Winston-Salem State University Winston-Salem, North Carolina

Strategies for Nurse Managers (ISSN 1535-847X) is published monthly by HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945. Subscription rate: $179 per year. • Postmaster: Sendaddress changes to Strategies for Nurse Managers, P.O. Box 1168, Marblehead, MA 01945. • Copyright 2004 HCPro, Inc. All rights reserved. Printed in the USA. Except where specificallyencouraged, no part of this publication may be reproduced, in any form or by any means, without prior written consent of HCPro or the Copyright Clearance Center at 978/750-8400. Please notifyus immediately if you have received an unauthorized copy. • For editorial comments or questions, call 781/639-1872 or fax 781/639-2982. For renewal or subscription information, call cus-tomer service at 800/650-6787, fax 800/639-8511, or e-mail: [email protected]. • Visit our Web site at www.hcpro.com. • Occasionally, we make our subscriber list available toselected companies/vendors. If you do not wish to be included on this mailing list, please write to the Marketing Department at the address above. • Opinions expressed are not necessarily thoseof Strategies for Nurse Managers. Mention of products and services does not constitute endorsement. Advice given is general, and readers should consult professional counsel for specificlegal, ethical, or clinical questions.

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For news and story ideas:Contact Associate Editor Jamie Gisonde • Phone: 781/639-1872, Ext. 3278• Mail: 200 Hoods Lane, Marblehead, MA 01945• E-mail: [email protected]• Fax: 781/639-2982Publisher/Vice President: Suzanne PerneyGroup publisher: Kathryn LevesqueExecutive Editor: Emily Sheahan

Online resources:• Web site: www.hcpro.com• Visit HCPro’s Nursing site at www.hcpro.com/nursing

Subscriber services and back issues:New subscriptions, renewals, changes of address, backissues, billing questions, or permission to reproduce anypart of Strategies for Nurse Managers, please call ourCustomer Service Department at 800/650-6787.

Disclosure statement: The SFNM advisory board has declared no financial/commer-cial stake in this activity.

Save the date!

July 28–29, 2005, Boston, MA

“Magnet Resource Center Advanced Workshop,” a seminar presented by The Greeley Company, a division of

HCPro, Inc.

Learn practical strategies to successfully complete the Magnetapplication process. Topics include establishing a work planand timeline based on your gap analysis; the 14 Forces ofMagnetism; the role of the project coordinator; documentorganization; evidence-based practice; the relationshipbetween Magnet and data collection/benchmarking; andpreparing for the site visit.

To register or for more information, call 800/801-6661 or visitwww.greeley.com.

Continuing Education ExamApril 2005–June 2005

Directions:

Fill out your contact information in the space provided.

Complete the exam by circling the letter that corresponds to the correct choice for each question. The questions arebased directly on content from the April–June issues of SNM, and you may refer to them as you take the exam.

Return all four pages of the exam to us by July 1, 2005. To qualify for three (3) nursing contact hours, you mustanswer at least 80% of the questions correctly—that’s 24 correct answers out of the 30 questions.

Upon successful completion of the exam, we’ll e-mail you a certificate that you may use for display and documen-tation of three continuing education (CE) credits toward your nursing certification.

Name: _______________________________________ Facility: _____________________________________________Address (city, state, ZIP): _____________________________________ Nursing license number: ______________Telephone: ____________________________________ Fax: _______________________________________________E-mail: ____________________________________________________________________________________________

Continuing Educat

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c. have the coder sign the a

d. have the PRO check eve

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new CPT books

A service of Strategies for Nurse Managers

1. The infection control committee at Spaulding Rehabilitation Hospital improved staff education and organizational policy by

a. conducting hospitalwide training initiatives and drafting policies that address workflowb. conducting unit-specific education and drafting policies without obtaining feedback from staffc. conducting unit-specific education and drafting policies that incorporate staff inputd. offering monetary incentives for classroom attendance

2. Which of the following is one of the JCAHO’s six new proposed National Patient Safety Goals?

a. Reduce length of stay b. Promote hand hygienec. Improve nurse-physician communication d. Avoid patient harm caused by worker fatigue

3. One of the proposed requirements to existing Goal #3 (improve medication safety) would expect hospitals to

a. promote the use of multiple-dose medication vialsb. eliminate the use of multiple-dose vialsc. require clinical education about proper cleaning techniques for multiple-dose vials

4. If parents don’t remember to bring medication and allergy information about their children, hospitals should do all but which ofthe following to comply with Goal #14?

a. Distribute copies of the JCAHO’s “Speak Up” campaignb. Team parents with caregivers on parent advisory groupsc. Host educational fairs for community membersd. Call the children’s pediatricians for the information

5. Twenty-five years ago, nurse managers, or “head nurses,” were mainly responsible for

a. interviewing and hiring staff b. providing direct patient carec. cooking patient meals d. running meetings

April 2005

Strategies for Nurse Managers Continuing Education Exam—April–June 2005Page 2

6. Which of the following budgeting practices begins with a predetermined percentage provided by the organization?

a. Zero-based budget b. Flat percentage increasec. Computer budgeting software programs d. Positive percentage increase

7. The primary purpose of a rapid response team is to

a. promote interdisciplinary approaches to patient careb. improve care of postsurgical patients and reduce LOSc. improve care of critically ill patients and reduce life-threatening code situationsd. improve staffing levels

8. Which is not a way that rapid-response teams improve patient outcomes?

a. preventing a code situationb. working during holidaysc. transporting patients immediately to the ICUd. assigning a respiratory therapist and a critical care nurse to the team

9. An advantage of customizing patient safety education to meet staff’s specific needs is that employees

a. attend shorter training sessionsb. don’t comprehend general policy reviewc. don’t have easy access to policies on their intranetd. can communicate how the goals relate to them and their patients

10. A patient safety training initiative that proved effective at Saint Luke’s Hospital in Kansas City, MO, is

a. 15-minute inservices with handouts b. 15-minute inservices without handoutsc. 60-minute inservices with handouts d. 60-minute inservices without handouts

May 2005

1. “Bad scenes” occur when

a. nurses don’t communicate properly with physiciansb. physicians don’t communicate properly with nursesc. nurses and physicians don’t communicate properly with patientsd. nurses and physicians don’t communicate properly with each other

2. A technique for nurses to prevent poor telephone communication with physicians is to

a. apologize for interrupting the physician’s dayb. remain on the line even if the physician is rudec. apply critical-thinking skills before making calls to anticipate what is neededd. never repeat the order or conversation back to the physician to avoid insulting him or her

3. Which of the following actions is not a preventive tactic to reduce patient falls?

a. Alert patients about a wet floor b. Keep siderails down after exiting a patient’s roomc. Stay close to patients when escorting them to the bathroom d. Lock wheelchair brakes

4. A key factor in the success of Northwestern Memorial Hospital’s approach to falls prevention is tracking the falls rate

a. on a quarterly basis b. on a monthly basisc. at the unit level d. at the divisional level

5. If a risk assessment for a conscious patient indicates that she has both shortness of breath and unstable glucose levels, shequalifies for

a. minimal precautions b. standard precautionsc. moderate precautions d. strict precautions

Strategies for Nurse Managers Continuing Education Exam—April–June 2005 Page 3

6. The main purpose of a dashboard system is to

a. comply with the JCAHO’s restraint-related requirementb. use it as a source of evidence when applying for Magnet statusc. disseminate information organizationwide so everyone can see how the facility is performingd. help organize department managers

7. A dashboard system is an important part of performance improvement (PI) efforts and strategies because it allows organizations to

a. prioritize their PI efforts b. ace their JCAHO surveysc. do away with charts and graphs d. please hospital administrators

8. The method that focuses on designing clinical ladders for all positions as a way to reduce turnover is to

a. offer competitive salaries and benefits b. set clear expectationsc. foster professional growth d. deal with conflict

9. Two methods that Teresa Eberhart used to respond to high leadership turnover rates are

a. general staff orientation and ongoing trainingb. unit-specific training and monetary bonusesc. a leadership training series and leadership orientationd. a leadership training series and ongoing clinical education

10. During leadership orientation, the topic that focuses on staffing and scheduling issues is

a. resource management b. leadership skillsc. the essence of leadership d. work force development

June 2005

1. Which is a method to improve nurse safety in the ED according to the article “Make the ED a safer place for nurses”?

a. Using chemical restraints b. Physical restraintsc. Deescalation training d. Self defense classes

2. One of the two practices that are critical to organizations successfully achieving the JCAHO’s primary stroke center certification is

a. a research council chaired by a clinical nurse leader b. PI initiativesc. support from frontline staff d. weekly interdisciplinary committee meetings

3. Which of the following is a strategy to comply with the JCAHO’s requirement for data tracking to achieve primary stroke cen-ter certification?

a. Educating frontline staffb. Implementing an electronic health records systemc. Collecting and analyzing the JCAHO’s performance measuresd. Holding a patient education fair about stroke awareness

4. An example of a communication barrier between night nurses and their units is that night nurses

a. don’t stock supplies on the unit for the next shift b. receive little to no trainingc. resent day nurses for carrying lighter patient loadsd. can’t participate in meetings or committees that convene during the day

5. A strategy to include night staff in meetings and committees is to

a. post minutes from departmental council meetingsb. have nurses conference-call into meetings on their days offc. rotate the night shift schedule so all staff have the opportunity to participate in meetings and committeesd. create a policy excusing night nurses from otherwise mandatory meetings

Strategies for Nurse Managers Continuing Education Exam—April–June 2005Page 4

6. According to Dr. Eugene Litvak, PhD, variability methodology means that when two flows have

a. the same goal, you must separate them so they don’t compete for the same resourcesb. different goals, you must separate them so they don’t compete for the same resourcesc. the same goal, you must invest your resources in only one flowd. different goals, you don’t have to separate them because they’re not competing for the same resources

7. To demonstrate compliance with the JCAHO’s National Patient Safety Goal on hand hygiene, interdisciplinary surveyors atLanier Health Services in Valley, AL,

a. used an audit form to document findingsb. made staff write down the times at which they washed their handsc. posted guidelines for proper hand hygiene in all unitsd. installed handwashing sinks in all patient rooms

8. Ongoing orientation for new staff helps reduce employee turnover because

a. it shows new nurses that you value their inputb. it is a chance to get feedback about your veteran staffc. Press Ganey nursing satisfaction results show that new nurses want to spend more time with their managersd. you get to know them on a personal level

9. The purpose of asking a new employee what he or she likes about their new job is to

a. discover which veteran staff lend the most helpb. clarify the new employee’s expectationsc. reveal whether there is a problem in your unitd. help a new employee realize that his or her adjustments may not be as trying as he or she thought

10. According to Gordon Barnhart, which element of commitment in the Elite Nursing Pyramid is often the most important factor?

a. Successb. Safetyc. Psychological returnsd. Material returns

Evaluation

1. Did this CE activity relate to its stated learning objectives?

2. Was the format of this CE activity easy to use?

3. Did we avoid commercial bias in the presentation of our content?

4. Will this activity enhance your professional development?

5. How long did it take you to complete this activity (include reading, exam, and evaluation)?

HCPro, Inc., is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center'sCommission on Accreditation. The SNM editorial advisory board has signed a vested interest form declaring nocommercial/financial stake in this activity.

If you have any questions or concerns, please contact Customer Service at 800/650-6787. Fax or mail your exam and evalua-tion by July 1, 2005, to Strategies for Nurse Managers CE Exam, P.O. Box 1168, Marblehead, MA 01945Fax: 781/639-2982, Attn: Robin Flynn, CE Manager

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