Sunday, February 24, 2013

Think Sexual Victimization is Not a Leadership Issue? Think Again.

The fallout from sexual victimization does not only affect the persons being victimized. From an article published in the November 2012 issue Journal of Interpersonal Violence, researchers examined the extent of unwanted sexual attention, sexual harassment, unwanted sexual contact, sexual coercion, and rape within the last academic year and their effects on cadets' and midshipmen's perceptions of their leadership's morality and intolerance for sexual victimization.

They found those military cadets who were sexually victimized had significantly more negative views of their leadership's morality and intolerance for sexual victimization than nonvictims. That's not surprising. Unfortunately, it means that these military members continue their progression in their military careers, but the feelings and experiences forever affect their interactions with others and flavor their responses to situations they encounter in the military, not always for good.

Leaders have an obligation to ensure the safety and well-being of their subordinates. This includes establishing a climate that does not condone these behaviors and that actively works to eliminate or, if possible, to rehabilitate members who display these behaviors. It also means providing emotional and moral support to the victims.

When all is said and done, it happened on your watch.

http://www.ncbi.nlm.nih.gov/pubmed/2258112

Overcoming Perceptions in the Emergency Department

I work as a Clinical Nurse Specialist in a community hospital emergency department. My most recent challenge has been ensuring we correct documentation problems on moderate sedation performed in the emergency department that were found as part of our annual Joint Commission self-survey.

Only one out of four procedures were documented thoroughly and accurately. Do I think we are taking short-cuts and harming patients? No. What I do think we're not doing isdue diligence in documenting the work we do and, if something bad were to happen, we have no way of proving before a jury that the work was performed to standard.

The problem is, the ER nurses don't see it that way and I am stymied in how to change this perception. Their first complaint was that the GI docs bring their patients down to do procedures at the end of their clinic day. "These aren't emergencies!" the nurses cry. They don't understand that these patients may not be emergencies, but these cases are urgent in that they drive the next diagnostic decision for that patient. They also don't understand budget constraints.

"If they keep their nurses past their standard working hours, they incur overtime which affects their budget. If there is somewhere else in the hospital that these procedures can be done without incurring overtime, doesn't it make sense to do the procedure there?" That just turned the conversation into complaints about how the ER nurses are dumped on and the hospital takes advantage of them.

I tried the approach that the nurse who is administering the sedation needs to "know" the patient and the best means of doing this was through documentation of the pre-sedation exam. "That's the physician's role," they asserted.

"You're right. It IS the physician's role," I agreed, "and there is nothing that says you can't ask the questions and review the patient's answers with the physician, especially if he or she is busy setting  up. If the physician has completed the pre-sedation paperwork, there is nothing that says you can't review it and tell the physician, 'Hey, you missed a spot over here.'" I am so frustrated that they can't see this is a teamwork and patient safety issue.

I spoke with my ED nurse manager and she doesn't know how to change this. This moderate sedation problem is just the tip of the iceberg in this department. It's like watching toddlers---everyone LOOKS like they're functioning as a team, but they're not. It's all parallel play: the techs are doing their own thing, the nurses are doing their own thing, and the physicians are doing their own thing. In the meantime, patients spend much more time in the ED than they need to, the physicians are not meeting benchmarks, and the nurses station looks like the Cantina in Star Wars.

The unfortunate thing is, I think I know how to fix this, but I only have the consultant role in this department. I've asked about the operationalized efficiency of an emergency department that sees patients within 30 minutes and I've been shut down. I've enquired about starting hourly roundingbedside shift report, and bedside triage when census is low and I encounter extreme resistance from everyone, including the director.

Saturday, October 27, 2012

CPR Makes You Undead

I'm always on the lookout for information or videos that will add to my credibility as an instructor or encourage learners to retain information. I think this video on Bystander CPR is outstanding, one of the most imaginative and visually stunning videos I've seen. Let me know if you think the same!

Tuesday, July 10, 2012

Assisted Living Article in Health Affairs Provides Direction for Future

I thought this article published in Health Affairs was incredibly poignant. The stories, or cases, the author, Martin Bayne, presents are heartbreaking. The one that affected me most was the librarian who told him she didn't want to die alone; would he stay with her that night?

In a culture that worships youth, we've forgotten the wisdom our elders have to pass on to us and we've made disrespectful choices in managing our journey of aging.

Bayne writes,
"To create guine long-term care reform, we as a nation need to perform a series of activities. We must understand the full nature and scope of the problem, including knowing the benefits that are and aren't available under skilled, custodial, and intermediate long-term care. We have to acknowledge the full range of policy options that exist and create a workable way to finance care using a mix of public- and private-sector support. People will also have to acknowledge their personal responsibility for leading purposeful lives, a part of which means considering the costs of long-term care and planning ahead for how to pay for them. In short, we must all be held accountable for ourselves and for the whole."
 Everything is at stake. If you want to read more, check out his literary journal: http://thefeatheredflounder.com/

Friday, March 25, 2011

Developing a Courageous Workplace


I am inheriting a dysfunctional clinic. One nurse is creating a hostile work environment and another nurse has resorted to communicating only by email to this nurse so she can limit her interactions. A clerk has "borrowed" over $1000 from her co-workers over the past year and HR says nothing can be done, that these "loans" could be considered "donations." I get ownership in May, but I am already pondering solutions.

I thought this article on workplace courage from the Center for Creative Leadership might provide some ideas for action.

According to the article, people in a courageous workplace:
•Take on more challenging or complex projects.
•Actively seek out tasks that stretch their skills.
•Speak up more frequently, forcefully and truthfully.
•Be less risk-averse, less self-conscious and less apathetic.
•Do less brownnosing and complaining.
•Get more work done.

That sounds good to me. A hostile work environment can cost a lot of money in recruitment and retention and lost productivity. So, one of the options I proposed to the current leader was the development of a code of conduct by the staff. I also proposed requesting a mediator from HR interview and evaluate the interactions of these workers for an unbiased opinion. Coming from a high-functioning unit and feeling quite competent, this clinic will provide quite the turn-around challenge.

Am I feeling courageous?

Tuesday, March 8, 2011

Enchantment

Enchantment by Guy KawasakiWell, it's official. I took the quiz and I scored very well. I am certified enchanting.

Monday, February 21, 2011

The Last Five Minutes of the Day

With the increasing workload, I would come in to work and be overwhelmed with the areas and issues that needed my attention. So, I started doing a to-do list at the end of the workday. That worked pretty well, except I had items that were left undone and carried over to the next day for extended periods of time. Taking a good hard look at this meant acknowledging that either 1) the task was not that important (to allow it to lie undone for so long) or 2) it was too huge to process. I had to break big tasks down into manageable steps I could actually demonstrate to my fearful self that the big project could be done.

I recently found another way to better use those last few minutes of the workday from the Harvard Business Review Blog:

Every day, before leaving the office, save a few minutes to think about what just happened. Look at your calendar and compare what actually happened—the meetings you attended, the work you got done, the conversations you had, the people with whom you interacted, even the breaks you took—with your plan for what you wanted to have happen. Then ask yourself three sets of questions:

•How did the day go? What success did I experience? What challenges did I endure?
•What did I learn today? About myself? About others? What do I plan to do—differently or the same—tomorrow?
•Who did I interact with? Anyone I need to update? Thank? Ask a question? Share feedback?


This is a pretty good tool for prioritizing the next day's tasks as well as for growing and maintaining relationships.