fast tips breaking down resistance - nurse managers · agree with the change proposal. at this...

• Lack of information. Staff mem-bers may not understand thedetails of the change, or may dis-agree with the change proposal.At this level of resistance, givingothers more information is impor-tant. We can continue to engageothers in the discussion of thechange, provide information, an-swer questions, and examine thechange proposal from differentdirections as long as resistancestays at this level.

Breaking down resistanceHow to ease staff into changes for the better

By Brenda Summers, MBA, MHA,MSN, RN, CNAA

You have a great idea to change awork process. You need others toagree to the change, embrace it,and make it happen. You’ve work-ed out all the details, and you knowthe change will help staff membersdo their jobs more easily. You can’twait to present the new idea. Be-cause the change is for the better,you know staff will readily accept it.

When you introduce the change,nurses meet your wonderful ideawith a barrage of questions and evenopen hostility. You are surprisedat resistance to what is so clearly achange for the better. You can’t un-derstand why staff members can’tsee the benefits as clearly as you do.They just don’t understand it, youtell yourself. Why can’t you makethem understand?

Nurses probably understand thechange proposal, yet resist out offear of the unknown or a lack oftrust. Resistance is less about thefacts and more about emotion. Thestrategy you pursue to address resis-tance will determine whether otherseventually accept, and even embrace,change. To break down resistance,seek to understand the other per-son’s reason(s) for resistance. Con-sult the following three levels ofresistance to change:

Support your staff’s professional development

An important component ofemployee retention is taking anactive interest in your staff’sprofessional development.

Nurses want to advance in theirrole, build upon skills, and growas professionals. As their man-ager, you are responsible forhelping nurses to improve.

Decide on a developmentgoal. Meet with each staff mem-ber to determine a specific devel-opment goal to work towards.Perhaps the nurse would like tolearn a new skill or become astronger leader. Document thegoal and list steps the employeewill take to reach it. Schedule asubsequent meeting to analyzeprogress made.

Encourage active employees.Let staff members become activeparticipants in finding their owndevelopment opportunities. Asknurses to brainstorm areas inwhich they could improve, aswell as especially enjoyable as-pects of their job. This will helpto get staff members thinkingand may result in creative ideasfor personal improvement.

Adapted from: 1001 Ways toEnergize Employees (Workman),©2001 Bob Nelson, PhD, www.nelson-motivation.com.

Management challenge

INSIDE . . .

Lift teams support patient andstaff safety . . . . . . . . . . . . . . .3

Refine delegation skills andempower your nurses . . . . . . .4

Nurse recruiters can help newemployees to navigate the system . . . . . . . . . . . . . . . . . 7

Developing humor habits canmotivate staff . . . . . . . . . . . .10

—Coming next month—Kimberly McNally, MN, RN,

offers coaching tips to readers.

Vol. 2 No. 10October 2002

FAST TIPS

> p. 2

Strategies for Today’sNurse

Don’t miss our new addition toStrategies for Nurse Managers—our new four-page publication forstaff nurses. Hand it out to your

employees today!

Strategies for Nurse Managers—October 2002© 2002 Opus Communications, a division of HCPro

www.accreditinfo.com

Resistance < p. 1

Management challenge

• Fear of change. This level is at work when indi-viduals react emotionally, rather than rationally. Whenthey’re afraid, people try to emotionally distancethemselves from the situation generating the fear.In this case, your idea for change causes fear inothers. People can’t focus on the details and bene-fits of the change if they are afraid, though. Main-tain an open dialogue to identify the fear.Giving employees more facts about achange won’t address their fear. Talkwith staff members and explore thesource of their worries.

• Lack of trust. In the thirdlevel of resistance, others re-sist change because they don’tcompletely trust you. Distrust maystem from past experiences, biases,stereotyping, unresolved issues, or con-ditioning. These suspicions can limit theway people see the world, how they seeyou, and how they react to change. No matterhow many details you provide, you can’t lowerthe resistance of people who don’t trust you.

Maintain contact with the other person to determinethe source of resistance. Know yourself and how yourespond to a perceived attack. If you begin to reactemotionally by becoming defensive, giving more ex-planation, or withdrawing from those who resist change,you will not identify the true source of resistance.Keep talking and stay open to other people’s ideas.

Building trust and interest To counter resistance, first determine the resistancelevel. With a group of employees, you may encount-er resistance at all three levels. Talk with people whoresist your change, and try to find a common groundon which you can all agree. Use this as the openingfor further exploration.

Keep your own level-two and level-three resistancein check as well, and focus instead on the relation-

ship you have with the person or group. Pay atten-tion to verbal and non-verbal cues that resistance isbuilding, and take steps to address this before it gen-erates its own energy. If necessary, scrap the entirechange presentation in order to explore level-two andlevel-three resistance.

People have to feel an emotional connectionwith the proposed change. They also have to

feel that you care about them, have theirbest interests in mind, and that the

change will further their own self-interests. They have to trust you.

The easy part is getting them tounderstand the proposed change.

The more difficult part is dealingwith the emotions of the change. To

prevent frustration, growing resentment, orlack of change, take the time to address level-

two and level-three resistance.

Editor’s note: Summers is a senior consultant for TheGreeley Company, a division of HCPro.

—Recruiting and retaining

your nursing staff—

How do you recruit and retain employees atyour facility? Strategies for Nurse Managerswants to hear about your creative recruitmentand retention strategies. Send us a tip and ifwe use it, we’ll send you a $50 prize.

E-mail Associate Editor Debbie Blumberg [email protected] or call 781/639-1872,ext. 3425 with your strategy.

The easy part is getting [people] to

understand the proposedchange. The more difficult

part is dealing with the emotions of

the change.

helped from a patient-safety standpoint, says Grant,ensuring that employees move patients in a safeway.

Grant says the initiative has been especially help-fulwith bariatric patients, or those individuals who aremorbidly obese. These patients’ mobility issues maypresent safety challenges for staff as well as for thepatient. The lift team has helped to move these in-dividuals in a way that they are safe, says Grant.“We have actually had the incident for patient andstaff related injury go down.”

Strategies for Nurse Managers—October 2002 © 2002 Opus Communications, a division of HCPro


Moving ahead

The University of WashingtonMedical Center’s (UWMC)“lift team” consists of a groupof health care workers whohelps staff to lift and movepatients, says Susan Grant,RN, MS, chief nursing offi-

cer at UWMC—the first facility to receive magnetrecognition in the United States. “[The team] address-es a couple of things. The physically demandingpart of nursing and, it has decreased our incidenceof work-related back injury.” The effort has also

‘Lift teams’ support patient and staff safety‘Magnet’ facilities feature innovative programs to support nursing

Health care providers must offer interpreting servicesto patients with special languageneeds. A hospital in New Jerseypaid $700,000 this summer to fourdeaf patients to whom it repeatedlydenied interpreting services over a10-year period.

The Department of Justice will forceimprovements, or levy penalties andcorrective actions against facilitiesthat fail to comply.

As a leader in your organization,you must help to ensure that yourfacility stays on the right side of thelaw.

See what the experts have to say:

Finding interpreters Discourage the use of family or friends as interpret-ers, says Jim Pfeiffer, vice president of sales and mar-keting at Carolina Interpreting and Consulting Services.

Stay sensitive to patients’ special language needs

Legal matters

“This is a weak line of defense if the case goes tocourt,” Dallas health care attorneyRobert O’Donnell says. Patients willsue the hospital—not the family mem-ber—over communication errors, headds.

Consider these cost-saving ideas fromPfeiffer:

•Hire volunteers, but make sure theyprovide you with credentials. The Regis-try of Interpreters for the Deaf and theNational Association of the Deaf certifysign-language interpreters. Requireone of these certifications.

• Test a current staff member’s linguistic capabilitiesand add interpreter duties to his or her job descrip-tion. Hold your employee to the same credential,training, and experience requirements as volunteers.

Adapted from: Health Governance Report,www.hcpro.com

Discourage theuse of family or

friends as interpreters.

This is a weakline of defense ifthe case goes to

court.

✓Be a resource and coach to your nurses, yet don’ttake the assignment over from them because youfeel you can do it quicker and better

Always remember the importance of delegation. Ifyou never delegate or empower staff members, youwill not only create the perception that you do nottrust them, but also impart to them a sense that theirskills are inadequate.

Adapted from: Manager Tip of the Week, HealthResources Unlimited ©2002 Shelley Cohen RN, BS,CEN, www.hru.net.



JCAHO requirements

The Joint Commission on Accreditation of HeathCare Organizations’ (JCAHO) new patient safety goalsrequire you and your nurses to be even more vigilantabout safety measures on the unit than ever before.Start preparing now. By January 1, 2003, facilities mustreview and adapt these goals, or offer surveyors areasonable explanation as to why these targets do notapply to their facility. The goals require organizationsto improve the following:

1. The accuracy of patient identification. Use atleast two patient identifiers when taking blood sam-ples or administering medications or blood products.

2. The effectiveness of communication amongcaregivers. Takers of verbal or telephone ordersmust verify them through a “read-back” of the com-plete order. Standardize facility abbreviations andacronyms.

3. The safety of using high-alert medications.Remove concentrated electrolytes from patientunits. Standardize and limit the number of drugconcentrations.

New patient safety goals also provide practical advice

Staff members may say they want to feel“empowered.” When nurses don’t fol-low through on tasks you delegate to

them, however, you might feel frustrated and wonderwhy you tried empowerment in the first place. Use thefollowing checklist to help prevent such a situationfrom occurring:

✓Clarify your expectations when you delegate a task✓Be specific with your timeline and how you will

hold staff accountable for completing the task✓Provide the background information and details

nurses need to perform well

Refine your delegation skills and empower nurses

Managing staff

4. Eliminate wrong-site, wrong-patient, andwrong-procedure surgery. Create a preoperativeverification process, such as a checklist, to confirmthat staff have all appropriate documents (i.e.,medical records and imaging studies).

5. The safety of using infusion pumps. Ensurefree-flow protection on all general use andpatient-controlled analgesia infusion pumps.

6. The effectiveness of clinical alarm systems.Ensure that staff can properly activate and hearalarms over competing noise within the unit.

The JCAHO’s goals are right on target, says VentryceThomas, RN, MS, associate director of nursing ad-ministrative services at Stony Brook (NY) UniversityHospital.

“If we clean up our acts in these six areas, we [hos-pitals] should be well on our way to creating asafer environment.”

Adapted from: Briefings on JCAHO, www.hcpro.com.

1. M edical

2. Evaluation/A

ssessment

3. Planof treat

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4. Progress r

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5. M edicalh

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6. Evaluation/

assessmen

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❏✔❏❏❏❏❏

✔✔



Evaluating your preceptor programAssess your success with these ‘top-ten’ questions

Managing right

By Kimberly A. McNally, MN, RN

A number of preceptors have told me they don’tfeel confident handling challenging learner situationsbecause they don’t have tools and easy-to-use struc-tures to support their work. Nurse managers are re-sponsible for ensuring that preceptors are available,competent, and effective in carrying out their rolewith new employees.

Assess the state of your preceptor programs and in-vest in the development and recognition of thisimportant asset. To evaluate your unit’s preceptordevelopment efforts, consider how well you meas-ure up with the following 10 questions:

• Do you have clear roles and responsibilities forthe new employee, the preceptor, and the manager?

• Do you have easy-to-use tools, structures, andresources to support the preceptor?

• Do you assess the “fit” between the preceptorand new employee throughout the orienta-

tion process?• Do preceptors have input in making patient care

assignments that support effective learning for thenew employee?

• Do you meet on a regular basis with the precep-tor and new employee to assess progress, andoffer support and recognition?

• Do you effectively deal with preceptors’ perform-ance management concerns?

• Do you have an ongoing learning plan for devel-oping and advancing preceptors’ skills?

• Do you have a formal process to gather feedbackat the conclusion of the orientation process?

• Do you know what kind of formal and informalrecognition preceptors value, and do you pro-vide it?

• Do you excite a passion for learning and develop-ment, and create a work environment in whichpreceptors and new employees thrive?

Editor’s note: McNally is president of McNally & Asso-ciates, a health care leadership coaching and con-sulting company.

Getting ahead

Consult staff when reviewing holiday request guidelines

As we bid farewell to summer and ease into fall,many employees begin to think about the time thatthey will want to request off for the major upcomingholidays.

It’s never too early to pull out your guidelines orpolicies for holiday requests. Don’t wait until it’s toolate: Now is the time to plan so you’re ready oncethe Thanksgiving and Christmas vacation requestsstart to pour in. Here’s how:

• Review the content of your guidelines and ask

yourself whether they meet the current needs of staff

• Identify what you would like to change, add, ordelete from the policy

• Post the current guidelines for staff and give nurs-es an opportunity (with a deadline) to offer theirideas for changes, additions, or deletions

Adapted from: Manager Tip of the Week, HealthResources Unlimited ©2002 Shelley Cohen RN, BS,CEN, www.hru.net.



Safety

services at Arizona State Hospital in Phoenix. Itemssuch as florescent lanterns, an AM/FM radio withbatteries, and work gloves might all come in handyduring an emergency situation.

These kits shouldn’t drain the budget. The commandcenter go-box, only considering the basic items onthe list, costs about $85 to assemble in Roill’s regionof the country.

Go-box complements planningIt’s easy to coach employees about the contents of ago-box, mainly because people already know howto use the everyday items in them. There’s more tousing a go-box than merely its contents, however. Asa manager, you must also drill your staff memberson the overall emergency plan, Roill says.

Adapted from: Briefings on Hospital Safety,www.hcpro.com.

‘Go-boxes’ help coordinate emergency response and recovery efforts

Illustration byDave Harbaugh

“Are you preparing for a diasaster? No, I wasn’t referring to your desk.”

You’re almost at the end of your shift when the lightssuddenly flicker, and the operator announces the codefor a tornado sighting. The emergency response plangoes into effect. You run to the second-floor confer-ence room, which acts as a base for the incident com-mand team. A staff member brings in a small plasticchest on wheels. The disaster “go-box” is literallyready to roll.

Go ahead, open it up So, what exactly is a go-box? It’s an idea that J. Douglas Roill, CHSP, CHFM, came up with to pro-vide useful items and supplies that any command cen-ter might need during response and recovery efforts.

Emergency management requirements from the JointCommission on Accreditation of Healthcare Organi-zations (JCAHO), along with the nationwide empha-sis on anti-terrorism measures, helped fuel the go-boxstrategy, says Roill, general manager of hospitality

Stock your go-box with essential supplies

J. Douglas Roill, CHSP, CHFM, general managerof hospitality services at Arizona State Hospital inPhoenix, offers a sampling of items to consider foryour emergency planning kits. For example:

Disaster command post go-box• Telephone directory• Two small flashlights• Multi-purpose fire extinguisher• Power Bars (rotated out monthly)• First-aid kit• Three whistles• Cell phones with radio capabilities

attention another area of his or her job that needs improvement.

Adapted from: Employer-Employee.com, www.employer-employee.com.

Sue just did a great job on a special project that yourecently assigned to her, and you are eager to con-gratulate her. However, when you call her into youroffice to discuss the project, make sure that youpraise Sue’s work rather than Sue herself.

When managers praise employees as individuals in-stead of the work that they perform, these leaderscan inadvertently communicate to staff that they areexcelling in all areas of their job—this can makedisciplining employees when needed a dauntingtask.

Instead, leaders should praise a specific task or skill.By communicating satisfaction with just one aspectof an employee’s performance, he or she will not betaken completely off guard if you then call to



Working together

Rewarding nurses

Nurse recruiters can help new employees to navigate the system

The Nursing Management Congress 2002 willtake place October 13–16, 2002, at the Hyatt RegencyDallas at Reunion. Topics include• calling all new managers—leadership tools and

resources for new nurse managers• recruitment and retention: finders keepers,

losers weepers!—the most recent research andstrategies to recruit and retain nurses

For more program information, go to www.nmcongress.com/ or call 215/628-7798.

nurses can also contact the clinical nursing supervisor oneach shift with any questions or concerns. After threemonths, Flynn holds a meeting with the new employeeto measure his or her satisfaction with the experience.

Mercy’s preceptor development program lasts one fullday. Topics include the following:

• Preceptor’s role and responsibilities• Interpersonal relationships• Adult learning principles• Principles of teaching and learning• Organizational skills• Reality shock• Delegation• Prioritization• Conflict management• Communication• Coaching

By Patricia A. Duclos-Miller, MS, RN, CNA

As the nurse recruiter and coordinator at Mercy Medi-cal Center in Springfield, MA, Kim Flynn, RNC, BSN,acts as the liaison between new nurses and the hos-pital’s various departments. Her role extends beyondthe initial interview and orientation day.

Mercy’s mentoring model supports new orientees byassigning Flynn to assist new nurses in navigating thesometimes-confusing hospital system. In her work,she helps new staff members with issues that may bedisconcerting for a new employee.

To Flynn, daily rounds, pagers, and voice mail accessoffer the orientee a friendly anchor. If the new nurseneeds education beyond the orientation phase, theclinical nurse specialist and education department pro-vide the employee with additional resources. New

Praise work, not workers

Save the date!

tion motivate them more than formal incentives. Offeremployees praise, assistance, and encouragement inreaching incentive program goals as often as possible.

3. Give employees input into rewards. Differentthings motivate different people. The same incentivewill therefore not effectively motivate all employ-ees. Conduct one-on-one interviews with employ-ees to find out what they would consider motivating.Employees will work harder to achieve a goal ifthey have an individual choice of rewards.

Adapted from: Alexander Hamilton Institute’s execu-tive briefing “Retention Strategies: Don’t Let Your BestEmployees Get Away,” ©2002 by Alexander HamiltonInstitute, Inc. www.ahipubs.com.

Stay sensitive to incentive program drawbacks



Rewarding employees

—Fellowship opportunity—

The Center for Nursing Historical Inquiry atthe University of Virginia School of Nursing offersa historical research fellowship for nurses engagedin historical scholarship that contributes to thefield of nursing. Administrators will base selectionon the scholarly rigor of the investigator’s project,including: the clarity of the project’s purpose, itssignificance, and its potential contributions to thefield of nursing.

Applications for the $3,000 award are due Octo-ber 15, 2002. Applicants should send a completedapplication and curriculum vitae to Arlene Keeling,director of the Center for Nursing Historical In-quiry, University of Virginia School of Nursing,McLeod Hall, PO Box 800782, Charlottesville, VA,22908-0782.

For more information go to www.nursing.virginia.edu/centers/downloads/hrfellow.pdf or call434/924-5906.

Employees at facilities with incentive or recognitionprograms may work harder to obtain a certain rewardor benefit. Many facilities across the country have im-proved employee retention and satisfaction with suchprograms. However, opponents of recognition pro-grams point out potential drawbacks to using onlythis type of program to motivate employees. Considerthe following points of view:

• Incentive programs may diminish intrinsic motiva-tion for some people, since the reward is external.

• Incentive programs can create competition withindepartments in some situations. Employees maystrive to look better than coworkers and in doingso, looking good may become more importantthan doing well.

• Reward programs can undermine teamwork. Em-ployees competing for a prize begin to regard theircolleagues as adversaries, rather than members ofthe same organization working towards commongoals.

• Incentive programs create losers. Staff memberswho are not the recipients of rewards, despitetheir efforts, may give up trying.

To overcome these potential problems, customize re-wards to individual staff interests and desires. Use thefollowing strategies to produce lasting results, and buildintrinsic motivation into your incentive programs:

1. Set goals that benefit the employee and theorganization. In many incentive programs, em-ployees have the opportunity to learn and developnew skills. Find out the career goals of each staffmember and customize the program to meet allprofessional needs. Go one step further by en-couraging employees to participate in goal setting.

2. Encourage employees every step of the way.Most employees say informal thanks and recogni-

• after a meal

Other triggers are vague or incorrect guidance, thingsthat cause people to become over-confident, impre-cise communications, and work stress. Train staff torecognize when errors are likely to happen and howto prevent them. Kudalis offers the following six tipsfor error prevention:

1. STAR (Stop, Think, Act, and Review).2. Communicate clearly.3. Adhere to procedures.4. STOP—when working beyond your policy plan

or procedure. Errors are 100 times more likelywhen people are working outside rules and mak-ing decisions based on knowledge.

5. Make conservative and structured decisions.6. Always assess personal readiness.

Adapted from: “Preventing the most common errorsin the operating room,” www.hcpro.com.



Preventing errors

Train staff to recognize error triggers

As a nursing executive, you are responsible for help-ing to prevent errors in your facility. Your employeesare more likely to make errors if they are under timepressure or are in a work environment with manydistractions, says Catherine Kudalis, a partner at Per-formance Improvement International in San Clemente,CA. Kudalis spoke during a recent audio conferenceon patient safety sponsored by HCPro’s Briefingson Patient Safety.

Most errors occur when people are straining under aheavy workload. They are also more likely to makeerrors on particular days or at certain times of day,such as

• the first day back after a vacation or time off• a half hour after they wake up

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Have you made special stridesin your organization? Perhapsyou’ve increased patient satisfac-tion, come up with new ideasfor the budget, or found newways to effectively communicatewith staff. Send us your successstory by November 25, 2002, to

be entered into a cash drawing. If selected asManager of the month, we will send you a$100 prize. The winner and his or her strategywill be announced in our first issue of 2003! E-mail Associate Editor Debbie Blumberg [email protected] or call 781-639-1872, ext. 3425.

—Manager of the month—

By Lynn Durham, RN

Pat Schwab, PhD, a humor educator from theSeattle-based company FUNdamentally Speaking,says there are three ways to motivate people towork harder, faster and smarter:

1. Threaten them

2. Pay them lots of money

3. Make their work fun

“The first two have had a limited and short-termsuccess rate, she says. “Only number three has atrack record of effecting real change. It’s time man-agers acknowledge humor as an interpersonal skill,and learn how to create an atmosphere that is chal-lenging, creative and fun for employees as well asfor themselves. Remember, [the one] who laughs . . .lasts!”

Minnesota consultant Kristin Anderson says sev-eral of her hospital clients have created a “humorcorner.” In this space, employees, patients andfamily members, post cartoons and quotations.

Staff members can also find a basket of donatedstress-relieving toys and comedy videos in thecorner.

So if you’re having a bad or stressful day, a co-worker can “send you to the corner.”

Periodically, nurses should make room for newcartoon postings and replenish the toy supplies,”says Anderson.

Plato said, “Life must be lived as play.” Now, med-ical studies prove what some have known allalong—cheer is good for us. Research shows that



Staff improvement

Developing humor habits can motivate staffMedical studies show humor helps

humor is a way to involve our bodies in our heal-ing processes.

Author Deepak Chopra, MD, once said, “Serious-ness is equated with responsibility, when, in fact, Ithink we would be much more responsible if wehad more joy and laughter in our lives.” I do, too.

Let humor help you during difficult times. Humorcan give a feeling of power in situations where youfeel you have none.

Adopt an attitude of raising spirits—one that al-lows individuals to escape or thrive duringloss and change, encourages risk taking, supportsstaying creative under pressure, and nourishesgood health. That’s the way to well-being.

Develop your humor habits and those of yournurses. Try the following tips:

• Read funny stories or jokes—share them

• Look for the humor everywhere—especially inmistakes and imperfection

• Laugh at yourself—never cease to be amused

Editor’s note: Durham is a Hampton, NH, well-being coach. She writes and presents programs onstress hardiness, relaxation, optimism, and joy,www.lynndurham.com.

Get a copy of Strategies for Nurse Managers for each of the nurse managers

in your facility at a discounted rate!

Call Dell Bobier toll free at 866/464-2776 to find out how.



Case study

Sources in this issueAlexander Hamilton Institute(p. 8)Hot topics in Employment LawTelephone: 800/879-2441Web site: www.ahipubs.com

Aspen Publishers, Inc. (p. 11)The Nurse Manager’s Answer BookTelephone: 301/417-7500Web site: www.aspenpublishers.com

Cohen, Shelley, RN, BS, CEN(pp. 4, 5)Health Resources Unlimited Telephone: 615/384-7760E-mail: [email protected] site: www.hru.net

Duclos-Miller, Pat A., MS, RN,CNA(p. 7)Sisters of Providence Health SystemTelephone: 413/748-9096E-mail: [email protected]

Durham, Lynn, RN (p. 10)Telephone: 603/926-9700E-mail: [email protected] site: www.lynndurham.com

Employer-Employee.com (p. 7)Web site: www.employer-employee.com

McNally, Kimberly A., MN,RN (p. 5)McNally and AssociatesTelephone: 206/547-3133

Nelson, Bob (p. 1)1001 Ways to Reward employeesManaging for DummiesTelephone: 800/575-5521Web site: www.nelson-motivation.com

Opus Communications (pp. 3, 4, 6, 9)Health Governance ReportBriefings on JCAHOBriefings on Hospital Safety“Preventing the most commonerrors in the operating room”

Telephone: 800/650-6787Web site: www.hcmarketplace.com

Simon & Schuster (p. 12)Supervisor’s Portable AnswerBookTelephone: 212/698-7000Web site: www.simonsays.com

Summers, Brenda, MBA,MHA, MSN, RN, CNAA(pp. 1–2)The Greeley Company, adivision of HCProTelephone: 781/639-8030E-mail: [email protected] site: www.greeley.com

2. Understand the behavior. Once you’ve iden-tified the behavior, you must then try to under-stand it. Consider your nurse’s personal situation—perhaps he or she is a single parent withthree children and can therefore not commit toextra tasks. Ask how your team feels as a whole.If the individual does not feel invested in yourteam, he or she may not be motivated to excelon the unit.

3. Craft a plan. Meet with the nurse to form agame plan. Begin by stating that you havenoticed certain behaviors that worry you, anddiscuss and agree upon on a few goals that fitin with the employee’s current situation.

Adapted from: The Nurse Manager’s AnswerBook, pp.99–101. Hansten, Washburn, ©1994 byAspen Publishers, Inc., www.aspenpublishers.com.

Problem: There are a few nurses on your team whoyou can’t seem to reach. Their motivation is low, andno matter what you do, you can’t seem to give themthe boost they need. Sometimes you ask yourselfwhy these employees even show up for work.

Solution: An unmotivated staff member can be veryfrustrating for a manager who wants his or her nurs-es to make the most of themselves. You may be tempt-ed to “light a fire” under these individuals, or encouragethem to transfer to another unit. These courses ofaction are unrealistic, however. Try the followingsteps to reach a solution:

1. Identify the behavior. You say the nurse is un-motivated, but what does that really mean? Identi-fy specific instances or behaviors that make youfeel your staff member’s enthusiasm is low. Sitdown with a pen and paper and compose a listof these behaviors.

Understanding unmotivated employees



Strategies for Nurse Managers

Editorial Advisory Board

Shelley Cohen, RN, BS, CENPresident Health Resources UnlimitedSpringfield, TN

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

Jorie MonkChief Nursing Officer andAssistant Chief Executive OfficerHighland Medical CenterLubbock, TX

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

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

Carole SiegfriedVice PresidentPatient ServicesKing’s Daughter Medical CenterAshland, KY

Strategies for Nurse Managers (ISSN 1535-847X) is published monthly by Opus Communications, Inc., a division of HCPro, 200 Hoods Lane, Marblehead, MA 01945. Subscription rate:$169 per year. • Postmaster: Send address changes to Strategies for Nurse Managers, P.O. Box 1168, Marblehead, MA 01945. • Copyright 2002 Opus Communications, Inc., a division ofHCPro. All rights reserved. Printed in the USA. Except where specifically encouraged, no part of this publication may be reproduced, in any form or by any means, without prior written consent ofOpus Communications or the Copyright Clearance Center at 978/750-8400. Please notify us immediately if you have received an unauthorized copy. • For editorial comments or questions, call781/639-1872 or fax 781/639-2982. For renewal or subscription information, call customer service at 800/650-6787, fax 800/639-8511, or e-mail: [email protected]. • Visitour Web site at www.hcpro.com. • Occasionally, we make our subscriber list available to selected companies/vendors. If you do not wish to be included on this mailing list, please write to theMarketing Department at the address above. • Opinions expressed are not necessarily those of Strategies for Nurse Managers. Mention of products and services does not constitute endorse-ment. Advice given is general, and readers should consult professional counsel for specific legal, ethical, or clinical questions.

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For news and story ideas:Contact Associate Editor Debbie Blumberg• Phone: 781/639-1872, Ext. 3425• Mail: 200 Hoods Lane, Marblehead, MA 01945• E-mail: [email protected]• Fax: 781/639-2982Publisher/Vice President: Suzanne PerneyGroup Publisher: Claudia Hoffacker

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New nurse manager

• Always make an effort to show appreciation fora job well done.

Adapted from: Supervisor’s Portable Answer Book,pp. 155–156, ©1990 by Prentice Hall, a divisionof Simon & Schuster, www.simonsays.com.

The relationships that you develop with nurses areimportant to the success of your unit. However,developing productive relationships can be a chal-lenging task for a new manager.

There are no specific steps to follow to achievesuccess; crafting strong relationships requires main-tenance. Consider the following tips:• Always be courteous to coworkers, especially

when you are under pressure.• Do not panic or act unsure of yourself in front

of your nurses; they expect you to be in controland in charge.

• Give employees responsibility to show thatyou have confidence in them.

• Be sensitive as to how you respond to staffmembers when they make mistakes.

• Fight for your employees. Who will if not you?• Remain consistent, but not inflexible. Employ-

ees should know what to expect from you, butyou should also adjust to unusual events.

Successful relationships require close maintenance

Copyright noticeWe know you want to share all the valuableinformation in Strategies with all of yournurse managers. However, if you make yourown copies of the newsletter or forward theelectronic newsletter via e-mail, you are violat-ing copyright law. Stay on the right side of thelaw by ordering a bulk subscription today.Contact Dell Bobier toll free at 866/GO-HCPRO(866/464-2776) and he’ll explain our great offer on

First in a two-part series

What do you do when patientscomplain about squeaky beds orcrying babies in the waiting room?

Brenda Summers, MBA, MHA,MSN, RN, CNAA, a senior consul-tant for The Greeley Company, adivision of HCPro, offers the fol-lowing list of creative solutions tohelp raise patient satisfaction:

1. “It’s so hard to get any sleephere. I’m woken up all thetime at night with people doingthis or that to me. Why can’t Ijust sleep?”

“Some hospitals are beginning tocarve out what they call ‘quiettime,’ ” says Summers. Such a pro-gram usually consists of a two-

hour block of time at least once aday, in which staff members givepatients their own uninterruptedtime.

All disciplines must agree to abideby the policy, says Summers, un-less a patient emergency occurs.

“They could sleep, they could read,they could meditate, they could dowhatever they like,” she says.

Quiet times would differ depend-ing on the unit, with each unit de-ciding upon a different two-hourtime block. The ultimate goal is toindividualize the quiet time, consid-ering each patient’s specific needs.

“If you wanted to do it reallyright, you would do it based onpeople’s usual sleep patterns, or

circadian rhythms.”

Such a process may take time todevelop, however. To start out, talkwith your nurse manager. Together,you can help form a work group tosee whether quiet time would workon your unit.

2. “No one explains anything tome. What is going on?”

Patient satisfaction experts say ifyou take just a few minutes to offerinformation before patients ever askquestions, you’re not going to beinundated with questions.

“One thousand questions comewhen we’ve done nothing to meetthat person’s needs,” Summers says.

Take a few minutes initially tooffer information to patients sothey will feel well-informed andcomfortable with their treatment.

3. “Everyone is always in such ahurry. Could you just listento me for a minute?”

Try these creative ideas to curbpatient complaints

Volume 1 — October 2002

Crafting successfulcommunication skills

• Creative ideas to curb patientcomplaints 1–2

• Staff members and managers collaborate to increase communication 3

• Communicating with colleagues who could contribute more 3–4

> p. 2

Innovative ideas increase patient satisfactionHow many of these patient complaints have you heard during thecourse of your workweek? Check out next month’s Strategies forToday’s Nurse for more creative tips to help handle the followingpatient complaints:

• “I’m not sure that this nurse knows what she’s doing.” • “I can’t stand the other patients here. That couple’s baby hasn’t

stopped crying since they walked in the door.” • “Employees here are making inappropriate comments about my

weight.”• “I can’t get any cold water to drink.”

Strategies for Today’s Nurse—October 2002© 2002 Opus Communications, a division of HCPro

Strategies for Today’s Nurse is a supplement to Strategies for Nurse Managers.Contact Dell Bobier at 866/464-2776 for subscription information.

Nurses can also address this pa-tient concern, says Summers, bytaking the time to talk with pa-tients and explain procedures andtreatment plans before questionspop up.

4. “Nothing you give me forthe pain seems to be work-ing. Why can’t you give memore medicine?”

Part of pain management is educating patients, saysSummers. Health care profes-sionals must first talk withpatients to discover their pain-reduction goal. Then, staffmembers can work with the indi-vidual to set expectations forachieving that goal.

Take for example a patient whosays his pain is 10 on the zero-to-10 scale, and wants his level toreach zero.

Summers recommends that nursessay something such as the follow-ing: “To get you from 10 to zero inone fell swoop isn’t possible. Whatwould you think about working toget your pain from the 10 it is nowto a six or seven in the next eighthours?”

If the patient agrees, the two workto lower the pain to seven or eight. Once the pain is reduced to seven,the nurse and patient should thenset a new goal together.

“The patient is always involved inthis dialogue,” says Summers.

“The reason patients have so many

concerns is that we don’t involvethem. We know what we’re doingand assume everybody else does.”

Summers adds that she has spoken with many nurses who think that all patients would like to reach a pain level of zero.

Some patients may live with achronic pain level of four, howev-er, and would never expect toreach zero, she says.

Dialogue with patients is thereforeespecially important to understandeach individual’s specific needs.

5. “This bed is the most uncom-fortable thing in the world. Itsqueaks and sags . . . can’t youget me something that works?”

When hospitals make decisionsabout changing vendors, saysSummers, administrators look atthe bed and its safety features, butrarely ask anyone to truly test thebed for comfort. She suggests thatwhen hospitals bring in new prod-ucts for a trial, they actually usethem with patients.

“Have people lie in the original one

and then the new one you’re try-ing out. See what they think isbest.”

For the first 18 or 24 hours, a pa-tient could lie in the current bed,and then the next day in the newone.

If it’s unfeasible to use patients in your facility for such a trial,then use staff members, suggests

Summers.

Nurses can propose the idea totheir manager and then volun-teer to help test out the new

products.

Editor’s note: See the Novemberissue of Strategies for Today’sNurse for more tips on enhancingpatient satisfaction on your unit.

Patient complaints < p. 1

Share with Strategiesfor Today’sNurse

Why do you love nursing?

How have you and your nursemanager worked together tosolve a workplace dilemma?

Send your success stories toStrategies for Today’s Nurse.

E-mail Associate Editor DebbieBlumberg at [email protected] or call 781/639-1872, ext. 3425 with story ideasand tips for coworkers.

“The reason patients haveso many concerns is thatwe don’t involve them.”

—Brenda Summers, MBA, MHA,MSN, RN, CNAA

Strategies for Today’s Nurse—October 2002 © 2002 Opus Communications, a division of HCPro


Stop staying silent, learn ways to improve communication with colleagues who could contribute moreEnhance morale, patient satisfaction with these team-strengthening tips

Staff members and managers collaborate to increase communicationUse a unit newsletter to share information, ideas with staff

Successful communication with your manager isimportant to maintaining a strong unit and a pleas-ant work environment. Your manager is there to lis-ten to your ideas and concerns. As a staff member,you should also consider the role that you play incommunications on the unit.

“I think [communication is] best face-to-face,” saysCynthia Gardell, RN, MSN, MBA, nurse managerat the Massachusetts Eye and Ear Infirmary inBoston. By communicating in person, as opposedto using e-mail, nurses and managers have the op-portunity to pick up on nonverbal communicationas well.

When employees approach their manager, theyshould be very clear on what it is they desire orwhat they think should happen, Gardell suggests.“Some of the responsibility lies on the manager todirect this,” she adds. But staff members must alsoplay a part. If you present a problem to your man-ager, also have ready a list of potential solutions, orideas as to how you might work together to createa change for the better.

Gardell finds that weekly staff meetings and weeklynewsletters help enhance communication on herunit. She produces the newsletter herself and poststhe information each week at the nurses’ desk.

The newsletter includes

• information from the week’s various meetings • important reminders, such as to check the code

cart when assigned

If your unit has a similar newsletter, consider sug-gesting staff input to your manager as a way to addto the employee-management relationship. Ask yourmanager how employees can help with the publica-tion. What could you contribute? If your unit doesnot have a newsletter, ask your manager whetheryou can start one. Recruit fellow staff members tohelp so that the time commitment is minimal.

Your work environment is full of a variety of per-sonalities. And with unique personalities come dif-ferent ways of getting work done. A nurse whorushes around the unit may have trouble under-standing a calmer coworker who perhaps organizeshis time a bit differently and therefore has a fewminutes to sit and chat with colleagues.

If you think you have coworkers who are truly lazy, orwho could contribute a bit more to the team, don’t sitand brood. You and your manager can work togetherto help all nurses pull their weight, so to speak.

Help your team reach its full potentialDon’t be too quick to label a coworker as > p. 4

Hot tip!

Contribute to unit communications

Perhaps you’ve discovered a new way to carry out a certain task, or have found an innovative way toaddress a patient worry. Your colleaguescould benefit from this knowledge. Ask yoursupervisor whether you could include yourtip in your unit’s newsletter.

Strategies for Today’s Nurse—October 2002© 2002 Opus Communications, a division of HCPro


Communication < p. 3

“lazy.” Remember that many employees are well org-anized and excel at prioritizing work so they are notoverwhelmed on the job. These nurses are usuallymore than willing to help you. All you have to do isask. One nurse manager says she finds the nursewho is constantly overwhelmed to also be the onewho is unwilling to ask for or accept help.

If you truly have a situation on your unit, however,in which nurses agree that one team member couldcontribute more, consult the following tips. DeborahEaton, RN, BA, assistant lead nurse at Adventist Med-ical Center in Portland, OR, identifies several behav-iors that colleagues may want to address, and offerspotential solutions:

1. The hider. This individual may use the bathroomand the break room significantly more than others,and can often be found chatting on the phone. Shemay go to lunch without telling anyone, stay twiceas long, and not inform others of her return.

TIP: Some floors assign a buddy system for breaksand lunches, says Eaton. This works well becauseall nurses are accountable for time off the unit.Eaton’s hospital has installed an innovative call sys-tem that uses a small device that staff memberswear. Because the devices are monitored electroni-cally, anyone can be found when help is needed.Talk with your manager to see whether such asystem could work on your unit.

2. The chatter. This nurse is usually a delightfulperson who enjoys everyone, and loves to tell sto-ries or jokes throughout the day, says Eaton. Hemay chat with patients for lengthy time periodsand even engage doctors and other staff membersin long talks.

TIP: The best strategy for chatty colleagues is togently but repeatedly interrupt them when they takea breath and ask them to help you with an impor-tant task. Some employees will eventually find away to both work and chat at the same time.

3. The super delegator. This staff member maysit at the nurses’ station, and ask others to just

answer that one light, or get so and so that coffeeshe wants, or get that bedpan because he or shejust sat down to chart

TIP: For those who delegate too much to others,coworkers should feel comfortable in telling them“no.” These super delagators will have to com-plete the task themselves, so that they will even-tually become more independent. “It only takesone kind heart to help perpetuate the behavior,”says Eaton, “so other staff need to be clued in asto how to ‘help’ this individual.”

4. The super-efficient employee. This coworkeris very organized, thorough, and smart, and doeseverything she needs to for every one of her pa-tients. However, she doesn’t spend more than thenecessary time with patients, rarely offers to pitchin, asks to go home early, and wonders whyeveryone else is so busy.

TIP: “The super-efficient nurse can do extrapaper work for the floor,” says Eaton, “but if afew patients complain, a little prodding to bemore compassionate is needed.” Try asking howyour coworker’s patient is dealing with his newdiagnosis. Such a question may help your col-league to reconsider how she interacts withpatients.

You might also consider saying something alongthe lines of, “I feel unsupported when we worktogether.” You may be surprised at your cowork-er’s response.

—Strategies for Today’s Nurse—For news and story ideas:Contact Associate Editor Debbie Blumberg• Phone: 781/639-1872, ext. 3425• Mail: 200 Hoods Lane, Marblehead, MA 01945• E-mail: [email protected]• Fax: 781/639-2982Publisher/Vice president: Suzanne PerneyGroup publisher: Claudia Hoffacker

fast tips breaking down resistance - nurse managers · agree with the change proposal. at this...

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