Department: Leadership Q&A
Senior Vice President of Patient Care Services and Chief Nursing Officer, Lutheran Medical Center, Brooklyn, N.Y.
Q My night and day staff members hate each other. They're constantly complaining about the conditions in which patients are left. Do you have any suggestions to improve this relationship?
Hate is a strong word, and I hope their feelings aren't actually that intense. These staff complaints about failed expectations have to be addressed from many perspectives, including quality, safety, and a healthy work environment. The nurse manager can sometimes ignore a passing interpersonal staff conflict, but not when it affects patient care and staff relationships as you describe.
If you have access to a facilitator to help with the team improvement process, make use of him or her. You should get the two shifts talking to each other so the conversation isn't triangulated through your attempt to solve the problem yourself. You'll need ground rules and representatives from both shifts. Staff members may choose the representatives and/or you may need multiple joint meetings. Don't let them attack each other; input must be objective, factual, and respectful. Find out what the problem really is by having staff members tell their stories. Don't assume anything or have any preconceived beliefs until you hear all sides.
Surprising results may unfold, and you want to make sure you've identified the right problem(s). Maybe it's as simple as not having the supplies and linens needed to change patients, or maybe it's a failure of communication about patient needs, or maybe you have some underperforming staff. Each of these problems has a different solution and there are probably a dozen or more possibilities for failed expectations.
End with a plan. Define expectations that are mutually agreeable, as well as the feedback mechanism. Bedside shift report offers an opportunity for both shifts to do a check on patient condition and provide feedback to each other. If it's known that expectations aren't going to be met, such as after a “crazy night,” then the oncoming shift must be informed about the reason for this up front. Charge nurses and evening/night supervisors are the key to coaching and supervising, as well as communicating progress to you and the staff. When achievements are made, thank your staff with specific and timely feedback.
This is a very fixable problem. Your own expectations for both staff behavior and performance must be clear. You're accountable for patient care and the practice environment on your unit; to be successful, your staff members must work with you to resolve this issue ASAP.
Q Two of the nurses who work on my unit have been dating for the past year and they've recently announced their engagement. Should they be allowed to work together after they're married?
You'll have to check with your human resource (HR) department for your organizational policy on relatives working together. Most likely the answer is no and one of them will have to transfer to another unit, or at least to a different shift on your unit. Some organizations even prohibit dating in the same department.
The predictability of personal carry-over into the work environment is surprising; staff dynamics change, as well as working relationships. The potential for conflict or staff discomfort is high, which is what drives typical HR policy against relatives working together. For example, something as simple as coordinating time off requests can become burdensome, with resultant partiality complaints.
After you've confirmed your facility's policy, your engaged nurses will have to decide who transfers. If they don't voluntarily decide, then HR will assist you and may advise based on reverse seniority. The second set of issues is whether there's a vacant and desirable position for the displaced nurse and whether there will be preferential treatment due to the situation in the event someone more senior wants the vacant position. Plan in advance to ease the transition and deal with any roadblocks early.