Nursing Management:
doi: 10.1097/
Department: Letters


Klaristenfeld, Jessica BSN, RN-BC; Novicke, Bryn K. BSN, RN, OCN; Scott, LaNell BSN, RN, CNOR

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Los Angeles, Calif.

Arlington, Tex.

San Antonio, Tex.

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Inspire your staff

I 've been a nurse manager at a freestanding children's teaching hospital for 6 years, and I'm always looking for ways to improve the work environment in my area. The article in the September issue “Listen to Your Nurses! Improving Work Environments” by Danielle H. Schloffman, MSN, RN, NE-BC, and Anna Ver Hage, BSN, RN, CCRN, CNRN, inspired me, but also really made me think. I applaud what the authors wrote, and I would like to add an additional perspective.

I concur that many of our nurses who complete the National Database of Nursing Quality Indicators® survey also frequently voice dissatisfaction about completing the survey and wonder what we do with the results year after year. The performance improvement plans developed by the Staff Nurse Councils in collaboration with unit leadership were impressive, but I believe their success was greatly impacted by the strong leadership supporting their efforts.

What I find even more impressive is the transformational leadership style the managers seemed to embrace. These transformational leaders were willing to openly communicate about areas for improvement on their unit. They collaborated with staff, shared the power and decision making, and were willing to take risks to improve outcomes.

I would also like to recognize the leaders in this article for their ability to really listen to their staff. Being able to truly listen to staff and use transformational leadership strategies don't come easy for everyone, yet it's imperative to the success of projects such as the one described in this article. As nurse managers and leaders, I encourage us to use evidence-based leadership strategies to encourage, enable, and inspire our staff to lead.

Having worked in three different Magnet® institutions that all participate in the National Database of Nursing Quality Indicators® (NDNQI®), I was interested in the performance improvement plans implemented in the article “Listen to Your Nurses! Improving Work Environments” by Danielle H. Schloffman, MSN, RN, NE-BC, and Anna Ver Hage, BSN, RN, CCRN, CNRN, in the September issue. The NDNQI is a very helpful tool for executive leaders to evaluate the satisfaction of nurses but, just as the authors explained, many nurses feel the results aren't being followed up. I agree with the article that it's important for nurses to create councils and be more involved in creating a satisfactory workplace, but I also think nurse leaders need to be open to suggestions and evidence-based practices to help increase nurse satisfaction.

The authors discussed some of the nursing interventions that were adopted through the newly implemented Staff Nurse Council, and two of the interventions stuck out the most. Both of the interventions focused on making it a priority for nurses to take undisrupted meal breaks each shift. Studies show that nurses who don't take breaks have decreased performance and increased fatigue. There are some states that don't have any laws regarding mandatory meal breaks or rest periods, therefore, it's imperative that nurse leaders make undisrupted meal breaks a priority for each of their employees, as well as themselves, to remain productive. After nurse leaders implement undisrupted meal breaks, their nurses will have increased job satisfaction and decreased patient errors.

The authors had good action plans, which included making the lounge a “no phone zone,” assigning times for staff members to take their break, and creating a buddy system. The first thing that needs to be done in an organization to make taking breaks a priority is to educate staff members on their rights, as well as the reason for taking these much needed breaks from their stressful shifts. After staff members understand the need for breaks and that the organization is going to support them, more nurses will feel less guilty stepping away from patient care for at least 30 minutes.

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Focus: End-of-life care

I was thrilled to read the article “Managing Care at The End of Life” by Ashley Hodo, MSN, RN, and Leisha Buller, BSN, RN, CMSRN, from the August issue. As patient-care providers, we tend to lack the education and teaching needed to care for our patients at the end of life. End-of-life care is often overlooked because it's a very difficult aspect of holistic care. As nurses we're trained to heal, but a much needed focus is knowing when to let go: for the patient, the family, and ourselves.

The Peaceful End of Life Theory is a resource that I plan to use in staff education. The section focusing on the role of the nurse leader is most important. As nurse leaders, we must create, provide, and sustain an environment of care for our direct care nurses, as well as for the patients for whom they care. The fact that this article was able to point out the real issue of compassion fatigue is very helpful for nurse leaders. This issue deserves recognition, and additional resources must be made available to our nursing teams.

I would also like to propose that we, as a profession, begin initiating open discussions and educational opportunities for our nurses, as well as physicians. This is the only way we, as a healthcare team, can provide the care needed to our patients. Thank you again for such an insightful article.

Jessica Klaristenfeld, BSN, RN-BC

Los Angeles, Calif.

Bryn K. Novicke, BSN, RN, OCN

Arlington, Tex.

LaNell Scott, BSN, RN, CNOR

San Antonio, Tex.

© 2012 by Lippincott Williams & Wilkins, Inc.

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