Associate Executive Director, Patient Care Services/Nurse Executive, Lenox Hill Hospital/North Shore-LIJ Health System, New York, N.Y.
Those long nails have got to go!
Q My director has long nails, which are against infection control policy. How do I address this?
I admire your courage in this situation—most people would shy away from addressing it. You'll want to use Crucial Conversation1 skills to avoid making a career-limiting gesture. According to the authors, a conversation is crucial when the stakes are high, opinions vary, and the results have impact—all of which apply in this case.
Your director is breaking safety rules and certainly not role modeling for the rest of the staff. Don't assume she's flagrantly and purposefully violating policy; maybe she isn't in direct patient contact and doesn't see herself posing a safety risk. Maybe she hasn't even thought of the negative impact her nails have on impressionable staff. I also urge you to avoid talking behind her back, making snide comments to your colleagues, joking about it, or using the compliance hotline. Nothing good comes out of negative talk, especially regarding your boss.
Prepare for your conversation. I'm assuming that there are no other issues, your relationship is good, and both of you are reasonable people. This issue could be addressed during your regular one-to-one meeting as an agenda item or at a separate meeting for this purpose. You don't want the conversation to take place in a hallway or for it to be informal. You'll want to be respectful at all times and desire to understand. What do you want to achieve? To simply express yourself, to know why she ignores policy, or to have her shorten her nails? All three have different expectations for the outcome.
Be honest, open, nonthreatening, and unemotional. For example, “I have something I'd like to talk about and understand better, which we may have different perspectives on.” A reasonable person will engage in a conversation with you about the issue, and most likely you'll reach agreement on an endpoint; at the very least, she may take your concerns under advisement. Because this is a safety issue, you're justified in escalating if there's no sensible, satisfactory conclusion. I predict it won't be necessary.
1. Patterson K, Grenny J, McMillan R, Switzler A. Crucial Conversations: Tools for Talking When Stakes Are High. New York, NY: McGraw-Hill; 2011. Cited Here...
Taking change one step at a time
Q I'm a new manager who realizes clinical practice changes are needed on my unit. How do I begin?
Change is always hard, even in the best of worlds. To maximize your chances of success, I suggest you begin with solid staff engagement in the process. Do you have a functioning unit-based council? If not, you could start with garnering interest in an evidence-based practice (EBP) team. Your approach might be to let the team pick the first project based on their interests; however, if the unit has an outcome or process problem on your radar, you may want to direct the group to start with that issue. Using a multidisciplinary approach may be even better depending on the project; a physician unit-based partner is ideal.
Use your organizational resources, including the librarian, quality professionals, education staff, and other colleagues. If any of your staff members are in school, they may be required to complete an EBP project. You'll need to review the literature with your staff, appraise applicability to your unit, define the scope of the proposed change, and outline measurement and feedback methodology. All of that work is needed before you even begin to teach the rest of the staff and implement.
Your director will want to know your unit plan, not only for informational purposes but primarily to integrate with hospital-wide initiatives and priorities, as well as to facilitate and plan for full rollout if successful. This is wonderful and immensely satisfying work to do with your staff, and I hope you have excellent outcomes moving forward.