Department: Leadership Q&A
Chief Nurse Executive, Baptist Medical Center Beaches, Jacksonville, Fla.
Navigating a difficult boss
Q The director to whom I report is demeaning, reactionary, and demanding. What are my options?
At one time or another in our careers, we've all faced a boss who demonstrates poor leadership qualities. Your first approach should be to evaluate your own work performance regarding unit-based patient outcomes for falls with injury, hospital-acquired pressure ulcers, catheter-related bloodstream infections, catheter-associated urinary tract infections, and patient satisfaction. It's important that you assess if any of these negative outcomes occurred when you were directly responsible for patient care. You may find that your director's approach is to hold staff members more accountable as your organization transitions to the transparent reporting of quality outcomes.
Next, spend some time observing your boss, just like you would a patient, to see how he or she interacts with staff members. In the process, you might learn that your director is getting pressure for performance outcomes from his or her boss and it's creating a stressful environment. After your assessment, you may have to accept that your director has a different leadership style than you've experienced in the past due to your organization's leadership team adapting to healthcare reform requirements.
Don't avoid your director. Attempt to engage him or her in a positive manner. Intentional and open communication can potentially lead to a productive relationship. Try to become the go-to person on your unit for problem solving and projects. You may find that your support will help your director deliver key messages through your direct communication with staff.
Remember, don't take the situation personally. Throughout your career, you'll encounter leaders who are demanding, critical, and downright volatile. Always take the high road and try to turn this bad situation around, but keep in mind it will take work. As a last resort, if you find your work environment is intolerable, begin to pursue other opportunities within your organization.
Get CHF readmissions under control
Q The floor on which I work has a 30% congestive heart failure (CHF) readmission rate. What are some best practices for decreasing CHF readmissions?
Your question is very timely because CHF readmissions are included in the quality component of the Centers for Medicare and Medicaid Services Pay-for-Performance program.
Common strategies for reducing CHF 30-day readmissions include proper hospital care coordination to home or a skilled nursing facility, the use of risk-stratifying tools to identify patients at risk for readmission, the use of educational materials adapted to appropriate literacy levels, and early scheduling of postdischarge medical follow-up appointments. Strategies at the unit level you can potentially champion include the implementation of a high-risk assessment on admission and a teach-back CHF education methodology.
The high-risk assessment includes a thorough assessment of the patient's clinical status, medication reconciliation, early identification of postdischarge needs, and communication of any change in patient status to the interdisciplinary team. Based on this assessment, the immediate postdischarge plan requires care coordination within 48 hours if the patient is at high risk or 5 days if the patient is at moderate risk. Early scheduling of medical follow-up provides an environment for the patient and family to clarify medication regimens and ongoing patient education. Patient teach-back education involves an interactive teaching method that utilizes plain language, focuses on the patient's key points, and requires the patient to verbally recall the information just reviewed.
You clearly play a key role in developing and implementing strategies that can better position your organization's future success.