Associate Executive Director, Patient Care Services/Nurse Executive, Lenox Hill Hospital/North Shore-LIJ Health System, New York, N.Y.
Blast off! Boosting unit collaboration
Q My unit medical director is aloof and not visible. How can I engage her in collaborative unit activities?
I understand how challenging this can be. It would be helpful to know what the organizational expectations are for nurse-physician unit leaders. Ideally, you should both be accountable for unit goals and outcomes, and established forums with organizational leadership should be in place. The combination of executive sponsorship, established goals, accountability for results, and a bit of unit-to-unit competition puts everyone on the same page and oriented toward accomplishment.
True collaboration involves a foundation of respect, good communication, and shared goals. Do you have that base with your medical director? If not, it's time to clear the air and engage her. Maybe she isn't visible because she's torn in many directions, is fundamentally shy, or doesn't feel wanted or respected on the unit. Maybe the role isn't clear and/or you don't have mutual interests. Finding those answers will help you make an effective plan for collaboration and engagement.
You should implement daily patient-centered rounds if you aren't doing so already. Establish a time for weekly meetings that can be short (15 minutes) or long depending on the issues. You should also plan for leadership rounding together, which can be focused on patient safety, staff, patient care, or even the care environment. Share unit metrics; for example, core measures, length of stay, patient experience, and quality findings. Depending on organizational priorities, there's most likely a joint initiative that you can lead together.
I would also invite her to staff meetings either for a specific agenda item or for the whole meeting—getting to know her and your staff better will help engagement on both sides. Involve your director and the medical hierarchy as appropriate. A collaborative partnership moving forward will be worth the energy you put into it.
Get adept at adaptation
Q Our organization is rapidly adding components of an electronic medical record (EMR). How do I help my staff adapt?
Change keeps coming at a rapid pace in many aspects of our practice, and effective implementation of an EMR is critically needed. The benefits are transformational in several ways, including patient safety enhancements, access to data and patient information, built-in clinical decision making, standardization, decreased duplication, efficiencies, timeliness, and reporting. Healthcare is years behind other industries. The “meaningful use” government incentives are intended to jump start widespread adoption. But only 40% of hospitals have met meaningful use stage I expectations. More progressive hospitals are preparing and executing stage II criteria. It's no wonder that you're adding new functionality quickly in your organization.
Change management starts with engagement of stakeholders. Your staff should understand the reasoning behind EMR additions or changes, as well as “how-to” information. There's most likely an EMR nursing forum coordinated by your informatics leaders in which workflow and changes are vetted. Ensure you have unit and/or clinical division representation, such as yourself, staff, educators, or other colleagues. These representatives may be your unit champions and super-users who'll help you and your staff adapt to changes and new functionality.
Barriers to adoption may include new workflows that don't work well. For example, if you've added immunization assessment and administration to your EMR and the process involves multiple steps in different parts of the electronic record, then bring this forward with ideas to streamline. Another barrier may be ineffective or inadequate devices. If you're desktop-dependent and the new functionality involves bedside work without an accessible, working device, then you'll have resistance for good reason. Inadequate training is another barrier. Ensure your staff members attend training, whether classroom-based, computer-based, or one-on-one on the unit. If training isn't available, advocate for it.
Obtain quality reports and/or monitor concurrently so that you can give timely and effective feedback. Use all the resources you have to resolve issues and assist staff members with adoption. They'll appreciate it and you'll be more comfortable, too.