Nursing Management:
doi: 10.1097/01.NUMA.0000444878.08311.4b
Department: Letters

Letters

Melendez, Giselle MS, RN; Loomis, Jamie BSN, RN; Keesler, Jennifer BSN, RN; Malter, Maryanne BSN, RN, PHN; Williams, Sandi L. BSN, RN

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Pediatric disaster planning for the win

Thank you so much for including the article “Consider the Children: Pediatric Disaster Planning” by Catherine J. Goodhue, MN, CRNP; Ann C. Lin, BS; Rita V. Burke, PhD, MPH; Bridget M. Berg, MPH; and Jeffrey S. Upperman, MD, in the November issue. This article is so timely and informative considering all the recent disasters the United States has faced.

As a doctoral student who recently took the certification exam, emergency preparedness was one of the questions. A good portion of what I wrote on the exam was geared toward what to do for children. Often, when a hospital looks at disaster planning, the specific needs of children aren't addressed. As a former patient care director for a pediatric ED, I was fortunate to work at an organization that addressed children's needs. In my current role as a clinical nurse specialist for a neonatal ICU, we're the first hospital in our area to develop a NICU evacuation plan. Part of my role will be to educate the nurses about what needs to be done when a disaster strikes.

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Clinical nurse leaders? I think so!

As a clinical educator for the past 9 years, I understand the importance of improving patient outcomes and monitoring adherence to regulatory agency requirements. The article “A Portrait of the Bedside: Clinical Nurse Leaders Complete the Picture” by Karen Schilling-Broderick, MSN, RN, CCRN, in the November issue was very informative. The use of clinical nurse leaders (CNLs) has an important and appropriate place in today's healthcare systems.

With the advent of pay-for-performance, bedside nursing staff, nurse managers, and physicians have an ever-increasing number of patient tasks to assess, order, complete, and teach. The CNL role is an asset that can offload some of these requirements. The CNL has the knowledge and support to ensure that these evidence-based requirements are met, thereby improving patient outcomes and increasing reimbursement. This role is a win-win for clinicians and the hospital administration.

The author did an excellent job describing the CNL role. It's important for bedside nursing staff and managers to understand this role. CNLs aren't “another set of hands” to help complete daily nursing tasks. Likewise, they aren't managers to deal with nonadherence, hiring, or scheduling. The CNL is a leader in the department in which he or she works. CNLs have a task-oriented style of leadership, favoring completion of tasks and supervision of others. The CNL has accountability for patient outcomes. Utilizing evidence-based practices, he or she designs, implements, and evaluates patient care plans. CNLs assist the bedside staff in the delivery of these practices. The CNL also utilizes an interdisciplinary approach, collaborating with all clinical staff involved in the patient's care to ensure best outcomes, which are the measure of the care quality that the CNL provides. CNLs must be accountable to their practice by synthesizing data to evaluate and achieve these outcomes. Facilities that implement the CNL role will soon realize the positive impact of care that these nurses can provide.

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The dangers of alarm fatigue

I was very excited to read the article “Managing Clinical Alarms: Using Data to Drive Change” by Maria M. Cvach, DNP, RN, CCRN; Andrew Currie, MS; Adam Sapirstein, MD; Peter A. Doyle, PhD, CHFP; and Peter Pronovost, MD, PhD, FCCM, in the November issue. I'm currently a clinical supervisor on a cardiac floor and this is a topic that we've been investigating as a hospital. I'm glad to see that The Joint Commission will be presenting this in 2014 as one of its National Patient Safety Goals. I think this is an area of grave importance. I was amazed to read how many deaths had been reported related to monitor system alarms. The problem of alarm fatigue is very apparent and I believe it will only worsen if systems aren't put in place to prevent it.

The hospital where I work has already taken steps to revise our current policy regarding monitor alarms. One practice that we're trying to implement is similar to something that's mentioned in your article—a policy that gives nurses some discretion regarding the discontinuation of telemetry monitoring of patients. We've found that physicians order telemetry and the patients are on telemetry for the duration of their stay, regardless of whether they have any significant events. We're looking at having telemetry ordered for a set period and if there are no events noted within that period of time, then the telemetry may be automatically discontinued. I feel that it's very important for an organization to include in its policy which patients have clinical indications that require monitoring.

The issue of alarm fatigue is a growing problem and one that warrants further research. It's a topic that has a huge impact on patient safety. I look forward to continuing my research on this topic.

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360-degree team building

I'm writing in response to the article “Leadership at 360°” by Cindy Reistroffer, MBA, BSN, RN, NEA-BC; MaryKay VanDriel, EdD, RN, FACHE; and Jean Barry, PhD, RN, NEA-BC, in the December issue to provide additional perspectives regarding the ways that the authors appropriately addressed the common manager's dilemma of being pulled in multiple directions, and how this may cause the loss of effectual leadership abilities. The authors examine how these issues are related to staff engagement and how they can also lead to strained relationships, which affect team building, lead to further detractions from nursing units running effectively, and impact patient care and nurse satisfaction.

During my 18-year career as an RN involved in various clinical leadership roles, I've experienced skilled leaders who were able to overcome various obstacles by taking specific steps. These measures allowed them to rise above and avoid administrative or staff meltdowns. Furthermore, these aspects of nursing management are extremely important for patient care units to run smoothly and effectively. Leaders who masterfully accomplish team building despite obstacles have established a vision for their direct reports and engaged in shared governance by communicating very clear and succinct expectations.

Not everyone can be a part of a team and share common goals, but effective leaders can help their staff members focus on what they're trying to achieve while also circumventing individual agendas. The most effective leaders hold their staff members accountable by setting priorities, communicate exceptionally well, and assign the tasks to get the work done. In addition, there must be effective role models in place for teams to be optimally engaged. I agree with the authors that formal leadership development is a necessary component for leaders to develop and engage in effective team building strategies.

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Condition H is A-OK

I'm writing in response to the article “Calling a Condition H” by Beth A. McCawley, DNP, RN, CCRN; Richard J. Gannotta, DHA, NP, RN, FACHE; Mary T. Champagne, PhD, RN, FAAN; and Kathryn A. Wood, PhD, RN in the December issue. I feel that there's a need for the involvement of families in patient care and I strongly believe that their involvement often results in improved patient outcomes.

Patient- and family-centeredness is a fundamental concept in the field of nursing and involving patients and families in the care they receive can hold significant benefits. Allowing patients to have their family members present and participating in the patient's care has its benefits, such as increased patient satisfaction, increased patient comfort, lower mortality, and fewer medical complications. Leadership support for family participation is paramount. In this article, the involvement of the CNO, chief safety officer, and administrators for promoting the Condition H intervention was a key to its success. With improvements in the safety and quality of care, Condition H implementation can be beneficial to many healthcare organizations.

As an RN, I've always valued patient-centered care and in my new role as a case manager, it's easy to see the level of involvement family members have in the care of their loved ones. It seems that the more involved a family member is, the better the outcome for the patient. When family members are active partners in the healthcare team and willingly participate in the patient's care and discharge planning, I've witnessed a more smooth and uncomplicated transition to the home setting. Positive patient outcomes are at the forefront of healthcare, and family members most certainly should be involved to enhance those outcomes.

Giselle Melendez, MS, RN

Jamie Loomis, BSN, RN

Jennifer Keesler, BSN, RN

Maryanne Malter, BSN, RN, PHN

Sandi L. Williams, BSN, RN

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