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Think About It
A forum for discussion of the latest news and ideas in nursing management and healthcare.
Monday, June 29, 2015

I’ve been working with staff on a mentoring project this week. There’s a wealth of available research on mentoring programs for nurses. I spent some time combing through articles and one thing I continually noted is the topic of retention. It’s during that first 30 to 90 days that you retain your employee. We know this is the time to engage them. Reach out, be supportive, and provide a safe environment where needs can be expressed and feedback given and utilized.

New employee mentoring is far more than orientation--the process whereby you show employees how to do their job and where to find what they need. Mentoring gives them a safe haven to vent, provide and receive constructive criticism, and learn how to navigate their new career and work environment. This should include short- and long-term goal setting.

There also needs to be a plan for long-term follow-up, checking in with them in 30 days, 60 days, 90 days, and 1 year. Are we meeting your needs? What have we done well? What haven’t we done well? Was your orientation effective? Has your mentor been effective?

Hopefully, the mentor relationship is something that will be maintained and continue. Does your organization have a mentoring program?

Lisa Lockhart, MHA, MSN, RN, NE-BC
Nurse Manager, Specialty Clinics
Alvin C. York VA Medical Center
Murfreesboro, Tenn.
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Monday, June 22, 2015

I was browsing through some of my magazines trying to catch up and I always notice themes. This week’s theme seemed to be case management of patients. We know that a multidisciplinary approach is best when managing a patient’s care. Getting healthcare professionals from all of the supportive methodologies to weigh in on what’s needed, what’s working, and what isn’t. The difficulty comes when you attempt to pull all that data together in one neat package that’s neither duplicative nor missing pieces. This is where case management comes in.

When I speak of case managers, I don’t mean only those individuals designated as such, but also the nurse managing the patient’s care that day. When your nurses sit and thumb through a chart, gleaning information on the patient and his or her course of care, they're beginning the case management process. They’re taking the puzzle pieces, placing them in order, and making sure the borders are intact and all of the elements are present.

If pieces are missing, they’re attending to that need, identifying those items, and communicating with the team. This is vital to the patient’s care outcomes, satisfaction with care, length of stay, and rate of readmission--not to mention quality of life. This daily task means everything to the patient, the family, and the care team.

Lisa Lockhart, MHA, MSN, RN, NE-BC
Nurse Manager, Specialty Clinics
Alvin C. York VA Medical Center
Murfreesboro, Tenn.
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Monday, June 15, 2015

I was browsing a recent issue of a nursing journal this weekend and came across an article dedicated to culturally competent care and instructions on using the ESFT model. We talk frequently about cultural competence and diversity in nursing; this is a great tool that aims to assist healthcare providers in determining patients’ perception of their illness.

Explanatory model of health and illness: What’s the patient’s explanation of what, where, why, and how?

Social and environmental factors: How will the patient manage medications, treatments, transportation costs, etc.?

Fears and concerns: What’s worrying the patient?

Therapeutic contracting: Does the patient understand the care plan and is he or she able to teach it back?

The overall goal is to enhance communication between the healthcare provider and the patient. Communication is a key factor in overcoming cultural barriers to care. How are your communication skills?

Lisa Lockhart, MHA, MSN, RN, NE-BC
Nurse Manager, Specialty Clinics
Alvin C. York VA Medical Center
Murfreesboro, Tenn.
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Wednesday, April 29, 2015
April showers bring May flowers and our Nurses Week issue of Nursing Management! It has some fantastic topics from our update on Value-Based Purchasing (CE) to the Leadership Q&A question on engaging recent grads.

Specifically for Nurses Week, the theme of which is "Ethical Practice. Quality Care," is the article on writing effective anti-bullying policies. Bullying has received a lot of attention, most recently, a Marie Claire article was published highlighting the unfortunate outcomes of workplace bullying, including:

  • 85% of nurses have been verbally abused by another nurse
  • approximately 1 in 3 nurses (worldwide) quits because of bullying
  • bullying, not pay, appears to be the major cause of the nurse shortage.

    These are harrowing statistics, however, nurse leaders have the power to help fix the problem. With this information in mind, leaders can be more aware of bullying and harassment that may occur in their organizations. Our anti-bullying article outlines behaviors to look for and provides a sample policy as well as a performance improvement plan. It’s up to leaders to help put a stop to this unwanted behavior, and there’s no better time than the present.

    Have you implemented any anti-bullying policies in your organization? Share your story in the comments.


  • Tuesday, April 28, 2015

    An interesting article was recently published about providing acute care at home. This idea isn’t entirely new or radically different than "standard" home healthcare, but it’s garnering attention. The New York Times article references a study from 2005 that examined the safety, efficacy, clinical and functional outcomes, patient and caregiver satisfaction, and costs of providing acute hospital level care in a hospital-at-home instead of admission to an acute care facility.

    Study participants were community-dwelling older adults who required admission for an acute care facility for any of the following:

    ·         community-acquired pneumonia

    ·         exacerbation of chronic heart failure

    ·         exacerbation of chronic obstructive pulmonary disease

    ·         cellulitis

    A total of 455 patients from three Medicare-managed care health systems and a VA medical center were included in the study. At two of the three study sites, 69% of patients chose hospital-at-home care over hospital-based care. At the third site, 29% chose hospital-at-home care. Compared with patients who were hospitalized, those with hospital-at-home care had a shorter “length of stay” (3.2 days versus 4.9 days) , and fewer complications. Additionally, hospital-at-home care was more cost-effective than acute care hospitalization ($5,081 versus $7,480, respectively).

    Fast-forward 10 years to a transformed healthcare system with a focus on quality over quantity and this hospital-at-home model sounds like a potential solution for cutting costs, maintaining quality care, and satisfying patients.

    Do you think we’ll start seeing more hospital-at-home models of care soon?

    About the Author

    Nursing Management
    “Think About It” is an extension of Nursing Management. Here, you can read and discuss professional information geared toward helping nurses excel as leaders. This blog tackles important topics without the worry of print publication deadlines!