Category Archives: General

Implementing Changes in the Emergency Room

An emergency room nurse asks how can he make changes in his emergency room to better serve the patients?

My response to the ER nurse was to acknowledge that I understood his enthusiasm in wanting to make the changes in his emergency department. In such a fast paced department where it is a matter of life and death,  it is hard to implement changes because the nurses may feel they do not have the time to learn but as managers we know that a change must take place (Stevens & Caldwell, 2012).  The emergency department is one of those places where there is never a happy medium making it difficult to staff and do trainings.  But as the website for the American Academy of Healthcare Communication noted “communication is the key to exceptional patient care” (http://www.health.gov/communication/resources/Default.asp).

emergency-room

In order for the nurse to feel that there needs to be a change, there has to be an explanation to them impressing that remaining in the same pattern is not helping the patients.  As managers though, we need to be careful on how this is communicated to the staff, because people are sensitive and if they feel that the work they are doing at the moment is not good enough, they will not accept new changes favorably.

new-year

One way to implement change is by communication in a narrative format;  doing a synopsis of what has been happening in the emergency department.  For example, how many patients have had complications as a result of starting an IV on patients with difficult vascular access because too much time was spent on trying to get an IV line in or calling someone else when attempts have failed?  Without laying blame on anyone,  if this study is brought as a statistic and narrative then it may help the nurses see the importance of a quick ultrasound to see the access.

Everyone is always afraid of change but if presented in such a format where they are given the time to learn it, for example paid education to come to the training on an off day with different options given for the training based on the two or three shifts that the hospital has.  Once the plan is implemented for training, being able to have the educators follow-up with each nurse on how they are doing, will show the staff that the management genuinely cares.  It is important to know if the new transition towards the change is working and if not why, so that the training can be revamped.

nursing-education-2col

Once the nurses see that the change is going to make their jobs easier and the patient’s quality of care rises to a new level, they will be more receptive.

change-challenges-for-nurses-2-13-638

 

References

Stevens, K. R., & Caldwell, E. (2012, August 29, 2012). Nurse Leader Resistance Perceived as a Barrier to High-Quality, Evidence-Based Patient Care. The Ohio State University Research and Innovation Communications. Retrieved from http://www.health.gov/communication/resources/Default.asp

Communication Resources

As a nurse leader, one has to be able to communicate with the staff and the patients as well.  Nurses are influential in informing people about changes that will affect their health (http://www.health.gov/communication/resources/Default.asp).   Patients do not like change, much like we do not like change.  In order for you to make an impact on someone to change, the person has to be able to feel that remaining the same will be more painful physically or emotionally than making the change itself.  For example, the patient that is a diabetic but insists on eating the wrong foods because they like cookies, cake, ice cream and soda, has to be willing to want to make a change.  The obvious change that we want to see is that the patient follows a diet and exercise routine to maintain his diabetes so that he can avoid elevated blood sugars and all the other complications to the body that come from elevated blood sugars.

Senior Couple Studying Financial Document At Home

Sometimes the assistance of oral agents to control the blood sugar is necessary. The painful alternative to not stopping the inappropriate diet would be, monitoring blood sugar four times a day and administering insulin on a sliding scale.  The pain of needle sticks and frequent trips to the doctor to manage the diabetes may be an incentive to the patient to follow his diet.

diabetic

Now on the management side of things, just as communication is going to be the key to our patient accepting change, this is also true for employees.  In a previous position, change was always happening.  We were dictated and told that the change was here and it was happening effective yesterday as the expression goes.  As managers we were to accept it, implement it and move on to the next thing (Stevens & Caldwell, 2012). The employees were kept in the dark and not given much information except to say that the change was here and it had to be done to perfection.  An example was a company department goal that was added to the staff evaluation was to have zero mistakes on any reports based on the staff doing their work one hundred percent perfect with no margin of error. It was an unattainable goal as no one in this planet is perfect.  The staff was never made aware of this goal and how it would be tied to the financial aspect of the company.   If the employee had one mistake this would affect whether they obtained a bonus or a raise.

prada650

When I was in a leadership position, my leadership with my team has to be such that I could be and  influence to them in a positive way and be able to help them  grow and embrace new changes.  This was not an easy process for me as I always try to be there for my staff, but there is no one there for me.  I opted not to be a transactional leader to my team.  I opted to be a transformational leader that will help their team grow in the long run.

boss

References

Stevens, K. R., & Caldwell, E. (2012, August 29, 2012). Nurse Leader Resistance Perceived as a Barrier to High-Quality, Evidence-Based Patient Care. The Ohio State University Research and Innovation Communications. Retrieved from http://www.health.gov/communication/resources/Default.asp