Nurse Consulting – Page 11 – JRM Nurse Consultants

April 04 2015

Multiple Factors Can Interfere With Teamwork

In every organization there are communication barriers, but overcoming them is part of being professional and respectful of others’ opinion. In some organizations the leadership structure has a medical director, senior health service director, a health service director, a manager and the case manager. The case manager manages the file, develops the plan of care with the assistance of the member or the family. The nurse is responsible to ensure that the member is attending their doctor’s appointments, taking their medications and maintaining their insurance eligibility monthly. This should be done by the social worker however in some organizations, the social workers manage the same types of patients that the nurses manage.

There are other professionals on the team that help maintain the members with their eligibility for their Medicaid insurance. Part of the team is the operations team. This is where things in an organization get blurred due to communication gaps, lack of resources, support and professionalism. The team in operations are not nurses. The operations team will email the nurse and copy the manager to let them know that the member is going to lose eligibility if they do not send in their paperwork timely to the state. When the nurse receives this email, the nurse is to drop all that they are doing to attend to the member’s eligibility. This will involve contacting the state to see what is happening with their eligibility. This is something operations can handle but they state their function is just to advise the case managers of the discrepancy.

Another barrier that is seen in management of cases is the inability to show respect to other team members and allow a learning environment. One agency case manager stated that every two weeks the team of case managers reviews case files on a conference call with the medical director. These cases are reviewed in their team meetings weekly before submitting to the medical director and as a team they discuss what has been done and make suggestions. The cases are emailed to the medical director and his assistant selects the cases. Recently, a case manager stated that two cases were selected for review from her team. The case managers present them to about one hundred and eighty people or more on the call from directors to managers and case managers. As the doctor asks his questions and makes his recommendations, the case manager indicated that her director, who is her manager’s superior, made a statement on both cases stating to the team that their manager should have known this and taken a different approach before sending this to review. The case manager did not know what to say, but this was stated over and over about five or six times throughout the presentation of both cases. At the end, what was stated by that director was if your manager does not know what to do, then call her. This is a prime example of a barrier in trying to be in a learning environment that will help the case manager grow and benefit the patient. (Rubenfeld & Schaeffer, 2014)

Collaboration can only exist in a team when the leader uses critical thinking, an interdisciplinary team approach and collaborate on cases together. But in the big picture of corporate America under some managers this is not acceptable, it is more along the lines of a multidisciplinary team. In this type of team, you only have individual thinking in the group, meaning their way and no other opinions. The focus will be on tasks and check off systems regardless if it is feasible to do. (Rubenfeld & Schaeffer, 2014)

In conclusion, nurses do have the ability to be leaders, educators and changers of a system, if assertive enough to make that change, but in order to do so a good team of interprofessional people are needed. Because at the end of the day, the patient is who counts and why changes are necessary.

References

Rubenfeld, M. G., & Scheffer, B. (2014). Critical Thinking Tactics for Nursing Achieving the IOM Competencies (3rd ed.). [P2BS-11]. Retrieved from http://online.vitalsource.com/books/9781284059571

Written by Rosie Moore, RN, BSN, LNC

April 04 2015

The Nurse Leader of a Healthcare Team

A nurse can play three different roles as part of an interprofessional team. The three roles consist of a nurse, nurse leader and nurse educator. The interprofessionalism team consists of other healthcare workers as well, not just nurses. (Sommerfeldt, 2013) However as nurses the roles can be at different levels depending on the patient’s condition. In speaking with a complex case manager working for a managed care company, the team consisted of registered nurses, social workers (masters prepared) behavioral health specialists, community health workers and nutritionists. The nurse case manager managed the patient, however if there was an issue with the patient in the home setting that required community resources, the community health worker would be consulted to assist in those needs. If the member had psychological issue or other financial issues that required the need of a social worker or behavioral health specialist, this referral would be added as well. There was collaboration on the plan of care and all participated because they were all looking at the patient as a whole, not just as the part that each discipline took care of. If the member cannot pay his light bill or water bill due to financial difficulties, until they take care of those needs through resources, any teaching that the nurse does would be in vain. A person cannot focus on teaching for their health or anything else if their mind is on their current financial strain, not their medical condition. In this instance the nurse is playing the role of the nurse leader.

When a patient is in the hospital a nurse can also play the role of a nurse that is doing dressing changes, medication administration and other treatments. The nurse’s role in the interprofessional team that may consist of the doctor, physical therapist and dietician, would be more medically involved because maybe the patient is recuperating from heart surgery and requires a lot of care initially. The patient is on a special cardiac diet, which can also be explained by the treating nurse, however in this instance, the member is starting something new, so a consult from the dietician can help the patient understand the diet and the nurse can reinforce the teaching.

The nurse educator as part of the interdisciplinary team can be seen for example in a disease management setting. This type of setting also has multiple specialties that can follow the patient. In this instance the nurse educator is educating the member on how to empower themselves and learn about managing their chronic disease by learning about taking their medications, following a diet and exercise program, learning to check their blood sugar or blood pressure. The nurse educator measures the members learning based on return demonstration through development of a plan of care.

All three roles bring value to the scenario that they are in, because the nurse is the one that will be around the patient most of the time. In each role the nurses is responsible for all aspects of the patient’s care. Regardless of which role the nurse is playing, working on an interprofessional teams is a style of partnership that allows decision-making to be collaborative. (Sommerfeldt, 2013) It takes many people to work together in getting a patient discharged to his home.

References

Sommerfeldt, S. C. (2013, February 25 2013). Articulating Nursing in an Interpersonal World. Nurse Education in Practice, (13), 519. http://dx.doi.org/http://dx.doi.org/10.1016/j.nepr.2013.02.014

Written by Rosie Moore, RN, BSN , LNC

March 03 2015

Corporate America Nurse …What Changes Can You Expect

When a nurse is working in corporate America, changes are bound to be evident, from what the nurse was used to at the hospital. When nurses take on the this role, they have higher skill sets in the business world than in the clinical world since they do not practice and they may not feel confident providing care. The role of a nurse manager in the clinical setting when she is managing the business aspect can be very confusing for nurses. This is because their training is that of a nurse and possibly they received their MBA to manage an office, however when put in a clinical situation, due to less involvement clinically, they lose their clinical awareness.

In some places, there are many nurse managers that are in this manager role and there is very little clinical involvement. The clinical they may get to do as a manager is when they go out in the field quarterly with staff or when they do chart audits. Some nurses maintain their clinical skills because they choose to be more involved in their staff’s patients, looking at their diagnosis and medications right along with the staff to be able to keep up with what is changing medically. Some managers are quite content with the non-nursing role.

This makes it very difficult at times dealing with a manager that is a transactional leader. Transactional leadership is a style of management when the leader promotes compliance from their staff through rewards and punishments. it is an antiquated method of management, where mostly punishments are used. After awhile the leader loses their staff due the rigidity of management. A transactional leader will not allow the status quo to change and when a nurse brings up evidenced based nursing approaches to help the staff, they may be quickly dismissed as this is not part of what a manager does. Some managers are told constantly that they are a manager and have to think like one, not like a nurse that is doing clinical. It sounds like a power struggle of the titles.

Marchionni, C., & Ritchie, J. (2007, January 25). Organizational Factors that Support the Implementation of a Nursing Best Practice Guideline. Journal of Nursing Management, 16(), 266-274. http://dx.doi.org/10.1111/j.1365-2834.2007.00775.x

Rubenfeld, M. G., & Schaeffer, B. (2014). Critical Thinking Tactics for Nursing Achieving the IOM Competencies (3rd ed.). [P2BS-11]. Retrieved from http://online.vitalsource.com/books/9781284059571

Rosie Moore, RN BSN, LNC

March 03 2015

Organizational Culture and Critical Thinking

In some managed care organizations, there are several factors that inhibit critical thinking skills to be utilized. Some of these factors are contract led and others are management style. Long term care programs are mandated by the state to follow a certain protocol on managing their cases for the members that are seen. The care part for the member is not an issue, however the reports and assessments that are required to be filled out, keep the case manager from adequately spending appropriate time with the member. If there is one item not completely filled out, the assessment will be returned by the state. The assessment is at times sent back late from the state, forcing the case manager to redo the entire assessment that can easily take two hours. This in turn causes a high turnover of staff because the demands on their time as salaried employees working 12 plus hours and 6-7 days per week are not what they want to do.

These company cultures do not lend themselves for new implementations for a better way to manage the staff and their time. The industry has seen some of the staff say that they have PTO (it should be paid time off) but at times they are still checking emails and phone messages for fear of getting behind, so one has to ask themselves are they on paid time off or pretend time off? One manager cannot implement changes in the entire company, but with their own team they can apply evidence based nursing and critical thinking skills to make a difference internally.

Some ideas that a manager can work on with their team can be, discussing best practices for different aspects of the job. It seems that all team members and managers have to address emails, projects and reports, these will always interrupt the flow of the day. The team however, can control when they see their patients, make phone calls and when notes are entered in the system. When a manager is preparing to discuss the best practices, some things to consider can be based on the issues that the staff come up with ahead of time during the week or audits on their files. This can help the morale of the staff as well as their performance, decreasing the amount of turnover. (Marchionni & Ritchie, 2007)

In conclusion, every manager has their own style of managing. The best style of management is always going to be one that empowers employees to do their job based on examples and positive reinforcement. If all the employee ever hears is what they did wrong and never a word of praise, the employee will not strive after a while to grow and better themselves.

” A word aptly spoken is like apples of gold in settings of silver.” Proverbs 25:11

Written by Rosie Moore, RN, BSN , LNC

February 02 2015

Role of Professional Nurse

The role of the professional nurse when implementing a change is to identify that there is a need for a change. (Rubenfeld & Scheffer, 2014, p. 321) Once the need for a change is identified by the nurse, the next step is to implement a change in behaviors efficiently and with quality. When identifying the area specifically that needs the change, nurses need to be deliberate in stating the purpose for the change. When speaking to the target group about making the change, it is important to keep their attention span with non-lecturing phrases. As nurses we are not always in our comfort zone to explain why changes need to be implemented. We should be prepared to explain why this change is needed and what improvements these changes will make.

Generally, people will always be resistant to change. But as professional nurses, our focus is to build trust and credibility. The goal is to acknowledge that the change is coming and that you empathize with the feelings of the upcoming change. (Rubenfeld & Scheffer, 2014, p. 324)

Some companies are very involved with AHCA (Agency for Healthcare Administration) because they hold a state contract. Evidenced based nursing is in a sense required as far as the patient care when case managers are managing a case. However on the same note, although case managers are not performing hands on care, they are required to know about all their patients’ diagnoses and treatments. These companies have social workers and nurses alike seeing the same types of patients. The issue that comes up with nurses and social workers seeing the same types of patients is when the social worker is not able to use his/her critical thinking skills in their area of expertise. The social workers are required to case manage a patient having medical issues that can possibly be on a ventilator or have more complex medical problems. Some companies, utilize social workers to assist patients with the community resources that they are all too familiar with. While other companies, say ACHA is not paying the company to rethink how cases are managed and by whom because it is not hands on care, it is case management.

These days nurses can work in many diversified places, even in corporations such as insurance companies. The problem for some places that employ nurses in a corporate role, is that there is very little nursing involved in their job role. Sometimes it is primarily reports, meetings to talk about reports and how to fix these reports. It is an ideal job for someone that has an interest in perfection of numbers and statistics. Most nurses are not geared this way, they are geared to use their critical thinking skills. As a nurse seeing that every other day there is a new change that is being implemented, will often make the nurse question why there is a change, but only too often to be told that the change is immediate and mandatory.

Nurses who are managers and supervise case managers have to explain new changes to them. For the case managers, these changes are difficult because the staff is in the field. They may receive an email about something needed to be changed as soon as possible, however they may have just returned home at 4:30 or 5pm in the afternoon looking forward to the end of their day. They check their emails and find deadlines on multiple items due. These changes affect the staff because they have to stay late after hours to get the work completed timely. This kind of change can cause many good nurses and social workers to resign.

As nurses or leaders we can tend to fall in to the routine of lecturing due to the pressures that we are under. However two of the six dimensions of dealing with complex dynamic changes are creativity and intuition. As a leader we should not just teach our group something, we should implement a way to bring creativity in to the change and use intuition to know how to speak to your group. The best way to implement a change is to get the group to commit to doing the new change and develop a smart goal with them that will allow them to measure their own goals.

Change is inevitable and we all have to change, but the way we implement those changes can be the success of the process being changed.

Author John Maxwell states, ” If you want to change your life, you must first change the way you think..”

References

Rubenfeld, M. G., & Scheffer, B. (2014). Critical Thinking Tactics for Nursing Achieving the IOM Competencies (3rd ed.). [P2BS-11]. Retrieved from http://online.vitalsource.com/books/9781284059571

(Rubenfeld & Scheffer, 2014, Chapter 11)

Written By Rosie Moore, RN, BSN, LNC

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Years of experience in Work Comp, Case Management, Disease Management, Utilization Review and Prior Authorization.

Category Archives: Nurse Consulting

Multiple Factors Can Interfere With Teamwork

The Nurse Leader of a Healthcare Team

Corporate America Nurse …What Changes Can You Expect

Organizational Culture and Critical Thinking