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In the recent NURSEWEEK/AONE research study, nurses
told us that the greatest impact of the nursing shortage
has been the decline in the amount of time that nurses
have to spend with patients. Is this because of the
lack of nurses alone, or are the systems around patient
care keeping nurses from patients as well?
Now, new research has focused on quantifying the link
between nurse staffing and patient outcomes. Evaluating
the impact of nurse staffing on patient outcomes is
no easy feat, given the many variables within the patient
care environment. In the midst of our efforts to quantify
the impact of RN staffing, we also need to keep in perspective
the importance of the overall system for care, and especially
the skills and knowledge that individual nurses bring
to this equation
I have seen care environments that have systems humming
like clockwork, providing the needed products, support
and technology to nurses at the point of care. A full
stable of richly talented, expert nursing staff carefully
nurtures students and the occasional new nurse into
a team culture of clinical excellence, innovation and
professionalism. Leadership exists to facilitate, coach
and reward the team.
I also have seen situations where the systems that
support nursing care were in chaos, greatly diminishing
the effectiveness and efficiency of bedside nurses,
pulling them away from patient care. Nurses are stretched
beyond reason to cover patient care demands. Overwhelmed
by turnover, these care environments cannot give the
needed support and guidance to students or new graduates,
and barely survive on various forms of temporary labor
to meet staffing needs. Nurses lack either the time
or the necessary tenure to provide relevant organizational
history. No energy is left to take advantage of any
educational or professional development opportunities.
Every day is a crisis. Leadership exists to put out
the next fire.
Amazingly, it is possible for these clearly opposite
situations to exist in the same organization. While
it is a vicious cycle, it can be brought to an end.
It just takes everyone tugging and pulling in the same
direction.
Recognizing it when we see it: Sometimes sliding
into chaos can occur without the right people noticing.
The monitoring of key metrics (turnover, staffing, etc.)
is essential to keeping on top of a complex nursing
organization. Human resources and finance are important
sources of data and assistance.
Agree on a plan: Along with the help of others,
staff needs to identify short-term vs. long-term goals,
with measurable milestones.
Build a sense of hope: Staff needs to understand
that everyone is there to help them get their feet back
under them. They need to be clear about the level of
commitment to solve the problems.
Call in the troops: You'd be amazed at who can
help out a unit when in crisis. Just ask for the help,
and then be sure to say thanks.
Create breathing space: Units in crisis need
senior leaders to take action and create some breathing
space. Close beds, limit admission, divert patients
and add extra help, just to give everyone a break. Yes,
I know, the doctors will complain, but ask for their
patience and expect their support.
Conserve energy: Don't waste nurses' time and
attention on anything but what's really important. Some
things can slide while you work on rebuilding a unit.
Local leadership is in the best position to identify
needs and buffer staff from outside pressures.
Raise the spirit: Charismatic leadership can
inspire and excite and motivate. Make sure that efforts
are made to recharge exhausted leadership as well as
staff.
Take charge and just fix it.
Discuss this and other topics with your colleagues
at www.nurseweek.com/rnvillage.
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