Who’s bullying whom?

I am doing a workshop in San Diego on horizontal violence in a few weeks.  Not because I suggested it but because I was asked to speak on this particular topic.  I am teaching an on-line class right now and received a phone call from one of my students asking me for help in dealing with bullying behavior on her unit.  Unfortunately, I guess this is still a huge issue in nursing.  I used to think that nursing created the term horizontal violence but I was wrong.  Paulo Freire, a Brazilian educator and influential theorist of critical pedagogy, coined the phrase, “Horizontal Violence” during his experiences in Africa where he observed oppression not by government to the people but rather between the people. Sandra Roberts in 1983 observed the same behaviors in nurses and adopted to phrase to describe the bullying of nurses by nurses.  Who’s bullying who?  We typically hear stories of older nurses “eating their young” and being mean to the younger nurses.  It’s shocking but I am now hearing stories of newer younger nurses bullying the older new nurses.  Take a look around, are we just stressed out and lashing out at each other or are we perpetuating oppression in our own profession?  A profession that is expected to provide care through knowledge, competence, caring and compassion.What is happening in your...

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Team Building

I read an article this morning about the power of teams and couldn’t help but think of nursing.  It does seem that every workday is similar to a sports event – physically challenging, requires a great deal of focus, and even if you play well, doesn’t always mean you win the game.  By looking at basic teamwork concepts, we could really tap into the talents/strengths of each other – not only nurses but other members of the healthcare team – to build stronger teams (champions), a greater nursing workforce (legends) and better patient care (touchdowns).According to Clark, basic teamwork concepts include setting goals, among others.  Ask yourself, does everyone on your team know the goal?  Is everyone moving in the same direction, focused on the same thing, making decisions with the goal in mind?  We often get sidetracked and don’t always remember what the goal is or perhaps nobody ever told us – and we never asked. Start now.  Ask you supervisor/manager to articulate the goal of your workplace.  If you are a supervisor/manager, make sure your staff knows the goal whether it be patient-centered care, or safe care, or collaborative care.  But you have to have a goal.  Then demonstrate the behaviors that lead to the goal.  Once everyone knows it, can speak to it, can recognize it, it’s like a well trained sports team trying to get...

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Nurses want the same thing

I was in the Bronx last week doing a certification review course for AMSN.  There were 26 nurses in the class – mostly women along with a few men. It was sometime during the second day (it’s a 2-day course) when something struck me.  Nurses basically all want to do the same thing – take good care of patients.  However, whether it’s because they don’t have the resources, time, energy or even the education, many feel like they don’t know enough, don’t provide good care, and struggle just to get through their day.  Regardless of educational level, the location, or the position – we all have the desire to do a good job.  It’s just a matter of knowing how.These nurses were knowledgeable, warm, caring, and respectful.  They allowed themselves to be vulnerable – admitting that they didn’t know enough.  And the humbled me in how gracious they were. I’ve met with nurses all over the country.  We are all the same.  Knowledgeable but still have a lot to learn. Competent with our skills but not always consistent.  Caring and compassionate without limits even when we think we don’t have any more to give. It’s good to be a nurse.  Even better when you take your role seriously as these nurses did.  Congrats!...

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Gossip – Using it to promote professional practice

I read an article about gossip this morning in the Harvard Business Review and immediately applied it to nursing.  Gossip is included as one of the characteristics of horizontal violence and tends to be perceived as negative.  However, if you really consider the definition of gossip – the exchange of information between two people about a third, absent person – it doesn’t always have to be mean spirited.  We tend to think of gossip in negative terms but gossip can be used to make a positive influence in our work environments if used constructively.  What can we do?  To make the shift from negative to positive gossip we just need to reframe how we engage in conversation with our co-workers. We tend to be so quick to gossip the bad, “Amy always leaves me dry IV bags”, or “Tom’s patients are always a mess when I get them”. Instead, focus on gossiping the good, “Carol really helped me out today.  She got my post-op patient from the PACU into bed when I was crazy busy in room 23”, or “I always like working with Sarah.  She is a great nurse.”  Just imagine how these conversations over time could shift the culture of a unit from negative talk to positive talk. Try catching yourself going down the path of bad gossip and flip the switch to good.  If you hear...

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Safe Nursing Practice – Part 2

The article written by Sally Austin titled, “Safe Nursing Practice” provides tips for nurses that they can apply immediately into practice.  Last week we talked about strategies to make sure we are practicing safely – using the nursing process, administering medications properly, monitoring for and reporting deterioration, and communicating effectively.  This week we continue focusing on how we can practice safely.  Follow the next principles outlined in the article: 5.     Delegate responsibly – Nurses are notoriously known for not delegating.  We try to do everything ourselves either because we think we need to, don’t know how to delegate or because we are “too busy” to delegate.  However, to provide safe, effective care, we must learn when and what to delegate.  Unlicensed assistive personnel (UAL) are typically the nursing assistants working with you.  Utilizing their help is important but you need to ask understand the 5 rights of delegation – right person, right task, right circumstances, right direction and right supervision. 6.     Document in an accurate, timely manner – A few blogs ago (check it out) I talked about the importance of documentation.  I know we are so busy but we have to find a way to document what we do to protect patients.  It’s both a legal issue and a quality one.  Accurate, thorough nursing documentation can demonstrate the value we bring to patient care. 7.     Follow facility policies...

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Evidence Based Nursing Practice

This blog was written by Carol Adams, a fellow nurse.  Carol is a DNP student at Waynesburg University.  She is passionate about the role of the nurse in evidence based practice.  Thanks Carol!! Evidence based nursing (EBN) has its roots in the same foundations as medical evidence.  It is defined as “the practice of nursing in which the nurse makes clinical decisions on the basis of the best available evidence, his or her own clinical expertise, and the needs and preferences of the patient” As well as helping  to develop  a better understanding of a patients conditions and treatment methods. (The free medical dictionary, 2010). The process of EBN always begins with the desire to find the best answers available to meet the needs of our patients while providing the highest quality and most efficient nursing care possible.  However in order to actively practice EBN, as practitioners, you must first understand the concept of research, how to evaluate the research and apply it.  EBN can be broken down into five steps (aka “the five As”):    ASK:  Information needs identified from practice are converted into focused, structured questions through the use of the question building process known as PICO (the patient/problem, the intervention, the comparison and the outcome). ACQUIRE:  The focused questions are used as a basis for literature searching in order to identify relevant external evidence from research....

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Safe Nursing Practice

Safe Nursing Practice I read a great article in Nursing2008 Titled, “Safe Nursing Practice”.  This article details how to deliver care that conforms to the standards of practice.  I found it to be so simple even in today’s complex environments.  According to Sally Austin, 8 key principles can keep you and your patient’s safe: 1.     Follow the nursing practice – Assessment, diagnosis, planning, implementation, and evaluation.  Believe it or not, this is your roadmap to great nursing care.  Don’t take short cuts.  It’s the nursing process that is our gift to healthcare.  Use it.  Embrace it.  Own it! 2.     Administer medications properly – Every nurse I know, including myself, fears making a med error.  Understanding the medications you are giving, any labs you need to check before giving, why you are giving them and what you expect as a result is crucial for all nurses to consider.  Also, the number 1 reason for medication errors is distraction.  Don’t allow yourself to be distracted when preparing your meds. 3.     Monitor for and report deterioration – Do you know what your patient is at risk for and are you anticipating that risk?  How would you know if your patient was having that complication? Focus your assessments specifically on their risk.  Are you monitoring labs?  Remember, it’s not one lab value but rather the trending up or the trending down that provides valid information....

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Owning your practice

There is a difference between “owning” your practice and “renting” it.  How do you tell the difference?  The “renter” walks past a patient’s room with their call bell on and says, “Not my patient” as she walks away.  As professional nurses, we need to own our practice and take responsibility for the role we play in the delivery of healthcare.How do you own it?  Here are some tips:Take your role seriously Nursing isn’t easy.  It’s one of the only professions I know that it is NEVER about you.  You are always asked to sacrifice for the sake of your patients, your colleagues and your organization.  Owning your practice involves knowing that it is about your patients – not about you. Nurses are responsible for human lives – not machine parts, hamburgers, or even money but human lives.  Never forget that the decisions we make on a daily, hourly and moment-to-moment basis impact lives.  This demands a serious approach and a serious commitment to always be practicing according to quality and safety.       Be a part of the solution So often I hear nurses complain about what’s wrong with the system – they complain about pharmacy, other nurses, administration, physicians and even patients and their families at times.  Just think if all of that energy wasted on complaining was invested in coming up with solutions.  Nurses are in the...

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Weekly Tip for new nurses: Time Management

Greetings Here is your tip for the week: Time management: This is definitely a skill that can be learned if you work on it.  The most important aspect of time management is in planning.  Even in the unpredictable environment of healthcare, there are still things that you can plan.    Tips: After getting report, spend 5 – 10 minutes planning your day.  Ask yourself, “Who should I see first, second, third, etc?”. For each patient, think in terms of why are they here?  What are they at risk for?  How would I know?  What do I need to do to prevent complications?  Thinking this through as part of your plan for the day can really help you anticipate and prepare for issues. Get into habits (knowing that sometimes things change).  I always saw each patient, introduced myself, told them the plan for the day and asked if they had any issues that needed to be addressed immediately. Then I would start rounding.  I would start with the first patient and do all assessments, give meds – until I saw all patients, then document, check for orders, check labs etc.  Once done, I would start all over again with the first patient.  On my second rounds, I would do the little things that weren’t necessarily a priority at first – check for patent IV, redress messy IV site, wound care, pt education, etc. ...

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Making a great first impression

It takes 7 seconds for somebody to make an impression of you the first time you meet.  As a professional nurse, we are constantly meeting new people: patients, their families, new physicians, new nurses, ancillary staff, etc.  How you introduce yourself, what you wear, what you say and how you say it during those first few moments will determine their confidence in you as a professional nurse.  To make a good first impression, follow these 5 steps: 1.   Be on time – You will lose credibility immediately by arriving late for a meeting, appointment, or even when you tell a patient when you will return and you don’t.  It can build or destroy trust with your colleagues and your patients. 2.   Dress professionally – Are you inspiring confidence in your patients and the other members of the healthcare team but what you are wearing?  When working as a professional nurse, not only are you representing yourself but you are also representing the nursing profession.  Consider the following: a.     Uniforms should be clean and pressed (avoid cartoons and “hoodies”) b.     Hair conservative, clean and “normal color” c.     Make-up and jewelry minimal d.     Nails clean and reasonable length e.     Clean shoes 3.   Maintain good eye contact – Looking at the person you are talking with implies that you are interested in them.  It makes them feel important, projects openness and keeps their attention. By not...

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Renee Thompson
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