8/21/2018
Nurses Caring For Nurses
Changing the Culture of Nursing!
Speaker Disclosure Statement • Virginia Beeson is a self employed nurse educator and consultant. • Virginia Beeson has no industry relationships to disclose.
I Love Your Theme!! • “Creating Connections—Shaping Tomorrow” • The most significant thing we can do to shape our future and create stronger connections is to change our culture…
1
8/21/2018
Objectives • Examine the current culture of nursing
• Explore the impact of our current culture
• Identify some actions you can take to create stronger connections & shape our future
The Definition of Culture • “The characteristic features of a group’s everyday existence” Webster • “The ideas, language, actions, customs, skills, abilities, behavior that define a given people” Webster
Our Current Culture • So, what are the “characteristic features” of the nursing profession today? • There are many great “features!” o Clinically excellent o Dedicated o Smart o Compassionate o Extremely hard‐working o Great patient care o Most trusted profession—yr after yr
2
8/21/2018
Our Current Culture • But there are some other “characteristic features” I’m extremely concerned about • The 2nd definition: o “The language, actions, customs, behaviors that define a given people…” o This is where we need some work o My observation: we take great care of pts & crumby care of each other
Our Current Culture • My most frequently requested class • The number of organizations addressing disruptive behavior in the workplace • The literature: o Combatting Nurse Bullying, Incivility & Workplace Violence, (2017), M. Ciocco o Toxic Nursing, (2013), Dellasega & Volpe o Creating & Sustaining Civility in Nursing Education, (2013), C. Clark
Our Current H/C Challenges • Intense focus on safety/quality • demand‐H/C personnel shortages • Unprecedented financial pressures • Exploding technology • The shift from volume to value • M‐health/Telehealth/Social media • Increased # of ethical issues • Increased involvement of the patient • Social issues as causes of h/c problems 9
3
8/21/2018
Our Current H/C Challenges • Mergers & Acquisitions • Pop health/wellness • Generational issues • Decentralization of care • Union issues • ACA issues/changes • Micro/macro hospital • Changing laws/policies • The “politicalization” of healthcare 10
Shaping Tomorrow: What We Need • Everyone pulling for the same thing • Trust among all players • A supportive environment • Open honest communication • Respect for all specialities • Outstanding teamwork • Joy in the workplace
What We Have • Silo behavior/Elitism • Nitpicking, backbiting, gossip • Lack of support for one another • Competition vs. collaboration • “It’s not my job, it’s not my fault, it’s not my responsibility”
4
8/21/2018
What We Have • Statements made on patient satisfaction surveys • Treatment of new nurses • Treatment of old nurses!! • Horribly ugly remarks & pictures on Facebook/social media 13
What We Have • “In 2012, a Google search using the words ‘nurse bullying’ revealed 6,300,000 hits for ‘bullying’ and 10,200,000 for ‘nurse‐nurse conflict’.” • We have an absence of team behavior at a time when we’ve never needed good teamwork more… 14
15
5
8/21/2018
What We Have • It is prevalent
• It is ugly
• It is destroying us
It Affects Everything… Satisfaction
Service Quality
Communication Morale
Workflow
Teamwork Safety
Retention
Productivity 17
What We Say… • Florence Nightingale/Jean Watson • Relationship‐based care • Patient‐centered care • Transforming care at the bedside • Work together for the best outcomes for pts • Do no harm…
6
8/21/2018
What We Say… General Hospital • “Our Mission is to provide the very best care and patient experience…” • Our Values: o Compassion o Dignity o Integrity
Respect Teamwork Excellence 19
What You Say! • APHON provides leadership & expertise to pediatric hematology/oncology RN’s by defining & promoting the highest stds of practice & care to the pediatric, adolescent & young adults • We support and advance nurses and their practice in order to optimize outcomes for children, adolescents, and young adults with cancer and blood disorders and their families.
What You Say! • Values: o Visionary leadership embracing innovation o Committed to professional and org excellence o Pride in the profession o Collaboration as an effective strategy o Absolute integrity and high ethical standards o Gratifying experience through involvement o Continuous professional development through life‐long learning
7
8/21/2018
What We Do • There is a giant disconnect between what we say…
• And what we do…
• We have to fix this 22
Current Culture • “We have met the enemy, and it is us…” • Are these the kinds of behaviors that we want to be the “characteristic features of nursing?” • Are they reflective of how we feel about our professioin? • Will these behaviors help us create connections and shape the future?!?!
The Good News! • We have everything we need to fix this • We are smart, we are dedicated, we know the answers…
8
8/21/2018
So What Can You Do?!
TO CHANGE THE CULTURE OF NURSING
25
#1 Be A Great Team Member • For as long as I’ve been a nurse, clinical excellence has trumped everything else… • Clinical excellence is really important • But it’s not enough • You need to be clinically proficient AND a great team member 26
#1 Be A Great Team Member • Every nurse has specific strengths, skills & talents in addition to their clinical skills! • You need to identify those strengths & use them to make work better/easier/more productive • Everyone contributes to making the team/unit better! • Your work is a team effort and not an ind asgnmt 27
9
8/21/2018
#1 Be A Great Team Member • Nursing is a team sport!!! • It cannot be “us” vs. “them” any more • IT HAS TO BE “WE” • Once everyone understands this, there will be no problem we can’t face!
#1 Be A Great Team Member • Find solutions, not just problems • Help those who struggle • Don’t name, blame, shame, moan, groan… • Support your colleagues • BE IN A GOOD MOOD!!! 29
#1 Be A Great Team Member • Take an active part in trying to make your unit the best it can be • Identify the strengths you bring to the team and use them to improve team & unit culture • Clinical excellence is no longer enough!
10
8/21/2018
#1 Be A Great Team Member • When we make excellence in teamwork as important as clinical excellence, we will change our world • This is the #1 thing you can do to shape the future…
#2 Be Proactive • Proactive: Taking a look at a situation and deciding to recognize the problem, take ownership, try to fix/solve, learn from it and make things better • Reactive: Taking a look at a situation and deciding to ignore it, blame someone else, explain why it isn’t your job, complain about it, pout
32
#2 Be Proactive • Nurses today are so reactive (poor me!): o “How can I be expected to do all this?” o “Nobody told me nursing was going to be so hard” o “Not in my job description” o “Patients are just so unreasonable” o “How come you always pick on me?” o “I always get the worst patients” o “Leave me alone”
11
8/21/2018
#2 Be Proactive • What I hear all the time! o “You don’t understand my ______” o “There’s nothing we can do …” o “It’s been this way for a long time…” o “That would never work here…” o “That may work in a hospital…” o “Have you ever worked in a school before?!” o “Really?! You really think you can change things?” 34
35
#2 Be Proactive • We jump in the “Pity Pool:” o Problems don’t go away o Behavior very contagious o Leads to toxic culture o People don’t like being around you o YOU are now part of the problem o Saps your energy and strength, your ability to remain proactive 36
12
8/21/2018
#2 Be Proactive • “We have a problem that needs attention “ • “We can solve this once we get the right info” • “How can I help fix this?” • “Let’s call our colleagues & see if they’ve had to deal with this” • “What can we learn? How can we prevent this from happening again?”
#2 Be Proactive • • • • • • • •
Gather information Own the problem Look for solutions Seek help and support Get more education & training Reframe the issue Partner with a colleague Take a break! 38
#2 Be Proactive • When it comes to changing our culture & shaping out future • You’re either part the solution, or part of the problem! • We need you to be part of the solution!
13
8/21/2018
#3 Watch Your Language • Closely connected to being proactive is our language: o Constantly complaining… o “Just the Nurse” syndrome o The way we describe nursing o The stories we tell
#3 Watch Your Language • We are “crazy busy” • “Run for your life—it’s out of control in there” • “There’s no way we can get this done” • “How come we have to deal with this stupid stuff?” • “Our boss is a freakin’ nut case!” • “I can tell it’s going to be a bad day!” • “Why did I go into nursing?!” • You will hear LOTS of others!!!
41
#3 Watch Your Language • Stop talking about being busy • Stop flying around like your hair in on fire • Stop talking about how awful everything is
42
14
8/21/2018
43
#3 Watch Your Language • Language determines behavior • Your brain is a giant computer • You “program” it with thoughts, self‐talk, language… • When you program it with “busy, overwhelmed, crazy, understaffed,” etc. you induce the stress mode… 44
#3 Change Your Language • Fight: o Tense Argumentative o Armed Closed vs. open o Ready for battle Barrels loaded
• Flight: o Tense o Avoid o Retreat
Nervous Acquiesce Run away 45
15
8/21/2018
#3 Watch Your Language • When you program your brain with: o “There’s nothing we can do about this” o “I can tell it’s going to be a bad day” o “We are crazy busy!”
• Your brain begins to search for evidence to support that belief • Program yourself to win!!! o “We can find the answer to this!”
46
#4 Develop Your Stories • We are great story tellers… • Have a ready response when someone asks you about your work • Tell the stories about the incredible things you do…
#4 Develop Your Stories • Tell your stories! o Stories paint a picture of what you do, and how you feel about it… o They tell other people what moves/motivates you o They help keep you proactive o They are the antidote to our negative language 48
16
8/21/2018
#4 Develop Your Stories • Tell your stories! o They help you remember why you do what you do… o They strengthen teamwork o The stories you tell create your culture 49
#4 Develop Your Stories • We did this in 9/15 after The View co‐hosts made a fun of Ms. CO’s monologue & her “MD’s stethoscope!” • In >24 hrs, there were over one million hits on social media! • “Now we have a question for you, Joy: We fight pediatric cancer every day, what is it that you do?!”
#4 Develop Your Stories • Everyone started talking about our super‐powers! • You all have done tons of amazing things • You have hundreds of stories… • If you are too shy to tell your story, tell someone else’s
51
17
8/21/2018
#5 Pay Attn Only to Important Things! • Your reaction to daily events & challenges is a choice you make, not something that “happens to you” • All the attention you pay to things that are not important drains you of the energy you need for the things that are important 53
#5 Pay Attn Only to Important Things • Don’t get upset over things you can’t control • Don’t get upset over things that aren’t “yours” • Don’t get upset over silly things • Life is not fair, get over it! • Reserve your energy for things that are important
54
18
8/21/2018
#5 Pay Attn Only to Important Things • Let go of emotional baggage: o Let go of “Charlie”
• Do not be around negative people • Know when you are close to the edge and take a break • Know what your emotional triggers are… 55
#6 Strong Support—At Work • We must support each other: create connections—make this you motto • Having co‐workers who strongly support you is the very best working condition • The stronger, more cohesive and supportive your team, the more successful you will be—& slowly but surely, we will change our culture 56
#6 Strong Support—At Work • Have a BFAW (best friend at work) o Other perspectives & solutions o Generates solutions o Provides clarity & objectivity o Increases your energy o Boosts your confidence o Helps you maintain “reality” o Increases your resiliency o Makes work more fun! 57
19
8/21/2018
#6 Strong Support—At Home • Family/spouse/kids/pets • Theater, music, dance • Exercise, sports • BFF’s • Things that take your mind off work
58
#7 Be Persistent • Changing our culture will be hard • Our current cultural characteristics have been around for a long time… • They are entrenched • So we need persistence…
#7 Be Persistent! • Every day try to be a bit better • “It’s a marathon, not a sprint” • Give yourself a break when you mess up • Never give up! The “5 P’s”
20
8/21/2018
#7 Be Persistent! “There are 2 ways to achieve success…One is to be smarter than anyone else. The other is not to be as smart as everyone else, but a lot more persistent.” Raoul Bott, Hungarian Mathematician
62
#7 Be Persistent! “Finish every day and be done with it; you have done what you could. Some blunders and absurdities no doubt crept in; learn from them and forget them. Tomorrow is a new day, you shall begin it well and serenely.” Ralph Waldo Emerson
21
8/21/2018
#7 Be Persistent! • We cannot give up • The work we are doing to too important • Changing culture is hard • We’ll never do it without dogged persistence
Summary • But we CAN do it!!!!!
• I’ve seen it, and so have you
Summary • When are we really great at coming together? o Practicing excellent teamwork o Being extremely proactive o Using professional language o Telling powerful stories o Paying attention to only important things o Strongly supporting each other o And being unbelievably persistent 66
22
8/21/2018
GOOD LUCK! GOD BLESS! Ginny Beeson
[email protected] ginnybeeson.com
23
