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    55 views86 pages

    Jurnal Nursing Management Periode 2016 S.D 2018

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    Abdur Rahman
    Manajemmen kesehatan

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    © All Rights Reserved
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    January ch "Ulav survey What's changed in 2years? Nursing Management January 2016, Volume 47 - Issue 1 Editorial Be a thought leader By Rosenne Reso, MS, RN, NEA‘BC, Editorin-Chief, Viee President and Chief Nursing Officer, NewYork Presbyterian Weill Comell, New York. N.¥. Strategic Coordination of National Thought? The concept behind the position is to build ‘networks among academics and intellectuals. You're probably considering this as yet an- ‘other example of typical governmental excess, and there's plenty of Argentinians who feel the same. But how does this ob title relate to nursing leadership? After listening to and interacting ‘with amazing nurse leaders, one can't help but be awestruck by the depth of national nursing ‘thought and action. We have so rmuch to be proud of in nursing that using the position of Stra- tegic Coordinator of Nursing Thought as.a metaphor seems appropriate. ‘You've no doubt heard the term "thought leader.” OF course, you instinctively reflect on past and present national nurse leaders in scholarship, service, research, policy, academia, govern ‘ment, practice, and more. Such brilliance and passion! They're our exemplars, our role models, ‘and our sources of inspiration. To think that there are people who still believe nurses only pass pills and bedpans, and nothing more... We must do a better job of marketing our talent and we ‘must believe in ourselves in the same light—you don’t have to be a renowned trailblazer to be 1 thought leader. Have you been passionate about a practice approach or a management process, or even @ ‘question needing an answer? What about an innovative idea fram your staff or yourself? Have you leamed everything about it, convinced your colleagues and staf ofthe right thing to do, shepherded the change, and presented i to a wider audience? Do your colleagues come to you for your wisdam on the topic? Then YOU are a thought leader, an expert by definition, and probably a transformational leader as wall. You den’t have to have an audience with the Presi- dent to be ina celebrated group of thinkers. “There's tremendous value in humility, as we've talked about before; however, this month we focus on the beauty of boldness and expertise actively shared with our community, which can be life-changing, and certainly work-changing. It's the world of making a difference ata bigger level than an individual one. If you're a nurse leader, you've entered this teritory. Be proud and find your niche for greatness, You owe it to yourself and our [Recognize the excellence around you and build your own network. This can even take the form of a virtual network from reading and following blogs. Thought leaders are a critical ‘part of what impacts us. Justa random review of the work of the latest American Academy of Nursing fellowship inductses reveals a plethora of greatness: biological and clinical research, ‘multimillion dollar grants, advancing the health of underserved and at-risk populations, pro- lific publications, promotion of advanced practice utilization at the top of one’s licence, and clinical translation of research into practice. Awesome leadership! "Nursing is so broad and impactful that the Strategic Coordinator of Nursing Thought ‘would be quite busy. What are you doing to create your legacy? The potential for thought leadership extends to everyone. Try this for a New Year's resolution: Be proud and make a difference. NM ‘D0 10.1007/01,NUMA.90D4 78490. 447E4 <3 fase nursing management@wolterskiuwer.com D2eeerccer re 6 Jonuary 2016 + Nursing Management vw. nursingranagement.com a a —— oE I . ™ lage Journal of Excellence in Nursing Leadershig® Se: sit second decisions ae | & Sa e 4 re oy ley \. ee piliiewcautsingmanagdment.com, ' f g Bl Si a February 2016 apid response ie CEI Stoke pidelines update 24 Performance appraisal wish list 40 Face to face with conference goers 48 Editorial Drinking from the fire hose By Rosanne Raso, MS. RN, NEA-SC, Editor-in-Chief, Vice President and Chief Nursing Officer, Newyork Prestyterian/Welll Cornell, New York, N.¥. ‘m sure most of us, at one time or another, have felt overwhelmed at work. Think about those days when new information and Issues are coming at you every minute, and there isn't enough tine or cognitive ability to deal with all of it. Maybe that’s often, and you may not be ‘alone. Can you visualize drinking from a fire hose? It's a metaphor that seems to perfectly de- ‘scribe this inundated feeling. Temay happen when you get a new boss, or your boss gets a new boss, or you stat ina new postion. Even if everything isthe same, sometimes organizational crises occu, ranging from ral- “ural disasters to sentinel events. Conditions may change in your work resporsibilities. Does this Sound familiar? “Can you take om this sdditional unit(s) /department(s) temporarily while we're looking for a new leader?” Or maybe you've gone back to school and/or added family obliga tions while trying to maintain equilibrium et work. There are probably a thousand more scenar- “organization, and Your staff ist always weil aligned. ‘Your itil call to action may be to figure out how t prioritize thexe goals. Avoid using precious time and attention on what ian’t valuable to you, which includes mindless catter. And make sure ‘what you've determined to be important Is coordinated with what your boss thinks; otherwise, it ‘may be a carver limiting gesture to sidestop the wrong things. “Ask good questions to igure out the answers to whats relevant. f you can learn how to turn the deluge into whats impertant to you and/or within your scope of immediate responsibilities, then you may beable to eliminate a fair amount of exiraneous aise. Requesting help with filter ing through and organizing your thoughts is a reasonable, but often neglected, step. As is dele- galing and receiving support. You'll want to gather your resources before you fea like you're owning tobe ready and armed forthe fre hose (Our colleagues who are passionate about mindfuiness must be clamoring for attention by now. Being truly present in the moment and having self-awareness are sometimes elusive skills that clearly contribute to being at peace with whatever is thrown your way. ‘who con argue with using positive energy to focus on the here and nove without juigment, leny- ing past regrets and future worries eisewhere? Be good to yourself calm your mind, and give ‘yourself a break. Drinking from the fre hose may corjure up silly images, but i's an urcomfortable state of mind. We are at oar beat when we're focused on shat we believe in, what our organization ‘ania, and what our staff members nced—hopefull fully aligned. Take a gulp and then switch {0a straw as soon as youcan. No drowning allowed! NAM ‘Doran 097/OLNiNA copOrTEASO SATA Te fore nursing. management@wotershuwer.cem G Feoeuory 2016 + Nursing Management www. narsingmanagement.con jingmanagement.com Ve | o™ March 2016 , eo pagement in Nursing Leadership® Y America A call to action». maa 1 p stack the odds for new Rts 22 : AACN CSt Academy's al abou that base 2 °- Improving patiet-rurse communications — Dyingin g America A call te action. SZ) ee ewe =n eee oe ee en ie a eee Nursing Management March 2016, Volume 47 - Issue 3 Editorial Who comes first? ‘By Rosanne Raso, MS. RN. NEABC, Ecitorin-Chief, Vice President and Chief Nursing Officer, NewYork-Presbyterian/Weill Cornell, New York, NX. of people as people no matter the angle, either the patient or staff perspective. acknowledgment Jo, I'm not asking about the chicken or the egg but rather patients or staff, Ata time when patient experience scores rule the C-suite—and when patient-centereciness i a national movernent—it seems logicel that patients come first. Who can argue with that premise? It's our purpose. How: ‘ever, we may put forth ancthor foundational elemen’ ef the puzale your staf members come frst too Staff engagement is popular inthe nursing itersture—how to measure it, the negative effects ofits absonce, that elements are needed to have it and how it cereats to cur patients’ experience. Are ‘we truly commited to pasitive work environments? Or are we sil turning our heads away from dlysfunction, systems ists, ad disrespect, thinking theyre to hart change? The aur to push forward with ataff engagement agenda does trickle down and can result in increased tumover,ab- seniecsm, errors, and of course, a poor patint experiener.On the positive side, eryed staff mer bers have purpose, arc les stressed, and area their best—another ane of oar pals as leaders Ta fact, it seems tha the principles driving both staff engagement and the patient experience are sitar Avoiding blame and improving systems are basic examples of sucessful leadership, ‘What about eflctive communicatica and respensivences? We can't have a positive work environ ‘ment ora great patient experience without these building blocks. ‘Asa leader, you show that you care ister, acknowledge, recognize, value, and respect your staf. Isnt thatthe same message we drive home to staff members about thei relationships with patients? Our staff members wan! to feel valued, and our paticnts want to fel Like they'e a eal person to us with individual needs I's all about acknowledgment of people as people no matter the angle, either the patient o staff perspective Another fundamental element is developing collaborative relationships at aleve. We teach it to new managers ana key to success, and we tachi © our ala in working with paticns and families. Relationship building is central to patient care and leadership. Again it works fr pa- tients as it ces for stl Patients can tell when staff members are dissatisfied. Invest in your staff Comeit to them. Cet them the resources they need todo the job. Truly make patient-centered decisions and systems. Unmet patent needs tend to foes on information, listening. and caring It wouldnt surprise me ifstaif needs are similar Reseach telus that they elo nee! growth, respect, and recognition. Soit’sall connected. We can’ fall into the trap of only focusing on patients. Sustainable change {in your patients’ experience won't occur without an engaged workforce. If we focus on stafl and ‘organizational values, then patients and fanslies wil fe Ihe postive effect in real and sub- stantial way. Ofcourse, this assumes thatthe entire organization is behind patient-centeredness. “Maybe it the chicken or the gg conundrum Without staf engagement and trie purpose, we ‘won't see an extraordinary patient experience; with engagement, is almost guarantced, We cat focus cn one without the ather and we must ute equivalent strategies to promote success. So lets ‘make the environment special for our patients and our staff, using the same principles for both and never lasing sight of either one. NMA ‘Dor i0e077o1 Mai ooeolecTeA DOSE fan nursing. menagement@wollersktuwer.com © Nasch 2036 + Nursing Management “rn nurtngmanegement.com e eae _ Pe Mu cee Ly a Prete Pee a LL ere) Tapping clarty to job shadowing 42 rid caer Seay ‘Be Management 6, Volume 47 - Issue 4 Editorial Are you listening? By Rosanne Raso, MS, RN, NEA-BC, Editor-in-Chief, Vice President and Chief Nursing Officer, NewVork-Prestyterian/Weill Cornell, New York, N.Y. Be courageous ‘and seek out the viewpoints of those who with you, fine art of Hetening shouldn't be lying dormant in your leadership tookbones it should be ‘ore of your mas irequenty used coruunication tools. Is? In our ally Our of meetings and responsilites with ite time to think nevermind engage others i takes active energy to listen. And this means ry kstening, rot petending that you'elistenung, Active listening takes practice and more time than other form of communication, which may be why we don't use it regularty. However, by not actively listening, we lse an efective way to build relationships and connect with people—from out stil, peers, colleagues, and bosses to our kids and spouses. Our mantra needs tobe talk les, listen more. ‘In uying to understand, we have to probe. Ask questions. Clarify. The repeet back technique we use clinically to ensure that we understand verbal orders o a care plan is the perfect coral- lary. We should strive to beable to repeat others” points of view, thoughts, or perspective. IF ‘we repeatback and receive validation that we have it right then we've tly listened. Years 20,1 heard a conflict lecturer give the audience advice on how ty handle a disagaceznentbe- thecen two staff members Tell them to come back and explain the isue from the other person's perspective. Briliant! ‘American psychiatrist M. Set Peck said, “You cannot tly listen to anyone and do anything lsc atthe sume time” Multitasking isthe enemy of listening, Think abou it: How much listen- ee peepare responses in our heads while impatiently waiting (and probably not Nisst)co Bek Re Ralpeageeer gerne Pliage ror dat i eee en eee {lente nonverbal responses sch asthe sample practices of eye contact ard hes ig Ge ere eee eve totes ie ato ta ally about boing in the moment. Avoiding distractions ic xo hard in our busy lives, but 3 great leader wil make a concerted efor o take the time t Usten with ro interruptions. f you're courageous, you'll seek out the viewpoints of those who disagree with you. How better to understand your environments dynamics than to appreciate all perspectives? You may be surprise to find that others have their on truth, not necessarily in dissent, but fer lent than your own. Acknowledge and repeat 10 rake sure that wha's being said and what you hear are the same I's powerful anda sign to your staff members that you're relly paying t- tention to them. You don't have to agree, but you do have to listen. True communication includes eflectve Hetevingan atzibute of genuine and authentic led- ‘ership, and connectedness with each other. Drop your smartphone, tum off your own thoughts, tnd open your mind to other. Ifs worth the efit. 1M Lone nursing.maragement@wottersktuwer.com © Api 2016 + Muraing Management ‘ww narsingmanagement.com oe Editoria Making teamwork dream work By Rosanne Raso, MS, RN, NEABC, Ecitorin-Chief, View President and Chief Nursing Officer, NewYork Presbyterian/Welli Cornell, New York, N.Y. we you sen the recent work sue of The Nw Vork Times Magasine? caught my attention ith an interesting article on what allows teams to thrve. You'd expect such an artic to ex pound on the importance of leadership and the crucial role we playin teambuilding and com ‘munication. But you may'be as surprised as me by is somewhat ctferent twist on teamwork. The report results of extensive Google research found only two essential attributes of suc- cessful teams and they are’ about demographics, such as smart people or certain personality types. The firsts tha all team members have equal time to speak up. The second? The team is ically sensitive to its members. Thats ithaving.a voice and feeling valued and safe. Now, this doesn't mean that as leaders we're irrelevant to teamwork; after all, we do promote e- pected behaviors that define our desied culture, However it does inform what we should be As we colebrate encouraging within our teams. ‘Nurses Week this Allowing everyone a chance tobe heard isthe foundation of shared governance: gvi month jobs not YO W staff members to determine ht practice. Ofcourse, istening 1 each india is tnore granuls than governance structure; t's how we operate within the team. Do we stop ‘forget thet We one or two people from dominating discussions or meetings and seek out every team member's do ourwork input? We should be doing so. And, clearly, our leadership style can’t be controling if we want oe to foster that ype of environment. Sensitivity Soward our colleagues may bea litle harder to rcalize. There's no recipe for social aptitude, interest in each other as people. and an empathetic atmosphere. This quality reminds the of emotional infelligence—a familar concept often on thelist of desired leadership trait. ‘We can help our less grow inthis way by role modeling and making it part of our daly work lives. Let's welcome each other listen, reserve judgment, and create human connectednes. ‘Combining these two attributes leads to joyful, high-functioning teams, according to Google's research. This type of teamwork is dream work. Bad days ae iti to none, you love coming to work, the energy i inspiring you have fun while you work, and the outcomes are fmazing. The results ae always better than any one person can don his orher own. "This year’s Nurses Week theme is that a culture of safety begins with every individual, far- ther distinguished by openness, mutual ust and transparency st this related tothe psycho- logical safety of being heard and feeling respected? As always, the clements that are important to our leadership journey are connected to each other [As ve celebrate al that's beautiful about nursing during Nurses Week this month, lets not forge that we do out work in teams. This isn'ta solo sport. Each of us contributes to the whole, and the sum is greater than its parts. There's plenty of evidence-based practice and research bchind teams and collaboration to back this up Let's allow everyone tobe heard and share without fear, and with sensitivity to our staff members feelings and needs. It boils down to listening and respect—two themes that keep resonating in our work. We must continue living them. ‘bor 30 3087/01 Noma e004E2500 5618250 fone ursing.managerenterwotterskiuwer.com © May 2016 + Nursing Management “wowm.nrsingmanagement.com Editorial Let’s he crystal clear fy Rosanne Raso, MS, RN, NEABC, Editorin-Chief, Vice President and Chief Nursing Officer, NewYork Presbyterian/Weill Comell, New York, N Vhen there's peaning behind yhat were doing, fere’s 8 much geater chance yf favorable ssmanagers—and os leaders—we've expected to deliver outcomes. Some are shorter: Is ‘Jour quality improvement report done? Some are intermediate: Are your salary expenses Tons of yourself and your staff, none ofthese goels will happen. At times, we get lost in The day to-day and leave our expected outcomes to chance, hope, and possibly even Prayer: ‘This isn't the path to success. ‘Ofer, although not always, the data and or evidence lead usto 2 strategy and we find our way Pethaps you, your colleagues, and/or your staff members sre par of work. rCuP at “develops a project plan to follow. Maybe your bosses are crystal clear about specific expesie dae Ne're not talking about endpoints; rather, how to get to the endpoint. It's so much easier when you have a path, you know the steps, and the expecta! Know the “why"--owhen there's purpose and meaning behing what we're doing, there's much greater chance of favorable outcomes Your stat members need the same surety: Do you expect everyone to be on time and partici- pate inbedsde shift report? Are you anticipating respect interactions a all times? Cals Pativered within 1 minute? Three minutes? What about regular patient rounds, chlorhexidine bathing for patients with central lines, or teach-back with patient and family education? Yow must make your expectations clear to everyone the why and the how. And Thane must be follow-up, either by you or via a pect model. Acknowledge those who do and crest those who don't-immediately. The rules of engagement must be defined, understood, and doable. "Be crystal clear on what you want and why you want it. fot, you won't seeit happen id your autcomes wil suffer. This int » power move i's leadership and should be done collab Teatvely with staf. Your expectations may need a workout to make sure the nesesary HPs srasschievable and resources are aVailable. Whatever shared govemance or participative man Sipement model your organization employs, use it to develop an action plan fr your unit or department that will actually work. Penk Ask Listen, When there's a specific process to be followed, you shouldn't wait for failure and then go back. You want a dynamic, high-reliability environment in which the ©, pectations are lived and everyone has a sense of Purpose Feedback is essential or else it won't FECL. postive or negative. Does this sound lke an accountability model? Yes. Does it sund ‘culture changing? Yes! Mae kar there's more to positive outcomes than the paragraphs on this page It should be so ny Pourdaticnaly, thes elements are the key to positioning you and your staff for sue- teas Clarity of expectations with a purpose and a goal—is a basic element on the path fo re- sults. Are we clear? NM eS ‘Der.90077/01 NOWA.DCODAESL23.2525714 Js pursing. management@woltershiuwer.com 6 June 2016 + Nursing Management www nursingmanagement.com e July 2016 The Journal of Excellence in Nursing Leadership® Should nurses at work? zl Last chance! | Nominate a Visionary Leader 10 Your take on executive visibility 34 Ethical peer review 44 Should nurses use cell phones at work? ast chance! Nominate a Vidonary Leader te Teer taka on cet wat 3 [ical peer reew 4 —_—_——_— Nursing Management July 2016, Volume 47 - Issue 7 | ———— Editorial Got hope? ‘By Rosanne Raso, MS, RN, NEASC, Edltorin-Chief, Vice President and Chief Nursing Ofticer, NewYork-Presbyterian/Weill Cornell, New York, N.Y. don’t know about you, but 've spent years proclaiming. “Hope isn’t a stategy“ even men Goning somewhat disparagingly in last mom’ eitoil on cart of expectations low toning tito scsaunabity and outcome be paved with hope? Mt of us, especialy those veal ained in work plats and/or lef-brain dominant, need cleas and organized strategic wee ThSemtion of hope asa sbmiegy jst tin ou leadership toolboxes, Or should Be? Per heclewe Achieving SMART goals—specific measurable achievable, resist and tine- Cees plan Your readmission rac for congestive heat failure patients won't decease ett a deep dive ino rook causes and multiisciplinay interventions acros the contintum. Enying “I hope the rate will come down now that we've identified the problems” doesn’t work, Ont eye focusing on yor murs engagement scores—they wor’ ncreae without a How can our reaingdisatsfiers satisfiers, nd more. Hope alone won't cut t- You sso can't hope staff ‘Goff members yerfonnanc sues away This is one ofthe toughest components of ou leadership prac, Seanggoa in henintobopein dsp Have yousen that oe? Sr aisepneded bape antl recerly, when {sw a Hareand Business Review (HBR) article ile ‘our work without “tiope ln» Seategy (ell Sort Of.” The Holy Grail for business strategy was touting hope? imagining bright You aiemae ae pabbl standing up nw, te. Maybe youve wishing at you can eh he futrcs other, Wows wrk pla in fv fae, Noa post five, you can get through tough times believing that goal achievement is stil posible, IVS the ‘opposite of throwing in the towel. It's. hope. mneother basiness author, writing for the Gallup Business Journal, offered a similar message, aking Hope Business Strategy” What? Another prestigious joumal believing in hops? I. turns out thet we all need hope. How can our staff members be engaged in our work without Imagining bright futures together, making a difference, and driving toward a shared vision? ‘Being dear and consistent about that vison, 2s well s joyful about the future, instills hope “Totop it off, Fortes published “Leadership Through Hope: Lessons from Reggae Music ‘important, very important. It's powerful and helps us swedigS tes bles Sree ‘Dortn S0S7/OT MMA DODONGAATS Coe et fame nursing management @walterskluwer com 6 July 2016 + Nursing Management ‘ww nursingmanagement.com Copyright © 2016 Wolters Kluwer Heatth Inc. Al rights reserved, ke os =] ss CO sale ae eS a i allo I era ee | Nursing Management August 2016, Volume 47 - Issue 8 Editorial Leaders with style By Rosanne Raso, MS, RN, NEABC, Ecitorin Chief, Vieo President and Chief Nursing Officer, NewYork Prestyterian/Welli Cornell, New York. N.Y. demanding, close to the chest, autocratic. And le’s not get started on the transactional, or compliance-oriented, style—the polar opposite of transformational leadership. With their charisma, transformational leaders inspire and create healthy work environments seemingly ‘with a wave oftheir magic wand. Is it that easy? OF course it isn’t ‘Are we naturally inclined to be transformational or transactional? Or even maybe laissez {aire? Our tendencies toward transformational or transactional approaches are likely to define us in a world focused on both fll staf engagement and seamless regulatory compliance—two expectations often requiring differing leadership methods. ‘The rah-rah is great, even essential, but we also need rules and accountability. Transforma- tonal leaders challenge the status quo and lead us to the future; they inspire us, which is foun- ational to engagement. However, sometimes we need the push of transactional management ‘when we have tobe focused on routine, required tasks (value-added or not). Mostly, we aspine to be transformational with encouraging and enabling methodologies. Other times, we know that we have to be transactional to deal with safety violations, performance issues, and proce dural precision. If you lean transformational, you may have trouble with deliverables; if you Jean transactional, you may jeopardize engagement. We can learn the best of both styles and should practice both, What's the trick? Perhaps when ‘we have to be transactional, we should do it in a transformational way, communicating well and with transpazency, providing the case for shared purpose, and underlying the ever impor- tant “why” We live in a regulatory world. Ideally, our direct reports are motivated to follow the rules because, as transformational leaders, we've convinced them that it’s the right thing to do. We don’t hear much about situational leadership anymore. It was the predominant model ‘back when the baby boomers were learning about leadership, published by the famed Hersey and Blanchard. Basically they described four styles (telling, selling, participating. and delegat- {ng) and said we should use the style that’s appropriate for the situation. This makes sense. ‘Then we have the leader versus manager comparisons: Leaders care about resus, whereas managers care about processes. Leaders are proactive and exciting, whereas managers are reactive and controlling. You get the idea. Can't we care about outcomes AND process? Be proactive AND reactive? ‘Our annual evaluations have a tendency to incentivize management; for example, quality, f- nance, and patient experience goals are often purely quantifiable. The “how” is usually silent. ‘Maybe there's a bit of a misalignment here if we're truly committed to an inspired leade=ship style. Transformational leadership is a basic component for Magnet® recognition, with good rea- son. Whether you're on the joumey or not, use the principles in strategic planning oF not, oF are designated or not, we know that an empowering, engaging style is what supports us in achieving greatness. So, yes, let's lead with enthusiasm and vision while keeping a strong eye ‘on reliability, course correction, and compliance. What's your style? NM §= aes leadership style when we see one: ‘0.3007/oL NUMA DEGENREROD 38OTEA fonne ursing.management@wotterskiuwercom © August 2056 + Nursing Management ‘ww sursingmanagement.com ‘Cesiamae Ren Undies Cieees Maem er. pene enereed, e Nurs teers September 2016 , The Journal of Excellence in Nursing Leadership® September 2016, Volume 47 - Issue 9 nutrition for adults with diabetes? by Robin Nwankwo, MPH, RO, CDE, and Marta Funnel, MS, RN, CDE, FRADE wor.nursingmanagement.com ave you heard this faulty advice? also been incorporated into the All people with diabetes should ADA Standard of Medical Care for beonadiabeticor American Dia Diabetes* ‘betes Association (ADA) diet. ‘A key element of the 2013 rec- White potatoes and other white ommendations isthe focus on foods are “bad carbs" that people working collaboratively with swith diabetes should avoid. patients and matching the meal Teweets, foods made with sugar, _planto the person with diabetes {red foods, and alcohol are also. andhis or her lifestyle and cultural off-limits. preferences’ Meal planning for ‘Everyone who takes insulin Uabetes has evolved to include should count carbs. many options that can be matched Everyone with diabetes should to patients” personal preferences, follow sodium restrictions. sgoals, and treatment. ‘Many adults with diabetes ask, ‘The general goal of nutrition What can eat?” Unfortunately, therapy is “to promote and support they're often given the incor healthful eating patterns ‘emphasiz~ eccadivige listed above.So what _ingja variety of nutrient-dense foods ‘an your staf members tell your __in appropriate portion sizes fs fpatintssbouthow toplan meals oxder to improve overall bell Fo reach their glycemic, weight,and The specific goals ae to: ‘her targets? Theevidence-based attain individualized glycemic. BP, ‘guidelines outlined inthis article and lipid goals en help you answer that question. «achieve and maintain body weight goals ‘Nutrition therapy ‘delay or prevent complications of recommendations: diabetes T2012, the ADA formed an expert «address individual nutrition needs committee to review the atest ‘based on personal and cultural secarch and zevise the nutrition preferences, health iteracy and Gpieline that were developed in numeracy access to Peat food ros for adults with type Land type and willingness and ability to make 2 diabetes The task force included behavioral changes “Fettiansand nursesa physician, + maintain the pleasure of eating fand a pharmacist. Theso updated by providing positive messages uideines, published in2013,have about food and limiting food Nursing Management + September 2016 25 Nib b es) Nene Lead-ereship, defined. Le rc tne front | lead-er- sip \ (noun) 1 the ac penta sod " Wy ore SAV 7% AKiOl =] Care transitions at the end of life 20 Executive Extra, part 2 40 - Experiential learning 46 Management Lead-ereship, defined.. ; Se the front \ al P . " lead-er-stHP (moun) 1tme a= ganizat Jon: : {a care transitions atthe end of te 20 Executhe Extra, part 2 00 Experiential learning. 45 an OY Nursing Management October 2016, Volume 47 - Issue 10 Editorial Data: The good, the bad, and the ugly By Rosame Raso, MS, RN, NEA-BC, EditornChiet, Vice President and Chief Nursing Officer, Newyork Presbyterian, Weill Comell, New York, N.Y. ast year, we talked about the things we do that matter besides what we measure, lamenting how metrics rule the workplace. Well, that hasnt changed. We're often awash in 9368 of data sometimes drowning init—and that may be the pleasant news compared with those cof us who cart get the data we need. We started the new millennium with the forecast of "big {ata” changing our lives ins bigger been better for you? ‘Are you getting a multtadeof daly emalls with huge attachments of unanalyzed data? Or receiving reports with old data that have lot thir meaningfulness? How abot being expected to krow and act on data that are Busied 10 clicks deep or tat you have no idea how vo find? ‘Another data nightmare comes fom the anual acquisition proces tha’ fraught with human ‘ror. Or being confused by te same data points with diferent definitions, depending on the We started the aia source and whose report yu have. could go on, but you get the picture: This the “ugly” new millennium ‘The “bad” is that we're data rich but information poor, as the pundits say, a syndrome de- ith the foroonst sted inmanogeren for many years. Daa that cant be tured into information just aren't {eel Lally, you aren't the one trying to analyze and gett the information; you're the one of “big data” receiving the ready-to-use repor. In this case, do-it-yourself isn’t only time-consuming, but it changing our _™ay.alee lead to different condusions or complot dsregard ofthe data fives Has bigger _ 33ers the “god Asn fy sed eoengue yt when you hare ney evan and actionable data pushed to you, reflacting cure status and pire which immediatly l- been better lows you to make decsions or draw conclusions. Dor yu iove opening» rept that lands a your for you? inbox and immediately seeing wha you need to krow? We 3 management tcl that alerts you and your staf members whether to celebrate follow-up, or jump it comectve acon without delay True and valid data are also impertive for evaluating results and telling a compelling story. ‘This relevant in our work environments. when preparing for surveys, meeting Standards, and even writing articles for this joucnal. Is especialy important in research, evidence-based prac- tice, and quality improvement Evidence-based management relies on data-driven decision making, Providing empirical outcomes for Magnet= source of evidence is purely a raph with pre-and postniervetion scores. We obviously can’ ive without dala—big and smal. ‘Ciical data from our electronic health records (EHRs) are important in day-to-day patent snaraigement, such as res-time triggering for ealy warning scores bigger perspectives of qual- ity management for discrete patent groups: or even a broader look at population health Then, of course there are Meaningful Use eriteia fr ur EHRs, Core Measure requirement for The Joint Cornmssion, and Clinical Quality Measures forthe Centers for Medicare and Medicaid Services Uh-oh, we were talking about the good and now we've stared descending into the overwhelming. again. So ler's embrace the good in our data, working with our organication to ensure that informa- tion is timely, relevant, and actionable when we receive it, when we create it, and when we con- tribute tit. 1's too important o be mired inthe bed and the ugly No matter where youTead in the contiraum of ear, efectve use of data is critical to your succes in driving outcomes. NM {1 10.3007/01 NMA DoDEAOORED 26827 Lynne nursing management@woltershluwercom © October 2016 + Nursing Management wo nursingmanagement.com Coppa © 2016 Wecters Kiewer Heath:; inc. Ail tighte reenrved. CONVENTION ISSUE Nurs : www. nursingmanagement.com November 2016 The Journal of Excellence in Nursing Leadership® EI Workforce update: Current and long-range forecast ED satisfaction survey 26 Executive Extra, part 3 44 Charge nurse training 50 a pnt Wit 8 wis Nursing Management November 2016, Volume 47 - Issue 11 Editorial Checking the box By Rosanne Raso, MS. RN, NEABG, Editorin-Chief, Vice President end Chief Nursing Officer, NewYork-Presbyterian/Welll Cornalt, New York, N.Y. ur to-do lists grow daily, and most of us truly enjoy dropping tasks off the lst: That's true in management, as well as with our frontline staff, educators, colleagues, bosses, and even ‘ur families. Unfortunately, the phrase “check the box” isn’t a positive one. Despite the joy cof completing a task, it means to do so atthe barest minimal standard. Did you check a box today? ‘We want to keep our heads above water, deliver on expectations, be the best we can be, and help our teams succeed. Can we accomplish this by only doing the minimum? Or, even worse, by crossing off a task mindlesly and without attention to what it actualy means? A colleague of ‘mine uses a frequently seen example: During quiet times, the lights may be dimmed (“check”) ‘but the decibel level hasn't decreased at all (rninimal standard at best). There's no het you can think of many other examples. All boxes on the electronic medical record flow endpoint in sbeetcorpleted? Check Quality assurance suit oot done? Check. Chemoterapy administra fhe journey to ter double vecaton ished? Check Procedural bch! led? Chach vnds e=~ plished? Check. Controlled substance waste witnessed and verified? Check. Performance ‘patient care evaluation submitted? Check. They may be “checked” but there's more than a remote chance excellence. that these tasks arent reflective of intent and havent been achieved thoughtfully. The result? ‘Ouicomes suffer and patient care may be compromised, ‘Some of the problem stems from natural human behavior, systems, and oxganizational culture We're overwhelmed. Our priorities are elsewhere or maybe even conflicting. We don’t believe in the importance of the task. We're constantly distracted and intecrupted. We forget it isn’t about the what; I's often about the how. We're congratulated for bor-checking. Do we show our own ‘approval of box checking or do we emphasize behavior, tought process, and attention to actual intent? ‘Of course, there are tasks along the way that do get done. But the bigger picture is that ow ‘re could tear up our to-do lists and declare victory. The actuality is that leadership is forever. Don’t despair! This isthe joy of our roles. “Solow do we ensure that we're paying attention to the right things inthe right way? Maybe when faced with failure or not achieving outcomes, whether clinical or not it will fore us to dig exper into the truth. Demonstrating inguistiveness and caring witha focus on why and how ‘can change everything. Itcan open minds to intent or open actions to new behaviors, including, ‘our own. Use your huddles and conversations to challenge the status quo, explore the whys, anc make improvements to the how. ‘Next time you check a box, think about avoiding mindlessness snd the minimum. Dare | say, think out of the box? Change your approach to full engagement and attentiveness, and, undoubt- ‘edly, you'l see the positive outcomes. NMI ‘Bacto sOa7 oT MA DOONAN ZAI. fame nursing management@woltershluwercom © Novernber 2016 + Nursing Management wo nursingmanagemert.com - wwrw.nursingmanagement.com Management The Journal of E ing Leadership® om Tt | Safety solutions ia ae A guide to patient-care considerations Nursing Management | December 2016, Volume 47 - Issue 12 | Editorial Patient safety and the public By Rosanne Raso, MS, RN, NEABC, Editorin-Chiet, Vice President end Chief Nursing Officer, Newyork Presbyteriany/Welll Cornell, New York, N.Y. We can't let our Suard down, despite recent advances in patient safety ave you read the September AARP Bulletin? The led article has a huge front page headline: Py 2eseeio titan yen cat ou Theat orm ees 1138 milion of them—that 250,000 people die each year from medical ecros as reported by 2 Johns Hopkins researcher, unfortunately true. And then he tells them “how to fight back.” My interpretation is thot the public sees the healthcare experience asa fight fo their lives. We have to do beter than thin our care environments. The author's advice is sound; in fact, most of it is what we consider best nursing practices: hhand washing, patient identification before medication administration, speaking up (aka pe- tient engagement), repeating back instructions, and medication reconciliation. Tis list is eerily similar tothe National Patient Safety Goals. Why are they still goals? They should be embed- ded practices by now. Several other approaches wore suggested, one being to check on various websites “that could save your life” such as medicare gov /hospitalcompaze and hospitasafetyscoreorg. Our organiza- tions spend a lot of time ensuring thatthe data deving these comparisons are acuraie, arguing the ‘validity ofthe scoring systems, and sometimes making excuses fr not hiting benchmarks. We're painfully aware ofthe nurse-sensitive indicators that we haven't yet nailed: als, presure ulcers, and infections. Many of us have achieved great results even zero incidents. Why net all of us? “Here's an olten discussed isue for clinicians and a piece of advice from AARP: Have someone accompany the patient during hospital stays and physician visits. Despite the evidence on open vis- ‘tation and the obvious risk mitigation from another set of eyes and ears, we stil struggle with i. Security concers, clinical time management, lack of space, apd privacy for overnight caregivers in semiprivate rooms—all gt inthe way of doing the right thing for patents. This i simply not good. ‘The AARP article also instructs ts readers to “look for signs of a safe hospital,” meaning vs bie information on infection rates unrestricted visitng hours, and noting how nurses and phy- sicians interact. The last one is incredibly insightful to me. We all know that true collaboration ‘makes for improved patient outcomes, never mind an improved practice environment for our staff. How are we demonstrating this to our patents? And, more important, if collaboration Is lacking. is ton our radar as leaders? It should be. [Even truer isa section on clinical burnout, clearly identifying that alow quality of work-hfe balance compromises patient safety: What's ARP’: advice to readers on how to counteract ther clinicians’ bumout? Be respectl and not obnoxious because the patient’ relationship with healthcare providers isthe “cheapest medical insurance you can buy.” We can’t argue that burnout and unhealthy work environments don’t have negative effets or that respectful, relationship-based care doesn’t has positive results. ‘AARP gives sage advice to 38 million people on how to fight bck against the threat of medi- ‘al errors. Much of iis what we know to be evidence-based practice. We cant let our guard ‘down, despite recent advances in improving patient safety indicators. The public may trust narses, but not our healthcare systems. As nurse leaders, we know there's still much work to do, Our patients have been cautioned to fight, and we must keep fighting for theen. NM ‘BOTT 07705 NA OOOO RES fe pursing management@wolterskluwer.com © Decomber 2016 + Nursing Management ‘ma.nursingrranagementcom wiww.nursingmanagement.com January 2017 ent fice in Nursing Leadership? KRAN ATA Editorial Confident leadership By Rosanne Raso, MS, RN, NEABC, Editor-in-Chief, Vice Presicent and Chief Nursing Officer, New/ork-Presbyterian/ Weill Cornell, Now York, N.Y. My New Year's wish for all of you is to get rid of self-doubt, think big, and use your ‘skills for “sales” positive He= New Year's resolutions have you thought about for 20172 [don’t know about you, but some of my resolutions start out full of postive intent and never quite make it to the Finish line, Here's something we can all siride into 2017 vowing to embrace confidence. Yes. confidence. Not confidence that’s arrogant or but on unquestioning invent in our opie ‘ong; athe true selfbeliet in our abilities and contributions. This is integral to succesful eadership. What does confidence look and feo! ike? Fist, image and impression maiter, including stance, ‘ye contact, demeanor, and ease with written and spoken words. These capabilities may seem {ike 2 tll order, but they're absolutely doabl...and half the battle. And we haven't even touche! ‘en knowledge and skills yet. Combine nonverbal and verbal poise with solid comfort your ‘content, and you can’t help but be confident. ‘What if you don’ fe!se-assured and ae afficted with “imposter syndrome?” High achievers ‘an sometimes be ful of sel/doubt, not believing that they’7e capable when faced with new challenges. You can do it! t's quite doubtful that you're actually living the Peter Principle (ising to the level of your incompetence). You wouldn't have been promoted oF given the opportunity to Jead if you didnt aleady demonstrate the skis. ou don't have to be a genius or perfet—both lofty selfexpecations of high achievers. Having room to grow should fatally raltle yourself reliance; ideally it motivates learning and can bea positive force. Recently consultant told me that | could oly pick one leadership development top for ‘manager it shouldbe sales. Sales? That's job I thought fd never wan. After reflection, realized tha this suggestion was biliant. We're actually “selling” every day: cling our organizations vision, goals, and initiatives to our stat, and selling out ideas to our bosses and colleagues. And What makes a good salesperson? Confidence! Knowing your stu having persistence, staying focused, aed being able to paint the picture of why you want and need the change. A winning ‘salesperson also loves the product while caring about you, too. These are admirable qualities, So, is confident leadership a sales kb? Your kneejerk macton may be “no.” So was mine, although sling is clearly part ofthe role. There are myriad isues we encounter and decisions we make every day that don't revolve around selling, bu they do demand sourd leadership. We can't approach these issues timidly and with uncertainty, which in't to say thatas a new leader, or ‘when faced witha first-time situation, you can’t ask for help. You can be confident and questioning atthe same time. Asking for team input gives your staff mezabersenidence in themselves, and Yyouas well Understanding when to get help and knowing your limitations seem to go hanndin- hhand with being confident, avoiding the abit hole of selfoubt we just discussed. Confident eaders exude positivity and courage. They believe in their teame, and those ‘relationships make for an aificmative work environment. Their decisions are sold, their direction strong, and their approach open and welcoming. Confident leeders “push the envelope’—my frst editorial exactly 3 years ago, My New Year’s wish forall f you is to get id of seit doubt, think big, use your “sales skills for postive iniuence, and enjoy being a leader. Confidence is one of the factors that will help make you love going to work every day, in 2017 and beyond. NM 10 1007/0 OWA O000ST 7108 8913.00 fanaa ursing.management@woltershluwercom © Jonusry 2027 * Mursing Managemont wo nursingmenagement.com unenUcs Damanagement con EAA) tsi NURSE SCIENTISTS: F iS UME nlr lubed peer oe CC td Perceptions of bedside shift report 44 Editorial Have heart? By Rosanne Raso, MS, RN, NEABC, Editor in Chief, Vice President and Chief Nursing Officer, NewYork-Presbyterian/Weill Comell, New York, N.Y. We need both our hearts ‘and our brains to provide extraordinary care, grow the art and science of nursing, and lead others ‘© you love what you're doing? In the spirit of February's celebrated value, and transfor- mation leadership, [hope so. An abundance of heart idioms describe our work. How about keeping our best interests “at heart?” Our fundamental concerne—patient- and {family-centereciness and healthy practice environments—must always guide our decisions and remain at the heart of what we do. What other heart phrases relate to leadership? “Heart to heart” talks are ingrained in our daily functions, Whether it’s a mentoring dia- logue, a dificult performance conversation, oc even a sulfering patient ot family, as nurse leaders we give from our hearts every day. A parallel is meaningful acknowledgment and appreciation, which drive staff engagement more effectively than recognition activities that aren't value-based and heartielt ‘Sometimes we have a “change of heart” from our original assessments as we seek different perspectives o- evaluate unanticipated outcomes. It takes courage to be honest, open, and will- {ng to admit that we aren’t always right the firs time. We neither intend to go down an ineffec- tive path, nor do we want to be accused of lip-opping: nonetheless, changing our minds shouldn't be forbidden when done for the right reasons. ‘Then we have the “heart of stone,” a prime challenge to work with anywhere on the ‘organizational tree. Lack of empathy is a line inthe sand for me: if we can't deliver compas- sionate care 100% of the time, then we have much more work to do from culture building to zero tolerance. value setting. and employee management. A “heat of gold” isthe preferred descriptor. Infact, patients and families who've been touched by their healthcare experience ‘ten describe the staff members who cared for them in this way—by whats in their hearts ‘You may feel confident about your decisions when your “heart is in the right place.” Doing, transformational. the right thing is an analogous phase. I's surprising how often that seeringly simple principle ‘an be elusive when faced with the myriad variables afectng our work. Staying true to our hhearts shouldn't he ignored. Do you appreciate colleagues and staff members who are “after your own heart?” ‘This commonly mears being similar or to your liking, which may comfortably steer your personal and professional relationships. However. does it provide the diversity needed on your team? Generally speaking, we don’t want to be constantly yessed, leaving othe: ways Of thinking unexpressed. Whether it's because of alikeness, feat or timidity this isn’t 3 healthy team dynamic: Let's get tothe “heart of i.” Weneed both our hears and our brains to provide extraordinary care, grow the art and science of nursing, apd lead others transformational o let your heart inspire you—it makes a diffeence. NM ‘Dor 101067761 Nak aOnneT 76 DSTEA Se nursing management@wolterskduwer.com © February 2017 + Nursing Management ‘wna nursingmanagement.com Mp ric Cabot Re ee Transitional care intervention EE Tied DO Sey CO Editorial Everything matters By Rosanne Raso, MS, RN, NEMEC, Editorin Chief, Vice Prosident and Chiof Nursing Officer, NewYork Presbyterian/Weill Cornell, New York, N.Y. Doing the right thing is always right, and doing something is better than doing nothing. love this year’s theme from the American Association of Critical-Care Nurses’ president Clareen Wiencek: “It Matters." Ifyou belong to that organization, you've probably read her ‘monthly messages, which resonate with what's really important to clinical nurses. The Institute for Healthcare Improvement has a related vision—"What Matters"—focusing on ‘engaging patients and families. What matters to you? Finding out what counts is key, whether for patients, staf, or colleagues. Sometimes it tums ‘ut tobe something that doesn’t rally seem important to your but it does to someone cls. What ‘you do can makea difference, even when you aren't trying. or when you go unnoticed for along, time or remain unacknowledged. Have you ever seen someone forthe first time in years (maybe you don’t even remember them) and they proceed to tell you how your advice completely turned their professional career around? That career discussion you hed about schol, job choices, or relocation may not have seemed like much to you, but it mattered to them Occasionally, you may wonder If what you're doing makes a difference, whether it's slog- ‘ging away at e-mail, rounding, writing thank-you cards, prepping for a council meeting, oF any of the other numerous activities we complete every day. The truth is that you may never now, but doing the right thing is always right, and doing something is better than doing, ‘nothing, Gandhi said something very similar, “You may never know what results come of ‘your action, but if you do nothing, there will be no result.” Maybe it's more of a physics desson: Every action has a reaction. ‘What we do always hasan effect on ourselves and others. Reflecting on that gives importance to our choices, our actions, and our work. I'm sure you can remember teachers, leaders. men- tors, and patienis who've influenced you in both litle and big ways. Although it may not always be positive, we leam from everything. ‘We can be scientific at this point and note that evidence-based practice isthe gold standard of imattering, Whether it'sclnial, educational, o leadership practice, making a difference is more guaranteed when you have the evidence behind you. The future is bright when what matters to us {5 exemplary professional practice, continuous learning, and full engagement, as well as elimina’- ing nonvaiue-added (‘not-mattering”) work whenever we can. Isjoy essential? It isto Clareen Wiencek and to me. IF what you're doing brings joy to your- self and others it definitely matters. We're leaning quite abit to the transformational side with this discussion, se let's not forget that outcomes and accountability also matter to everyone in a 360-degree way. "You never know” often refers to unlikely scenarios, such as winning the lottery In the case of “everything matters,” it means that you may never know the effect of your actions, but you can ‘count on a reaction from someone, somewhere, somehow. At the beginning of exch day, reflect on what you're doing, and atthe end of every day, acknowledge yourself. Everything matters! NM ‘Borin 097/01 NIMADODOSIOS SBOE) nursing.management@wolterskiuwer.com 18 March 2017 « Nursing Managemont ‘ww. rsingmanagement.com «Straight talk =" about role stress. Editorial Find the why By Rosanne Raso, MS, RN, NEMEC, Editorin-Chief, Vice President and Chief Nursing Officer, NewYork Presbyteriary/ Weill Cornell, New York, N.. Ask until there are no more answers, and larify until there are no more questions. ‘“c * isan essential component of our leadership repertoire. To succeed as leaders, we need a limitless spirit of inquiry to help us fully comprehend and explain our clinical and management practice. Our ability to explain rationales and dig deep understand reasons is important, too. It's all about asking and answering. {In his iconic book, The 7 Habits of Highiy Effective People, Stephen Covey ranks listening as habit number 5. He notes that listening with a reply in mind doesn’t allow us to truly under- ‘stand: instead, our goal should be to ask the right questions. ‘Without asking the questions, we don’t get the answers or innovations we need to solve {issues and share best practices, This holds tm lor patient, workforce, and efficiency outcomes. ‘Data aren‘t enough—you have to go further. Maybe it ian’t the right data or it doesn't tell the ‘whole story. Scrutinize until you know. ‘We've al heard of the “five whys” in a just culture environment when we ask “why” repeat~ ‘edly until we get to the root cause. Until we keep asking at each revelation, we won't reach the Source. Currently, some believe that five levels are inaclequae; we may need “many whys" to sgrapple with cause ard effect within complex systems fraught with human factors. Solutions come from knowing reasons and consequences, not jumping to conclusions. “A cultuze of inquiry is the Holy Grail for evidence-based practice, described by the National League for Nursing a8 a persistent sense of curiosity. Asking questions and challenging the status quo aren't just for clinical practice; queries should be raised every day to inform our leadership practice. as well. Examples from just one afternoon on my calendar include cecrait- ‘ment, retention, working hours, certification, orientation, Magnet® standards, and quality ‘approaches-all substrate for examination and research. ‘Tow about the rationale for initiatives? Understanding why something is important is criti- cal to staff engagement and our own buy-in. Inspirational leadership connects to values, and taking the time to make those links contributes io a higher likelihood of successful change. Explanations help staff members find meaning, significance, and a higher purpose. if you ‘can’t connect to a reason that makes sense to you or if you can’texplain why something is {imporiant, then maybe it isn’t. or you haven't asked the right questions. ‘The message is simple: question, learn, and explain, Why? Because it's our duty as leaders to improve practice, ensure that our work is valuable, and facilitate engagement. Ask until there ‘are no more answers, and clarify until there are no more questions—strategy and satisfaction at the same time. NW ova0.30077o7 NA 0000S 4864458 ursing.management@voltershluwercom © April 2017 + Nursing Management wow nursingmanagement.com i a ee ursingmanagement.com a Together into the future pharmacogenomics.. AN _ Take our survey 11 Code compassion 18 - Relationship-based care 26 — Editorial Ith restoration 2.0 fy Rosamne Raso, MS, RN, NEABC, EditornChief, Vice President and Chief Nursing Officer, NewYork-Prestyterian/ Weill Comet, New York, N.Y: Too often, we turn unhealthy into badges of courage. ries, and care plans. What about you? I mean, really, YOU and the restoration of your health, It’s May, the month we honor nurses everywhere during, National Nurses Week. What better way to celebrate than promote healthy nurses? Earlier in 2017, the American Nurses Association (ANA) declared its campaign for Healthy Nurse, Healthy Nation, defining a healthy nurse as one who “actively focuses on creating and maintaining a balance and synergy of physical, intellectual, emotional, social, spiritual, per- sonal, and professional well-being,” This sounds like a New Year's resolution—something we hope for atthe dave of every year but akandon soon after. Why? Isnt our own health as im- portant as our mission to restore our patients health? ‘Of course it is. Bt it scems that we aren't starting from a strong place. According to the exec tive surnmary of the ANA's Health Risk Appraisal, a majority of us are overweight; drive distract- cally; work through breaks; stay late; and are exposed to inci, stwss, and physical assault in tho workplace. The good news is that many workplaces offer safety and wellness programs. Too ‘often, we tun unhealthy behaviors into badges of courage. Only you know your own health risk assessment Is there room for improvement? ‘Let's commit to health and wellness for our staff and ourselves. As leaders, we should be role- modeling and supporting behaviors that benefit this goal. If our clinical staff members want to set Lup a wellness room with nutritious snacks, power nap station, aromatherapy, spa music, and aot massager, then we should be figuring how to help them make it happen rather than thinking, ofall the reasons it cart happen, even if is only some of the wish for some of the time. ‘We know feeling good ist only physical health, and self-care isn’t only about exercise. Creative Health Care Management recently sent me a trandomactsofcaring card, encouraging selfvompession ‘and paying it forward to others. This is clever and brillant —akin to putting on your oxygen mask first belone helping those around you. Random acts of caring do improve our wellbeing, along with the recipient's, and they're restorative, helping counteract the effets of emotional exhaustion. “Then there's our leadership in creating healthy practice environments as part of professional well-being, We often talk about communication, authenticity, transformational leadership, and ‘evelopment, but what about a commitment to safe patient handling, no employee harm, and ‘zero tolecance for abuse of employees? This would be a true gift for Nurses Week. ‘The ANA concluded that “a healthy nurse lives life to the fullest capacity, across the wellness / ness continuum, as they become stronger role models, advocates, and educators, personally, for their families, thei: eommunities, and work environments, and ultimately for their patients.” ‘These are stiong swords that capture the essence of why restoring our own health as leaders endl influencers is essential. Join me in believing in and supporting a commitment to health and well-being, Individually and collectively, it will make a better world. Wishing you a joyful-—and healthy—Nurses Week! NM W222 it brings me back to nursing school courses, theo ‘Dor101087/01 NWA 0ONGHISTIS.6473.73 nursing.management@walterskluwer.com © May 2027 + Nursing Management ‘worn. sursingmanagement.com Ai 6 — Editorial Finding our way By Rosanne Raso, MS, RN, NEABC, Ecitorin-Chief, Vice President and CNO, NewYork Presbytorian/Weil Cornell, New York, N.Y. ately, it seems that everywhere I turn there are signs that frontline leaders are struggling, ‘often counterbalanced by affirmations that the role is essential to organizational success. Should we be worrying? And should we be translating that worry into positive actions? started in February with an alinarses.com blog post titled “The Enemy..The Nurse Manager” in which an ethausted new nurse manager who couldn't engage her staff no matter how hard she ‘tied wrote a despairing plea for advice. Then we had the Robert Wood Johnson (RW}) Foundation report “10 Reasore Why Nurses Want to Leave Hospitals,” which lists managers in the top 10. When the ‘American Assocation of Crtcal-Care Nurses posted the report on its Facebook page, several comments ‘affirmed management 2s ane ofthe reasons, with one remarking on “incompetent nursing leadership.” “The last dose of role assault occurred when {had dinner with a dear colleague who teaches leadership in an RN-to-BSN program. She told me how unhappy her students—sll practicing, rurses—are and that they're desperate for “compassionate direction.” At that point, it was hard to ignore the persistent, nagging signs of trouble. ‘Are we at 3 crossroads where if we aren't on the right road, we'll ose the passion and energy of ‘our clinical staf? Is this a generational issue ora leader development issue? Or are these anecdotal ‘commentaries not reflective ofthe real world? I like to magically think myself into believing the last ‘question, at last for most of the time. We know that transformational leadership has a positive effect ‘on nurse saicfaction, but we don't know how prevalent this style is. The write-in responses tothe des- [perate manager on the allnurses.com blog were similatly about the characteristics ofthe best leaders — ‘communication, transparency, honesty, and making connections—all transformational traits. ‘The RW] report did mention the criticality ofthe frontline manager role, particularly for new ‘graduates who need empethetic support. Many other sources in the management literature indi- ‘cate the importance ofthe middle manager and, maybe more important for this discussion, how difficult tis to be “caught in the micdle"—a leader of a frontline team and a direct report of more senioe superiors at the same time. Our own Wellness Survey on work stress may give us some ‘more clues and insight (see page 9). Frontline managers create the unit culture and work environment, are pivotal to all ofthe ‘outcomes that we care about, and role model the values dhat matter. We've seen floundering units tum around under new leadership, and thriving units whose leaders have wisely turned into facilitators so that unit staff members flourish on theit own. “My tahexway is that we have to help each other and do a better job of preparing. supporting. and engaging frontline leaders. We al struggle at times—some times more than others—but it shouldn't bbe all ofthe time and certainly not at the risk of disengaging our staff. Maybe encouragement ‘comes from the work in this journal and other reading, or the mentoring and coaching of others, or thoughtful educational experiences, or an inspired vision with clarity of expectations, oral of these and then some more actual workload relief Let's make sure that the support is available. ‘We must find our way through leadership vacuums and to distressed colleagues so that we ‘can shoulder the burden of hard times together and come out on the other side with our well- being intact. There's just too much at stake. NW ‘Dorie s067/OT NOMA RODOSTIeZIZ1588 pursing. managernent@woiterskluwer.com 6 June 2017 + Nursing Management swrw.nursingrnonagerent.com So pee vaewcnursingmanagementcom ee 3 s a ty ee - ~~ + Editorial The opioid crisis By Rosanne Raso, MS, RN, NEAEC, Ecitorin Chief, Vice President and ‘Chiet Nursing Officer, NewYork-Presiyterian/Weill Comell, New York, N.Y. We can't snap pid (entany) ae up 72% Prexiptons for opioids have quadrupled The mune of tins 9 Sie ith opioid use disorders rapidly growing (primacy our patients overage 65} Mesicald Heer carcahave aneven higher rate, The lack market for these drugs alive ad wellin our corey Manali of “blame” being thrown around—from prescribers to drug companies to the Centar for Medicare and Medicaid Services for making patient perception of patn management ‘pay forperormance ise, 0 TheJoint Commission fr its pain management stands dear lack of coverage, to. our government for ecarity of interventions, and others. Are actors? Probbly allof ther and more. Inthe end, i's up to all of us help fx the prob Jem however our roles and in‘iuence allow. Tins the biaes and atigmas that we place on patients with opioid use disorder are unortunate and prevalent. At the most local evel, we can advecate for basi human rights and he SPS ras Saints deserve. This is actionable in our cw backyards, whether athome ce work Ad aa an disease jut Hike diabetes, equirng lfeiong treatment and suppor. The brain altrar Gton’hose with opioid use disorder don't allow senple will power to cre itin most ses: Ca cling care and efits must continue tobe based on maintaining ow patient HEM What abet remembering that there's safe opioid prescribing and administration? Noto pe- tee teup seking ora isk for addition fom short duration of efetive pain rit We aed’ be Swinging too far inthe other direction and underprescsibing or undertreanng ooo bone tena of nursing practice is education fr patients families, prescriber ici ing Ps) sath and each other. Thee’ cetainky much ols: praent prescribing nechtn Prevention, opioid allematives, naloxone ase, nonpharmacologs pain manager! methods, hophysilegy, treatment options and more. The American Nurses Atscclation (NY Te rans recced several revised positon statements on substance use sod udemcoing the ‘educational needs of caregivers aan er level we should be advocating for access to care and treatment. We can't sraP us Tnges and expect diction t disappear without intervention. There ar resus 2005 seiner tiple websites, including the ANA, other profesional organizations, and cos'ions i tan nflocnoe an individual patient's cae, presrivers community resourers and Jeflators Ts encouraping sce many local sac and federal agencies actively Woving aaa rverions States with required registries have significantly decessed prescriptions, BI organi Trhion on evidence-based pain management practices have lessened opioid winston eat oe thould take individual, gTUP, ard advacecy actions to combat his pubic heath crisis. This isnt the time to be complacent, NM a ‘Bor 10 CHT /OH NA ODODEDOTIS O80 de frome pursing. management@woRershiuwer.com 6 July 2017 + Mursing Management wor nursingmanagement.com Copynght©@ 2017 Wolters Kiuwor Health Inc. Allrights reserved. o Editorial The opioid crisis By Rosanne aso, MS. RN, NEA-EC, Edltorin-Chief, Vice President and Chief Nursing Officer, NewYork-Presbyterian/Welll Comell, New York, N.¥. We can't snap our fingers and expect addiction to disappear without intervention. couldn't read another article about the public heath criss of opioid use, misuse, abuse, addiction, [and overdose without a cal to arms from this page. It seems like everyone | know has been | ouched by it, whether in our professional capacities, in ous neighborhoods, or in our personal lives, including tragic deaths of daughters, sons, and loved ones by unintentional overdose. What about you? Has this crisis fortuitously managed to escape you or are you alarmed as well? ‘The statistics ae staggering. Thousands of deaths are seported each month, Deaths from synthetic ‘opicics(fentany) are up 73%. Prescriptions for opioids have quadrupied. The rumber of Medicare ben- cficiaries with opioid use disorder is rapidly growing (primarily our patients over age 65); Medicaid ‘beneficiaries have an even higher rate. The black market for these drugs is alive and well in our country. There's alot of “blame” being thrown around from prescribers, to drug companies, to the (Centers for Medicare and Medicaid Services for making patient perception of pain management a pay-for-periormance issue, to The Joint Commission for its pain management standards, 10 insurers for lack of coverage, to our government for scarcity of interventions, and others. Are these factors? Probably all of them and moze, In the end, it's up to all of us to help fix the prob- Jem however our roles and influence allow. Firs, the biases and stigmas that we place on patients with opicid use disorder are unfortunate and prevalent. At the most local level, we can advocate for basic human rights and the respect these patients deserve. This is actionable in our own backyards, whether at home or work. Ad- diction js a disease just like diabetes, requiring lifelong treatment and support. The brain altera- tions of those with opioid use disorder don’t allow simple will power to cure iin most cases. (Our nursing care and efforts must continue to be based on maintaining our patients’ dignity. What about remembering that there's safe opioid prescribing and administration? Not all pa- tients are drug-secking or atrsk for addiction from a short duration of effective pain relief. We shoulda be swinging too far in the other direction and underprescribing or undertreating, ‘Another basic tenet of nursing, practice is education for patients, families, prescribers (includ ing NPs), staf and each other. There's certainly much to learn: prudent prescribing, addiction prevention, opioid alternatives, naloxone use, nonpharmacologic pain management methods, pathophysiology, treatment options, and more. The American Nurses Association (ANA) re- cently released several revised position statements on substance use disorder, underscoring the educational needs of caregivers ‘Ona broader level, we should be advocating for access to care and treatment. We can't snap our fingers and expect addiction to disappear without intervention. There are resources avail- able on multiple websites, including the ANA, other professional organizations, and coalitions. As nurses, we can in‘luence an individual patient's care, prescribers, community resources, and legislators. I's encouraging to see many local, state, and federal agencies actively working on interventions. States with requiced registries have significantly decreased prescriptions. Fist responders with access to naloxone have saved lives. Healthcare organizations with focused ‘cducation on evidence-based pain management practices have lessened opioid utilization. ‘We can and should take individual, group, and advocacy actions to combat this public health

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