Time To Care

Like you, I have, as a distant observer, been deeply affected by this week’s tornado and its aftermath in Moore, Oklahoma. The television reporters and their stories have created a continual hum in my house. Every once in awhile one actually draws my attention and I turn the volume up and pause to watch and listen. There were several stories reported that made me pause today.

There was the reporter at the bedside of a teacher with spinal injuries and a fractured breast bone. She was gentle in her questioning. Listening attentively as the teacher recounted the terror of the ordeal and the profound sorrow she felt having lost seven of elementary school students. She laid in bed on her back unable to move from right to left, unable to lift her arms she stared at the sealing as she spoke. The tears welled in her eyes and slowly pooled before gently rolling down her cheek. I myself welled up with tears.

There was the elderly woman standing in the rubble that was her home recounting taking shelter in a bathroom with her beloved dog. Now alone and amazed at her own survival she speaks about her experience with a reporter. As she describes the events she is most concerned and sad in the belief that  her dog is forever lost and expresses her desire to simply find him. As this painful story unfolds on camera, a voice off-camera can be heard saying “the dog…there’s the dog!” and with that the camera pans to find the dog slightly visible under a large piece of metal – and he’s alive! The joy of that moment came right through the television as the elderly woman reaches to remove the rubble and free her beloved dog. The camera clearly captures her looking off camera and asking – “help me, please!” as she struggles to move the debris. Again, I welled up with tears.

Thinking back on these two experiences I found myself asking an interesting question: if nursing is a described as a helping profession, could the reporter talking supportively with the injured teacher and the reporter who was assisting the woman remove the debris entrapping her dog be considered “citizen nurses”? They were exhibiting some of the qualities we associated with nurses. Or do nurses have not just these helping instincts, but something more?

After much thought, I realized that nurses are different. If I had not known these were reporters in each story and had to decide whether the person was a reporter or a nurse, could I? YES! I could. Let me tell you how I could tell the difference.

The reporter in supportive conversation with the teacher would have sought to be closer to the teacher holding her hand as they spoke and gently dabbing her pooling tears. She would have anticipated this most basic need to use a special sense to convey support and caring.

In the second story, the person off-camera being asked by the woman to help was clearly not a nurse. A nurse would not have needed to be asked to help, but would have sensed the limitations of the elderly woman and intervened.

You see, a lot of people do great and deeply touching nurse-like things and as a society we are eternally grateful, as are the people of Moore, Oklahoma. But a “nurse” is a very special person who goes a little bit further and uses a “sixth sense” that only “nurses” possess – the sense of oneness with the patient.

I am thankful for the “citizen nurses” in Moore, Oklahoma and forever appreciative of what they have enabled me to articulate in this blog post is a unique quality of a “Professional Nurse”. For all those who take the Time to Care, whether unexpectedly in a time of crisis or routinely as part of one’s life work, the human spirit is uplifted by what you do!

Susan

Nurses face many ethical dilemmas every day.

Our decisions are reached using guiding ethical principles. Among those principles is beneficence which supports the belief that our actions should promote “good”. The result of beneficence is nonmaleficence which is to do no harm. These culminate in an overarching guiding ethical principle which many consider to be the highest ethical principle – respect for others.

There is a very thought provoking article in the May 2013 issue of the American Journal of Nursing entitled: Telling patients about staffing levels. The author, Douglas P. Olsen PhD, RN, presents a case study of an understaffed unit and challenges the reader to decide “to tell or not to tell” the patient.

Here is the Case Study he presents:

“It’s a very busy Monday. Because of chronic difficulty in recruiting staff, the unit has only three-fourths of its RN positions filled. In addition, Mary Evans, an experienced nurse who always helps less experienced staff with their patients while carrying a full caseload herself, has called in sick.

Linda Smith is 68 years old and two days post-op from hip replacement surgery. As you enter her room, 45 minutes after she first requested pain medication, you can sense her irritation—but worse than that, you can see from the grimace on her face and her guarded movements that she’s in pain. After several days of good nursing care, you’ve let her down, and you consider telling her about the staff shortage. But you wonder: Is it right to disclose today’s short staffing to Ms. Smith?”(Olsen, 2013)

Read the authors discussion of the decision-making process that takes place when deciding “to tell or not to tell” by following this link: Telling patients about staffing levels

If you were short-staffed to the degree that Mary Evans describes and it was hard to find the Time to Care…

What would you do?

Reference

Olsen, D. (2013). Telling patients about staffing levels. American Journal of Nursing. 113(5), 62-64. doi: 10.1097/01.NAJ.0000430239.60186.d1

This past week I had the pleasure of traveling to the United Kingdom for Kronos. Our healthcare time & attendance, e-rostering (scheduling) solution for the National Health Service – produced by SMART – was hosting a customer conference and I was asked to speak at the meeting. Never having been to London, I was very excited for the opportunity.

I arrived early in the morning after a long overnight flight. Certain that jet lag would soon be upon me, I decided to go out for a walk to begin the process of resetting my internal clock. As I left the hotel, I was startled by the sound of an ambulance siren and then the sight of St Thomas Hospital directly across the street from the hotel. It didn’t hit me at first, but it wasn’t long before I made the connection.

I was in London. It was in London that Florence Nightingale started her school of nursing. Her school was started at St. Thomas Hospital. Could I be staying across the street from “THE” Florence Nightingale Training School? I was…

Once I realized the serendipity of my trip to London, I circled back toward the hospital for a longer more meaningful look at the place I had learned of so many years ago in nursing school. I was thrilled to find that within the hospital was the Florence Nightingale Museum!

It’s a small museum, but packed with artifacts and stories. I fully expected to find a reference to “The Lady with Lamp” as she is often described. And I wasn’t disappointed, but I was surprised. Every drawing I have ever seen of Florence Nightingale with a “lamp” has rendered the lamp to look like a “genie lamp” with a long spout from which a flame emerges. What I discovered in the museum was that the lamp that she would have carried on her nightly rounds of the wards would have been a “fanoos”!

A “fanoos” is a Turkish lantern. It was used in Scutari during the Crimean War when Nightingale tended to the soldiers. I’ve included a picture of a “fanoos” that I took at the museum. It has forever changed my mental image of Florence Nightingale.

As we celebrate Nurses Week, May 6^th – 12^th, this little known fact is fun to share!

To all the nurses past and present “thank you” for continuing, as Florence Nightingale once did, to keep watch on those in need. We at Kronos are in awe of what you do…and we will continue to help you overcome the obstacles in the workplace that interfere with your ability to find the Time To Care!

e-Patient Dave deBronkart having beat stage 4 kidney cancer by having access to his own health data and working with his medical team has become an infamous crusader for the power of data and a patients right to access their own data.

His story is inspirational!

In fact, he has inspired me. Take a look at his video below. I want to be an e-Manager as much as he wants to be an e-Patient.

Oh! did I mention that Kronos released Workforce Tablet Analytics for Healthcare today! Now you can take your damn data with you!

Just substitute e-Manager for e-Patient in his “rap”.

I just watched a news report on the horrendous events of April 15th in Boston – the bombs at the finish of the Boston Marathon. The physician being interview was asked about a memorable moment. He recounted completing treatment of a young woman. As she turned to leave the medical tent, he describes, with a shutter to his voice, her asking “what is your name?” Interpreting this as her wanting to express her thanks, he is almost brought to tears, as was I.

There are many whose actions on April 15th, 2013 in Boston deserve our thanks. There are many yet to come into the lives of the victims who also will deserve thanks. Many whose names we will never know…

There is the nurse scheduled for the night shift next Tuesday who will respond to the call bell of a new amputee that can’t get to the bathroom without help. There is the CNA that will take a little extra time getting the injured grandmother dressed and her hair combed properly before the first visit from the grandkids. There is the young physician who will never forget the lessons about compassion that this tragedy will have taught and will be forever giving that gift to patients in the future. There is the dietary aide who didn’t just leave the meal tray, but took the minute to make sure that it was delivered with care. There is the rehab therapist who understands that the pain of the process of rehabilitation is a necessary evil to a patient’s future independence.

And finally, there are those whose names we will never know, but can never forget. The members of the healthcare workforce who looked the victims in the eye and let them know they were not alone.

The healthcare workforce is a very special group of people. We need to take the Time to Care for them and support them in all they do for us!

Susan –

You may have noticed I have been gone for awhile…let’s just say I took a nice long nap…and now I’m back!

The past several months have been hair raisingly wild for me. And I mean that in both a good way and a scary way. The future looks bright and I have lots to share with you going forward!

And what better place to begin the conversation again than here in Denver, Colorado at AONE2013!

So let’s get to it: “Hot off the presses!”

DENVER, March 20, 2013 — A new survey titled “Nurse Staffing Strategy”, commissioned by Kronos Incorporated and conducted by HealthLeaders Media, revealed that nurse fatigue is pervasive in the healthcare industry and may negatively impact quality care delivery, patient and employee satisfaction, and operational costs. Sixty-nine percent of healthcare professionals surveyed said that fatigue had caused them to feel concern over their ability to perform during work hours. Even more alarmingly, nearly 65 percent of participants reported they had almost made an error at work because of fatigue and more than 27 percent acknowledged that they had actually made an error resulting from fatigue.

News Facts
The “Nurse Staffing Strategy” survey showed that current scheduling processes in hospitals are largely manual — which can result in inefficient scheduling processes, a lack of visibility into the larger staff scheduling picture, little or no alerts to compliance with staffing policies or regulatory requirements — leading to extremely high levels of fatigue and absenteeism that can be disruptive to operations.

The majority of survey respondents either considered current staffing levels as inadequate (39 percent) or unsatisfactory (38 percent). Thirty-four percent said they use manual processes such as whiteboard and paper and more than 20 percent use basic programs such as online calendars and Excel to schedule. Only 28 percent stated that they have the ability to self schedule.
Fifty-seven percent noted that they had witnessed inequitably distributed workloads in the last 12 months and 54 percent had personally experienced an excessive workload. Seventy-eight percent of respondents said they currently use 12-hour shifts within their organization.
Ninety-six percent reported having felt tired at the start of their shift and more than 92 percent while driving home after working their shift, both of which may negatively impact patient care and employee safety.
Sixty-three percent of respondents agreed that nurse vacancies impact scheduling and staffing overtime more often than anticipated during a payroll cycle. Despite the fact that 79 percent said that they monitor key performance metrics for overtime, absenteeism, rest periods taken, and deviations between scheduled and actual hours worked, it is often after the payroll cycle and therefore not preventable.
Also, according to the survey, the majority of organizations have policies to regulate shift length, overtime, and on-call shifts. But more than 56 percent neglect policies requiring rest periods and nearly 65 percent have no policy on cumulative days of extended shifts.
Without a centralized, automated scheduling system, it is nearly impossible to proactively handle staffing vacancies in an optimized, cost-effective manner. Kronos offers the market’s most advanced, clinically focused workforce management suite that helps align labor with anticipated demand while consistently adhering to all organizational and regulatory scheduling policies. Supporting the premise that there is no such thing as a static schedule, Kronos offers paperless workflow, mobile applications, and self service to more effectively manage the modern workforce.

I’m thinking it’s Time to Care!

Susan

Note: “Some things are better the second time around. It is for this reason that I’ve decided to re-post last years Thanksgiving blog. If you enjoyed the post last year, it should be even better this year - consider this - Thanksgiving Leftovers!” 

I am in the midst of waging the first battle of the holiday wars – preparing for and delivering – Thanksgiving dinner! As the appointed leader of the skirmish and a nurse, I have spent many hours planning the attack.

First, the decision to go traditional or be unduly influenced by the Food Network to “put a spin on it” – akin to deciding how patient care will be delivered: Decision – Traditional.

Secondly, the crafting of the menu which should be straight forward when you consider it’s suppose to be a traditional meal, but it turns out there are many decisions to be made. Should the Turkey be frozen/thawed, Free Range, or Organic? And the cranberries, canned, frozen, fresh, or brandied? What about the sweet potatoes – marshmallows? The only sure thing on the menu is the green bean casserole. Changing the green bean casserole in any way would probably cause the epitaph on my head stone to be changed from “dearly missed” to “finally gone”.

With the menu completed, it’s time to begin the procurement plan of attack by developing the grocery list. The grocery list contains not only the description of the required items for the meal, but the quantity needed. Here’s where that nursing management background really kicks in and exerts its influence on the holiday meal. If nursing management taught me anything, it taught me the importance of knowing exactly what you need to get the job done – Hours Per Patient Day – HPPD! How, you ask, does this apply to my development of the grocery list?

I have developed a holiday meal metric, based on nursing’s tried and true HPPD, called Quantity Per Holiday Guest – QPHG! I simply determine what a single person requires to be satisfied with the meal portions and then multiply it by the number of expected guests. This results in my Quantity Per Holiday Meal – QPHM – metric.

So for every item on the grocery list I calculate the Quantity Per Holiday Guest (QPHG) and then multiple it by the number of guests I expect to serve to get the Quantity Per Holiday Meal (QPHM). Grocery list completed!

Next is the actual tactical plan for the execution of the meal. I create a detailed day by day plan – a.k.a The Schedule – for the crafting of each element of the meal and assign specific tasks to specific family members. It is here that some care needs to be taken to match a family members skills to the task. Assigning the wrong job to the wrong person could spell disaster. Much like the time I gave the pre-teens the job of polishing the silver only to have a pretty scary sword fight play out with the knives – lesson learned!

If everything comes together as planned, I have also defined a metric for evaluating the actual success of the holiday meal once completed. That metric entails calculating the percentage of recumbent holiday guests and multiplying that number by the actual percentage of food consumed adjusted for expected leftovers. The calculation looks like this:

So by my calculations, the goal is to have everyone recumbent and 80% of the food gone when it’s all said and done!

Variance reports for performance outside these expectations will be due one week from Thursday! (relax, Susan, relax!)

Nursing and Analytics…ya gotta love it!

Happy Thanksgiving!

Susan